Diabetes During Delivery

What I didn’t include in all my lengthy posts about Thomas’s entrance in to the world is mention of my diabetes. I didn’t really want diabetes to intrude on those memories. To be perfectly honest, I didn’t want diabetes to be a part of it at all, but unfortunately there are no breaks from chronic medical conditions and even amongst all the turmoil of a failed induction and a very much unwanted c-section, my blood sugars still needed to be managed.

When I was admitted for the induction, it was agreed that I could stay on my pump, and monitor my own blood sugars, until I was in active labour. You may recall that I’d already had a frustrating discussion with my obstetrician about what would happen from that point. I’ll admit that I never had any intention of letting the hospital get in the way of what was best for me, but made a conscious decision to take things one step at a time. I was happy that they were happy to leave me to it to begin with, meaning I could save any battles for later. I was, however, told that if my blood sugar went above 8, I’d have to be transitioned to an intravenous sliding scale.

Of course, given that I was responsible for monitoring my own blood sugars, the easy way around this was not to tell them if I went above 8! But equally, I knew that there were good reasons for keeping tight control of my blood sugars at this final hurdle. So I set about managing them with military precision, using the task as something concrete to focus on during all the anxious waiting. Here, I can be honest and say that I did have a couple of blood sugars over 8, but since these were post-food and always came down quickly as the bolus insulin took effect, I wasn’t ready to own up to them. Similarly I stuck to treating lows myself with the stash of Lucozade and Jelly Babies we had amongst my bags. I didn’t trust the hospital not to want to treat low blood sugars with something wholly inappropriate – like milk, or hot chocolate, as I have experienced before, or rush to get me on to IV glucose that could start a whole unnecessary roller coaster soaring up high, and crashing back low.

On the day of Thomas’s birth, things were further complicated by the fact that I wasn’t allowed to eat anything in preparation for surgery. Since a c-section seemed so likely, I was actually made to fast from around 2am. The biggest challenge with fasting is avoiding hypoglycaemia, since treating it requires ingestion of food and so would instead have been an automatic transfer to intravenous glucose and insulin without passing Go and without collecting £200. With birth so imminent, I didn’t want to risk highs either, for a variety of reasons including not wanting to have a raging thirst, or hunger, whilst fasting, worry about healing less well if the surgery was performed at a higher glucose level and of course worry about increasing the chances of low blood sugars for my baby. My new “acceptable range” was between 4 and 7.

I’ll admit that I felt under pressure, if only from myself. With everything else slipping out of my control, I wanted to do something the way that I really, really wanted. By a strange twist of fate however, my body picked that very day to act a little as though I was cured. If it couldn’t do labour “properly” at least my blood sugars were behaving! I actually ran a temporary basal rate of close to or at zero for much of the day leading up to going down to theatre. I bounced along nicely just above the lower limit on the CGM, testing with a finger stick every 30 minutes to confirm. I was also tossed a life line by the lovely anaesthetics registrar who said that consumption of Glucogel was absolutely fine as it was so rapidly absorbed it would not pose a problem even with GA. In the hours before going down, I did consume the best part of a whole bottle to keep myself on the right side of the line. My final stroke of luck was having a midwife who herself had type 1 diabetes, and therefore completely “got” my need to do things my way, and fully supported me in that.

Testing Times

I was due a new insulin pump infusion set on the day of Thomas’s birth and I elected to put this in my arm so that it would be well away from the operating field. The CGM was more problematic. The week old sensor was on the left side of my abdomen, on the front of my hip. Right on the edge of the operative field. I assumed that I’d have to remove it and was nervous about flying blind. There wasn’t time to insert a new sensor and get it working, and since the first day often throws odd numbers anyway, I wouldn’t have felt the same confidence had I done this. To my utter surprise, however, I was allowed to leave the sensor in place, covered by a fresh piece of Opsite tape, which meant I could keep the CGM going throughout. Ian also kept my testing kit in his scrubs pocket whilst I was in theatre, although I can’t recall that we actually used it!

Once in theatre, diabetes went clean out of my head. I had bigger concerns about the spinal and whether or not I was dying. Ian, however, stepped up to the role we’d always planned for him to have, keeping a close eye on what was going on. We’d clipped the pump to the neck of my hospital gown and Ian diligently checked the DexCom line for me. Either the stress or the Glucogel caught up with me and he informed that I had double up arrows, indicating that I was rising fast. I opted to take a very tiny bolus to head off the high, but switched back to a zero basal rate again, ready to mitigate the effect of the removal of the placenta. I really didn’t fancy a crashing low. I did breach the high cut off, right at that last moment, but by then they were already opening me up and it was really too late to worry about.

I think the fact that I managed to keep such tight control, along with a few helpful healthcare professionals and not drawing too much attention to diabetes is what allowed me to get through with minimal fuss. Getting through with such brilliant blood sugars is a victory I want to claim all as my own, though. I’m still ridiculously proud of this graph form the day of delivery.

A short while after my transfer back to delivery suite, the DexCom sensor ended and needed to be restarted. Once I’d eaten, I commenced the pre-programmed lower basal profile on my pump – a profile much lower than my pre-pregnancy doses with the aim of avoiding hypoglycaemia whilst dealing with a newborn and to balance the possible blood glucose lowering effects of breast feeding.

Beyond this, diabetes doesn’t really feature any more in my thoughts or recollections. I am proud, for I have much to be proud of, but I’m so glad that this is the extent of what I can remember about diabetes on the day I became a mum.

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