Diabetes During the C-Section: Here's the Plan.
I've received a lot of emails about the how diabetes will be handled during the actual "birth" of Ms. Bsparl, and while I won't have all the details until it's all over with, I do have a few answers for now. I talked with my OB (who will be performing the c-section) and my team at Joslin about some of the details. This might be a detailed, kind of boring post, but I wanted to make sure I'm answering all the questions possible!
Here's what I know so far:
On Wednesday night, an IV will be "installed" in preparation for the insulin drip. I'll still have my insulin pump on, though. As of midnight on Wednesday, I won't be able to eat anything from that point until post-surgery, so the IV will be at the ready in case I go low during the course of the night. In the event of a low blood sugar, my team will do one of the following: suspend my insulin pump, administer glucose through the IV, or potentially allow me to drink apple juice, depending on the circumstances.
The c-section will be first thing in the morning (8 am), so the night before will be spent checking my blood sugar with the glucose meter every 30 - 45 minutes to ensure the tightest, steadiest control possible. In my circumstances, I plan to keep the Dexcom connected throughout the night, too, to help with that goal.
The morning of the c-section, I'll get up wicked (pissah) early (5:30 am, I think) and I'll rip out my insulin pump and remove the Dexcom sensor. The nurses will hook me up to the insulin drip and my blood sugar will be monitored - wait, strike that. Stalked. :) I'll be hooked up with the drip, etc by 6:30 am and up to the delivery room.
We'll move into the operating room and my blood sugar will be
monitored stalked by the Joslin team while the OB/GYN team prepares to deliver my baby girl. Chris will be in the waiting room while they administer a spinal epidural (Do not Google this, because it will make you cringe. I made the mistake once of Googling it. Never again. It made me want to give birth orally.) and then they will ensure that my lower half is numb and ready for surgery. Chris will scrub in and be brought in to the room, where he'll be situated up near my head and the surgery will begin. My team said that Chris is welcomed to hold my meter and test my blood sugar at our discretion, and the Joslin team will be doing the same using their meter or mine, depending on our preference. But if I feel nervous about going low, etc, I am able to keep tabs on my own numbers.
During the course of the surgery, I'll have a regular IV in for fluids, etc, and then the insulin drip will be combined with a glucose drip, the contents of which can be adjusted based on my blood sugar needs. So if I start to spike, they can increase the insulin titration. If I start to drop, the glucose can be turned up. All of this is handled by the Joslin team, so my OB team can concentrate on BSparl's escape.
According to my doctors, the whole c-section will take about an hour, from start to finish. Bsparl should be in Chris's arms by 8:30, and I should have all my pieces back together again by 9:00 am. I'll be brought to the recovery room and Chris and BSparl will join me soon thereafter, barring any issues. The insulin/glucose drip will remain in until I'm able to eat something, at which time the pump will be reconnected (by me), and after an approximate 30 minute overlap, the insulin drip will be removed.
The Joslin crew told me that my postpartum insulin settings on the pump will be a whisper of what they were during the pregnancy, and about a third of what they were pre-pregnancy. At this stage, they're assuming that I'll jump down to a midnight to midnight basal rate of 0.3u, an insulin-to-carb ratio of 1:20, and a sensitivity factor of 1:80. (My pre-pregnancy basals were more around the 0.4 - 0.6u range, an I:C of 1:10, and a sensitivity factor of 1:55.) And once I'm breastfeeding, all bets are off as to how that activity could affect my blood sugars. Only time will tell.
So that's the low-down on how the diabetes, at least, will be handled during delivery. I don't want to think too much about the surgery itself, because it freaks me out. But handing over all of my diabetes control also has me a little tweaked. After over 20 years of doing it myself, it's hard to grasp the concept of "let someone else handle it entirely." But I know I'm in capable hands with Joslin, and I know that my focus needs to be on the baby.
She's worth every hurdle that we, as a family, have overcome to make it to this point.
Because at some time during the whole ordeal, her little teeny cry will cut through all the noise, and in that moment, I'll become a mom.