A typical man, yesterday
Forgive me, I’ve slumped to the level of the tabloid press, unable to resist a provocative headline. My point really is that there are some interesting diabetes tips to be picked up from pregnant women.
There’s this myth surrounding diabetes and pregnancy that it’s a challenging struggle to maintain fabulous control against all odds. I’d like to debunk that myth but sadly it’s pretty much true. Some people say they find their diabetes easier to control during diabetes. I’m definitely not one of those people. But overall, it’s just a more high octane version of what everyone with diabetes is trying to achieve, with the motivating factor of a healthy baby and a 9 month timeframe providing a massive incentive.
Most of what I’ve been doing is simple stuff, trying to get the basics right, and it’s making a difference.
Get the basal rates right: This is much easier on a pump than on MDI, but if I can flatline through the night at around 4/5, that’s about a third of the day when I’m in range without too much effort. A CGM makes this much easier as you can look back in the morning at what happened overnight and adjust accordingly – even borrowing one from your hospital for a week would give you some insight into what’s going on. Otherwise, you’ll need to set the alarm through the night to do the dreaded basal testing.
Be disciplined with food: When it comes to food, my aim is to avoid rising above 8 following any meal. It seems like rocket science, but it really isn’t. Bolusing 30mins before a meal gives the insulin plenty of time to work and in most cases avoids the spike. Bolus even earlier if you’re high before eating (and if you’re really good, don’t eat until you’re back in range), bolus as you eat if you’re low before the meal. And make sure you bolus for everything, even that little biscuit, few grapes or couple of chocolates – otherwise you will rise.
Super bolus: I like this a lot for avoiding post meal peaks. When bolusing for a higher carb meal (or if I’m high before the meal) I sometimes steal the amount of insulin that would make up my basal for the next hour, and add that to the bolus. I then put a temp basal on of 0% for the next hour. That gives me more insulin to deal with the meal upfront, but avoids me going low later because there’s too much insulin sloshing around my system. If I don’t do this, I find splitting meals helps too – eg if I’m having a sandwich and an apple, I bolus for everything up front, but only eat the sandwich. Then I eat the apple about an hour later (obviously don’t forget to eat the apple, that causes major issues). I find it gives me a much smaller rise and fall after a meal.
Embrace free food: low/no carb food is a real help when I’m high and starving, or just want something to eat without impacting blood sugars. I never realised that a few spoonfuls of cottage cheese can actually stave off hunger for quite a while. I can also be found nibbling on raw carrots and chunks of cucumber when carbs aren’t really an option.
Motivation matters: The only real difference between my diabetes efforts now and before pregnancy is that I’m much more motivated. To the point where diabetes is pretty much the most important thing I do. I couldn’t live like that forever, but perhaps I could motivate myself better when I’m not pregnant by setting shorter term goals eg I’ll get my basals sorted before Christmas, I’ll carb count properly for the whole of January and see what difference it makes.
Hold back on the hypos: I think an almost psychotic preference for hypos over highs is the sole domain of pregnant women – the knowledge that the baby absorbs excess sugar from our blood when we’re high, whereas mild lows don’t really do any harm makes it an easy choice. But dealing with hypos well makes a difference for everyone. Overtreating is easily done, and inevitably leads to a bouncing high, that rebounds back to a low, which is overtreated and ends up as another high. I’ve been trying to avoid the bounce at all costs, because I don’t want that high. So I treat with 10-15g of fast acting carbs and then I wait an interminable 15mins to see what’s happening. And most times, it does work. Unless I can see on my pump that I have 5 units of insulin on board and I’m tanking downwards, then I lose most self-restraint. But the theory is sound.
Test! I have never tested so much, and it makes a difference. Knowing what’s going on does tell me things I’d perhaps rather not know, but it does give me the data I need to make decisions.
Do not panic bolus: In the first few weeks of pregnancy, I hit every raised number very hard with insulin, because I’d rather be low than high, often resulting in lows. Then I calmed down a bit and realised that I should revert back to my normal approach of actually believing the insulin I already had in my system would bring the numbers down and didn’t need an extra bit for luck. Patience is a virtue and all that.
Deadlines are good: one of the best things about pregnancy is that it only lasts for 9 months. The knowledge that there is an end to all the hard work makes it much more palatable. Compare this to the much harder “I need to sort my diabetes out forever” dilemma facing most pancreatically challenged types and it’s easy to see why people get overwhelmed. I’ve never appreciated the motivating power of a short deadline so much – perhaps I need to use them more.
None of this was really new to me, it’s stuff I kind of knew but never really had the motivation or commitment to do on a regular basis. It does make a difference though. Once I return to the normal world of diabetes, without the pregnancy bit, there’s no way all of this will continue at quite this obsessive level, but I hope to still use ;
Hmm, interesting about the super-bolus. I’ve never heard of that before (or I probably have done but then forgotten about it).
I think I first saw it in Pumping Insulin by John Walsh, but I couldn’t swear to that
Oh, what you mean the book I own and have read from cover to cover? That one? Hmm…
Don’t beat yourself up too much on that one just yet, I wouldn’t put any money on that being where I read it, that’d just be my first guess.
Good advice – thanks. I’ve been scribbling it down on post-it notes! Am going to try to put the 30 mins-before tactic into practice for my ever-ongoing pre-pregnancy phase! Although I guess it’s tricky if you are going out for dinner, or a dinner guest at someone’s house, or things are cooking in the oven and so you can’t weigh things out yet….how do you do it?
If I did this, I would make a rough under-guestimate and inject half an hour before and then top up to the exact amount when I’ve weighed everything.
Me too. I work on the assumption that getting some insulin in early is better than none.
On the 30 mins before thing – you might want to start by doing it 15/20mins before and then working up to it, because while 30mins works for me, some people find it’s too early and they go low before they eat/mid meal.
Too late – I’ve already savagely beaten myself up about it. I’ve got a nasty black eye now and it’s all your fault!
First off, congratulations Alison .Sleep well, it becomes an unheard of luxury when the baby arrives :))
My first experience of diabetes was Gestational Diabetes – such fun ! not diagnosed till after 4 months of constant all day sickness. I must have enjoyed it as I became a “proper” diabetic 18 months later.
As for the 30 minutes before thing, I find this works for sensible things like a roast dinner, but that 15 mins works better for treaty stuff like apple crumble and custard.