How to control bg after birth

I’m 30 weeks and starting my countdown (I still have some time…!).

My OB mentioned that I would be on an insulin/glucose drip during labor. My question is about what happens after delivery. My insulin needs have changed drastically during pregnancy (considering that I wasn’t even using insulin at all before pregnancy, and now I’m increasing almost every day). I understand that things can change almost immediately after delivering baby and placenta. When I asked my endo how I should dose or even if I would continue the same regimen (Humalog and Humulin N), she said something like, “well, it’s ok for you to run high for a few days before you can make a follow up with me. The nurses will dose you on a sliding scale.” Um, what? That doesn’t seem right! I know that I’ll figure it out longterm, but I’m kind of worried about having out of control bg in the days following the birth.

Any insights here?

i guess your endo is somewhat right with that (especially being ok to be high for a few days after birth), even though i wouldn’t wait until the next appointment. having no experience in giving birth myself, i would just keep the insulin you were on for like 2 days (unless you are in severe hypos), and then start adjusting it as you always have.
the sliding scale administered by the nurses would give me some headache though, i would prefer to get my responsibility back asap (as soon as that drip is disconnected).
You have managed an entire pregnancy mostly on your own, and since postpartum high BG aren’t bad anymore for your baby, i wouldnt stress too much about it. you can totally do this!
Good luck!!! :four_leaf_clover:

I suppose it’s not as urgent - since the immediacy of achieving and maintaining such tight control has a huge impact on the baby during pregnancy. So in that sense, I know that running high won’t be as harmful.

I am worried about the sliding scale situation. I guess that means that I won’t be allowed to dose myself? I just don’t exactly understand how they do that - do they just guess what I’ll need? It seems really silly!

1 Like

Sliding scale is in fact silly.
I would stress to your endo/OBGYN that you want to be in charge of your BG as soon as you are off that drip. i know people who are even unhappy on insulin drips, but i understand it is easier for birth. if you are as cooperative as letting them use a drip, it is not too much expected from them to let you self manage your D.
just push them hard enough, this is already stressful enough for you without worrying about incapable nurses using an outdated insulin regimen on you after giving birth.

4 Likes

They had me on an insulin and a glucose drip and i know my sugars were swinging all over during my emergency cs (nothing to do with diabetes) based on reactions of the anesthesiologist who was responsible.

Just have to say that your bg will drop dramatically and immediately after birth / delivery of the placenta. I found myself going low immediately post delivery. Had to tell at the nurses to give me glucose NOW or I’m going to pass out. Ended up on glucose drip for 2 days. So beware. Things may change dramatically.

Expect to need very little immediately post delivery (i assumed id be back to prepregnancy dose - about 80 units less than end of pregnancy), and then readjust dosing from there.

I did self manage the whole time , except during the cesarean.

1 Like

another good reason NOT to be on a bulky sliding scale after birth.

1 Like

Good luck with the last 10 weeks (be prepared for time to somehow s-l-o-w down come week 37 or so, when every day will feel like a week…) and let us know when your baby is born and how everything played out! You are in my thoughts.

1 Like

Thank you @rgcainmd!! I know I still have plenty of time, but I’m starting to feel “the end is near…”
@JustLookin That’s what I’m afraid of. I assume that my insulin needs will be drastically lower post-delivery. I really don’t want the nurses dosing me…
@swisschocolate Yes, I like your suggestion of insisting self-management. I’ve heard this can be very difficult in a hospital setting, where they want to monitor every.single.thing. Perhaps something to clear with my doc before birth.

@yourhanner There is a lovely group on Facebook (Type 1 and Pregnancy) that is vastly helpful with this particular situation. Lots of Experienced D Moms to ask questions of!

Thanks @Anne16. I wonder if there’s a similar T2 group - I’ll have to investigate :slight_smile:

I don’t have any advice personally, but while searching on PubMed I came across an article which may be helpful/relevant, thought I’d put the abstract here:
Objective To compare postpartum with preconception insulin doses in well-controlled (HbA1c ≤ 7.4%) type 1 diabetes mellitus (T1DM) and to characterize differences in postpartum insulin dosing based on infant feeding. Study Design The primary outcome in this retrospective cohort was the change in total daily insulin (TDI) from preconception to postpartum. Insulin administration (continuous subcutaneous insulin infusion [CSII] vs. multiple daily injections [MDI]), HbA1c, body mass index (BMI), and infant feeding were abstracted. Results We identified 44 women with T1DM and HbA1c ≤ 7.4%. Preconception mean BMI was 24.6 ± 3.6 kg/m(2) and median (interquartile range [IQR]) HbA1c was 6.4 (6.0-6.9)%. Of these, 73% used CSII and 27% used MDI. Additionally, 80% of patients reported exclusive breastfeeding, 7% were exclusively formula feeding, and 13% used both breast milk and formula. Median (IQR) preconception TDI was 0.64 (0.49-0.69) U/kg/day, and postpartum: 0.39 (0.30-0.50) U/kg/day. Postpartum TDI was 34% lower than preconception TDI (p = 0.02). There was no difference in the postpartum TDI in patients who were breast versus formula feeding or when comparing CSII with MDI. Conclusion There was a significant decrease in the TDI required postpartum when compared with preconception. Dosages do not seem to be impacted by administration route or breastfeeding. These findings warrant consideration when dosing postpartum insulin in patients with T1DM.

1 Like

It’s ALWAYS easier to get things cleared before you go into a hospital than it is after, when everything’s chaotic and they may/may not be able to get ahold of your doctor when you want.

2 Likes

Actually I’ve read that it is comon even for women post delivery not to need any insulin for a day or two… so be really conservative on the dosing and treat frequently.

1 Like