Question from Keshena, Wisconsin, USA:

I am a 29 year old type 1 diabetic who is currently 26 weeks pregnant. I have had diabetes for almost six years. My A1c about six weeks ago was 5.9, down from 7.9 at the beginning of my pregnancy. I have no other medical problems. I have been under the intensive care of an endocrinologist, nurse practitioners, my obstetrician, and a dietitian. However, it seems we are all at a loss as to how to get my fasting blood sugars even close to range. I am writing to see if any of the other professionals have any further ideas or suggestions. Right now, they are hovering at around 200 mg/dl [11.1 mmol/L]. My daytime ratios and blood sugars are working well. I have not gained any weight since becoming pregnant (which I believe is directly related to the better blood sugar control I have now). With the high fasting blood sugars, I am concerned my A1c is going to begin to increase again.

I was taking Lantus prior to pregnancy and wish I could go back. At first, we realized I was taking way too much long-acting insulin, NPH, overnight. This was causing lows, some of which I was not waking up from. Whether I woke or not, I seemed to have rebounding blood sugars. So, my NPH went from about 28 units down to 10 units over several months. However, I was still having high fasting blood sugars. I was also having lows really early in the morning (like midnight to 1 a.m.), so we added a bedtime snack. However, I am still waking up with high blood sugars. I have been trying to increase my overnight NPH because I have not been on 10 units since being diagnosed and it just doesn’t seem like enough for me. However, last night I set my alarm for 2 a.m., after taking 14 units of NPH at 10:30 p.m. and going to bed with a blood sugar of 208 mg/dl [1.5 mmol/L]. I skipped the snack and did not take any insulin. I woke up with a blood sugar of 38 mg/dl [2.1 mmol/L], treated it and went back to bed about 1/2 hour later with a blood sugar of 70 mg/dl [3.9 mmol/L]. This morning I was then 278 mg/dl [15.4 mmol/L]. I have tried testing blood sugars at all hours of the night. I really want these fasting numbers down, but don’t know what else to do and it worries me going into the third trimester as I am told it gets harder to keep your blood sugars in target range. Also, my ketones are almost always negative, even waking with a blood sugar greater than 200 mg/dl [11.1 mmol/L]. Do you have any suggestions?