I'm new to this site but I've been reading up on alot of the discussions here and everyone is so helpful.
I have been really frustrated with my fasting numbers and was hoping if someone can give me some insight or have experienced the same thing.
A little background about me, I've been Type 2 since I was 20 and have been mostly on oral meds like glipizide and metformin. I am currently 33 weeks pregnant with my first baby. I have read about insulin resistance and I've hit it since week 24. My OB put me on insulin around week 12 but since the resistance started, she's been upping the dosage. I started out with 8 units of NPH at bedtime and it slowly increased to about 24 units at week 24 or so.
I am now at 46 units of NPH in the morning, 32 units of R before breakfast, 14 units of R before dinner and 82 units of NPH before bed. I also take one 500mg of Metformin bedtime and in the morning.
So the issue I've been having is that my morning numbers do not seem to want to come down even with the amount of insulin I'm taking. Every time the OB increases it by 4 units, it'll go down by 20 points but right back up the next day.
My lowest number I've seen since Mid-March has been 99 and the doctor wants me to be under 90 for the fasting number. It's been very frustrating because everytime we increase the dosage, I would have a number of 99 but the next day, it will go back up to 120 to 130. My other numbers are fine, all <120 2 hours after meals. I have tried everything from eating a snack before bedtime to not having a snack, eating carb/protein ratio snack, splitting my dosage of insulin at night to 3 shots so i'm not getting all 82 units at once. Nothing seems to help and even my OB is perplexed by this. We are increasing my nighttime dosage every 3 days by 4 units but that doesn't seem to help. Sorry for such a long post but I am getting really frustrated at this. I also eat a fairly low carb diet, less than 100 grams a day. Can anyone provide any insight on this? Has anyone encountered a situation like this before? Thanks in advance for any advice or opinions! Kaitlyn
Aside from the fact that you have numbers many of us would kill for?? Ok, I understand you are pregnant and it's important to have really tight numbers!
My suggestion would be to get on a more modern regimen of insulin like a long acting basal insulin (levemir or lantus) combined with a bolus insulin for your meals like humalog, novalog or apidra. They are a lot more useful for controlling numbers and maintaining tight control than R and NPH.
Thanks for the reply!
I was wondering if i should try a different type of insulin besides the R and NPH but my OB seems to think they are the best for pregnancy.
I know these numbers aren't bad, but since I'm pregnant, the doc wants those numbers to be lower. It's just frustrating when I feel like I've done all I can but yet the fasting numbers aren't what they should be.
I wonder if I should ask the doc about switching to a different basal insulin.
Basal and bolus. You also need the fast acting insulin to prevent meal spikes. I've never heard anyone say the older insulins were better for pregancy before, though I've never been pregnant so don't follow the subject that closely, and someone will correct me if I'm wrong. But I would think the more up to date treatment is better at managing blood sugar without the need to eat to prevent lows, so anything that would better control blood sugar would be better. My guess is your OB just isn't up to date on current treatments. I've even seen PCP's prescribe the older less effective insulins, but often it was at an HMO that I (cynically) think was trying to save money by using the much cheaper insulin types.
It's kind of unfair of him to expect you to do better without giving you the right tools to do so!
I was wondering about that too. This is the first time i've ever used insulin, before being pregnant, I've always just done oral meds. It just seems like my PP numbers are good, just the fasting number isn't.
I just figured since R and NPH have been out there the longest, she probably thinks it's the safest thing to use. I tried asking her about maybe the insulin isn't working for me and to possibly switch but I didn't really get a definite answer from her. Maybe I'll bring it up again when I see her on Thursday.
Does NPH work differently than Lantus or Levemir? Those are the two that seems to be most popular now.
Lantus and Levemir are both long acting insulins; there are only the two. There are three rapid acting insulins to choose from. The idea of MDI is to mimic as closely as possible what the non-diabetic pancreas does. So the long acting or basal insulin provides a small amount of "background" insulin all the time. (You take it in either one or two doses). If the dosage is correct than you should stay level all day and not be required to eat on a regular schedule as you are with NPH. Then the fast acting insulins give an extra burst or "bolus" of quick acting insulin which you are able to dose accurately for the food you are actually eating. (A salad needs a lot less insulin than a bowl of pasta). It only lasts 3-4 hours and the goal is to bring you down quickly to the appropriate level. This is what the normal pancreas does naturally.
MDI or basal/bolus insulins have been around since the 90s. I'd say they are what the majority of insulin dependent diabetics now use, so safety is not a concern.
Can you ask for a consult with an Endo. OBGyn don't get up to date like diabetologists do on the subject of diabetes.
They think it's all going to go away after the baby arrives, so their treatment can be temporary, but your best treatment would come from an Endo and his/her crew. And it should be an every other day congenial affair with these people, not a "come see me in a month."