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annsrum 10-14-2013 21:05

Pregnancy and people who already have Diabetes - What I experienced
 
I decided to write this since I had wanted to know what to expect while pregnant with diabetes and did not find a lot of information. I figure that there is probably someone out there that would like to know what can happen and what doctors will do.

I am a type II diabetic with PCOS.

I tried oral medications and still not enough improvement. Then the endo added Lantus at night and Humalog for meals (and 2000mg metformin ER) and finally got the right combination that was safe for pregnancy. It took about 1 year to get where they wanted me to be. I also was diagnosed with hypothyroidism and started taking thyroid pills.

I got pregnant within 2 months and after the 8 week check at the regular OBGYN I was sent to a high risk dr. I had regular ultrasounds every couple of months. I also had regular Endo visits as well. My a1c was running between 4.8 and 5.3. She had me back off a little after the 4.8 because I was losing the ability to feel lows.

Oh and they made me collect all my urine for 24 hours (every single drop while keeping the collection container on ice... yeah ewwww) to check for proteins in my urine (think this was around 18-20 weeks). I believe they said this was to help look for signs of Preeclampsia (high blood pressure induced by pregnancy) later... kind of finding out what is normal for me I think so they would notice a difference?

I chose not to go super low carb during the pregnancy and instead went with the carb recommendations for pregnant diabetics. I've already forgotten what they were, but I think it was 30 carbs for breakfast, 40-50 for each meal and 15 for snacks. I chose this because I did not want to take the chance that the baby would not have enough carbs to develop properly. This is what was most comfortable for me.

I had to check my blood 1 hour after each meal and two hours after each meal. They wanted my fasting to be below 90 in the morning and I think it was 120 at 1 hour mark and below 90-100 at 2 hour mark. I generally kept it around 70-80 for the most part at the 2 hour mark and in between meals.

Even though they advise you to wait 4 hours between giving insulin, I would do my corrections when I noticed it was not on target (often even at the 1 hour mark). Luckily I had practiced this a lot prior to pregnancy and knew what did and did not work for me.

Oh and do not let them give you a glucose tolerance test. This test is to check to see if you have diabetes and well, you already know!!!!

My insulin needs increased drastically throughout the pregnancy due to the hormones being given off by the placenta. what normally would have required maybe 3 units of insulin was requiring as much as 15 at some points. The endo let me decide when to increase insulin on my own. Other then checking me every 2 months she did not check on me at all besides that. I will not lie, this level of testing was very stressful in the beginning and hard to adjust to. I would get busy with work and miss the hour mark or the two hour mark or have trouble figuring out how much insulin to increase to. It took me at least a month or two before I started falling into a more comfortable habit. Oh and I had to request more test strips since I was testing 6-8 times a day (still didn't quite give me enough)

Toward the end of the pregnancy I had to go in for non-stress tests. Which is basically they have you sit in a recliner in a room with a TV and they hook you up to where you can hear the baby's heart beat and another monitor that could detect baby's movements. They wanted to see good activity of the baby's movements and heart beat.

They told me they would not let me go past 38 weeks and would induce (standard protocol for pregnant diabetics). At 37 weeks when I went in for my final ultrasound they told me my amniotic fluid was low and my blood pressure was a little too high and told me to head to the hospital to be induced.

They tried to induce me and at first not much. They broke my water and then it was hurting a lot and started the epidural. The baby's heart rate was dipping after contractions and they had to back off the pitocin and tried to let me body do it on its own. A nurse told me that my placenta was failing and causing the heart rate dip and said it was because of my diabetes. I never did figure out whether she knew what she was talking about or not. Eventually they cranked the pitocin back up.

After almost 28 hours and dilating to an 8 they said my contractions were just not regular enough and regular delivery was out of the question and wisked me in for emergency c-section (I have read that insufficient contractions are not uncommon in diabetics of both kinds). By this time either I was so tired I was getting dizzy or some of the meds they gave me were making me dizzy (I do not handle narcotics well at all), not sure. Last thing I remember was them saying I was going to feel pressure and I was saying OW OW OW because it felt like pain to me. I did not see the baby until I woke up in my room a couple of hours later. Still do not know if they knocked me out on purpose or if I passed out on my own. (hopefully this does not scare you too bad)

Thankfully baby was healthy and doing fine. She is almost 4 months old now and a joy and worth every effort (although until she got there I had a hard time grasping this).

Shanny 10-15-2013 07:01

Wonderful! So happy to see you again & know how things have come about for you - a beautiful baby girl. I'm sure your last paragraph is true for many, although your journey did have a few more curves than some. ;)

Do keep us posted if you ever have time . . . and thanks for bringing us the great news. Congratulations!




JT Reagan 10-15-2013 14:31

I don't understand why they didn't do a caesarian instead of trying the inducement? Seems odd to me.

annsrum 10-15-2013 17:47

Quote:

Originally Posted by JT Reagan (Post 260826)
I don't understand why they didn't do a caesarian instead of trying the inducement? Seems odd to me.

While a lot of diabetics do end up having a caesarian, it is not a given that you have to have a caesarian. They wanted to let me try and see if regular birth would work. Not sure why they let it go on for so long though before they switched course.

From what I understand it is a lot easier to recover if you have a regular birth.

I had some difficulty with healing afterward, but I believe it was due to my incision being stitched up quite unevenly. It was kind of bunched up in one spot and that spot oozed yellow clear liquid for almost 6 weeks. The doctor said a stitch or a hair was probably working its way out. Unfortunately it healed to where there is a decent size dimpling in one side and is definitely not straight :/

The percoset they gave me for pain after delivery was making me feel really weird. I felt like I was awake while asleep and couldn't hold my eyes open for very long. At some point they started to give me Motrin in addition to the percoset and I asked them to just switch me to nothing but Motrin. It hurt quite a lot, but I do not like feeling out of control of my body and therefore I endured it anyway.

Also on the way home from the hospital my husband was saying we should get the velcro swaddling things and knowing he is not good at locating items that aren't easy to find I told him I would go in. BIG mistake. I got about 10 foot in the store and realized that my small purse suddenly felt like it contained an anvil! I ended up taking a step, stopping and putting purse on shelf, then taking a few more steps, etc. It felt too far to go back and get a cart! I am stubborn though and got what I wanted and got out.

when I hear about other women feeling awesome a day or so after regular birth I cannot even imagine what that must feel like.

Shanny 10-15-2013 18:10

Yeah, I would say 28 hours is quite a bit too long to spend trying, but I guess they have baby monitors assuring them the baby is all right. Thing is, you were completely exhausted by such long labor, so it's no wonder you were so weak afterward.




JT Reagan 10-15-2013 19:39

Quote:

Originally Posted by annsrum (Post 261017)
While a lot of diabetics do end up having a caesarian, it is not a given that you have to have a caesarian. They wanted to let me try and see if regular birth would work. Not sure why they let it go on for so long though before they switched course.

From what I understand it is a lot easier to recover if you have a regular birth.

I had some difficulty with healing afterward, but I believe it was due to my incision being stitched up quite unevenly. It was kind of bunched up in one spot and that spot oozed yellow clear liquid for almost 6 weeks. The doctor said a stitch or a hair was probably working its way out. Unfortunately it healed to where there is a decent size dimpling in one side and is definitely not straight :/

The percoset they gave me for pain after delivery was making me feel really weird. I felt like I was awake while asleep and couldn't hold my eyes open for very long. At some point they started to give me Motrin in addition to the percoset and I asked them to just switch me to nothing but Motrin. It hurt quite a lot, but I do not like feeling out of control of my body and therefore I endured it anyway.

Also on the way home from the hospital my husband was saying we should get the velcro swaddling things and knowing he is not good at locating items that aren't easy to find I told him I would go in. BIG mistake. I got about 10 foot in the store and realized that my small purse suddenly felt like it contained an anvil! I ended up taking a step, stopping and putting purse on shelf, then taking a few more steps, etc. It felt too far to go back and get a cart! I am stubborn though and got what I wanted and got out.

when I hear about other women feeling awesome a day or so after regular birth I cannot even imagine what that must feel like.

Yeah, percocet does weird things to me. I have only taken two in my life and that is all I am ever going to take. If you do this again, insist on something else! Not all of us react as predicted to pain meds. I know that lydocaine (sp?)--the stuff the dentist uses--does not work on me. You may be another with atypical responses. BTW, thank you for sharing.

Mary, 10-16-2013 00:43

Quote:

Originally Posted by annsrum (Post 261017)
While a lot of diabetics do end up having a caesarian, it is not a given that you have to have a caesarian. They wanted to let me try and see if regular birth would work. Not sure why they let it go on for so long though before they switched course.

I think it may be the same course for non-diabetics, too. When I delivered my son, I wasn't a diagnosed diabetic. I was in labor for 29 hours and 20 minutes (exactly!), before they had to do an emergency c-section because I developed the same problems as you did, with contractions. I often thought after that, we couldn't have done this c-section about 20 or so hours ago??? Glad to hear your'e all doing well!

annsrum 10-17-2013 14:04

blood sugars in hospital
 
I forgot to mention how they managed my blood sugars while going through labor.

First I had to tell them all my medications and dosages when they took me to my room when I arrived at the hospital. I had to say more than once that I was a diabetic as they seemed to forget (scary). Apparently they have a diabetic protocol and the nurses had to figure out what that was for sure and kept getting distracted on other parts of the check in procedures.

The IV they hooked me up with had some sort of sugar in it. Dextrose maybe? Since I was not allowed to eat, this did not end up causing any issues although I was pretty concerned and kept asking about it.

They would come check my blood sugar periodically. I want to say about once an hour or two hours. It seems like they let my sugar range up more than what I would have.

I was told to let them manage my meds. They did not give me any of my thyroid pills or metformin or insulin until a day after I had the baby and had begun to eat again.

Since I am not a type 1 diabetic, they did not end up having to worry about me going low since they were not giving me any insulin. I am assuming they would have given me insulin had my blood sugar gone high. Not sure about how they would have handled a low since they wouldn't let me eat. More dextrose solution?

I have to say that it was annoying not to be allowed to check my blood sugar on my own and also annoying to be woke up to have it checked (after baby was born during the night). I couldn't sleep during labor even with the epidural. I was too scared about what was going to happen next.

If I think of anything else, I will come back and add it later.

JT Reagan 10-17-2013 18:21

Everything you have told us about the baby's birth can be described as "traumatic" IMO. Be gentle with yourself. You are still healing both physically and emotionally. When you feel anxious or "grumpy" try listening to soothing music. Use imagery to appreciate beauty. Rock the baby to sleep. Forget about the housework for a time. Have a good day!

annsrum 10-21-2013 14:15

Not dwelling
 
Quote:

Originally Posted by JT Reagan (Post 262513)
Everything you have told us about the baby's birth can be described as "traumatic" IMO. Be gentle with yourself. You are still healing both physically and emotionally. When you feel anxious or "grumpy" try listening to soothing music. Use imagery to appreciate beauty. Rock the baby to sleep. Forget about the housework for a time. Have a good day!

Don't worry about me. While it was not the most fun time I ever had, I have pretty much been so wrapped up in baby since she got here that I really haven't dwelled on the birth much. :) Thankfully going into the whole thing I set my mind that the birth process would be unpredictable and to just go with the flow so to speak (although of course asking plenty of questions and let my opinion be known) and try not to get too upset about anything.

I mainly outlined everything here in order to give people like me who want to know the details a place to read them. The only insight I cannot give would be that of a type 1 diabetic. I would assume that their experience would be a little different in that their blood sugars can go low.

I know from reading that some hospitals give you more freedom to move around etc during the birth process and I think I would have liked it had my hospital allowed it. I did not like being confined to a bed the whole time. But if we decide to have another one, unless I go to the only hospital that does VBAC's, it would be a scheduled C-Section which from what I hear is a little less traumatic than an emergency one.


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