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role of long-acting insulin v short-acting - Diabetic Pregnancy

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October 29th, 2008

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11:30 pm - role of long-acting insulin v short-acting
I rarely post - with two kids, endo appointments, OB appointments, and life, I rarely have time -- but I need to pick the brains of the group.

I just passed the 20 week mark in this pregnancy. I was GD in 2002, dx as t2 in 2005, and used Lantus + Novolog + Metformin during a successful pregnancy in 2006.

I've had to start the lantus and novolog much earlier this time - I was very proud to make it to 26 weeks last pregnancy, so the diabetes fairy thwapped me around 14 weeks this time. :)

Here's the question I wanted to run past y'all:
how do you determine whether to increase your short-acting carb ratio OR increase your long-acting?

After looking at my readouts from a CGMS trial, the endo has his office call me and change my novolog ratio to 1:8. I've had some really high post-meal spikes lately. Problem is, in hour 3 after an injection I drop very quickly. For example, at 11:45 I was 100. Ate heartily (about 60 g of carb) and 2 hours later, I was at 132. Not quite in target, since my goal is 120, but very close. I'd taken 5 u of Novolog, since under the old scale, I was 1:12. 45 minutes later, 85 here I come.

My theory is that maybe I need more Lantus instead of increasing the novolog. Thinking that additional lantus might give the novolog a head start, so to speak. Am I totally off base here? I've spent the last 3 days bouncing. On the way to the endo's office this morning to drop off the CGMS, I had to pull off the interstate as my levels went from 130 to 160 in something like 15 minutes, yet at the 2-hour mark, I was at 111. I don't know if it's a roller-coaster or a trampoline!

I didn't try discussing this with the nutritionist when she called -- it would have confused her mightily. I usually confuse her. And I am willing to try the increased novolog instead of adding more lantus, at least for a bit before I call back in. It's always easier with data to explain it.


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(Deleted comment)
Date:October 30th, 2008 04:07 pm (UTC)

Chasing is apt

Chasing is probably an apt description. I'm not doing it on purpose, though -- everything just made so much more sense last pregnancy.

Or at least, that's how I remember it being. Maybe I'm just seeing it through rose-colored glasses.

Last week, I was fighting lows. This week, it's highs.
Last week, I ate Long John Silvers: 1 fish + 2 chicken + corn + slaw = 64 g
Started at 126, took 5 units (1:12) plus 1 unit for correction, and 2 hours later, I'm at 70.

Yesterday, I started at 92, took 5 units, ate the same food, and was 122 2 hours later. 122 isn't high -- with meter fluctuation, I could easily have been within goal -- but still, same food from same restaurant at the same time of day and one week I'm at 70 and reaching for the skittles and the next week I'm 50 points higher.

I'm finding it hard to figure out how to knock the top off of the rise that I'm getting and I'm guessing that the timing of the novolog is contributing to that. I so rarely know exactly what I'm going to eat that I'm hesitant to inject too early.

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