How to lower fasting sugars?
November 4, 2012 4:34 PM Subscribe
I have gestational diabetes, am on insulin, and cannot seem to get a grip on my fasting sugars. Please help.
I'm 18 weeks pregnant and have gestational diabetes. I had it with my last child, and controlled it through diet mainly, and then was on glyburide for a while. This time, though, I'm already on insulin. My after meal numbers are fine. But my morning fasting numbers are running high, despite the fact that my MD keeps upping my insulin (I take two kinds - long acting and short acting, and I'm currently taking 16 units of long acting when I go to sleep). It doesn't seem to matter what my sugar is before I go to bed - when I wake up, my number is always between 96-103. The doc wants it below 90. I was on 12 at night, then 14, then 16, but the numbers aren't budging.
Any ideas about what this might be? I'm not eating in the night, obviously. I can't exercise while I'm sleeping. So I have no idea what I should be doing.
One thing I read is that if your blood pressure is low, your body might release sugars to combat the lowness - I'm not blood pressure medicine as well, and my blood pressure is much lower than it normally is for me (this happened with my first child in the second trimester as well). I will ask my doctor about that. But I guess maybe waking up in the middle of the night and taking my sugar and blood pressure might give me some clue?
I love my doctor; but I suspect that he will just keep increasing insulin. Which is fine if it helps, but so far isn't helping. So frustrating.
(Other info: I'm also on 40mg of lovenox at bed time; multivitamins, extra Vitamn D, Folgard, prevacid, and DHA).
I'm 18 weeks pregnant and have gestational diabetes. I had it with my last child, and controlled it through diet mainly, and then was on glyburide for a while. This time, though, I'm already on insulin. My after meal numbers are fine. But my morning fasting numbers are running high, despite the fact that my MD keeps upping my insulin (I take two kinds - long acting and short acting, and I'm currently taking 16 units of long acting when I go to sleep). It doesn't seem to matter what my sugar is before I go to bed - when I wake up, my number is always between 96-103. The doc wants it below 90. I was on 12 at night, then 14, then 16, but the numbers aren't budging.
Any ideas about what this might be? I'm not eating in the night, obviously. I can't exercise while I'm sleeping. So I have no idea what I should be doing.
One thing I read is that if your blood pressure is low, your body might release sugars to combat the lowness - I'm not blood pressure medicine as well, and my blood pressure is much lower than it normally is for me (this happened with my first child in the second trimester as well). I will ask my doctor about that. But I guess maybe waking up in the middle of the night and taking my sugar and blood pressure might give me some clue?
I love my doctor; but I suspect that he will just keep increasing insulin. Which is fine if it helps, but so far isn't helping. So frustrating.
(Other info: I'm also on 40mg of lovenox at bed time; multivitamins, extra Vitamn D, Folgard, prevacid, and DHA).
Are somogyi effect or, especially, dawn phenomenon possibilities? (Quick Googling brought up this article, that covers both.)
posted by gnomeloaf at 4:48 PM on November 4, 2012
posted by gnomeloaf at 4:48 PM on November 4, 2012
Don't take this as specific medical advice.
It depends on the type short and long-acting insulin you're taking. If you are truly on short or ultra-short acting insulin (lispro, aspart, glulisine) its primary purpose is to address the bumps in glucose you will have with your meals. Increasing short-acting insulins may be the wrong answer, because the effects of these will have worn off by the time you wake up in the morning, and while you are sleeping it might cause hypoglycemia. Fasting glucose levels are more of a reflection of your basal (ie long-acting) insulin requirement, not your short-acting needs. [Note: This does NOT apply to a regimen with regular insulin, which does lasts longer in the system and can impact morning sugars]. Overshoots can also cause this problem though, as gnomeleaf notes.
posted by drpynchon at 5:12 PM on November 4, 2012
It depends on the type short and long-acting insulin you're taking. If you are truly on short or ultra-short acting insulin (lispro, aspart, glulisine) its primary purpose is to address the bumps in glucose you will have with your meals. Increasing short-acting insulins may be the wrong answer, because the effects of these will have worn off by the time you wake up in the morning, and while you are sleeping it might cause hypoglycemia. Fasting glucose levels are more of a reflection of your basal (ie long-acting) insulin requirement, not your short-acting needs. [Note: This does NOT apply to a regimen with regular insulin, which does lasts longer in the system and can impact morning sugars]. Overshoots can also cause this problem though, as gnomeleaf notes.
posted by drpynchon at 5:12 PM on November 4, 2012
I am a doctor, but I am not your doctor, this is not medical advice, yada yada.
This is probably a Somogyi effect, especially if it's gotten worse with increasing doses of bedtime (or post-dinner) insulin. You can test this in one of two ways: First, you can measure your glucose at about 3am. Low blood sugar at 3am with high glucose upon waking is suggestive of Somogyi, and your evening doses need to be cut. More easily, you can try having a snack before bedtime and see if that helps.
posted by LittleMissCranky at 6:37 PM on November 4, 2012 [3 favorites]
This is probably a Somogyi effect, especially if it's gotten worse with increasing doses of bedtime (or post-dinner) insulin. You can test this in one of two ways: First, you can measure your glucose at about 3am. Low blood sugar at 3am with high glucose upon waking is suggestive of Somogyi, and your evening doses need to be cut. More easily, you can try having a snack before bedtime and see if that helps.
posted by LittleMissCranky at 6:37 PM on November 4, 2012 [3 favorites]
It could be the Somogyi effect, I suppose. But if that were the case, I would expect a much higher bounce than you seem to be seeing. (Caveat: I have type 1 diabetes, so my experience--and numbers--are much different than yours).
I think (while annoying), the best thing might be to wake up every couple of hours at night to check your blood sugar. That should help you get a sense of exactly when your blood sugar is rising, which will tell you if you're experiencing a slow and steady rise or a low and then upward bounce.
posted by McPuppington the Third at 7:49 PM on November 4, 2012 [1 favorite]
I think (while annoying), the best thing might be to wake up every couple of hours at night to check your blood sugar. That should help you get a sense of exactly when your blood sugar is rising, which will tell you if you're experiencing a slow and steady rise or a low and then upward bounce.
posted by McPuppington the Third at 7:49 PM on November 4, 2012 [1 favorite]
McPuppington is right; you should test in the middle of the night. I suspect dawn phenomenon rather than Somogyi, though.
I'm a type 1 who recently had a baby. The amount of insulin I needed increased dramatically throughout the pregnancy (both basal and my carb ratio). I'm on a pump, though, which means that I can do some fine-tuned tinkering -- I don't take long-acting; it's all fast-acting (Humalog), delivered in tiny amounts constantly (plus bolusing for food.) So I can have different basal rates at different times of the day.
Point: I needed startlingly high basal rates from around 2 or 3 am until around 8 to keep my fasting #s below 90. Pregnancy hormones really do a number on you.
posted by kestrel251 at 7:28 AM on November 5, 2012
I'm a type 1 who recently had a baby. The amount of insulin I needed increased dramatically throughout the pregnancy (both basal and my carb ratio). I'm on a pump, though, which means that I can do some fine-tuned tinkering -- I don't take long-acting; it's all fast-acting (Humalog), delivered in tiny amounts constantly (plus bolusing for food.) So I can have different basal rates at different times of the day.
Point: I needed startlingly high basal rates from around 2 or 3 am until around 8 to keep my fasting #s below 90. Pregnancy hormones really do a number on you.
posted by kestrel251 at 7:28 AM on November 5, 2012
Hate to answer a question with a question, but how much supplemental vitamin D are you taking?
posted by rhombus at 12:52 PM on November 8, 2012
posted by rhombus at 12:52 PM on November 8, 2012
Disclaimer -- I am not your doctor.
I will just answer with what I am thinking. You might want to try increasing your vitamin D intake. Hollis and Wagner have done some studies -- including at least one double-blinded RCT -- showing that daily doses of 4000 IU are safe in pregnancy, and an inverse correlation between reduced rates of preeclampsia, which is linked with gestational diabetes, and serum vitamin D levels that are at least suggestive of a causal relationship.
Here's a presentation that might interest you.
posted by rhombus at 1:22 PM on November 8, 2012
I will just answer with what I am thinking. You might want to try increasing your vitamin D intake. Hollis and Wagner have done some studies -- including at least one double-blinded RCT -- showing that daily doses of 4000 IU are safe in pregnancy, and an inverse correlation between reduced rates of preeclampsia, which is linked with gestational diabetes, and serum vitamin D levels that are at least suggestive of a causal relationship.
Here's a presentation that might interest you.
posted by rhombus at 1:22 PM on November 8, 2012
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