Insulin treatment during labor - please share your experiences/suggestions!

Hi,

I am looking for some advice/info about insulin treatment during labor. I am ~35 weeks pregnant, and have had type1 for ~25 years. I don't use a pump - I take lantus (for long acting) and apidra (for quick acting insulin), and my A1C has been good (5.5 - 5.7 throughout my pregnancy so far).

In all the years of having diabetes, I have never had to rely on someone else to control my blood sugar and determine how much insulin I should take, so I'm worried about it during labor! - I was wondering what others of you, particularly that take multiple injections, have planned for you insulin treatment during labor - ie, will you be hooked up to an IV for glucose and your short term insulin, and continue to take your long-term insulin yourself?

While my endo will write out, for the labor nurses, how many units I take for a certain amount of carbs, and for corrections, etc, they will only monitor my blood sugar with finger sticks occasionally so they won't know if my blood sugar is increasing or decreasing, if a previous correction has actually kicked in yet since correcting last, etc. I am most worried that the nurse will just inject me with insulin without talking to me first (and making me go low), or insisting on an insulin injection if I am a little high but dropping (and not listening to my suggestion or not communicating with me). I am mostly scared because when I (politely) asked my doctor about this, he said the nurse will have the final say and if I don't like it I should go to a different hospital. (I wish I could, but being I'm already 35 weeks, I don't think another hospital would accept a new 'high-risk' patient this late!).

I plan to wear my CGM throughout labor.

Would you please share your 'blood sugar control' experiences during labor or suggestions with me - thanks!

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Replies to This Discussion

When I was in labor, my ob actually asked me what I wanted on hand iv wise. He allowed me to keep my insulin pump on and my cgm to monitor my own sugar. He left all the decisions in my hand. I was also in the hospital for a week before my daughter was born, so the staff had a chance to realize that I knew what I was doing.
So did you not use have an IV (w/ neither glucose nor insulin) on hand, and only controlled it yourself with your pump? Did you go low at all during labor? Did they allow you to drink juice or did you have an IV for that? Thanks.
I dont have experience with Type 1 and labor, but I've been to a lot of hospitals for other reasons and something ALWAYS gets mixed up. I take Apidra and Levemir. I'm allergic to Lantus and Humalog / Novolog / Humilin all don't work with my any longer. I've had nurses demand that I take a shot of Lantus even though my chart clearly states that I'm allergic to it. I've also had nurses bring in a vial of Humilin R, stating that "it's the same thing as Apidra"... ummm... no, it's not.

So, needless to say I'm extremely anxious about this too. I've done all of my own testing and dosages (even changes to my basal dosages) without the advice of my Endocronologist since the age of 21. Mostly because after 3 years of bad Endocronologists and bad doctor suggestions, I ended up in the hospital for Dka and insulin shock comas- simply by following their advice. I don't have much faith in the medical profession regarding Type 1 treatment any longer.

In the end, I believe there is actually a law that the patient must give consent to all drugs administered during treatment. I believe you can sue if they attempt to take your insulin away from you. There is no need for it if you can show them that you are capable of taking care of yourself. Will your baby's father be at delivery with you?

My husband has pulled me out of 7 insulin shock comas during this pregnancy- with no medical assistance. I've trained him on what my correction dosages are, as well as my food intake exchanges. He's given me shots and checked my BG levels while I'm driving. I've even told him at times, "You dose me what you think is right and I won't say a word." And so far, he's always dosed correctly. So... he will be my voice if I'm too exhausted to speak for myself.

Good luck to you.

I'm going to a birthing class at the delivery hospital this weekend and will ask all my medical questions to the staff at that time.
It sounds like you know exactly how I am feel! - I am actually more anxious about the hospital nurses trying to control my insulin without communicating with me (giving me insulin, and possibly the wrong amount/type of insulin!, without telling me) than the actual labor pains!

Yes, I've also been trying to teach my husband, and definitely want him in the room with me the whole time to make sure I know about the insulin going into me, and to keep check out my dexcom all the time, etc.

Good luck to you also! Please let me know if you get any helpful info/suggestions regarding your insulin plans for labor at your upcoming hospital visit!
I talked to the OB yesterday at my appointment and he said he will write a note to keep in my file that I am in charge of my insulin needs. He said he would then call my Endo and have him put a note in my file, too, that I am in charge of my insulin needs.

I feel much better about it now. Still going to birthing class this weekend and will ask the nurse on staff about it too, to see what the hospital rules are. But my OB office is affiliated with the hospital I'm delivering at.
That's good!
Similarly, I had an appointment w/ my endo and he is going to write that I should be in charge of my insulin needs - I am leaving now to go meet w/ my OBGYN (who had previously said that that is not ok/ to go to a different hospital then) - so I'll see how it goes/what he says today - wish me luck!!
No I didn't get any iv glucose or insulin. I dialed my basal rate down. Checked my blood sugar every hour until I had to start pushing. Once I had to start pushing they had a nurse on hand doing finger sticks for me every hour with my making the decision on what to do with my insulin. I was pretty much insistent that I be the only one that had a final say in my insulin just for the simple fact no one knows my body better than myself. Sit down and talk with ob and explain to him that you know how to handle your diabetes and with an A1C as low as yours, that is the proof you can handle it on your own. What I found funny is after I had my daughter, the immediately took me off the diabetic diet in the hospital. The dietician there assumed I was gestational. I was not allowed anything to eat or drink because of a good possibility of a c-section.
Yes, I tried having a conversation with my OBGYN but unfortunately there's no talking to him (he's insistent that the nurses have the final say in my insulin dosages, and unfortunately I think it's too late to find a new doctor being I'm 36 weeks!).
If your blood sugar had gone low during labor, would you have just snuck in some sips of juice (being they told you no eating/drinking), or what? (I would also prefer not to have an IV for this, but I'm scared what they'll do if they catch me drinking after they tell me not to! - I know it's ridiculous, but I picture them kicking me out of the hospital while I'm delivering!)
thanks again
Hi and congrats! My daughter is two now and I had a lot of the same worries about labor. The nurses tested my blood sugar for me about every hour while I was in labor, however I controlled ALL of my insulin. You will have an IV in your arm so I am betting if they needed to get you glucose they could just do it through that. I did run a little high during my labor, you know, just because my body seemed to be a little stressed out ;) but the nurses did let me do what I needed to do concerning my diabetes. They should listen to you about your concerns and answer all your questions and never inject you with anything without your ok! Plus, it's not their main job to be controlling your diabetes they should be focused on making sure your baby is safe and healthy. If you feel like you are not going to be "with it" enough to keep an eye out for things like that, make sure you have someone with you that can watch out for your concerns as well. You have the final say about what the nurses do concerning your insulin, be strong, I am thinking your doctor just sounds like a jerk who really doesn't know what he's telling you. Good luck with things!
Thank you (and congrats to you too - your kid look's like a cutie).
It's good to know that you and others did have good experiences and were allowed to control your insulin yourselves during labor (and that for me to ask and want that want that was not absurd!).
Talk to you endo and see if by chance if there is anyway he will be in the room or maybe see if one of his staff members can be with you in the room. That way they can make the decisions based on your blood sugar.

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