Congratulations! You made it through a 9-month rollercoaster of blood sugar swings, weight changes, mood shifts and some bizarre food cravings. Your beautiful new baby is taking up most of your time and attention... but don’t forget to take care of yourself too. Managing your blood sugar is still important to the safety and development of your baby.
In most cases, insulin levels return to near pre-pregnancy levels soon after delivery. Sure, there may be a day or two immediately after giving birth when insulin requirements are unusually low (due to the sudden elimination of placental hormones and your temporary ability to secrete some insulin). But all good things do come to an end. I always recommend that my clients keep a written record of their pre-conception insulin doses so that they can revert to them after delivery.
So that’s it, right? Not quite. New times call for new challenges.
Many moms choose to breastfeed their baby. And for good reasons. Breastfeeding provides more than just ideal nutrition for the baby. There is also evidence that it leads to better immune function and may offer long-term protection against type-1 diabetes. Moms who breastfeed tend to recover faster from the trauma of delivery. Resumption of menstrual cycles is delayed. The risk of breast, uterine and ovarian cancer later in life is reduced. And few moms will argue that breastfeeding may be the most intimate bonding time they ever get with their baby.
What’s more, breastfeeding can promote weight loss -- something desired by many new moms. Breastfeeding women use approximately 200 calories daily from their fat stores to produce breast milk. Weight loss will almost always result in reduced insulin requirements. Basal/long-acting as well as bolus/mealtime doses will need to come down as weight comes down.
It is important to prevent hypoglycemia when nursing. Obviously, losing your balance or coordination can result in an accident while holding the baby. Hypoglycemic episodes that trigger the production of adrenaline (epinephrine) will also reduce milk production and milk let-down.
During a nursing session, a woman’s body also uses up large amounts of sugar to produce milk. This can cause a modest drop in blood sugar. If nursing soon after a meal, a small reduction in the mealtime insulin dose may be necessary. If nursing before or between meals, a modest snack before/during the nursing session can do the trick. One of my clients found that a Hershey’s miniature was perfect for keeping her blood sugar stable while nursing. Nevertheless, keep a sugar source within arms’ reach while nursing, just in case.
Avoiding hyperglycemia is also important when nursing. Passing too much sugar into breastmilk can cause the baby to gain too much weight. There is also evidence that it may contribute to dental problems once the baby begins teething.
During pregnancy, the importance of preventing ketosis is always stressed. Ketones are caused by a severe lack of insulin in your body. When you produce ketones, your blood and other bodily fluids become acidic. Ketones pass directly into breastmilk and will be ingested by your baby. This greatly increases the workload on the baby’s liver, and can contribute to jaundice. So if you use an insulin pump, continue to troubleshoot high blood sugars aggressively with an insulin injection and infusion set change-out. And if you take injections, be sure not to miss or delay your long-acting insulin doses.
What Sleep Schedule?
Newborns and infants have a sleep pattern all their own. And rarely does it coincide with mom’s normal sleep pattern. This can result in blood sugar control problems related to basal insulin doses.
For those who use an insulin pump, basal insulin levels are based on the production of hormones that cause the liver to secrete glucose into the bloodstream. Some of these hormones are produced in relation to the sleep cycle. This is what produces a “dawn phenomenon” in most adults with type-1 diabetes. When your sleep cycle changes, the production schedule for these hormones changes as well.
If your sleep schedule is altered radically, it may be necessary to make adjustments to your basal settings. If you are waking frequently during the night, check your blood sugar to see if it is holding steady. If it is rising or falling, basal changes are probably needed. Work with your endocrinologist or diabetes educator to help you fine-tune.
As you probably know from years of experience, emotional stress can cause blood sugars to rise and stay high. Caring for a newborn brings with it all sorts of new opportunities to get stressed-out.
If breastfeeding has become frustrating for you, contact a lactation consultant or attend a La Leche League meeting. There are probably simple solutions to the problem. If your blood sugars are a source of stress, work with your endocrinologist or diabetes educator to smooth out the rough edges. If lack of sleep is taking a toll, negotiate with your partner to tend to the baby during certain hours of the day so that you can get some consistent Z’s. And if all the extra work placed on you is more than you can handle, reach out to friends and family (at least the ones you get along with!). This is a time when the people close to you want to help and be involved. Give them that opportunity – for their sake as well as yours.
There is a significant association between diabetes and depression. Depression is several times more common in people with diabetes than in people without. There is also an increased risk of depression after having a baby: between 7 and 20% of all women experience postpartum depression. Combine having diabetes with having a baby, and the risk goes up exponentially – particularly when blood sugars are not well controlled.
Symptoms of postpartum depression include feelings of dependency or inadequacy, major sleep difficulties, significant appetite changes, and thoughts of harming the baby. Symptoms may begin within four weeks of giving birth, but tend to peak three to six months after delivery. The consequences of postpartum depression can be severe, but it is treatable. If you experience any of these symptoms, talk to your primary care doctor or endocrinologist.
Fitting In Fitness
There is a reason you hear the same FAA instructions every time you fly: “Please make sure to put on your own oxygen mask before assisting others.” If you don’t take care of yourself, you’re going to be worthless to those who are depending on you... now and down the road.
Finding a balance between your baby’s needs and your needs can be tricky. But with a little creativity, it can be done. Most babies find the gentle rumble of a moving stroller to be very soothing. So get out in the fresh air or head to a local mall and cover a few miles together. If you prefer to be at home, introduce your baby to some of your favorite music and dance, dance, dance.
The “Diaperbetes Bag”
Every new mom develops a special attachment to two things: their baby, and their diaper bag. They both go with you everywhere, like personal sidekicks. Make a special place in your diaper bag for some key diabetes stuff: a blood glucose meter & strips, glucose tabs, insulin, syringes, ketostix, extra pump supplies, batteries, etc… That way, when it’s time to go out, you’ll have everything you need to take care of your baby, and yourself!
Note: Gary Scheiner MS, CDE is owner and clinical director of Integrated Diabetes Services, a private practice specializing in blood glucose regulation and advanced self-management training for people with type-1 diabetes. A portion of his practice focuses on pregnancy and type-1 diabetes. He and his staff of CDEs offer their services remotely via phone and the internet for clients throughout the world. A devoted husband and father of four, Gary has had type-1 diabetes for 25 years and makes extensive use of both pump and CGM technology. For more information, visit www.integrateddiabetes.com, or call 877-735-3648.