GD and dawn phenomenon?

FrozenMommy · April 2015

This is my 3rd pregnancy with GD. First one I took Glyburide in the AM and slow acting insulin at night. Second I took fast acting insulin before meals and slow at night. My numbers were NEVER what they wanted them to be for fasting (90 and under), with the strange exception of the last 2 weeks of my second pregnancy, still don't know why. I was up to 120 units of slow acting insulin at night, which I think is ridiculous! So far they put me on Glyburide 2.5 at night in the hopes of lowering my fasting, but nope. Still in the 110-120 range. They always say things like, "The other patients I treat don't have this problem", well,. I am not those women! I have read all about dawn phenomenon and that seems to be my problem. Has anyone else had this, and what was done to help your numbers? It's so hard to find a balance with diet that doesn't involve insulin, which I really want to avoid, but it's pretty much inevitable. Also the diet they prescribe for non insulin users seems crazy to me. I find that a low to no carb and high fat diet works best for me, of course they say it's too much fat and not enough carbs. It's very frustrating to be yelled at because I am not following their plan, but it's not working for me, so why should I?

princessbmw · April 2015

I have also had difficulty with my fasting numbers in my previous and current pregnancy. With my first, I took a small dose of insulin at night and with this one I am on glyburide. I was hesitant to take meds, but both have helped my fasting numbers which I have no real control of.

It is very important for you and baby to get enough carbs. It is vital for proper development for your baby. If you are not happy with your doctor, you can always get a second opinion.

FrozenMommy · April 2015

@princessbmw, thanks for answering. I have been taking glyburide for about 2 weeks now at night, and my numbers are ALL over the place as usual. 125 a few days ago, 105 this morning, but never under 95...sigh. Been doing ok eating baked potatoes for some reason, so that's my go to carb right now. Tried a Think Thin bar for lunch today, 30g carbs and 20g protein, still waiting to see what that's going to do. I'll probably have to go on insulin, I see the diabetologist next week.

hpatalano · May 2015

The dawn effect is compounded by pregnancy hormones which also spike at night. At night time in a non-diabetic, other organs, like the liver secrete glucose to keep your blood sugar from not dropping too low over the 8 hours sleep period. In a diabetic that glucose isn't counter acted with insulin and your numbers rise too high. Making it even worse, when pregnant, pregnancy hormones also increase overnight to make sure we are protected while we sleep. This combination sucks my will to live!!!!!!! HAHA, not really but it is very frustrating.

You might want to try slow digesting carbs vs. simple carbs. The slower digesting carbs might help keep you more consistent over night. Because they take longer to break into sugar they don't spike you and they trick your other organs into thinking you have carbs to burn so they don't secrete more glucose. I do a whole wheat sandwhich thin with a chicken breast and it works, even though it's disgusting!

Best of luck and congrats on the baby!

FrozenMommy · May 2015

@hpatalano, They put me on Humulin at night, and still not working. In fact, I find that nights I fall asleep before having a snack and taking my insulin, the numbers are better in the morning. Fo gigure! Diabetes is the most confusing thing ever. I cannot eat rolled oats at any time of day, but pasta and rice have been ok so far...what the heck?

hpatalano · May 2015

I hear you! Diabetes is incredibly confusing AND it's different in everyone. The good news is that hopefully, this is a short period of time and it will end. Are you only sleeping 8 hours? Anything over that may cause them to continue to rise. Also, if you wake up in the middle of the night and get up it can also cause your morning number to rise. Unfortunately for me, I have to follow a very strict routine to keep my fasting under control. The rest of mine are great. That damn fasting number has a mind of it's own!

ssinnwell · May 2015

I struggle with morning as well, I take humalin n, I am only 9 was, do a pretty low dose. I agree if you sleep longer than 8 hours it can cause problems. For myself no bedtime snack also raises it, night protein helps as well.

FrozenMommy · May 2015

@hpatalano, HA! 8 hours...what's that like? I have a 3 and 4 year old, my husband works strange hours, and I get up at least 2 times to pee every night. So I don't know why they expect me to have perfect numbers. I sleep 5-6 hours normally, 7 on a good day. This morning I was awoken at 5:30, fasting was 100. I took 16 units last night. I mean, 100, can't they accept that as good enough? My fasting yesterday was 118 at 6:30, took my pill and then ran to the store. My after breakfast number was 66, ate the same thing today and it was 112. It's hard to be consistant when you have chaos in your life. My oldest starts K this year, so hopefully can get into a better routine over the next few months.

FrozenMommy · May 2015

Welpp, she put me on Humloag full time. 4 measly units before breakfast, 1 whole egg, 2 egg whites and an 18 net carb english muffin. 168....ate the same thing a few days ago and 115 on Glyburide. I don't understand why insulin is the better choice, it has a much different learning curve. I told her 4 units wouldn't be enough for 2 starches. I like this woman less and less each time I see her. Making me feel guilty about oh 10 high results out of 84, and most of them were still in the 130's. Now I have a 168 breakfast, get to wait and test again in 30 mins to make sure the insulin is working at all, and waste more and more strips when insurance only covers 100 a month. Fasting was 108 this morning. I really hate this crap.

hpatalano · May 2015

It sounds like your provider doesn't have a great bedside manner. That can make this entire process even more frustrating. Can you switch?
As much as we would like to trust our care providers 100%, in the end we are our best advocates. I really had to play with my night time snack to fix my fasting number. I learned that walking 1 mile after dinner and then having 21 grams of protein and 1 serving carb at bedtime instead of 2 of protein that my number went lower in the morning. It took me a couple weeks to figure it out.

Keep trying new things! Do your best to get a full night's sleep. I asked my Dr. about waking up when my 14 month old cried in the middle of the night and she said if it's after 3 am and I'm going to be standing up and moving I need to test and eat. If I'm up and laying in bed it's OK and my number won't rise. Hope that helps!

tpete12 · May 2015

Don't give up FrozenMommy! I have been type 1 diabetic for 16 years so I understand where you are coming from. Your doctor may be driving you crazy but all this work will be worth it in the end. I love being on injections because I can do an extra dose here or there if I want a piece of cake etc. i wish you the best of luck and hopefully your doctor and you start seeing eye to eye

FrozenMommy · May 2015

@tpete12, I am so glad you posted. I need a type 1 to ask a question of. So my fasting numbers are always over 90 right, first day on Humalog yesterday, and at 11 last night I took my NPH and injected on the LEFT side, instead of the right like usual. Fasting this morning was 64!!!!! How in the world? Can the side switch actually make a difference? I mean otherwise I did like I always do and have a cheese stick and 2 cups of popcorn before bed, threw in an egg white too last night just to be safe. Actually after snack level was 143, so high, but this fasting number I cannot get over! So I took 8 units before breakfast but ate after only 5 mins, instead of the 30 I usually wait. Since I am fat, I think the insulin takes longer in my body to metabolize. But yes any insight on this would be very helpful, I am so confused lol!!

Missykay28 · May 2015

@tpete12 @FrozenMommy I am type 1 diabetic as well...for 20 years, in fact and am now on my second pregnancy. Diabetes is no piece of cake (no pun intended)! I know there is a learning curve with insulin but for the most part, Humalog tends to be a very predictable medicine since it doesn't hang around in your body for nearly as long as other meds. It gets in there, does it's job and it's out. This is probably what the healthcare provider was thinking. I've been solely on it, with my insulin pump, for 15 years and I love it. Everyone is different though and our bodies react differently and this whole pregnancy thing really shakes it all up! Mine will swing from one end of the spectrum to the next. I've gone from 130 to 30 in a matter of an hour...not pretty! I can tell you though that with all the swings, my first child was born perfectly...a perfect little 6lb 14 oz baby girl with zero health issues. The Drs will all try to scare you to death with all of their horror stories that can happen and they're supposed to but my dietician told me not to freak out over every number and just focus on the big picture. Easier said than done, I know! One tip though...if you're injecting, are you using a long enough needle? I thought you mentioned something about being overweight and if you're using a really short needle then that might affect absorption.

FrozenMommy · May 2015

@missykay28, I am using the needles they gave me lol. It's not long at all. Do you ladies have a particular carb to unit ratio? When my doc told me start on 4 in the morning and 6 at lunch and dinner, I already knew it wouldn't be enough for even the lowest amount of carbs they want me to eat. I started with 4, ate a 14 net carb english muffin and it was 168 after....so today, I had a burrito, took 10 units around 30 mins before, and it was 152. I mean I guess just keep going up? I really was thriving much better and worrying less on the Glyburide. It was lowering the numbers more quickly. I just don't understand if it's my body, or simply not taking enough units. I found an article that contributes you weight and weeks of pregnancy to how much you should be taking. Basically at 16 weeks .7 units to every kg daily intake of insulin. She had me starting on WAY less than the article says. She is allowing me to adjust as I see fit, but I really need a little guidance so I don't take TOO much. But I guess that's neither here nor there, because just drink some juice right....sigh. I really hate insulin.

FrozenMommy · May 2015

Oh and also to both of you, do you test your sugar 1 hour after START of eating, or FINISH of meal. That's something that has always confused me. I mean if you eat a salad, then 20 mins later eat a carb, why would you test at the beginning of the meal, right?

Missykay28 · May 2015

@FrozenMommy I check one hour after I finish. Don't know if that's correct or not. Before pregnancy, my insulin to carb ratio was 1:15 (1 unit of insulin per 15 gm of carbs) but now it's all the way up to 1:7! However with all the lows I've been having, not too long after I eat and the battle I was fighting over the amount of test strips I needed per month, I've slacked off on checking an hour after I eat. Tonight I had pizza which would normally reek havoc on my BS but just 2 hours after eating and checking, it was 56! I will say they lows should scare you much more than a slightly above normal reading. The other night mine dropped to 35 quickly and I drank 8 oz of juice and checked 10 minutes later and it had dropped even lower, to 30! My vision started to get dim and and I couldn't hardly think. Thank The Lord I was at work and was surrounded by an army of nurses that helped me out! I'm pretty sure since my placenta is starting to take more responsibility for the baby, and my hormones are lightening up that my insulin resistance isn't what it was and I'm requiring a lot less. Being a type 1, I unfortunately can't speak for any other meds other than insulin so I haven't a clue about glyburide...just hang in there! I feel like as long as you're checking very frequently and your hbA1c stays low, all should be good.

Missykay28 · May 2015

@FrozenMommy I'm not sure what you're meaning by "net" carbs but the English muffins I eat have 29 gm of carbs (have raisins in them though). Normally I have a cup of milk with it, which was 12 gm of carbs so now I've got a total of 41 so I would take around 6 units of insulin. I've also heard some people say that humalog doesn't work real well for them but that Novolog does. Might consider that an option too.

FrozenMommy · May 2015

@missykay28, net carbs meaning you deduct the dietary fiber from the total carbs, because fiber "doesn't count" or something, that's what my paleo trainer sister in law told me. And my Whole Grain plain English muffin has 18 i think, with 2 fiber, so 15 net carbs.

What it seems to me, is I have SUCH severe insulin resistance, that pure insulin is not helping me all that much, if that's even possible. Glyburide is actually supposed to help your pancreas recognize your own insulin, and it was doing a fine job. Last night I took 12 units of insulin before dinner, had rice with w/ chicken and bell peppers, it was 108 afterwards. That was like 60 carbs. But then, it wasn't enough to cover my night time snack, and I spike to 172! That's another concern of mine. I also took the insulin about 1 hour before eating. Doc suggested 5 mins. There is just no way. I don't understand why it takes so long to work in my body, could be the extra weight, could be the severe resistance, who knows. But am I seriously going to be taking 50-60 units just to eat a dang piece of toast by month 8? That just seems insane to me!!!!!!

I see her again in two weeks, and I am going to beg her just to let me take Gly twice a day instead. That way I know what I have been eating will be ok, and I can't just be like "take 100 units and eat cake!" I will talk to her also about maybe trying Novolog instead as well. What's the difference do you know?

FrozenMommy · May 2015

@misskey28, another thing about the testing time. My diabetes educator told me with my first child, I should test exactly 1 hour after I START eating....to which I said the same thing, if I eat a salad with NO carbs, then 20 mins later eat my first bite of carbs, I would be testing in the peak...what sense does this make. Really they should just take me off all meds and I shouldn't eat any carbs in that case. Do they also make you write down literally everything you eat? I told my doc, I am not a child, I remember what I can and cannot eat. It's hard enough shooting up with a 3 and 4 year old in the house, remember to eat on time etc. Sorry I am just so frustrated with the insulin. So just now I took 14 units and I am going to eat my same old energy bar that on Glyburide puts me well under 130 every time, yesterday on insulin it was 128. 14 units for 20 carbs, isn't that a lot???

Oh and my A1C, is 5.5....so I don't even know what to say to that. I had two perfectly healthy babies with TONS of high sugars, and they are just fine. I guess I don't understand why all the scrutiny. Why is 135 so frowned upon?

Missykay28 · May 2015

@FrozenMommy I know how frustrating it can be and yes, that seems like a lot of insulin. I don't know what the difference is between Novolog and Humalog. I've used them both and never noticed anything but on a Type 1 board on here there were several people who said humalog doesn't work for them but that Novolog does. Why is your dr so hell bent on you not using glyburide?

tpete12 · May 2015

Diabetes is a guessing game. I am also facing quite a few lows lately. One day I can eat toast, do my insulin and then be 16 twenty minutes later - the next I can have the same food, same insulin, same meter reading and drop to 3. Where are you injecting your insulin @FrozenMommy? If you inject in the legs and have an active day your body will absorb that insulin a lot quicker creating lows and later spikes. My doctor is constantly after me to stop injecting in my legs, but it is a hard habit to break. I don't have a carb to insulin ratio. To be honest I don't even count carbs. My fast acting insulin is on a sliding scale - Blood Glucose - 6, divided by 2 plus a base unit of 8 (my base unit is going up as this pregnancy continues). I am currently doing 30 units of Novolin NPH in the morning and another 8.5 at bedtime.
My doctors call me an atypical diabetic because when one thing should happen with me, the opposite does. I hope this helps you out. Feel free to ask me anything else

FrozenMommy · May 2015

@missykay28, I wish I knew why she's so opposed to Glyburide. I guess because insulin is typically deemed safer for the baby. But honestly if it's not going to cover certain things where the pill is, it seems like a no brainer to let me take the pill instead.

@tpete12, it really is a guessing game, and I hate that! I have never had lows like you before! I inject in my belly fat. Mind you I am very heavy, so I am pretty sure my absorption rate is longer because of it. But still, doc tells me 5 mins, and the insulin takes between 30-60 mins to work...that can't be normal. I too have opposite things happen. My dietician always told me that most women with GD have good breakfast numbers and terrible dinner numbers, where mine were pretty much opposite. I look at a carb in the morning and I spike, yet am able to have rice, potatoes, pasta at dinner and keep it under. Today, I took Humalog 14 at breakfast, 14 at lunch and 16 for dinner. My after dinner was 142, but dropped in 10 mins to 120, so I wasn't so worried. I hate how they stress me out about my numbers. I have gone through 30 strips in the last 4 days, it makes me so mad! I took 22 NPH just now, but I swear it will never get me under 90 on a regular basis. My 64 fasting was a fluke the other day, no clue what made it drop.

I saw this article the other day https://perinatology.com/Reference/CDAPP SS Guidelines 2002.pdf and it contradicts a lot of what my doctor said. The amount, the timing. So basically I take more each day and hope for the best. Seems like a crappy plan, but it's what I've got for now. Thanks all for the input.

tpete12 · May 2015

If you are new to injections, it can take awhile to get your carb-insulin ration just right aswell as your NPH. I waa diagnosed in 1999 with type one and it took a solid 6 years to get things straighteded out. My doc tried to switch me to a different insulin last year and I gave up on it because I could not get my numbers down to where I wanted them. As your pregnancy goes along, you will become more resistant to your insulin - this could be messing with your numbers too. Maybe you could talk your doc about switching to another brand of insulin. Humalog and I did not get along, but the Novolin brand worked well. If you aren't 100% sure about what your doctor is saying, could you switch doctors? Some doctors understand diabetes way more than others.

FrozenMommy · May 2015

She's a specialized Diabetoligist, and my diabetes educator said she would rather me be with this new Doc. So I think she has a good understanding of diabetes, but perhaps not a grasp on how severe my resistance is yet. So now this morning, I took 16 with my same old English Muffin, eggs and bacon, and got a 133. Lunch I took 20 units, and just finished a grilled cheese with a hot dog and some veggies on dill rye. So 20 units for 30 carbs. Perhaps I should just take a unit per carb and call it a day.

6 years huh? I wish I had that window. She's freaking out on me because of our "time constraint", but really she isn't listening to me when I tell her that I have been here twice before, and both my kids were healthy. I really mean TONS of highs both pregnancies. Ya know, since I wasn't about to go totally carbless. With my first I kind of did though. Very minimal carbs, only a piece of toast at breakfast and then no major carbs, just whatever was in the veggies or nuts I ate. Second time around I took insulin and ate like poo. Fast food all the time since I had a baby and didn't feel like cooking. Now I am eating literally only healthy carbs and I feel like my highs are higher than with FF during pregnancy 2. It's like my body just hates gluten right now. I can switch to gluten free again, it's not a problem, maybe it would help. So I will report back what my after lunch number is. And just for reference, I did have KFC last week on glyburide, and got a 153 just from chicken with some breading. Actually higher in protein than carbs though. May eat it again tonight, my kids have class and we usually grab some on the way home. I think I will try taking 30 units and see what happens. It's not like I will go low from it, so I guess it won't hurt right?

tpete12 · May 2015

Gluten and insulin can have fights! I am celiac as well. Whenever I accidently ingest gluten, my sugars spike. Going gluten free might be a place to start.

GD and dawn phenomenon?

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