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Followup To
Question -
Dr Rappaport:
Thanks for your time. I am 35yo 34 weeks, 2nd pregnancy with gestational diabetes. Due to a sulfa allergy and high fasting blood sugars (115-130) my perinatologist has put me on 25u N qam and 10u N, 10u R qpm. I am definitely eating enough as my weight has increased VERY quickly(3 pounds this week)since the adjustment, however, I keep having issues with very low blood sugars (woke up last nite at 2AM with bs of 42)..My doc is wonderful, however, has been a bit resistant when it comes to my insulin adjustment...I would like to best advocate for myself on the following issues:
1. I am wondering if I should not take short acting insulin near bedtime
2. Do you think 25u nph too much in AM based on frequent and rapid drops in blood sugars (blood sugars in 40s have happened on several occasions during day)
3. Is reduction of insulin necessary to reduce caloric intake--I have to eat SO much to maintain my bs.
Any advice on this matter so I can discuss it diplomatically with my doc would be helpful.
Thanks!
Jodi
Answer -
I would continue the 24U N in the morning and 10U N in the evening. HOwever, I would check your glucose four times per day and use a sliding scale for Regular Insulin. If your blood glucose is over 120, take 4U R, if it is getween 180-240, take 6U, and if it is over 241 taike 7U R. Also, I think it is important to take a snack just before you go to bed (in case you become hypoglycemic). This can be some Graham Crackers, or a piece of pound cake, etc. Tell your doctor that your glucose was 42 at 2A.M. That is not acceptable and is dangerous. Keep some candy or Orange juice at your bedside for an emergency.
Dr Rapaport:
Thanks for your timely and detailed response--2 more quick questions, however:
1. the hypoglycemic episode in the middle of the nite (BS:42) happened DESPITE the fact that I had a snack before bed (peanut butter sandwich on wheat bread)
2. with the sliding scale insulin--is the coverage based on bs before or after eating?
Thanks again...
jodi
AnswerIf you became hypoglycemic even after a snack, you are obviously taking too much insulin in the evening. I would discuss cutting down the N in the evening and using a sliding scale of R. You may also consider using Lantus insulin, which is a long acting insulin and which can be taken once a day. You should always take your glucose prior to eating. The sliding scale is based on the value of glucose, no matter if it is prior to eating or after eating. The object is to maintain a steady glucose level throughout the day. As long as your glucose values are controlled (cover yourself according to the sliding scale) you will not fluctuate too much and you will not become either hypoglycemic or hyperglycemic. Discuss it with your doctor or an endocrinologist.
