I am a MAJOR type A personality. I am 35 wks measuring 42 weeks with a big baby boy and lots of amniotic fluid. I know this kid will come out, I have no idea how or when. What I NEED to know something about is that to expect with BG's for either a c-section or labor and delivery. I can't find any good info anywhere. Are there any trends? Did you rise, did you fall? Who monitored your BG's? Did you stay on your pump or go on an insulin drip and trust the doctors to do it? If you haven't delivered yet what are you thinking and why? I just need info. I know, I am a dork.
Plan on less insulin needs (in fact - plan on one of the reasons you are induced is because of drastic less insulin needs - means placenta is starting to ‘fail’ (there is medical term) and insulin doesn’t get to baby). Not sure your breast feeding plans, but you may want think about either just fixing highs and no basal or lantus or going on 20% basal & bolus rates. I needed no insulin until about 36 hours after delivery… (but that did 't stop hospital from telling me to give it). For breast feeding… What I finally found worked - start at 150, drink 6oz OJ, feed one side. Drink another 6oz OJ while burping and then other side. And 1/2 the time, about 30 minutes after… I’d need more OJ. And then, about 30 minutes later, we’d start all over again. CGM can only help - along with temp basals (neither were available when I had my girls 9 & 11 years ago)
During labor my pump did fine. Just tested occasionally and I don't really remember having lows or any major highs. You can't eat during labor and if you're induced aren't allowed to get out of bed, so that keeps blood sugar pretty stable. When I finally opted for c-section and had to remove pump and go on IV insulin. Used IV for about 24 hours after surgery, which is good because I was pretty out of it until later that morning.
I used pump for maybe 4 days at much lower insulin levels (and I was starving the whole time, my husband had to keep bringing me food from snack bar because they had me on a "diabetic diet"). Then my milk came in. Between the hormone changes, breastfeeding and not eating or sleeping much, I didn't use ANY insulin for a week or so. Should have been great but it was unsettling, after being a type 1 for 28 years. Gradually my numbers started coming up and I reconnected to pump.
When you go into the hospital bring your meter, test strips, extra snacks, infusion sets, syringes and insulin. My nurses were very nice, but they have to follow what is charted, which is usually pretty infrequent testing (with an antiquated meter) and no concern for high blood sugars. Just be polite and make sure that your chart says you're managing your own insulin dosing. Nurses will be okay once they see how good your numbers are.
It's so exciting that within a few weeks your baby will be here! Congratulations!
Following devivery, insulin requirements drop precipitously actually. Its theorized that the placental hormones build insulin resistance and suppress that pituitary function. When you remove the placenta, you remove the hormones and it takes the pituitary some time to rev back up. During labor, it varies. I personally liked going with the IV insulin gtt because its much more rapid acting. Had 2 c-sections. No problems with blood sugars. Wore my Dexcom throughout the surgery though (placed it on my back) which the anesthesiologist loved. They test your blood glucose. Post-partum hypoglycemia can be a problem.