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November 18, 2002

Family Planning

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Question from St. Augustine, Florida, USA:

I am a 33 year old female diagnosed about diabetes about 11 months ago. I am now 28 weeks pregnant, and I am having a hard time controlling my sugars. Currently I am taking twice daily NPH and Regular, and It seems that I have to eat little or nothing to get the numbers my doctor is looking for. I have several questions:

When should you take your insulin? Is it right before you eat or should you wait a while and how long?

When should you test it? Two hours after you eat to the minute of the last bite? Would a stopwatch help?

Which is the fast acting and which is the slow acting insulin? What is the time that it takes for both of them to be effective?

What is the ideal range for a pregnant person, fasting and after meals?

Answer:

For the type of insulin that you are using, I would suggest waiting 20-30 minutes after your injection before you start eating, but do not forget to eat. I usually recommend testing blood glucose one hour after eating, but two hours is acceptable. It does not have to be down to the minute.”R” (Regular) is the shorter acting insulin and “N” (NPH) is the longer acting insulin. Regular insulin activity peaks around two hours after injection and lasts about four hours. NPH peaks around four-six hours and last about 8-12 hours. This may vary from one person to another.

Ideally, your fasting blood sugar should be 60-90 mg/dl [2.2-5 mmol/L] l, before your other meals it should less than 100 mg/dl [5.6 mmol/L], and after meals it should be less than 130 mg/dl [7.2 mmol/L] at one hour and less than 120 mg/dl [6.7 mmol/L] at two hours. It sounds like you need more insulin if your sugars are persistently too high.

OWJ

[Editor’s comment: It appears to me that you have had very little in way of diabetes education and that there are much better insulin regimens to help you control your diabetes. I suggest that you ask for a referral to a diabetes team. This group of individuals can best help you design a treatment plan conducive to your lifestyle and aimed at optimizing blood glucose control. Please do not hesitate in doing this — your life and your baby’s may depend on it.

The timing of when to check postprandial blood sugars should be with the first bite of a meal, not the last.

SS]