I am 32 weeks pregnant, and am getting nervous/excited for the birth of my first child. I have been seeing both a regular OB/GYN and a perinatologist throughout my pregnancy. However, neither one of them is very knowledgeable about type 1 diabetes and pregnancy.

I am currently taking Lantus (currently 50 units, up from 36 pre-pregnancy) and Humolog based on whatever I eat. I have been diabetic since I was ten (am now 23), and am in good control. I am also a nurse, and I consider myself to know a lot about my diabetes.

However, I willingly admit that I know nothing about being pregnant and diabetic. It has been a huge learning curve.

Basically, I'm getting nervous about the upcoming delivery. What have other people done to manage their diabetes while in labor/delivery? Do you still take your lantus like usual? Has anyone asked to do their own blood sugars instead of having to wait on the lab or the nurses to do them? Do they put you on an insulin drip? What happened to your blood sugars while in labor/after delivery? What about dealing with lows? Basically, I'm trying to get all the information I can!


Expect that your doctor may want to induce early and that it's likely you'll have a c-section.  The nurses who taught my birthing class said they'd never seen a diabetic woman allowed to go to term.  I had a healthy pregnancy and expected to be an exception to the rule, but my doctor still insisted on inducing at 38 weeks and because my body wasn't ready I labored for a day and then finally had a c-section.  I've come to find out my experience is very common.

Because you do shots they may put you on an insulin drip during labor.  I use a pump and was allowed to adjust my own insulin, but went on a drip after delivery.  When you go to the hospital take your own insulin and snacks.  Hospital staff isn't always knowledgeable about diabetics who make their own insulin correction.  The folks helping me wanted to keep my blood sugar around 200 and there always seemed to be a disconnect between what my doctor promised and what was actually in my chart.  So I just started doing my own insulin and correcting lows as needed.  

Because of the cesarean it took a while for my milk to come in, but once it did I didn't take any insulin for about 2 weeks!  At that point I'd had type 1 for 28 years and I never knew such a thing was possible.  Sounds great but it was actually kind of stressful.  Slowly my insulin needs increased and I went back to pretty normal levels, though I still was more prone to lows while breast feeding.  

Most pregnancies in diabetic women don't go to term for two reasons: large babies and placental aging. Just like all other complications associated with diabetes, the vasculature is affected and causes the placenta to get old faster. This increases the risk for complications as the pregnancy progresses (abruption among other). I think C-sections are safe given risk of large baby not fitting through the pelvis. I am not entirely familiar with intra-labor glycemia as its usually managed by an insulin drip. However, I DO know that shortly after the removal of the placenta, the insulin requirements drop considerably, down to pre-pregnancy levels. The effect of lactating and equilibration of the body's hormones (it takes a few weeks for the hormones that normally worked against the insulin to return. they are replaced in the latter part of pregnancy by hormones produced by the placenta). So blood sugars are LOW post-partum and your insulin doses will be much lower than you expected. This can be very dangerous as the mother of a newborn so close glycemic monitoring is just as important!

I too am a pregnant, diabetic, nurse and I'm due in November.  Doc said they would definately PLAN on utilizing my insulin pump during delivery however if my sugars are crazy they did say an insulin drip may be necessary.  I agree with Hayley completely and would like to add that checking your blood sugar with your supplies as often as you see necessary (and on schedule) is a good thing!  Just be sure to communicate your blood sugar results and insulin dosages to the hospital staff.  I would also recommend checking with your endocrinologist regarding how to adjust your lantus the day of delivery and for the days after.  As far as snacks for lows, keep them in the room!  They let non-diabetic moms keep food and drinks in the room, and they have no reason not to let you keep yours.  Easy access to food when I'm low is important, and I'd hate to have to wait 10 minutes for someone else to get me something.  When I'm low 10 minutes is FOREVER!

Read balancing Pregnancy with Pre-existing diabetes by Cheryl Alkon she covers ALOT of info about labor and delivery

2 things happened to me while hospitalized that you should watch out for with nurses.

I was on injections at the time and I loved to let the nurses give me my shots in my arms because

a) I needed a break from injecting myself and b) it is difficult to do shots in my arms myself.

One night before I gave birth, the "know it all nurse" calculated the snack of pretzels incorrectly and disregarded my history of overnight lows and insisted on giving me way to much humalog, even after I asked her to cut the dose in half. I had the most ridiculous lowest blood I can remember, needed and IV of sugar, and it was awful. I was super pissed.

Two mornings after delivery, a new nurse came in gave me my am shots of lantus and humalog, and I said, "where is the Lantus?"  She said, "it was in the syringe"

We all know you cannot mix Lantus and Humalog.

When I went on my walk around the floor with the baby, I saw her getting lectured by my Endo.

So, double check the dose, you have the right to refuse treatment (insulin shots by idiots), tour the hospital before delivery and ask a ton of questions, find out what they know about diabetes and delivery. make sure you are comfy with your ob and endo. Send the nurses flowers and presents before you expect to deliver :)