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Diabetic pregnancy and the pump

I am a Type 1 diabetic since 1991. I have had two children and desperately want a third, but cannot face another pregnancy like the second due to severe hypoglycaemia which kept occurring.

I breastfed for a very long time (2 years +) after the birth of my second child and since stopping my sugar levels have been very unstable – this also happened after stopping breastfeeding the first child and I was labelled a brittle diabetic at that stage.

I want to get a pump and have approached Roche. My doctor did initially suggest it and I have asked for a referral to a centre that deals with pumps as my present doctor does not. I have heard that there are two centres in Pretoria that deal with pumps, but have had no information about Johannesburg. I have also been told that no endocrinologists specialise in/are dealing with pumps in this country – that only GPs are doing so at present – is this true? I also would like to know what the chance of getting a pump on medical aid is if it is recommended by a doctor and if the medical aid is paying for CDE at the moment? I have been told that a pump costs R26000 at the moment – are there cheaper options? What type of motivating factors would a medical aid be wanting to approve a pump?

I am trying to control my sugars now but even tracking them 6-8 times a day, taking multiple extra shots when needed and tracking my diet closely is not helping and the problem appears to be with the night time readings – as some nights I do go hypoglycaemic, but whether I do or not my sugars always rise very heavily between 04:00am and 07:00am when I get up so even if they are normal at 4:00am they will be high by 07:00am and if they are low at 04:00am then they will be even more high by 07:00am (sometimes as high as 18/19).

Can a pump help to correct this as a bad reading in the morning seems to mess up all control for the rest of the day no matter what I do to try to correct it. Also can a pump prevent the severe hypoglycaemic episodes I had during my second pregnancies which resulted in ambulance trips a few times if I were to fall pregnant again?

– Bronwyn

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9 Comments

  1. Kimberley Graham Kimberley Graham

    Hi Bronwyn,

    The CDE has 5 pump centers in Johannesburg. 011 7126000. They also have an amazing 5 day course called DINE. Speak to Michelle Daniels

    Regards, Kimberley

  2. M Wratten M Wratten

    HI Bronwyn,
    I hope this may be of some help in resolving your control problems.

    I used a pump for 10 years and found it to be beneficial particularly as you can control the long acting ( basal) insulin for your individual requirements. All other means of dispensing can only vary the time ( 24 hour or 2 x 12 hour), dose and the product used by injection. You programme the pump to dispense whatever you need for each hour of the 24 hour day which will be exclusive to your needs. My nurse educator often emphasized the importance of getting pregnant women onto the pump even on a temporary basis. A phone call to your medical aid should be able to tell you if they will support the purchase fully or partially. I stopped using mine because my levy on the consumables was increasing beyond reason.

    It needs time and expertise to learn how to use the pump. I know we are all different but I believe that with the proper advise and treatment you should be able to get control before getting a pump. You need to start with the right medication in the right dosage and unfortunately not all GPs can provide it so you need an expert and CDE provides them. The headquarters of the CDE group is in Joburg and they will tell you where your nearest CDE GP is. If your medical aid tells you they support CDE things will be easier but mine does not so I just use a CDE doctor anyway. There are good diabetes knowlegible GPs but all CDE ones are required to be. It will help your new doctor (it seems you need one) if you keep a record of insulin taken, food consumed, and exercise taken. You probably know that the insulin and exercise will bring the Blood Glucose down (sometimes too far) and the other one will increase the BG. Going high after a 4 AM low is a natural reaction which correct treatment should almost eliminate . I still have lows but rarely at night (+/- 5 a year) and they are all due to not taking enough carbs to balance the energy used. Mums use plenty of energy without the recognised ‘exercise’, you need to work out what action needs what food, or lower your quick acting insulin. This sort of info you must get from the Doctor, Nurse Educator team. Please find one.

    I’m a chairman of a support group, find one of these as they can also be very helpful. (The support Group not the chairman who tend to go on a bit so I apologise if I have).

    Regards,
    M

  3. Bronwyn Bronwyn

    Thank you for the comments – I have set up an appointment with a new doctor to discuss these issues. I have belonged to the CDE for quite a while and was getting reasonable results until shortly before becoming pregnant with my second child when I was struggling with hypoglycaemia and hypoglycaemic unawareness.

    It seems clear that I am either on the wrong long acting insulin or that the hormonal changes early in the morning are preventing things from being in control – no matter what my sugars are around 02:00am, they will be about 7 points higher by 06:30am – so either the insulin is not working long enough or my body just pushes out huge amounts of sugar at that time or both. No amount of fiddling with the insulin values has helped – I have had perfect values at 02:00am and still over 10 in the morning – having a near normal value in the morning (and I mean 8, not the recommended 5) means that I went low in the night.

    I have been keeping a record of insulin, food and exercise and even then the values seem extreme – doing exactly the same thing from one to the next (I have experimented with eating exactly the same thing at the same time too) has not resulted in statistically comparable values – perhaps the insulin is not being absorbed correctly or I am having trouble with the pens or with where I am injecting – this is the only thing I can think of that could be causing this.

    Right now I am just waiting for the CDE to switch me over to the new doctor and have an appointment next month, so trying to remain hopeful.

    • How frustrating that must be!
      Please let us know how it goes?

  4. Bronwyn Bronwyn

    I have been switched to Levemir and Novorapid now with carbohydrate counting – here is how the amounts I am taking have changed: was 13/13 protophane and 11-12 units novorapid before each meal. I am now taking 10/10 Levemir and around 4 units Novorapid now before meals. This appeared to be making a big difference and I was no longer going either low or extremely high though my morning readings remain high as though I need more basal insulin at this time (not possible without a pump) – there were some adjustments that still need to be made but it was much better…

    until I got flu and PMS simultaneously right in the first week on this new insulin. I guess that is just bad luck, so now I am riding out the flu and hopefully by the time it is gone I can go back to the normal doses that were working and adjust again from there. My insulin needs seem to be very high when sick – I can eat nothing, take 5 units of novorapid in the morning and still not be back to normal levels by lunch time, but only when sick.

    The pump application process has started and will wait and see what happens – trying to remain cautiously optimistic.

    • Hi Bronwyn,
      I’m glad you’re on the right insulin now! Any updates on how you’re feeling? Flu can be a huge problem for blood sugar, I know…

  5. Kimberley Graham Kimberley Graham

    Hi Bronwyn,

    How are your readings looking now? Hope all is going well and you feel less despondent.

    Regards,
    Kimberley

    • Bronwyn Bronwyn

      Thanks – its been almost two months now on the new insulin. My readings are looking much much better and the carb counting has added a flexibility to my life that I was desperately needing. I am still testing an enormous amount and having to make a lot of adjustments all the time (seems my basal doses change rapidly and all the time) but things have not looked this good probably ever.

      I am still awaiting a medical aid decision – I am in contact with the medical aid and also with the centre who recommended the pump so will have to keep being patient. I am dependent on the pump to get pregnant again as my husband would not agree to another pregnancy without one (and preferably with a CGMS too)

      I am still going hypoglycaemic on the injections though far less so than I was and also never to the levels I was dropping before – I also have some hypoglycaemic awareness back now and know if I am under 3mmol (before I could drop to 1.7 and not have a clue)

      So in general things are looking much much better.

      • That is great to hear! Keep us posted how things go with the pump application…

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