Type 1 Diabetic Pregnancy: Managing Insulin While In Labor

Kelsey Bonilla Health Guide
  • Pregnancy Tracker: 2 weeks postpartum

    Size of the Baby: A little over 8 pounds

    Biggest Obstacle: Getting enough sleep!

     

    For the past year, I've tested my blood sugar an average of 15 times per day, sometimes less, often times more. My blood glucose monitor has been my constant companion, accompanying me to work, going to the pool, and causing me distress when I lost it on Thanksgiving Day. Throughout my pregnancy, I received daily confirmation that I was taking care of myself and the baby when my blood sugars remained in range.

     

    When I arrived at the hospital to deliver baby Sienna, I relinquished control over my blood sugar management to the nursing staff. My insulin was delivered via an IV and my blood glucose was tested on the hour throughout labor. It was a relief to let go of that concern, so that I could focus on having the baby! (Read Kelsey's story of the birth.)

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    My blood sugars stayed between 69 mg/dl and 119 mg/dl for the entire 10 hours I was in labor. The nurse would test my blood sugar and adjust my insulin rate depending on the result. If I was between 80 mg/dl and 100 mg/dl the basal rate remained .50 units per hour. When my blood sugar went over 100 mg/dl the rate was increased to 1 unit per hour. Initially I thought my blood sugars would drop too low, because of the physical exertion of labor. However, the method worked well and my blood sugars were one thing I didn't have to worry about during labor and delivery.

     

    Soon after Sienna arrived, I was able to disconnect the IV and start back on my insulin pump. My insulin needs that first day dropped to a third of my pregnancy rates. I think I took 12 units of insulin all day!

     

    For the first 12 to 15 hours post-delivery, my nurses asked me to report on my pre-meal and postprandial blood sugars. The thing was I didn't want to eat much of the hospital food. The choices they offered for diabetics were pretty ridiculous. White rice, orange juice, and pancakes were served to me during my three-day hospital stay. I ate the lower carbohydrate options and avoided the rest. My mom and sister brought in food from the deli across the street and Dennis grabbed other food choices from the hospital cafeteria.

     

    It didn't take me long to feel resentful toward the nurses for their constant blood sugar badgering. When I reported a number out of range, I received disapproving looks. They also seemed concerned that I didn't eat all the food provided. My feeling was, I'd just delivered a healthy baby despite diabetes, didn't that prove my ability to control my blood sugar?

     

    The next morning I received a phone call from my primary doctor. He asked about the basal and bolus rates we'd determined the day before. Everything was going well, I reported. Thankfully, he must have added a note to my file, explaining that I should manage my blood sugar and insulin doses independently, because I received very few inquires about my blood glucose management from that point on.

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    As someone who has worked hard to master diabetes, it was very difficult to hand over control to the hospital staff. My confidence in their ability to help me was further challenged when one nurse talked to me about her condition. Apparently, she was taking an oral medication for diabetes because she was "borderline type 1." I didn't have the interest or energy to tell her that was impossible. She then asked me if I ever cheated and ate chocolate.

     

    With the lack of sleep and postpartum hormones, I was impressed with my capacity to suppress my thoughts during this conversation.

     

    All in all, when the baby arrived, my blood sugar management took a back seat to caring for her. I continued to test my blood at least 10 times per day during the hospital stay and didn't receive any results over 160 mg/dl. Despite growing resentment toward other people's attempts to manage my blood sugar, my control remained intact and my temper in check.

     

Published On: January 22, 2008