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Thursday, December 22, 2016

Postpartum adjustments. aka taking care of a baby... and diabetes too

If you scroll back a few posts (back to 39 weeks) you would see in my Dexcom report that I used to calibrate my Dex about 5 times a day while pregnant. I also tested about 10 times a day on top of checking Dexcom obsessively. In fact I made diabetes the biggest priority of my life (as in a bigger priority than my job or anything else). I would bolus down a BG of 110 or 120 while driving, I would stash my insulin pen in my back pocket for quick access during work lunches. I would check my BG and bolus in public if needed. I would eat one smartie at a time to treat a 55 BG to ensure I did not shoot up too high. I would eat the same two options of breakfast and lunch each an every day to ensure I met my targets. Not to mention the part where I would download my two-week Dexcom history in preparation for every prenatal appointment. As a result, I stayed in the non-diabetic BG range aout 90% of the time throughout my entire pregnancy, achiving non-diabetic A1Cs in the low 5% range consistently, and generally felt very accoplished about my management. The work was worthwhile. I delivered a healthy baby girl at full term and experienced exactly zero complications related to diabetes during my pregnancy. In fact, my diligence (or obsession) paid off so much so that I felt I had a relatively normal and overall quite easy pregnancy and I can't wait to do it again. Overall, it was a very positive experience. Also, if I can do it, anyone can - I really believe that.

Now, almost 4 weeks after giving birth, things are quite a bit different. Let's back up to the day of the surgery. Within a few hours of delivery my BG was registering in the 80s and 70s consistently, which prompted the gradual lowering of insulin infusion in the IV drip. This escalated, and the insulin was shut off altogether (while the Dextrose drip remained) and my BG stayed in the 70s for hours without additional insulin (as the Levemir from the previous day was still doing its work I presume). These developments prompted my decision to go to 5 and 5 units Levemir split for my initial "return" dose instead of the 7 and 7 I originally planned upon. I also set my I:C to be 1:15 at first. Within the next day and a half - promptly after surpassing a BG of 200 for the first time in months, I re-set my doses to be 6 and 6 for Levemir with a 1:10 I:C, which was where they remained for a few weeks. (Aside; the hospital staff was excellent - just excellent - at letting me do whatever I needed to do, including using my own meter [which as I learned reads about 20 points higher than theirs] and insulin pens.) Currently, I am doing 8 and 8 Levemir and a 1:8 I:C, although I am now planning to lower the evening Levemir dose back to 7. Whew.

In the past 4 weeks there were night-time low battles - the only pattern I can identify is that sometimes I drop low after baby cluster-feeds and my milk supply is being replenished. All I can do is eat Pizelles, drink Capri Suns, or (my favorite!) eat giant sour patch kids to fix these lows. There was one night where I consumed about 30g or 40g of carbs uncovered and did not go high. There was last night where I only had to consume about 15g overnight to stay stedy in the 80s and then wake up at 62, but 15g is still too much for me to keep my basal dose. Things do not have as much of a pattern as they did during the pregnancy, which is annoying. But another reason for this lack of tight control is that I am not as diligent as I was during pregnancy at identifying the patterns, perhaps. I no longer freak out about a BG of 140. I certaintly do not calibrate 5 times a day. Seriously, I am lucky if I test two times a day! I have not downloaded my Dexcom history since the week before delivery. Also, after the past year of excellent control I never thought that I would be so relaxed about bouncing between 60-180 on many days, but.. I am. My food choices are well... not as strict as they were during pregnancy. And to be honest, I am ok with that.. for now.

I am still happy that I am not really hitting 200s ever. I haven't had serious lows.. yet. I am pretty sure any endo on the planet would be happy with my A1C right now (even if I would personally consider it too high). So it's not like I have completely gone off the control train - in fact my control is still much much better than all the years leading up to preparing for pregnancy. I guess I have just come to expect a lot of myself if you know what I mean.

Now, when it comes to taking care of my baby girl, I am much more diligent. Sometimes I have to put her down to check BG or take my insulin, or eat when I haven't in hours, but let's be serious - she rules the show and I wouldn't have it any other way (have I mentioned that I lucked out and it seems she is an easy baby? that I actually am getting enough sleep? that I am probably jinxing myself by writing this? that I am so freaking happy she is in my life?) I also feel that re-assessing my food choices and becoming more stringent in my control goals again is on my radar in early 2017, because I want decades of health for myself and for my family (which I definitely plan on expanding on).

Happy holidays everyone - best wishes for a very happy new year!


  1. Best wishes to you and your family as well.

  2. It's kind of amazing the effect that getting pregnant has on the way you focus on your diabetes and NOTHING ELSE. It's happened to me every single time. I can hardly imagine how I'll do it again in between pregnancies, and then I get pregnant, and it just takes over again (in a good way. :) I'm so happy for you both!