To disagree with the way they are treating my diabetes - insulin user

[SaIIycinnamon]

My post meal spikes are high. They have me on the lowest 2 units of novid rapid. My post meals range anywhere from 9 -11.
All they keep doing is upping and upping my background insulin ( twice daily) to treat my post meal spikes and its making me feel insafe. Background insulin works slowly over 12 -24 hours whereas its the rapid insulin i need to bring down those post meal spikes.i feel like they are just putting me at risk of having a hypo and ive actually read you can cause over basilizsation .
Am I wrong in thinking they are dealing with this incorrectly? Everything im reading on Google suggests this is not the correct way to treat post meal spikes. Wondering how others are treating their spikes. The increasing my background always comes from the diabetes nurse.
I dont understand why they wont increase my novorapid especially to deal with my dinner spikes.

When you say perfectly in range what exactly are they? In pregnancy the aim for people with diabetes is really tight control, more so than any other time in your diabetes management. Ideally you want your fasting level to be below 5.3. Is it that consistently? If not, then they are absolutely correct to be advising increasing your lantus. Your long acting insulin is like the foundations of a house, if they are not built properly first, then adding on walls (your fast acting) won’t give a solid structure (or in this case good control).

Sudden crashing hypos can be a big thing in pregnant women with diabetes on insulin, so this is possibly part of why they are aiming to get really tight background control before edging up the fast acting. If you start getting big hypos it can lead to big swings back intohigh numbers, which can end up as a bit of a vicious circle of ups and downs, which is what you definitely want to avoid.

Asking us randoms on here isn’t going to help you. You are in a very specific situation, and the DSN and endocrinologist who are looking after you do this regularly, and have spent years getting qualified, getting clinical experience, attending courses and conferences to build on their knowledge. They are the ones who know all your diabetes history.

Please can you also tell them everything. Tell them you haven’t increased, so they know what they are working with. Their aim is to keep you and baby as safe as possible, and they can only do that if they know what’s actually happening. Good luck with everything op. I hope you get into a good plan for your pregnancy soon.

I agree with this. Sometimes, if one is spiking after a meal, it can be because 2 hours or so before the meal, there wasn't enough insulin on board. So as soon as the carbs hit the bloodstream, glucose go up like a rocket. It's a tricky balance, especially during pregnancy. They're not wrong to suggest changing the Lantus dose, although it's all very individual and may not be the right solution for you. The ideas suggested by PPs of a CGM or Freestyle Libre may help, along with post-prandial exercise. Definitely keep in close touch with your Diabetes team, it will help if you keep meticulous records of doses and carbs eaten.

I think you will need to tweak your dose of novo rapid and see what happens. Start with making small changes.

My DH is Type 2 but insulin dependent. He went onto insulin (at that time it was Levemir former nasal and Novo Rapi d with meals) about 7 years ago after suffering from DKA. At that point he was told to keep taking metformin but to stop the other diabetes medications he had been on. He started buying the Libre which was a massive help (he now gets that in the NHS). Do you have a CGM? DH has always used his readings to help him adjust his dose.

After a while he was prescribed Trulicity (dulaglutide) and told to stop using Novorapid. He did that for about 2 years but then he found it no longer controlled his blood sugar sufficiently well, so he was told to reintroduce bolus insulin but at a low dose. This time I think he started at 2 units with every meal, but he’s had to increase it, to 12-14 units. Everyone has different sensitivity though so you’d need to up it gradually and monitor the results. if you’re not on one of the GLO-1 receptor agonists it might be worth discussing that with them because it has been a game-changer for DH.

He’s always just tweaked his levels himself to find the best dosage. Initially (before he was on Trulicity) he would count carbs and work out a ratio but it was a bit hit and miss. He used to get a lot of hypos but since being on Trulicity he doesn’t need to inject so much with meals so doesn’t get many at all.

Just seen you’re pregnant…GLP-1 receptor agonists might be contra-indicated in pregnancy, so that might not be an option for you.

@PudgeJudy im aware of the tight controls but fasting levels are consistently in range 4 - 5 which shows its working as it should so increasing it doesnt make sense.

I’m not diabetic, but I know that asking people online about managing type 2 diabetes whilst also being pregnant cannot be a good thing.
The only advice we should be giving in this situation is to speak to your diabetes nurse or ask for a midwife who has experience of dealing with a pregnant woman with T2.
I hope you find the right solution and can enjoy your pregnancy x

You can’t possibly decide your basal dose is correct based only on your morning reading. To decide if your basal dose is correct you need to fast through the whole 24 hour period, but you can split this across multiple days, to check that your basal is holding you steady all day. Google how to do a basal test for a better explanation or do the Bertie online course I referenced previously which is an NHS written course that explains how to manage insulin dosing yourself

With all respect, i didnt ask anyone here on how to manage my diabetes.
I simply asked if this is how spikes are dealt with correctly, by increasing already stable background insulin to deal with post meal spikes

Yes, it can be. You may not have enough background insulin on board to keep you steady over the whole 24 hours and for the rapid-acting insulin to work as expected. It's normal for a diabetes care team to titrate the dose in this way.

The problem with adjusting the quick acting dose if the underlying dose isn't quite right yet, is a horrible yo yo-ing effect.... I would keep a meticulous diary of what you eat and maybe do the same thing again and again over a few days. If you were type 1 I would say your carb ratio is off but I'm aware type 2 is treated differently. Given that your pregnant and crushing low blood sugars can be a problem, don't adjust your dose yourself because you don't have a basis for it, ie. A carb ratio so it's shooting in the wind... I have no idea why they don't teach type 2's to read their plate and adjust accordingly, it's seems bizarre to me.. but the point is, do not so it by yourself. Getting it wrong, either way could be very dangerous for you and your baby and yea, 9-11 isn't ideal but a full of hypo you've then got to dig yourself out of with a lot of glucose (and then possibly a very high BM afterwards) is my more dangerous. Titration rakes time and is more tricky in someone who is pregnant. I think this is a trust the process situation.

Bolus isn’t adjusted until the basal is correct

Yes, I dont really understand either why they arent advising me to adjust my insulin according to carb ratio. I do feel i need to trust my own judgement because my sugars have been spiraling for months with no progress. I have had to subtly increase my rapid insulin myself over the past few days. Ive been gradually adding a unit each meal to see if i can achieve my target any better and im now finally getting perfect post meal readings which really does confirm to me that I absolutely require higher doses of rapid insulin for my meal spikes and I havent had a headache or light head in days now that my blood sugars are in range ( ive monitored sugars carefully during this process )
I had gestational diabetes in my last pregnancy and it was a very similar approach and they failed to get my blood sugars in range which resulted in my child being very poorly at birth.
I plan on collecting more data and presenting it to them so that they can see how this is working for me because taking the same 2 units with every meal that isnt combating the spike afterwards makes no sense. As an adult in their 40s, I should mention able to make my own judgement .Ive asked quite a few people i know and nobody else on insulin is having to check in every few days to require permission to increase their doses. Theyre adjusting accordingly themselves so im not sure why this is an exception.

I'd ask to be referred to an endocrinologist.

I’m T1 and have been insulin dependent for many years but in the early days I was absolutely on a 3 day check in schedule to establish my ratios. Now I simply adjust my dosing according to my cycle or how I’m feeling but it can be dangerous to titrate up/down without taking the time to monitor and understand the change properly