Tuesday, October 5, 2010

Blood Sugar Management During Delivery

When I gave birth to my first son, I had basically managed my blood sugars throughout the whole pregnancy, so it made sense for me to do it during delivery, too. I don't think my doctors even suggested otherwise. My husband helped me by checking my blood sugars every hour, and they let me drink apple and orange juice to keep it elevated when necessary. Unfortunately, my blood sugar rose during the pushing stage and was around 180-200 when I delivered, so my son was slightly hypoglycemic despite my best efforts. I attribute this rise to the extreme effort I had put forth and the extreme stress my body was under for so long on very little fuel (about 30 hours without eating).

Now that I am in a new city with new doctors at a different hospital, I am once again faced with the decision about how to do blood sugar management during delivery. If I don't do it myself, I will be on an IV glucose drip and IV insulin, administered by someone else (nurse or doctor?). Has anyone had a positive experience doing things this way (e.g., achieved better blood sugar management this way than if they had done it themselves)?

I'd like to do it again myself because I think I know myself better and will be able to respond to changes in my blood sugar more rapidly than a team of doctors and nurses that haven't lived with my diabetes every day for the last 17 years and two pregnancies. I won't have to wait for the nurse to come in to check my blood sugar or give insulin (since they have better things to do and don't always have time for it when the floor is active!). This time, as compared to last, I will be more vigilant when I see my blood sugar start to rise, and give higher boluses a little sooner to prevent the high from happening. As long as I can still drink Gatorade or juice, I should be OK even if I trend low. I will also try to eat at least a small meal before I go to the hospital and hope that I am not in labor very long after that! I might consider IV glucose and insulin only if I am nauseated and can't keep anything in my stomach.

I am learning that the more and more I rely on someone else to tell me what is going on with my body (e.g., why are my blood sugars doing this?), the more often I am disappointed. There are too many things about diabetes that we still don't understand, and every individual is too unique to explain according to the epidemiology. My experience has taught me that careful self-observation has led to the best results, since I am the only person in the world with my entire blood sugar management history in my brain. And sometimes that involves going with my gut, which even care based on the best epidemiological studies doesn't accomodate well.

Would love to hear if your experience during delivery has been different.

5 comments:

  1. I think you are right to go with your gut on this one, Beth. Since it is SUCH a critical time for baby, I would hate to trust that to someone else who isn't "invested" in the situation as you and your husband are. I think I would also feel very "out of control" (no pun intended!) if someone else were managing my diabetes. I mean, lets be honest, WE are the ones who manage our diabetes, not the doctors anyhow. I felt SO much better during Audrey's delivery when the doctors, nurses, my husband and myself were all on the same page before delivery that I would be the one managing the diabetes. I realize that there are advantages to not having to "worry" with bloodsugars when you are laboring, but I don't know with my personality if I could not "worry" about them :) Good Luck Beth!!

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  2. Hi Beth and Jenn, I have been reading your blogs tonight and am very inspired. I am wondering if you were allowed to stay on your pump throughout your labour and delivery? Did you have any push back from your doctors? If so, how did you get past that?
    Thanks for sharing your stories,
    Katy

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  3. Hi Katy, I'm not sure where you are or what type of medical person is managing your case; but I imagine this would play a role in what's the norm for the area.

    For me, the first time with the high risk OB and the second time with a "regular" OB... I was encouraged to manage during delivery on my pump.

    It was more difficult for me during the first delivery when I received an IV that contained glucose. During the second delivery, I knew to request a saline IV and asked that I only get glucose via IV if I went low.

    Both Beth and I encountered much push back from our doctors on other issues, such as wanting to deliver naturally. I remember speaking to both sides of each decision that was made. (even when I declined ultrasounds) I wanted my doctors to know I had researched BOTH sides and was making my own informed decision. They seemed to respond well to this. I always tried to be respectful of their expertise, while reminding them that I was also trying to do what was best for Me and Our Baby :)

    Best Wishes to you, please let us know of any other thoughts, Jenn

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  4. Hi Beth & Jenn and everyone else. I am a 24 year old who has had T1D for the past 21 years. I am 18 weeks pregnant with my first and I am very very interested in having a natural birth. I just know I will heal much faster and my sugars will be better afterwards too! Are there any Facebook groups for T1D mothers?!

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    1. I don't know of any, but I'd certainly join it if you started one!

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