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Diabetes During the C-Section: Here's the Plan.

Preparing for the diabetes part of BSparl's birthI'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. 

Comments

Kerri, sounds like your team (or maybe the entire hospital) has it all well planned out. I'll say prayers that it all goes even better than planned. This will probably be the best tax day you've ever experienced, way better than a big refund. :-))

I'm so excited for you. All those highs and lows are so going to be worth it. I understand how hard it is handing over control of your diabetes management. I've had to do that for 6 different surgeries. Sounds like you have a fantastic team to help you out and that makes all the difference in the world.

Thanks for posting the nity-grity of the c-section. My own delivery is still 3 months away but I appreciate learning how its going to work out for a fellow Type 1. I'm excited for you and Chris!
I'll definitely be following your story over the next year. We're also planning on breastfeeding so it'll be nice to have an insider's prespective on that as well.

it really sounds like you have everything covered and that you're going to have exceptional care.

I feel like we've all been on this non-stop-full-speed journey with you for 9 months (only you get to do the hard part and we just get to enjoy the ride).

Oh, and epidurals..the whole thought of tube in my body grossed me out soooo much that I couldn't do it. I remember thinking, the first time I saw a cannula for a site, that this was complete irony.

I've got tears in my eyes remembering the first cry of my first little girl! Your whole world will tilt and that's all you will hear at that moment. The entire OR will disappear and it will just be you and Chris and your baby. It's just awesome and the most powerful thing you will experience. Good luck and enjoy your beautiful birth!

Wow... sounds like your team is very well prepared. My c-section was a bit of an emergency due to preclampsia at 38 weeks. Before surgery, I removed my insulin pump and left my Dexcom back in my hospital room. The entire process was very laid back. Because this was last minute, and I was very stressed at the situation, my blood sugar spiked to 180 right before surgery which the Dr. chose not to correct. My baby girl was born perfectly healthy, she did not even require glucose due to my blood sugar pre-surgery. My A1C was in the 5 to low 6 range throughout the pregnancy.
The part that actually surprised me was during recovery, my body was shaking a lot, which I hear it quite normal. So just to be on the safe side i asked the nurse to test my blood sugar. She actually, asked where in my purse she could find my monitor! (recovery was actually in my hospital room, which was nice) I could not believe it! I figured they would be on top of everything. Nope, I was in charge of everything from start to finish.
Kerri, you will do great! Believe it or not, after going through the last 9 (ok, 10) months of diabeties boot camp:) and all the stresses, and guilt of those tricky spikes.... i could not wait to do it all over again. She is such a blessing.

It sounds like they have a solid plan with absolutely everything covered. I know it's scary, but it's going to be over so fast and go so smoothly - by this time next week you'll be wondering why you got so stressed out about it. (Wondering from HOME!!!) Again, if you have any questions for someone who's been through it - about any little thing at all - just let me know and I'll ask my best friend. She found a c-section so much better than pushing . . . . although I haven't asked her what she thinks of the Oral Birthing option. ;)

i'm so happy to read this post as i've been wondering all this myself (for you, of course, but for my own selfish future reference purposes too!!) it sounds like the "mechanics" of ot all are very similar to my surgery last week but i was under general anesthesia so couldn't monitor my sugars myself. that had me more nervous than the actual surgery itself!! happy to report i came out of the OR at 109 and was fine all throughout. when i thanked them for stalking my sugars pre-op, during and in recovery...they laughed and said "hey that's what we do." yes, that's true, but it was scary for me so i was so thankful!!

sounds like your team is way on top of things and day after tomorrow you'll be on top of the world with your beautiful daughter in your arms.

i am so anxious to hear how it all goes and am so excited for you, k.

Oh Kerri you sound like you are in fabulous hands there at Joslin. I am crying thinking about how life-changing it all is. Her cries will be music to your ears and nothing as you knew it will be the same. It's that profound. I will be saying some extra special prayers for good glucose control and a healthy and happy BSparl.

The epidural is not so bad. I've had 3 so far. Can I suggest something to you? Have Chris stand in front of you and you hang off of him to get the epidural. Honest, it helps. A LOT. My 1st one I hung onto the nurse when all I wanted to do was hang onto my hubby. The 2nd and 3rd ones, for those kiddos, I insisted my hubby be the one to support me. It sounds like a little thing, but it's big. He whispered in my ear as it was being done. It saved me tears. If they will let you (they will if you insist), have Chris there for that part. You will be glad you did.

Here's wishes for a smooth C-section, a healthy happy little girl, and the making of a Mommy and a Daddy!

Even though we don't know each other I am so excited for you to become a mom. You are such a wonderful example of how one can live a full life even with diabetes. I have never seen someone more prepared to have a baby. You and Chris will be wonderful parents.

Mel

Don't fret too much about post-delivery highs. I was worried that healing would be affected but, just like those pregnancy highs, as long as you don't let them linger too much you'll be ok. (and sorry about the blank comment I just submitted)

Good luck!

Hopefully you're daughter won't require much glucose. Nurse her as soon and often as possible. That's the best way to regulate her glucose levels. Praying for a smooth delivery!

Good luck, Kerri! I had a wonderful T1 birth day about 8 months ago when we welcomed my son. My c-section was a breeze, as was the spinal block. I kept my pump and CGMS running the whole time because the thought of handing over the reins was too much for me (control freak?). Enjoy this awesome experience!

Kerri, thank you so much for writing about this. I'm 25, I use a pump, and I want to have kids someday. These are things I need to know, and your perspective is so valuable. All the best to you, to Chris, to BSparl, and to your herd of cats!

Kerri,

I've had two epidurals and I can tell you that you're so in the moment that it won't be as bad as your mind makes it out to be beforehand.

You have a fantastic team and I only wish that we lived closer to the great care that you are receiving.

I'm sure that today and tomorrow will be busy exciting days for you. Hope chris was able to get the cats off the baby stuff.

Kerri, I'm so excited for you! Thanks for sharing all the details of the c-section. I'm due in September, also type 1 for 24 years and this is my first baby too! I've been following your journey as you prepared and through all the ups and downs of diabetic pregnancy. Thank you for putting yourself out there and helping other type 1s like myself know that we're not alone. Take care and good luck!!

So close now, the weirdest thing for me when I had a C section was knowing the time and date A would arrive! That first cry and sight of the babe is just the best thing ever :)

I am so excited for you! I am going to my endocrinologist tomorrow and will be asking what I need to do to get ready for pregnancy. I have been diabetic for a little over 10 years (diagnosed at 18), and I was unsure if I wanted to take the chance of having kids of my own. Your blog has been so helpful, knowing that it will be a hard road, but it will be totally worth it. Hopefully we will be able to start trying to get pregnant in July. Fingers crossed. :) Good luck and take care! So, so, so excited for you! :)

great plan, fantastic goal, and awesome ending to your post. So excited for you!

Awesome! Maybe it was just the severity of the contractions, but the spinal wasn't as bad as google made it sound for me. :)

I was allowed all control over my diabetes with my husband. My pump site got ripped out during delivery and my poor husband was shaking so bad from the whole "experience" he didn't get the new new site in right and I would up at 350+ a few hours after delivery. You're in good hands with Joslin!

Bsparl will be in your arms so soon!

Hope everything goes great!

Woo Hoo! Wishing you the best of luck Momma!!

And, yes, the shaking IS normal... I shook more this time with Ellie than I did with Noah. AND, if you don't already have one up there, have Chris bring you a heating pad for your shoulders after surgery... I promise you won't be sorry to have it. Good luck!!!

I don't think I'll be sleeping Wednesday night- just thinking about you and how close you are to holding BSparl! (and your numerous blood sugar tests!)

You're such a strong person and you can get through anything!

You are so so already an amazing mom, you just don't know it! Bsparl is so lucky to have you and Chris as parents. Lots of luck and make sure someone takes some pictures for you. I know you have so much else to think of, but someone will take them for you. I can't wait for you to hold your daughter. There is absolutely nothing better in this entire world...nothing!

Awesome plan!! I'm sure it will all go well. :)
I didn't take my pump off during my C-section, but I suspended it for the first hour or so, b/c my OB told me I'd "crash" with a hypo otherwise. Apparently the minute they remove the placenta, your BG can drop like crazy (probably because of 2 things: the absence of the hormones that cause insulin resistance PLUS the huge amount of energy that your body is expending to produce colostrum/milk).
FWIW, 2 things I wish I'd known before I delivered were... (1) even if your BG is flat and perfect the day and night before the surgery, your baby can still be born with a low BG. That's what happened to me. My DD's BG wouldn't come up after they gave her formula, and they had to put her in the NICU and on a glucose drip. She turned the corner and was fine within a day or so, but I was so bummed b/c my numbers the day and night before the surgery were the flattest EVER-- between 70 and 90 the whole time. I didn't sleep the night before and checked every 2 hours. And my A1cs during pregnancy had been 4.8 to 5.4! The neonatologist just said that sometimes, for moms who have had T1 for a long time, the baby is born with a low BG, even though the mom's control has been awesome. (I hope this doesn't happen to your DD, but I wanted to tell you about it just so you don't feel like you have done anything wrong or could have prevented it if it happens!!) And (2)... the spinal made me feel completely hazy and weird after the surgery. I kept making my husband check my BG because I just KNEW that it must be low-- I just felt like I was having a constant hypo. But no, it was fine. I think the highest I got after the surgery was 160 or so, and I was on a glucose drip to keep me from crashing. But something about the spinal makes you feel just completely out of it. I wish I'd known that before, so I could have felt more prepared or something. I didn't shake with the spinal, but I did itch like crazy.
Anyway, in the end, none of that stuff will matter b/c you'll be holding that precious little girl!!!!! Good luck ;)

So very excited for you. Can't believe that the day is so so close. I have been following your pregnancy since you first spoke about preparing your body for it. You have been an amazing inspiration and am wishing nothing but the best for you and your family.
Can't wait until 'BSparl is here' post :)

Sounds like an excellent plan! My c-section and most of the labor process before it is pretty much a blur to me, because of my pre-eclampsia and the combination of magnesium for that and pitocin for the induction and the antibiotic and the epidural, etc, etc.

One thing you may want to push for later in recovery and back in your room (your nurses may be better about this) - an ice pack REALLY helps with the epidural site recovery. And, apparently hospitals are different about the epidural policies, because mine wouldn't allow anyone to be in the room when it was inserted. Something else to find out...

AHHHH!!!! I am soooooo excited for you!!! :D

(sorry I had nothing productive to add!)

okay Kerri!! this is awesome...another post to be tucked away for C to read when she's older...right next to your wedding posts and self image post...thank you! when will the book be out?!

Oooohhh Kerri, I am SO excited for you!! You get to meet her so soon!

FIY about Breastfeeding Kerri; (my 2nd baby is 13 mos old and weaning now) at first you may go low when your milk comes in ... and if you are nursing every 2 hours at first, thats a LOT of lows...but if you want a long term breastfeeding relationship, don't worry, things will level out when your milk supply normalizes to baby's needs around 2-3mos old. GOOD LUCK!

I can't believe it is happening already. Feels like you just announced your pregnancy just a month or two ago!

I'm excited to meet your little angel! :-)

I can't believe your big day is just about here!! You are in good hands and I will be thinking of you and the birth of Bsparl on Thursday!! Best wishes for a healthy delivery :)

Kerri, you are already one of the best moms that I know (Wow! I do feel like I know you from reading your posts.) Much love to you, Chris, BSparl, and those very bad cats.

Yaaaaay!

This will make you smile..... I was sooo scared of getting the spinal! When the doctor walked in, he was a TOTAL BABE!!!!! Also his name was Dr. Peter Benton, which I found hysterical because back in the day when E.R. was actually a cool show (ya know when Clooney was on it!) there was a doctor on the show named Dr. Benton so I made a corny joke that he'd probably heard a million times. Any ways, I was so busy trying to keep cool and be funny that I don't even remember the pain of the insertion of the needle......

SO...... here's to hoping you get a hottie named Dr. Benton to insert your spinal. HAHAHA!

Good luck, Kerri! I hope everyting goes well, you should be so proud of yourself for doing such an amazing job! I can't wait to see pics of you and your dear daughter! As a T1 just starting to plan for my first pregnancy, all of this information is so helpful! Sending you the very best wishes!!!

Being a childless T1, I don't have advice, but do have a great big thank you for sharing all the details of what one might expect from a diabetic pregnancy. Good luck and best wishes to your family!

Why can't Chris watch your levels and the CMD still be attached? If your hooked to a IV drip, wouldn't the CMD prove to be an important tool in monitoring you?
I'll be praying for you,the baby and Chris and can't wait for all this to be over and your back at home....
Bless you and best wishes!
David

Kerri, best of luck to you and BSparl! I am so excited, and in awe of your already awesome mom-ness!

Kerri! I've been thinking about you and Chris and BSparl a lot, and I am getting so excited for you! Thank you so much for covering so much of your pregnancy journey. Good luck with this next step!! Can't wait for the BSparl news!

Good luck, Kerri - I will be thinking of you, Chris and BSparl on Thursday and wishing you all an easy delivery! Keep us updated!

Oh, and I forgot to say - enjoy your last final days as a non-mom. Your life is going to change in so many ways (mostly good, don't get scared!) but it will change. Maybe it's only me who does this, but I like to mentally note those occasions where my life has changed - marriage, first child, second child, and the not so great ones, like deployment and Ian's dx. It helps me visually have this picture of where I've been and where I've gone.

So, try to keep a note of what today and tomorrow feel like because you will never be this Kerri again, the Kerri who doesn't have a child. and some day you're going to need to reach back and find that Kerri again at some weird moment in time and you need to know she's back there somewhere in your memory. :)

Kerri, it sounds like you are in good hands. I had a C-section almost 20 years ago and the epidural was what scared me the most. The funny thing was that the nurse kept telling me to arch my back like a cat but I was so huge that it was almost impossible. They got it in though and things went like a dream.

Thank you so much for posting this Kerri! A baby of my own is always on the back of my mind, and something that I really want in the future, and it is so helpful to know another diabetic that has gone through it!!

You are in our prayers, I'm sure all will go well and BSparl will be beautiful. I think the scariest part sounds like all the diabetic monitoring. Can't wait to hear how it goes.

Oh so excited for you :) Good luck. She should be fine even if she is a little low at first. My husband didn't tell me our daughter was low until the next day...I was so out of it after surgery and he didn't want me to worry...she was just fine. Sounds like you have a great team. Mine suggested I wouldn't need insulin at all, most likely, now that she was born....uh...I'm not gestational, I'm type I dudes. Inspired confidence. My sweetie stayed close and took care of me, so that rocked. All the best. Can't wait to hear how it went. You will be super-busy, so we'll understand if it's awhile before you post!!

sending well wishes your way

Oh it's all so real and so close now.

That IS one bonus of being a T1 - you tend to get the first elective slot of the day. All the very best!! :)

It is Wednesday morning here in the UK. I will be crossing all available digits for you over the next two days. Such times full of wonder ahead. Big hugs to you and Chris.

:) She'll be here tomorrow!!! So excited for you guys. I truly wish you the best of luck and an easy delivery!

Kerri, you're already a mom - and a great one at that! Don't worry about the spinal and the surgery. I'm the biggest wussy wuss out there about stuff like that and I did totally fine. I was sitting up chatting with my OB while they put the epidural/spinal in and I barely noticed it. The whole thing really wasn't even half as bad as I expected. You can definitely do it!! It sounds like you have a great plan and are in great hands! All the best tomorrow. I (and a few hundred other folks) will be thinking about you! Update us as soon as you're able!

Good luck!!! Thinking of you and praying it all goes well. Good on you for sharing your journey. xxx

I'm so excited for you and Chris. I just want to thank you for blogging about your pregnancy (and everything else!). Yours was the first blog that I found when I was diagnosed with Type 1 2 years ago at 31. The first thing my doctor said to me after giving me my diagnosis was "If you want to have children, you should do it soon." The only thing I've ever truly wanted out of life is to be a mom. After getting the diagnosis and reading up on it, I didn't know if it was really going to be possible. So I just want to thank you for showing me that it can be!! And also for showing that it's not a piece of cake and takes alot of time, dedication and courage. But that it can happen. So a big thank you!!! And all the best wishes for a safe and healthy delivery of BSparl! You guys will be in my thoughts tomorrow!

From someone who has btdt, you'll be great! And my husband, who couldn't watch any of the videos during labor class, watched the doctors put me back together!

As for the breastfeeding, I was barely on insulin at all when I was doing that. My doctor equated it to running around the block a couple times. Almost made me want to breastfeed until my kids were out of the house....just kidding!

Looking forward to seeing you on the other side:)
~Toni

I've been reading your posts even more eagerly than usual. Thanks for sharing the info in this last post. So happy for you that it's almost time. Hang in there and know that we're all cheering you on.

Good luck tomorrow, Kerri. You will have A LOT of people thinking about you, Chris, and your little girl!

Kerri - you are already a mom! On the epidural thing - don't worry! It really is very quick. I gave birth naturally with my first daughter, in part because I was VERY nervous about the idea of an epidural (apparently, I am very paranoid about anything medical in the same zip code as my spine), and then my son was a surprise breach -so it was an unscheduled c-section. I was very nervous, and had kind of had the rug pulled out from under me generally on the whole c-section thing. It was a breeze. Really. It will all be okay, and the actual epidural is SO quick. Of course, I was also paranoid that it wouldn't work, so I kept wiggling my toes and saying "I can still feel my toes." Very kindly, they did NOT say "hey, crazy lady, it takes a few minutes to work". Instead they just kept telling me to let them know when I could NOT feel my toes. And then I couldn't. And then he was born. And then it didn't matter about anything else! With my third child (daughter) I was supposed to have a scheduled C - but she decided to bust out early. Less nervous about the epidural that time, but still with the toe feeling thing. Guess what?! She's awesome too (big surprise, right?!) and it was all fine. You will do great - you have a great team and lots of support. Best wishes!

I'm don't have type 1 (my daughter does) so I can't give input on your plan, but it sounds good to me. Do NOT worry about the epidural. It really isn't that bad. I honestly don't recall the pain at all. I remember being nervous about it and then thinking "that's it?". Of course maybe all the drugs they gave me after, many sleepless nights and ten years have dulled the memory lol.

Good luck, I'll be thinking of you, Chris and BSparl tomorrow morning. I'm so excited for you!

My hubby stuck by me for three epidurals then on the fourth he said, "I..uh, think I'm going to, uh...go get something to eat." LOL

I'll be thinking good thoughts for you.
Take care,
Bethanne

I think you are in good hands for tomorrow! So glad that you've kept other PWD's wanting to get preggo all abreast (suck, suck, suck of BSparl soon ).

We'll all be thinking of you tomorrow :)

We'll be thinking of you!

Hi Kerri!

I guess BSparl must be on the outside by now ... so congratulations!

Thanks for sharing all of the C-section info. I am really nervous about the whole birth thing, too, so the information you shared is helping me feel more normal.

I can't wait to hear how it all went and how the three of you (and the cats) are getting along.

Hey Guys,
I am Happy for both of you. I will pray that your little Bsparl is Ok too. I wish you all the happiness in the world for you new family.

Happy Happy for all of you! So excited!!!

Donna

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