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Question:

From Surrey, United Kingdom:

I am a 33 year woman with diabetes and coeliac and have been pregnant for five weeks. I am on insulin injections, taking Humalog before my main meals and Humulin I before bedtime. Now that I am pregnant, I have to reach a tight sugar control, maximum 5.5 mmol/L [99 mg/dl] before meals and maximum 7.5 mmol/L [135 mg/dl] one hour after main meals. The problem is when my sugar level is 5 to 6 mmol/L [90 to 108 mg/dl] one hour after my main meals. I become hypoglycemic for two hours. The only way to avoid this is try to reach the 7.5 mmol/L [134 mg/dl] target for an hour or eat extra foods when my glucose level is 5 or 6 mmol/L [90 to 108 mg/dl] for an hour.

I was also advised to introduce slow acting foods into my diet. Unfortunately, apart from basmati rice or new potatoes, I could not introduce anything else because most of these items contain gluten, which I cannot have as a coeliac. I think Humalog is not suitable for me, as I would need an insulin where the one and two hour results could both be kept between 4 and 7 mmol/L [72 and 126 mg/dl]. I had the one hour high peaks before pregnancy, but on check-ups, I was only asked to show two hour results. Because these were within the target and my A1c was normally between 6.2 and 6.5, my specialists were satisfied with my results. I also do not want to put extra weight on by eating extra after every one hour injections on top of my six meals/day. Could you please advise me?

Answer:

If your blood glucose is 5 to 6 mmol/L [90 to 108 mg/dl] one hour after eating, then you may be taking too much Humalog before your meal. A goal of 7.5 mmol/L [135 mg/dl] one after a meal is what I recommend to my patients. You may wish to consult further with a dietician to determine an insulin to carbohydrate ratio to better calculate your premeal injection. A typical ratio would be one unit of Humalog for every 10 grams of carbohydrate in your upcoming meal. Your choices for carbohydrates in your diet are limited by your coeliac condition. You should also be taking your Humalog just before you eat so that it does not peak too late after your meal. I think that the Humalog remains a good choice since it allows you to adjust your insulin dose to fit your meal rather than eating a certain amount based on an insulin injection from a few hours ago.

OWJ

DTQ-20061110075913
Original posting 13 Nov 2006
Posted to Hypoglycemia and Insulin

  
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Last Updated: Tuesday April 06, 2010 15:10:10
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