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• Types of Diabetes
• Facts about Insulin
• When to Inject
• Hypoglycemia
• What can cause low blood sugar
• Blood glucose monitoring
• Common Questions about Insulin
• Sick Day Guidelines
• Clinic Contact Phone Numbers

What type of diabetes do you have?

The three most common types of diabetes are:

• Type 1 diabetes
• Type 2 diabetes
• Gestational diabetes

Type 1 Diabetes

• Used to be called Juvenile Onset Diabetes Mellitus or Insulin Dependent Diabetes Mellitus (IDDM)
• Usually occurs before age 30
• No insulin is made by the pancreas
• Found in 5-10% of people with diabetes

• Used to be called Adult Onset Diabetes Mellitus or Non-Insulin Dependent Diabetes (NIDDM)
• Usually occurs after age 30
• Some insulin is still made by the pancreas
• Person is often overweight
• Person often has other members in family with diabetes
• Found in 80-90% of people with diabetes

• Is found for the first time during pregnancy
• Usually goes away after baby is born
• The person is at risk to develop Type 2 diabetes later in life (especially if overweight)

Facts about Insulin

There are several types of insulin. Each one works on a different time schedule, which is why most people take two or more types of insulin.
 

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When to inject insulin:

Inject your insulin at the times told to you by your health care team. If you are taking Regular (R) insulin, it is important to wait 30-60 minutes after you give your shot to eat. If you are taking Lispro (Humalog) insulin, it is important to eat within 5 minutes.

DO NOT go to sleep after taking Regular or Lispro insulin without eating first.

Where to inject your insulin:

Insulin can be given in the stomach, arms, thighs, and the area above your hip bone. Where you give it changes how fast the insulin works. It works fastest when given in the stomach; slowest when given in the thigh. Talk with your health care team about where to give your shot for each time of the day. For example, it is usually best to give your breakfast and dinner shots in the stomach, so the insulin will work quickly before the meal. It may be best to give your bedtime shot in the thigh, so the insulin will work more slowly during the night. Rotate your shots within the same area for each time of day, but not to different areas. 

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Hypoglycemia (Low Blood Sugar)

If your blood sugar is too low, you may feel:

• shaky
• sweaty
• weak
• headachy
• a fast heartbeat
• nervous or irritable
• numbness or tingling around the mouth
• tired and sleepy
• confused or slow thinking
• clumsy or have jerky movements

What should you do?

If you can, test your blood sugar. Less than 60 mg/dl is too low. If you cannot test, but think your blood sugar is low, treat yourself right away to one of the foods below.

Treat low blood sugar immediately by:

1. Eating foods with fast-acting sugar. Good choices are:

• 3 glucose tablets or 1 pack glucose gel
• ½ glass (4-6 oz) apple or orange juice
• 1 glass (8 oz) milk
• 2 tablespoons raisins
• 4-5 pieces of candy (Starburst, Lifesavers)

2.  After eating one of these foods, wait 10-15 minutes. Then test your blood sugar again. If it is still too low (less than 60 mg/dl), have another food or drink from the list above.

3.  After your blood sugar is above 60 mg/dl, eat a snack if you do not plan to eat a meal within 30 minutes. For example, eat ½ a sandwich or crackers and peanut butter.

If you pass out and cannot eat, someone needs to:

• Inject you with glucagon
• Measure your blood sugar, if possible
• Call 911 for emergency help if glucagon is not available
• Someone should NOT force food or drink on you if you are unconscious

What can cause low blood sugar?

• Too much insulin or changing the time of your insulin
• Not eating enough food, or skipping/being late with a meal
• Extra exercise or activity
• You may have more low blood sugars between 9-11 weeks of pregnancy.

• Keep food or juice with you at all times: at work, in your car, when you exercise, etc.
• Wear a Medical Alert bracelet or necklace
• Teach family/friends/co-workers about hypoglycemia and how they can help
• Eat meals and snacks on time
• Know how to adjust your insulin or food for unplanned exercise
• Talk to your nurse or doctor if you are having low blood sugar readings without any symptoms

• You have 3 or 4 low blood sugars in a row
• You have low blood sugar at the same time every day for several days

Blood Glucose Monitoring

Meters for testing blood sugar:

We will loan you a meter for testing your blood sugar during your pregnancy, if you wish. We use the One Touch brand because we have a computer that will print out the test numbers from your One Touch meter when you come into the clinic. This helps us review the results and make needed changes. You must return the meter at your 6-week visit, after your baby is born. If you need a meter after pregnancy, we will help you get your own.

Recording your blood sugar numbers:

Be sure to write your insulin amounts and blood sugar numbers on the log sheet we give you in clinic. Writing numbers down on your log sheet will show you how insulin, activity, and different foods affect your blood sugars each day. Use the comment section to write down changes in your food and activity, as well as illnesses, insulin reactions, unusual stress, or other events that may have changed your blood sugar levels. Bring both your meter and your log sheet with you to every visit.

How often do you need to test your blood sugar?

We know it is difficult to test as often as we ask during your pregnancy. However, people who test often have the best blood sugar control. Testing will also help you and your health care team see how to adjust your insulin for different foods, exercise, and changes during your pregnancy. Your doctor or nurse will tell you how often you need to test. It may be as often as 7-8 times a day! Once your blood sugar levels are stable, you may be able to test less often.

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Some Common Questions about Insulin

How is insulin made?

Most insulins today are ãhumanä insulins. They are chemically the same as insulin the human pancreas makes. However, they are made in a lab. They are not from the human pancreas. This means there is no risk of catching HIV/AIDS or any other disease from your insulin.

How should I store my insulin?

Keep the bottle(s) of insulin you are using at room temperature. Keep extra bottles in the refrigerator. Do not let insulin get too hot or frozen. Do not leave it on a windowsill or in a hot car. Do not put it in the freezer.

Can an insulin shot in the stomach hurt the baby?

No. The needle is much too short to reach the baby, even in very thin women and even late in pregnancy.

Should I stop my insulin if Iâm sick and canât eat?

No. You may need more insulin when you are sick. DO NOT skip your insulin unless your doctor tells you to. See the Sick Day Guidelines sheet.

Can I become ãaddictedä to insulin? If I have to use insulin during my pregnancy, will I always have to use insulin?

Your body will not become ãaddictedä to insulin. Whether or not you will need insulin after pregnancy depends on the type of diabetes you have. If you needed insulin before you became pregnant, you will still need insulin afterward. If you were on diabetes pills before pregnancy and if you had well-controlled blood sugars, you may be able to go back on the pills after pregnancy. Most women with gestational diabetes will not need insulin after pregnancy. They do, however, have a higher chance of developing Type 2 diabetes sometime in their lives.

Can I reuse my syringes?

Yes, it is safe to reuse your insulin syringes. Do not wash them or clean them with alcohol. Just replace the cap after use. You may reuse a syringe until the needle feels dull (many people reuse their syringes about 5-7 times). Do not ever use a syringe that has been used by another person.

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Sick Day Guidelines

Sick day rules:

• Do not skip your dose of long-acting insulin
• Tell your doctor you are sick
• Test your blood sugar often, at least every 2-4 hours
• Test your urine for ketones
• Take extra short-acting insulin (Regular or Lispro) as directed by your health care provider, for blood sugars over 250 mg/dl
• Drink plenty of fluids ö at least ½ to 1 cup (4-8 ounces) each hour
• Try soft foods from the starch/bread group, such as dry toast, crackers, or broth, if you cannot follow your regular meal plan. Drink liquids, such as juice, sugar Popsicles, or soda pop with sugar. Take small amounts of food and liquid every hour.

• You vomit more than 1 time
• You cannot keep down calorie-containing food or fluids
• You have moderate or large ketones in your urine
• Your blood sugar is over 250 mg/dl for two tests in a row

Staff / Phone Numbers

Registered Nurse
 Becky Harney, RN   598-4070

Diabetes Nurse Practitioner
 Emily Holing, PhD, ARNP   685-1149

Nutritionist
 Candace Terlaje

Social Workers
 Jen Lavine  598-6192

Maternal and Infant Care Center (206) 598-4070

Labor and Delivery   (206) 598-4616

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Last Updated:
3/31/03