Post Delivery Insulin Requirements

Pregnancy
1

My induction date is 10 days away (woo hoo!) and I'm starting to think a bit more about post delivery! 

BASAL RATES:  I'm working with my endo to set up a 2nd pattern for my basal rates that I'll switch to as soon as I deliver the placenta.  She was originally thinking to just go to my pre-pregnancy settings... but we're going to talk again on Monday as I didn't have nearly as many adjustments based on "time of day" pre-pregnancy as I do now.  I'm wondering what worked for other people... I know everyone is different but it's always nice to hear what other people experienced.  I was thinking that rather than just go to my pre-pregnancy settings I should keep some of the "time of day" differences I'm using now and focus more on making my total basal insulin/day the same as pre-pregnancy.  I didn't have CGM before I was pregnant, so am not sure if some of the "time of day" changes I made were pregnancy related or me just having better knowledge to make those adjustments (and they may have already existed if I'd had the CGM sooner).  Right now my basal rates are ~65% higher than pre-pregnancy.

BOLUS CHANGES:  I am also wondering what people experienced for their bolus changes.  I only had 1 bolus ratio pre-pregnancy and now I have 4 different ones... so similar questions to above did people experience a change in needs by "time of day" due to pregnancy and did your bolus requirements change as much as your basal requirements?  Since I just had the one ratio before some of mine are still the same as pre-pregnancy but some are giving me as much as 70% more insulin.

Insulin Sensitivity:  Same questions on sensitivity as I had above for bolus changes...  Although, I don't think my pre-pregnancy sensitivity factor was right at all (it's amazing what patterns you can see and learn from with the CGM), so kind of want to approach the post-pregnancy change a little differently. 

Active Insulin Time:  I'm also wondering if others changed their active insulin time as a result of pregnancy.  Starting at about 30 weeks I changed mine from 4 hrs to 3 hrs... but even before I made the change to 3 hrs I often found myself needing 2 corrections if it had been more than 2 hrs since my last bolus (because the active insulin calculation was too high so the reco'd correction was usually too low).  So similar to above, I'm curious to know if other people also made this type of change and if so, did you go back to your pre-pregnancy sensitivity after delivery. 

Breastfeeding:  Last question on the topic of post delivery insulin requirements... my endo is recommending that I take my basal rate to 50% while breastfeeding.  Is this similar to what others have done and how did it work?  Any advice on this topic would be appreciated as well.

Overall, I had good control before I went on CGM (consistently had A1C's in the low 6's), but am just unsure if some of the fine tuning I've been dong throughout the pregnancy were truly pregnancy related or just me having better information...(my A1C is now 5.5).  I'd hate to lose some of the learning’s if they're still relevant.

Thanks in advance for any info!!

Theresa

2

For about 3 days post delivery, my basal rate was probably about .25 or .33 my pre-preg one. But, it really depends on the person. I've heard of some people taking NO (!!) insulin for a few days after delivery. I think I was taking about 2-3 units/day as basal in the post-partum period.

Then, because of nursing, I was probably using about 60-75% of my pre-preg basal. But, I was still having lows and WAY too tired to try to fix the problem, lol. In hindsight, I think 50% would have been better! Then, my basal needs gradually went back up to "normal" from 6 to 12 months as my son started solid foods and slowing cut back on nursing. He was down to 1-2 feedings a day at 12 months, and weaned at 17 months. Nursing was *amazing* for my BG's once I got the right basals! I swear I was never high, and was so disappointed once we stopped. (:

I think it's probably better to be conservative so you don't go super low afterwards. I aimed for 140-180 in the hospital after delivery, much to the nurses dismay who thought I was too high according to their stupid charts. But, I was probably more like 80-140 after...

Good luck! I'm sure you'll do great. My husband was great about managing my BG's in the hospital (i.e., reminding me to test, writing down the numbers for the endo, getting me juice form the nurses, etc) which was very helpful...

3

Hi Theresa!

Here's my thoughts for you...

Basal rates: I would go to about 50-65% of your basal rates pre-pregnancy  to avoid being low. Also I'd recommend lowering your basal rates during labor since you will not be able to eat once you are at the hospital and you won't need as much as before. (Have an energy bar before you walk in the door!!!)

Bolus: I still have different carb/insulin or point/insulin rations depending on day. I did before pregnancy though too. I would suggest lowering them back to a bit lower than your pre-pregnancy amount and you can adjust based on what you see in the next few days. You will have to adjust both your basal and bolus rations for a few weeks and up to a few months after delivery while your body adjusts to the different hormones and especially the work it takes to make food for your baby. 

Active time--- I've left this the same throughout...

Breastfeeding- be really careful about lows especially at night. I actually wrote about this on my website and have some tips out there... (www.mommabetic.com  See "Hypo")

Great job on the A1c and on the healthy pregnancy! 

Best,

Danielle