Postpartum Diabetes Challenges

There is something to be said about the hoops T1s jump through to maintain a healthy pregnancy.

The countless doctor appointments and tests.

Scrutiny to what you ate 3 days ago that made your blood sugars spike and drop uncharacteristically (while suffering from pregnancy brain)

The assumptions and misinformed medical staffers.

All of those ultrasounds that measure your peanut larger than he’ll actually be born. (Not a unique problem to PWDs.)

And then you have baby and all is right in the world because all of your hard work has paid off and you have this awesome little nugget in your arms who will unconditionally love you. YAY! Time to leave the hospital.

Wait…

Oh, no one told you that you actually are coming home with TWO children? A real-live newborn and a cranky chronic condition which just spent the last 10+ months being micromanaged and now wants to party like a college freshman on spring break? Welcome to the next stage of your pregnancy with diabetes care: the postpartum period.

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In addition to “normal” bits of new parenthood, like sleep deprivation, baby blues, and healing from childbirth, we have a whole set of unique challenges to consider.

Your blood sugars will be shit. 

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Thank those postpartum hormones and the fact that you no longer are sporting a placenta. Sometimes it comes as welcomed relief to those who were burned out by the constant testing and dosing. (Meh – #BGnow 180, #zerofucksgiven #sleepneeded) For others, it means downing a juice box every hour while 70 mg/dl seems to be your weekly average. But suddenly, a rebound of 320 shows up.

Tip: Write down your pre-pregnancy insulin doses and keep them in a safe, but easy to find, location. Once the placenta goes, so does your need to take 150% more insulin than usual. (Usually.) Having these doses handy will at least give you a starting point. And if it’s still too much, you can adjust with your medical pro from there.

Remember that these WTF blood sugars are temporary. I know it’s probably hard to go from super mega control to… not in a matter of 12 hours. But in the grand scheme of life with D, this is a small blip on your A1C’s radar.

Keep a basket of goodies near you at all times.

There are a ton of Pinterest posts about “nursing baskets” to keep handy if you are breastfeeding your baby. (Also applies if baby likes to nap on you after a bottle, etc.) These baskets generally have burp rags, a bottle of water, something to read, the TV remote, your phone, breast pads, lanolin, a blanket for baby, snacks… pretty much anything you would want in arms reach if stuck under a sleeping/nursing baby for several hours.

I would add for us PWDs: a glucose monitor with an extra vial of test strips, a full bottle of glucose tabs or your low treatment of choice, snacks you can eat with one hand and have a ton of protein (because oh, God, you will be hungry all the damn time), your continuous glucose monitor, if applicable.

For snacks, I liked anything with peanut butter, almonds, cheese and crackers, high protein granola bars, and my lactation cookies.

Refill your supplies before baby comes – or set up Auto-refill.

It’s one thing to have a screaming newborn and surviving on no sleep. It’s another to have to make an emergency stop at CVS with said screaming newborn because you don’t have any test strips. Of the three companies I have for refills, all of them have some sort of automatic refill option when your insurance says you can reorder. Medtronic automatically sends me my supplies and then invoices me, for example. Make this one less thing you need to think about.

Double check that all of your scripts are current as well. I went through a long process with Medtronic at year-end because my prescription authorization expired and no one could get a hold of my endocrinologist.

The Baby will still be there if you need to treat a low.

The baby will also probably be crying. And that’s okay. This was probably the hardest thing to do during postpartum – remembering to take care of me, even if Bean was screaming. Because I am no good at parenting and picking up a screaming child if my blood sugars are under 50 mg/dl. I was home alone with Bean quite a bit before returning to work. There were plenty of low alarms and times that I had to set her down for 2 minutes while I found a juice box. It’s fine. You are responding to baby’s needs by being able to actually respond to her needs in about 3-5 minutes. (And not drop her/fall with her.)

Disclaimer: Nope, still not a doctor. Consult one if you have more specific questions.

Friday Five: Parenting Edition

Today I’m reflecting on some of the trials and tribulations my parents went through  raising a T1D daughter. There are a number of D-Parent blogs out there that I peak at every once in a while. However, here’s what I remember as a child about having D-Parents in the 80s.

1) I complain a lot about my CGM waking me up every hour, on the hour with alarms. My hubs also grumbles a bit. However, my parents didn’t have the alarms of CGMs… only the alarms of their analog clocks and their best guess at patterns and research of when my NPH would send me crashing down at 2 am every night. I mastered the art of drinking juice while unconscious. It helped me later if I passed out in a grocery store, or in front of the neighbors’ kids, or on the playground. Generally, I remember waking up to the fuzzy image of my mom’s permed 80s hair with a killer headache.

2) I don’t really remember being a very picky eater. But I had my moments. Particularly, during weekends away at Family Camp. Y’know, go hang out in the woods with your family and a slew of other T1 Families. Go on hikes with nurses and heavy backpacks. Learn square dancing. Do crafts by the campfire. Yadda yadda yadda. (For those that know me in real life, YES, I went camping!) Anyway, my nemesis on these trips was the camp cafeteria. Because it wasn’t home cooked at home, nor was it a grilled cheese sandwich. And these meals were prepped by dietitians and not chefs so everything tasted like cardboard. But I needed my Regular insulin. And my parents gave me my same dose before dinner every night… then sat with me for as long as two hours after the dinner buffet opened because “I wasn’t hungry/didn’t want to eat this food/bleh.”

3) Vacations were always exciting. Particularly if we flew anywhere. (Which was often.) The amount of snacks we smuggled on to flights was insane. We still had to abide by the 2 luggage per person rule, but we kind of took that for granted… sometimes… most of the time? I remember tupperware jugs of chex mix, crackers and whatnot. On that note – hypoglycemia and flying didn’t mix well with me. Particularly if the airplane food was bad (see above story). Those kids that you often roll your eyes at for the incessant crying and whining. That was me. But I had good reason. Right?

4) Negotiating with restaurants always seemed to be a favorite past-time of my parents. My mom usually kept Ketone strips in her purse. Not for testing for Ketones on the go. But for testing sodas to make sure the restaurant gave me diet. I remember one time, my mom somehow deduced that this fast food restaurant had the lines for the diet coke and regular coke switched because my Ketone strip was coming out bright ass blue. (And it tasted funny.) So rather than asking for a refund for the soda I couldn’t drink, my parents asked that the lines be switched so the correct soda could be distributed. Mmkay.

5) My parents just made shit happen. Didn’t matter what it cost. Where they had to drive. How many doctors they had to call and fight with. My mom knew I didn’t fit the textbook definition of a T1 and probably would have thrown my sugar free jello at the nurses in the hospital if she were that type of person. Their daughter was special and they were going to put everything on hold financially to make sure I was healthy. They were the first to handle the stares, the rude questions, the inquiries, and the fanny pack full of D-supplies.

We say in the DOC that you are the only person that knows your D intimately. D-parents need to know it well too, especially with a young diagnosis. To this day, I still consult with my mom on the phone when my docs can’t give me straight answers. (My dad usually just listens to me whine… but he’s good at that.)

So this Friday, I honor D-parents. While you may not think your D-kids are remembering what you do… they are.