New to Insulin and have questions....

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turtledove773
New Member


Date Joined Apr 2006
Total Posts : 10
   Posted 4/19/2006 6:45 AM (GMT -7)   

Morning all! I am 32 weeks pregnant and have been dx with gestational diabetes for the 2nd time. As of yesterday I had to begin taking an Insulin shot before bedtime to lower my fasting am #'s. I have been started out on 5 units of Humulin N. This morning my Fasting #'s were even higher than the were the morning before WITHOUT the insulin.

  1. My first question is does it take some time for your body to adjust to the insulin for it to start lowering your levels are should I have seen results this AM?
  2. When they say inject it before bed, what exactly does that mean? I usually go to bed around 10pm, so last night I had my snack around 9:45 ( 2 TBLS peanut butter and about 9 apple slices) and then did the injection at 10pm. I probably did not actually go to sleep though till closer to 10:30. Did I do this right?

Thanks for listening!

 


Jeannie143
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Date Joined Apr 2004
Total Posts : 6056
   Posted 4/19/2006 6:59 AM (GMT -7)   
Turtledove,

I use Lantus which is a long acting 24 hour insulin... so I'm not familiar with yours but it's possible that you are experiencing Dawn Effect. This happens when your blood sugar drops overnight and this causes your liver to convert stored glugogon into glucose and pumps it into your system. The brain signals this activity to prevent your blood sugar from dropping too low. (Your brain runs on glucose and its demands are always met first.)

I wish I could be more helpful. You should probably call your Gyn office and get the doctor to call you back.
~ Jeannie

"People are like stained glass windows: They sparkle and shine when the sun's out, but when the darkness sets in, their true beauty is revealed only if there is light within."

- Elizabeth Kubler-Ross


turtledove773
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Date Joined Apr 2006
Total Posts : 10
   Posted 4/19/2006 7:26 AM (GMT -7)   

Thank you for your response, I am sure you are correct that PDP is creating the increase but isn't the insulin suppose to combat that? I do have a call in to my OBGYN and but the waiting is killing me :)

Humilin N is an intermediate release insulin so it should take effect 4-6 hours after injection. Do you think my dosage may just be to low, or I am eating to much or too little prior to bedtime?


Warren
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Date Joined Oct 2005
Total Posts : 534
   Posted 4/19/2006 10:31 AM (GMT -7)   

LOLOLOL Turtledove,

NINE slices of apple and Peanut Butter is whats causing your fasting BS to be higher.  Try not eating after 8pm if you are going to bed at 10 pm and this alone should bring your numbers into line.

scool Warren
It's not that some people have willpower and some don't. It's that some people are ready to change and others are not. - James Gordon, M.D.
What some call health, if purchased by perpetual anxiety about diet, isn't much better than tedious disease. - George Dennison Prentice

I can only please one person per day, today is not your day...tomorrow doesn't look good either.


turtledove773
New Member


Date Joined Apr 2006
Total Posts : 10
   Posted 4/19/2006 10:43 AM (GMT -7)   
Now what is wrong with Turtledove tongue
 
I have tried not eating a snack as well prior to going on the insulin and BS were actually higher than when I did eat something...so with now having to do insulin at bedtime you think I should remove the snack completely? With my doseage being so low I'm not a too much danger of going too low am I?
 
Thanks for your input!

Claire-Bear
Regular Member


Date Joined Oct 2005
Total Posts : 242
   Posted 4/20/2006 1:22 AM (GMT -7)   

Hi Turtledove,

From what you're describing it sounds as though the insulin is bringing your blood sugars down too much and therefore your body is compensating by releasing more sugar.  Try lowering your dose of insulin by just 1 unit and see what happens.  Obviously, consult your doctor first but I agree with what Jeannie said about being the 'dawn effect'. 

Also, I'd probably say to do your shot a little earlier - before your snack.  But again, it's best to ask your doctor.  I'm not familiar with how your insulin works so I couldn't really advise too much on that, but I guess you should do it at 9 or 10 pm. 

You can still have lows on such a low dose of insulin - as you have gestational diabetes I'm presuming your body still is making insulin but just not enough.  You are therefore supplementing your body's insulin rather than replacing it.

Hope this all makes sense!

Claire x


Warren
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Date Joined Oct 2005
Total Posts : 534
   Posted 4/20/2006 12:59 PM (GMT -7)   

Hi Turtledove,

You are 32 weeks pregnant and your doctor has just told you that you have gestational diabetes and put you on insulin. So lets review for all the newbies to gestational diabetes.

Pregnant women who have never had diabetes before but who have high blood sugar (glucose) levels during pregnancy are said to have gestational diabetes. Gestational diabetes affects about 4% of all pregnant women - about 135,000 cases of gestational diabetes in the United States each year.

We don't know what causes gestational diabetes, but we have some clues. The placenta supports the baby as it grows. Hormones from the placenta help the baby develop. But these hormones also block the action of the mother's insulin in her body. This problem is called insulin resistance. Insulin resistance makes it hard for the mother's body to use insulin (sound familiar to you type 2's?) and she may need up to three times as much insulin.

Gestational diabetes starts when your body is not able to make and use all the insulin it needs for pregnancy. Without enough insulin, glucose cannot leave the blood and be changed to energy. Glucose builds up in the blood to high levels. This is called hyperglycemia.

Gestational diabetes affects the mother in late pregnancy, after the baby's body has been formed, but while the baby is busy growing. Because of this, gestational diabetes does not cause the kinds of birth defects sometimes seen in babies whose mothers had diabetes before pregnancy.

However, untreated or poorly controlled gestational diabetes can hurt your baby. When you have gestational diabetes, your pancreas works overtime to produce insulin, but the insulin does not lower your blood glucose levels. Although insulin does not cross the placenta, glucose and other nutrients do. So extra blood glucose goes through the placenta, giving the baby high blood glucose levels. This causes the baby's pancreas to make extra insulin to get rid of the blood glucose. Since the baby is getting more energy than it needs to grow and develop, the extra energy is stored as fat.

This can lead to macrosomia, or a "fat" baby. Babies with macrosomia face health problems of their own, including damage to their shoulders during birth. Because of the extra insulin made by the baby's pancreas, newborns may have very low blood glucose levels at birth and are also at higher risk for breathing problems. Babies with excess insulin become children who are at risk for obesity and adults who are at risk for type 2 diabetes.

Treatment for gestational diabetes aims to keep blood glucose levels equal to those of pregnant women who don't have gestational diabetes. Treatment for gestational diabetes always includes special meal plans and scheduled physical activity. It may also include daily blood glucose testing and insulin injections (in your case Humulin N). For you as the mother-to-be, treatment for gestational diabetes helps lower the risk of a cesarean section birth that very large babies may require.

Gestational diabetes usually goes away after pregnancy. But once you've had gestational diabetes, your chances are 2 in 3 that it will return in future pregnancies. You are one of the lucky "2" it appears. In a few women, however, pregnancy uncovers type 1 or type 2 diabetes. It is hard to tell whether these women have gestational diabetes or have just started showing their diabetes during pregnancy. These women will need to continue diabetes treatment after pregnancy.

Many women who have gestational diabetes go on to develop type 2 diabetes years later. There seems to be a link between the tendency to have gestational diabetes and type 2 diabetes. Gestational diabetes and type 2 diabetes both involve insulin resistance. Certain basic lifestyle changes may help prevent diabetes after gestational diabetes. Im not going to go into all the lifestyle changes that can prevent diabetes but there is plenty written about it in this forum.

So lets talk about your Insulin and what it is or is not doing for you. There are many different types of insulin and they are absorbed at different rates and work for varying periods of time. Humulin N is an intermediate-acting insulin. It takes one to three hours to begin working after injection, reaches its maximum effect between five and eight hours, and stops working after about 18 hours. Since you're fasting test is taken while your insulin is peaking, AND your readings are still too high, there are one of two things happening. 1) Your dose is not high enough as your readings will only go up from here.  2) You need a drug like Metformin (glucophage) to stimulate your sensitivity to the insulin you are taking and the insulin you are producing naturally.  This could drop your numbers dramatically.  In any event, you absolutely have to discuss this situation with your doctor - sooner than later.

Hope this helps

scool Warren


It's not that some people have willpower and some don't. It's that some people are ready to change and others are not. - James Gordon, M.D.
What some call health, if purchased by perpetual anxiety about diet, isn't much better than tedious disease. - George Dennison Prentice

I can only please one person per day, today is not your day...tomorrow doesn't look good either.

Post Edited (Warren) : 4/20/2006 2:59:50 PM (GMT-6)


turtledove773
New Member


Date Joined Apr 2006
Total Posts : 10
   Posted 4/21/2006 4:54 AM (GMT -7)   
Good Morning all and thanks for all your responses. I did speak with my Doc and we increased mu units for 5 to 8 and numbers seem to be right on target this am! Thank you again for all your advice! This is all overwhelming and it just helps so much to be able to speak with people about it wh actually understand what it is all about!

Jeannie143
Veteran Member


Date Joined Apr 2004
Total Posts : 6056
   Posted 4/25/2006 6:23 AM (GMT -7)   
And, yes, in case you didn't know it Warren IS a rocket scientist! tongue

Gosh Warren, I'm impressed! You are very much smarter than the average bear or moderator for that matter! Keep on putting out this great info. I'm learning here.
~ Jeannie

"People are like stained glass windows: They sparkle and shine when the sun's out, but when the darkness sets in, their true beauty is revealed only if there is light within."

- Elizabeth Kubler-Ross


Coco23
New Member


Date Joined Apr 2006
Total Posts : 2
   Posted 4/27/2006 1:59 AM (GMT -7)   
Hi All,

Me too, I've just started insulin (Mixtard 30 Novolet) last night and this morning (2units and 4 units respectively). Thing is, my blood sugar rose higher than before taking the insulin. 156 last night and 194 this morning.

Called the doctor and she told me to double the dose to 4 and 8 and see what happens.

I think the problem could've been, I was so terrified at the prospect of injecting the insulin, and the after affects - even though it's the smallest dose, that I took more carbs than I normally would have at night. I had potatoes with green veg, milk and an orange. But this morning I had two small pieces of multi-cereal bread with quarter of an omelette and tea... and it was one of the highest readings I've ever had, and this was after injecting the 4 units of insulin.

Any advice. Should I do what the doc says and double the dose? I'm 27 weeks pregnant.

Coco23
:-)

Warren
Veteran Member


Date Joined Oct 2005
Total Posts : 534
   Posted 4/27/2006 5:22 AM (GMT -7)   
Well...your choice is high blood sugar and the perils that I posted above or doing what your doctor says.  I think this one is a no brainer!!
 
scool  Warren
It's not that some people have willpower and some don't. It's that some people are ready to change and others are not. - James Gordon, M.D.
What some call health, if purchased by perpetual anxiety about diet, isn't much better than tedious disease. - George Dennison Prentice

I can only please one person per day, today is not your day...tomorrow doesn't look good either.


JenGDM
New Member


Date Joined Apr 2006
Total Posts : 8
   Posted 4/27/2006 2:55 PM (GMT -7)   
Hello, I just joined this group because I have the same problem as turtledove773.
I'm 25 weeks pregnant with gestational diabetes. This is my second pregnancy with GDM.
My doctor keeps raising my night time insulin (Humilin N) because my morning fasting plasma level is over 100. My highest number has been 114 which was last night. I'm now taking 22 units. My doctor insists that I eat a snack before bed of less than 15g of carbs to keep my ketones=negative. Usually I have a 3" green apple or CarbSmart Ice Cream which is 10g of carbs for 1/2 cup serving. BTW, I hate to eat before bed because I'm never hungry that late at night.
It seems that everytime I increase my insulin, my fasting level gets higher and higher.
I don't have any trouble 1 hour after my meals. In fact, I'm supposed to be between 110-140. Half of the time I'm actually under 110 one hour after I eat.
So what is going on? Is my doctor too conservative? Can it be possible to take insulin that has the opposite effect? There are drugs out ther that make me react opposite to the general population. For example: Vicotin makes me hyper and Ibuprophen gives me insominia.

turtledove773
New Member


Date Joined Apr 2006
Total Posts : 10
   Posted 4/28/2006 7:27 AM (GMT -7)   

How long have you been taking your insulin... since I'm just as confused about all this as you I know I'm not going to be much help, but I did want you to know your not alone! I have read that it can sometimes take a week for your body to regulate to the insulin.. (I thought you would have results the next day!) So I guess that's why my Doc is wanting to leave me at my dosage for a week at a time to see if it's actually working??? Who the heck knows at this point! I guess I'm just going to have to be patient and trust my Doctor to know what is safe or not..


JenGDM
New Member


Date Joined Apr 2006
Total Posts : 8
   Posted 4/28/2006 10:16 AM (GMT -7)   
I've been on insulin for 9 weeks with my current pregancy. I was on insulin for a total of 2 weeks my previous pregnancy. The insulin immediately lowered my blood glucose levels then. I took 12 units from the very first day until I went into labor.

Coco23
New Member


Date Joined Apr 2006
Total Posts : 2
   Posted 5/1/2006 1:34 AM (GMT -7)   
Hi Again,

Okay, so I've done what the doctor suggested, doubled my insulin dose, am religiously watching what I'm eating, but the fasting readings are still high in the morning, 126 this morning.

Do I keep doubling the dose until my readings are under 90? My readings during the day fluctuate, but in general are under the 120 mark.

Thanks for any advice.

Coco23

JenGDM
New Member


Date Joined Apr 2006
Total Posts : 8
   Posted 5/1/2006 9:39 AM (GMT -7)   
My doctor has me increase my insulin 2 units each time my fasting levels are above my target twice in one week. However, you really shouldn't increase without your doctor's recommendation. There's always the possibility that you could give yourself too much and then have a hypoglycemic reaction.
I'm now taking 25 units and I haven't had any highs over 100 in the last few days, but I'm still in the 90s.

Cynthia33
New Member


Date Joined May 2006
Total Posts : 3
   Posted 5/2/2006 6:38 AM (GMT -7)   
Hello everyone,

I am 33 years old and currently at 28 weeks pregnant. My doctor put me on insulin NPH a week ago because I failed 1 hour testing and my number was 202. Without insulin, my fasting number was always high in the morning, around 130, then, it came back to normal during the day. My doctor gave me 10 units at night and my fasting number came down to 116. The number stayed there for a few days. I called my doctor and she increased my dosage by 5 units. Then, my fasting numbers were 106, 86, 91 and 107 this morning. It is up and down. Have you encoutered such situation? I am trying to eat the same food, so it shouldn't affect my numbers. Any advice will be appreciated.

Cynthia

JenGDM
New Member


Date Joined Apr 2006
Total Posts : 8
   Posted 5/2/2006 7:31 PM (GMT -7)   
I also experience fasting numbers up and down. The numbers will always fluctuate and it doesn't matter if you eat the same thing every day. It's part of being human and not a machine. My doctor told me today, that as my pregnancy progresses, it is common to have more insulin resistance. For me, that means that my fasting BG is likely to continue to get high and that I will have to increase my insulin dosage. I'm now instructed by my doctor to increase my insulin dosage 2 units every time I go over 100.
Your doctor is likely to continue to increase your insulin dosages until you are able to maintain fasting BG under 90 but more than 70.
I've learned a few new things about what I should and should not eat at dinner and my bedtime snack. Here's a few: 1) Do not eat high fat foods at dinner or before bed. I learned this after having a 6carb cheesecake at the Cheesecake Factory. My 1 hr BG was within range, but the next morning was very high. Apparently the extra fat turns to sugar while you sleep. 2) a 3" green apple as a bedtime snack seems to provide just enough sustenance to keep my ketones=negative and my BG low in the morning. 3) I can add more starch carbs to a meal if I am very active after I eat. It's amazing how quickly my 1hr BG level goes down if I've been vaccuuming my house.
BTW, try to get some variety in your meals within the plan. If you don't, you will bore easily and want to go back to your old habits. Also, read nutritional information on the internet before you go to restaurants. You can usually find something at any restaurant to fit into you plan.

Jeannie143
Veteran Member


Date Joined Apr 2004
Total Posts : 6056
   Posted 5/2/2006 8:11 PM (GMT -7)   
I admire you ladies doing so well and trying so hard. My last baby was 9 lb. 4 oz. and she was 10 days early... most likely I was diabetic at the time... So I salute all of your efforts at keeping yourselves and your babies healthy!
~ Jeannie

"People are like stained glass windows: They sparkle and shine when the sun's out, but when the darkness sets in, their true beauty is revealed only if there is light within."

- Elizabeth Kubler-Ross


Cynthia33
New Member


Date Joined May 2006
Total Posts : 3
   Posted 5/3/2006 6:10 AM (GMT -7)   
Thanks so much for your help. I had some soybean milk last night and my fasting number came down to 101 this morning. Maybe I can try a small green apple tonight.

Have a great day!

Jeannie143
Veteran Member


Date Joined Apr 2004
Total Posts : 6056
   Posted 5/3/2006 10:22 AM (GMT -7)   
Cynthia,
Nuts and cheese are great appetite curbs and don't raise your numbers much. Could you add those to your night time snack?
~ Jeannie

"People are like stained glass windows: They sparkle and shine when the sun's out, but when the darkness sets in, their true beauty is revealed only if there is light within."

- Elizabeth Kubler-Ross


Cynthia33
New Member


Date Joined May 2006
Total Posts : 3
   Posted 5/4/2006 7:28 AM (GMT -7)   
Jeannie,

I had a small green apple last night, and my fasting number went up a little bit this morning 106. However, I didn't sleep well last night, that might cause my number going up. I will try nuts and cheese tonight to see what will happen.

Thanks,
Cynthia

JenGDM
New Member


Date Joined Apr 2006
Total Posts : 8
   Posted 5/14/2006 11:18 AM (GMT -7)   
I now think that I'm in a predictable pattern. As soon as I have a fasting glucose above 100 if I increase my insulin 5 units it will go down to the high 80s and then slowly climb back up. If I increase by 5 units when it reaches 98 or so, then the fasting # will go back down to the 80s. So, far I've been able to keep myself from going over 100 since then. I'm now taking 50 units.

Just thought that I'd share.
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