August 12, 2013

Pregnancy and Hypoglycemia

Good morning.  

My name is Tammy.  I have followed your blog for quite sometime now. I am a Christian mom to 8 and our little bonus guy on the way.  I was diagnosed gestational diabetic at 22 weeks and it went smoothly for several weeks.  But my resistance to insulin is increasing everyday. We are at a ratio of 4 units per carb. I am struggling with balancing exercise, eating and injections. Oh, by the way, I am 45.  Which, according to the medical profession, I am extreme high risk.  I just wondered if there was anything or any advice you could give me to help me through the next 8 weeks. It has been very hard on the family.  One minute I am fine and we are out side playing.  The next minute my sugar is 54 and I am sweating, shaking and only partially able to function. But I seem to suffer reactive bounces.  After these I can't get it to level off.  For hours I am either high or low.  Please, any advice is more than the medical profession is sharing right now.  

Thoughts and prayers, 

Tam 
Ps... My children lovingly refer to our new little guy as Rutherford and you had your Henry.  LOL.  My husband actually asked if we could keep Rutherford.  Yikes!  The three year old son will not discuss any other alternative names.

Hi, Tammy.

I am glad you took the time to write. It is always a pleasure for me to get to know my readers a little bit.

Let me start by saying congratulations on your Rutherford! I've got to tell you my gang thinks that is an awesome name and they are quite jealous we never thought of it. For seven children their in utero nicknames disappeared as soon as our little ones made their appearance in the world. However, I am here to warn you that Winnie never went away for Carmella and it looks like Henry is here to stay as well.

 As for the medical profession, where diabetes and pregnancy are concerned I don't give them too much thought. Quite frankly, you need to make a point to know what to do and manage your own diabetes. I was in the hospital for several days with Addison and no less than 5 time the nurses tried to give me the wrong insulin. The dose that they were going to give with the type of long term insulin would have killed me. Fortunately, I am used to managing my own diabetes and I as alert enough to catch the error.

As for your age, If you are in good health and have had a baby as recently as 3 years ago, I think they are typically over reacting as far as high risk. When I was in my 30s they considered me a geriatric maternity patient. No kidding! God made our bodies to do this and if He didn't want us to we would go through menopause a lot earlier in life. That's just my two cents, anyway. So congratulations, again. Enjoy the ride for it goes way too quick!

So, let's talk diabetes, hypoglycemia and pregnancy. I feel your pain, my friend! When people think of diabetes they rarely think of the debilitating lows. It is very stressful on a family, particularly when you have young children. And it is very hard to live life when you constantly have those interruptions into even the simplest of tasks.
Thanks to advances in medicine and technology it is possible
for a diabetic to successfully welcome a healthy baby.
I am going to send along some information to hopefully help you out, but I could use some more specific details to really help you come up with the best plan possible for you.

1. I am surmising you are around 32 weeks?
2. What times do you eat your meals and snacks?
3. What is your carb/protein intake at meals?
4. What time of day and what type/intensity/duration of exercise do you do?
5. What type of insulin and how much are you taking? What time do you do your insulin injections?
6. How often are you testing and perhaps you could give me several days worth of numbers to look at?
7. How do you do overnight? Do you crash or do you get up to eat?
8. Have you had training in managing diabetes with diet? I am finding more and more that doctors do not do this. Which is bad on all front because you can lower the amount of insulin you take if you know what to eat and when to eat. Also, not knowing what to eat and when makes hypoglycemia far worse.
9. What time of day and during what type of activities do you experience hypo incidents?
10. What parameters has your doctor set for your glucose levels?

For the average insulin dependent diabetic your insulin
needs to increase every 5 days.
During pregnancy your hormone levels are constantly fluctuating. And there in lies your problem. In fact, for the average insulin dependent diabetic your insulin needs increase every 5 days. And it takes about three days for your body to adjust to the changes in insulin. So that means you might get two good days out of every five. Bummer, right? But it's not impossible if you really stick to that diet and stay on top of it. Even 20 years ago it was extremely difficult for a diabetic to carry a healthy pregnancy to term. But, thanks to advances in prenatal care and diabetes management, we can very successfully welcome our babies. Count yourself blessed to have technology, such as home meters, at your fingertips. No pun intended! 

Understanding how your body deals with insulin during pregnancy may help you to manage your glucose
better. However, sometimes, there doesn't seem to be much you can do except do your best and pray. I have had great success in managing my diabetes and controlling lows and highs throughout all my pregnancies but with Addison there were days it was mostly hit or miss. And I know that gets to be incredibly frustrating, so on those days we just turn it over to the Lord.
Rule number one:  Test! Test! Test!  If you don't know the trends, it is hard to deal with oncoming lows. Warning signs of lows can often be elusive.  Over time we become used to them and do not notice them until it is too late. During pregnancy, often the normal warning signs of hypoglycemia don't exist at all. By testing we can know a low is coming on before it hits. So, for example, if you often have lows during your morning playtime in the yard, I would test every hour or so. If your glucose is dipping toward 75 then it is time to have a snack.

Train yourself to stop and examine your situation during activities. I am notorious for getting into something and losing all track of time until my glucose is in the 20's. Get your kiddos to help you with that. My kids will ask me at different times during the day, "Mom, did you eat?" or "What did you eat?" or "When did you eat last?"

When all the kids went Christmas shopping and I was
 home by myself the kids placed  snacks throughout
 the house and left this map for me to find them in
case of  hypoglycemic episodes.
Rule number two.... I don't know how old your children are, but I am guessing by your age there are at least one or two who could be taught to recognize the warning signs of hypoglycemia. I have been diabetic for a long time and I am blessed with older kids, but even Sam, when he was 7, knew the warning signs. My kids would often be handing me a snack and saying things like, "Mom, it's not hot you'd better eat." One big warning sign for me is that I become disoriented and snippy. My family knows that my sugar is dangerously low when that happens. So, I would suggest really sitting down with your kids and teaching them about the warning signs and sharing specific examples they might remember. Ask them to be your helpers.
While you are at it, teach your children how to test your glucose in the event you should be unable to do so. There are times my children knowing this saved me from a diabetic coma. Make sure they understand what range your glucose should be in and how to treat a hypoglycemic incident and call for help. Let them practice doing your tests during your normal testing times so they will be ready if an emergency should ever arise. 

Rule number three... Eat on a schedule. I do not mean about the same time. I mean set your alarm and eat when it rings. Every three hours, whether you want to or not. During pregnancy I need to double my calorie intake (which stinks because that means I gain a ton of weight that I have to work off later) in order to manage diabetes and hypoglycemia. But it works. I have 9 healthy kiddos to show for it. You should be eating every three hours from the time you get up until you go to bed and a snack before you go to sleep at night. This is your absolute best defense against hypoglycemia. I use the alarm on my phone and keep it with me at all times to track my eating, testing and insulin times. If you do nothing else, get on an eating schedule.

Rule number four... Balance carbs with protein and fat.  This seems so simple but it is the second greatest key to reducing the amount of insulin you take and the number of hypo incidents you experience. At every meal and snack you need to have 30 grams of carbohydrate, and at least a serving of fat and protein. This ratio helps keep the glucose level in your blood stable so you don't experience as many of the lows and highs.

-Excellent carb/protein/fat ratios->>peanut butter on two slices of whole wheat bread
>>2 frozen whole grain waffles with Canadian bacon
>>crackers and cheese
>>lunch meat, tuna, or grilled cheese sandwiches
>>Half a bagel with cream cheese or peanut butter
>>A whole grain English muffin with peanut butter
>>A toasted English muffin with lunch meat and/cheese
>>Two graham crackers with peanut butter or one with nutella
>>A glass of milk and an apple dipped in peanut butter or topped with sliced cheese

Rule number Five... Be prepared. It takes a little effort but you will be so grateful. When you have many children around, despite your best intentions, it can be difficult to eat at a set time. Always, have an idea of what you will eat at your next meal and be sure to start preparation it in time to eat at your three hour schedule. Better yet, prepare some quick meals, such as a sandwich, to have ready in the fridge when the time arrives. So if you are in the yard playing with the kids and it's time to eat, even the three year old can bring it to you and you can eat on schedule.  This is great because everyone doesn't have to stop what they are doing.

With home schooling, lunch is my hardest meal of the day. I hate to stop what I am doing and interrupt the flow of everyone's work to go get something to eat. My big kids are a huge help with this and consider it an honor to go fix me a tray and bring it to the school table. Your kids, too, will love to know they can do something to help Mama through a difficult time and at the same time help Rutherford to be healthy and well nourished.

Also, have a snack with you at all times. When hypoglycemia strikes I can become too disoriented to even find my way to the kitchen or prepare a snack. Actually, with Addison I could no longer drive a car or be left alone at home. But that is definitely the extreme. One of the things that literally saved me many times over was always having several types of snacks handy.

There were juice boxes in the kitchen, in my purse, in the car, beside the bed and in the basement where we have our school room, laundry and family room. A juice box is just the right amount of juice to counteract a hypoglycemic incident.

Kashi bars and V8 juice boxes are great
solutions for hypoglycemic episodes.
In addition to juice boxes, there were always kashi bars. After a hypo incident is resolved it is important to get the right amount of carb/protein and fat to prevent those rebounds you are talking about. A kashi bar has the perfect balance and is easy to keep with you. Half a meat and cheese sandwich is also a good choice, but not something you can stash around or carry in your pocket. I mean literally, you should not even take a walk with the kids unless you have a juice box and kashi bar (or some equivalent) in the bottom of the buggy.

One other snack you should keep handy is some sort of candy. It doesn't really matter what it is, as long as it is 15 grams of carbohydrate. Find what you like and measure it into the correct serving size.  Keep it where you have quick access.

Rule number six... Know the technique. Make sure you know the proper way to treat a hypoglycemic incident. This may sound simple but I am shocked at how little doctors tell their patients. So, I apologize if this is something you already know. When you have a crash, immediately consume your 15 carbs of milk, juice or candy. Retest your glucose in 10-15 minutes. If it is not about 75, have another 15 grams of simple carbs. Retest in another 10-15 minutes. When your glucose is in a safe range, eat your carb/protein/fat snack.  Remember that kashi bar and sandwich?

If you do have a rebound, and sometimes it doesn't matter what you do, it will still rebound, make sure you
still eat on time and that you consume your 30 g of carb. It seems off kilter to eat more carb when your glucose is too high, I know. However, there are several reasons for this.

1... eating on time means you are taking your insulin on time. Insulin is the key to bringing that glucose down. 2.... if you do not eat every 3 hours your body starts releasing glucogen (stored glucose) in order to nourish your baby. That in turn will cause your blood glucose levels to rise even higher.

I would ideally like to go over your glucose numbers, insulin doses and exercise regiment because each of those or a combination of the three could be the cause of your hypoglycemia. If you can get me that information perhaps I can be of more help to you. Also, in the meantime, you could check out these posts that deal with pregnancy, diabetes and hypoglycemia.

Eating Well For You and Baby
Food Journal
Juice boxes and kashi bars 

Well, it is time to feed my Henry so I must scoot out of here. I hope this will be of some use to you. If you can get me the answers to some of those questions I could probably be a little more helpful. Let me know if you have anymore questions and, by all means, please let me know when your Rutherford arrives!

Hugs, Kat

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