First off, due to the wonderful guest post from Gem I did not feel I forgot to pack anything. The most thankful item of her list was a socket extension, as she stated, most hospital beds do not have a power outlet close enough for you to hold your phone whilst in the bed. During the induction we had the phone plugged in at all times to ensure a full battery once we would head in to the delivery suite which worked out great. After having the c-section I was extra happy with the fact I could now reach my phone without having to twist and turn behind me.
A piece of advice my MFM doctor gave me was to have an additional site ready to go in case the first one let go. He had experienced it on numerous occasions that his women would go high, they would pump in all the insulin and not come down only realizing way too late that the catheter had disconnected. Since we knew when we would be induced I also planned my CGM change according to my ideal time-frame that I would have the best days while in the hospital.
The general gist of my labor ‘treatment’ was mentioned in Labor of love and loop – part 1 however there were some things I wanted to elaborate on. I gave my husband complete control of the diabetes side of labor, it boiled down to him feeding me a sachet of fluid sugar worth 12 carbs every 1.5-2 hours once contractions set in. My labor profile was set to 50% of all my insulin in the beginning and we slowly decreased it to 30% once contractions got more intense.
The mistake we made was to not increase the labor profile once contractions ceased, it’s quite logic, if you go for a jog in the park you also decrease insulin during but go back to normal levels once you’re done. Since I was sleeping and hubby was a little stressed about the lack of contractions and baby actively participating in labor we didn’t realize this in time. I had written down a whole plan for him which explained what to do when, what treatments to do and when to change profiles but we didn’t expect this beforehand and thus it wasn’t in the plan. While we were heading towards the OR we added another 1.5 units but this was too late. After 9 months of non-diabetic sugars baby came out while I was outside of my target. Unfortunately he was 1mg below the cut-off twice so he got two supplementary feedings just to be sure. The two measurements after that he was fine.
Once baby was there I waited a bit to decrease my profiles, also thanks to Gems post. My endo had told me to eat 12-24 grams of carbs without a bolus because my sugars would supposedly crash but I never needed them. A couple of hours after the caesarean, once my sugars were starting to slowly decrease we gently decreased basals and I continuously evaluated and adjusted them every couple of hours.
Something else that happened after the caesarean was that my Dexcom readings were off all of a sudden. So tired and exhausted of labor and I didn’t actually realize until day 3 post labor that they were giving me a paracetamol pain-killer during the day to cope with the pain from the operation. Since I had a Dexcom G5 this messed up the values. The general gist of rises and falls were pretty good and every morning and evening I would get a stronger medication which did not affect CGM readings so it was only for a couple of hours during the day in which I did some extra finger measurements.
- G5 Dexcom
- Medtronic 722 with Rileylink
- Contour next blood glucometer
- Apple iPhone 7 with Loop
- iPad with nightscout ready to run (although we didn’t end up using this since the nurses realized we had it under control and didn’t want to bother us)
Diabetes / loop things to pack:
- (Back-up) Riley link
- Extension cord
- Chargers for phone & riley link
- Sugar tablets / fluid sugar sachets
- IV3000 or rock tape to stick down any plasters
- Test strips
- Extra pump batteries
- Tablet showing nightscout
Notes in my looping through labor plan for hubby:
We practiced all this in the weeks before labor but I figured it was best to write this all down in case he forgot how to do something / when to change settings in the heat of the moment
- Target blood sugars
- If sugars rise to do a finger measurement, check for air bubbles and if my site is still properly connected my body
- How to :
- open loop
- suspend delivery from the pump
- change profiles
- What settings to change during vaginal birth vs caesarean
- Profile changes for after birth
- Phone number of my endocrinologist
- List of the most common red loop trouble shoots from the loopdocs