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Pregnancy with type 1 diabetes is no walk in the park. In fact, for many women, it may be the most challenging diabetes management phase of your life. Fortunately, it’s remarkably rewarding, too, when you finally meet that little bundle-of-joy you’ve been creating!

But the challenges and demands of managing your blood sugar during pregnancy don’t come to a screeching halt once your baby is born. While the demands do lighten, they change, too, as your body faces hormonal shifts, breastfeeding, weight changes, sleepless nights, emotional stress, and suddenly being responsible for the moment-by-moment well-being of your newborn child.

Here, we’ll look at managing type 1 diabetes (T1D) during the first year after your baby has arrived, including blood sugar goals, breastfeeding, and potential postpartum anxiety and depression any mother might face, whether it’s your first child or your fourth.

Sure, in an ideal world your blood sugar levels would continue to be as tightly managed postpartum as they were while you were pregnant, but then reality makes an entrance.

It might be easy to think that blood sugar levels don’t matter that much now that your child is born, but that’s not the case either. A few things to keep in mind when it comes to why your blood sugars do matter after your baby is delivered:

  • Your body is healing! High blood sugars impair your body’s ability to heal — especially if you’re recovering from a C-section which means you’ve endured multiple layers of cutting that are trying to heal.
  • Blood sugar levels impact your energy, and you’re gonna need as much energy as you can muster to meet your newborn’s needs.
  • If you choose to breastfeed, persistently high blood sugars (above 200 mg/dL) can impair breast milk production and lead to chronically high amounts of glucose in your baby’s milk. (More about that in a moment.)
  • You’re a mother now! That little baby is going to need a healthy mama to watch it grow up! Your health matters. Taking care of your family includes taking care of yourself.

Your body is going to be juggling several things that have a big impact on your fluctuating insulin needs and blood sugar levels, including:

  • Producing breast milk (if you choose to nurse)
  • Unpredictable feedings that vary in time and length (until baby is older and feedings become more consistent)
  • Gradually shifting hormone levels (estrogen and progesterone levels drop significantly)
  • Interrupted sleep schedule (which can affect cortisol levels, appetite, energy to exercise)
  • Weight loss as your body sheds some pregnancy pounds
  • Weight gain for some women while juggling new daily demands

While you may have been aiming to keep your blood sugars between 80 to 130 mg/dL (for example) during pregnancy, you may find that your “high” blood sugar target needs to ease up a bit simply because you’ll be juggling several completely new variables.

“It is okay to loosen up blood sugar goals postpartum,” explains Jennifer Smith, Certified Diabetes Education Specialist (CDES) in Pennsylvania and co-author of the Pregnancy with Type 1 Diabetes book.

This includes your A1C level, too, which will likely rise a bit from your mid-pregnancy goals — and that’s okay. You’ve just welcomed a new life into the world and that new life demands a lot of attention and love.

“You need to give yourself some grace because you’re juggling major change. You’re now taking care of this little human who has a demanding schedule. For most women, aiming to stay under 150 mg/dL, for example, is more doable.”

That means occasionally spiking to 180 mg/dL or above 200 mg/dL is not the end of the world. Remember that a ceiling of 150 mg/dL is a goal. If you’re keeping your blood sugar below 150 mg/dL for a larger majority of the time, and taking action quickly when you do rise higher, you’ll continue to thrive.

“Don’t let it sit at 180 mg/dL, or say, above 200 mg/dL for hours and hours, but don’t beat yourself up either. Correct it as soon as you’re aware of it and move on,” emphasizes Smith, who coaches women through pregnancy at Integrated Diabetes Services.

That being said, you also need some sleep. While sleeping, some new mothers may find it critical to increase the high alarm on their CGM (continuous glucose monitor) slightly to ensure uninterrupted sleep when possible. Those first few weeks are so exciting, and every baby is different, but one thing most babies have in common is their total disregard for sleeping through the night!

“I had to turn my alarms completely off for all high blood sugars,” says young mom with T1D Heather Walker on Instagram.

“I wanted to keep my ranges set at 140 mg/dL, but not interfere with baby’s sleep every time I crossed the threshold. As a result, my sugars have been a little higher. Still not too bad though. This is my second baby, and while it’s been easier than the first time, it’s still a challenge. I think I’m just letting my best in this circumstance be okay, even though it isn’t as good as in other circumstances,” Walker shared.

You can expect to see significant changes in your insulin needs within the first 24 to 72 hours after giving birth.

“The majority of women will need a significant decrease in their basal/background insulin needs,” explains Smith.

Immediately after giving birth, some women may need as much as 50 percent of their pre-pregnancy doses for the first couple of days.

Within a week postpartum, your insulin needs should return closer to your pre-pregnancy levels, but you’ll likely want to keep your background insulin dose slightly reduced by even just 5 to 10 percent to help prevent hypoglycemia during and after breastfeeding if you choose to nurse.

If you wear an insulin pump, it’ll be easy to make these changes quickly. Women taking long-acting insulin for their basal needs will want to work with their healthcare team to anticipate this dramatic reduction, stay ahead of it, and prevent severe low blood sugars.

The same is true for your carbohydrate ratios and correction factors.

“If you were using a 1:5 ratio (1 unit of insulin for 5 grams of carbohydrates) for carbohydrates during the last few months of your pregnancy, you’ll likely need to go up to 1:10 so your meal boluses are cut in half,” explains Smith.

Just as you checked your blood sugar often during pregnancy, checking often (or keeping a close eye on your CGM) is essential postpartum, too.

“Extreme high and low blood sugars postpartum are usually related to nursing,” adds Smith. “The highs would be the result of over-treating lows and the lows would be just after nursing.”

If you’re experiencing frequent and severe high or low blood sugars, this is a clear sign that your insulin doses need to be fine-tuned. Work with your diabetes care team to make these adjustments quickly to ensure your safety, Mama!

Women with T1D can absolutely breastfeed their children if they so choose! While many older medical guides will imply that T1D may make milk production difficult, that is rarely the case these days thanks to the many tools we have to achieve tighter blood sugar levels.

A few things you need to know about breastfeeding with T1D:

Some women with T1D will find their milk comes in a day or two later than non-diabetic women.

According to research reported by the journal PLAID: “33 to 58 percent of women with diabetes may experience a lag in milk production ranging from 24 to 48 hours later than the expected time frame of non-diabetic lactating women.” This delay could be related to variables including insulin resistance, obesity, persistently high blood sugar levels, and insulin’s overall role in the production of milk.

For most, if you’re managing your blood sugar levels within a relatively healthy range, don’t let T1D cause you to worry that you won’t produce adequate milk!

Chronic high blood sugars and insufficient insulin can impair your body’s ability to produce milk.

Neglected diabetes management can have an impact on milk supply. And remember that regardless of diabetes, some women simply struggle to produce adequate milk. This is something you should discuss with a lactation consultant if you’re concerned about your milk production, while also doing the best you can to keep your blood sugar levels in a healthy range.

Breastfeeding itself (or pumping) will drive down your blood sugar levels, especially in the first 3 to 4 months after your child is born.

“Think of a nursing session with your baby as though it has the impact of a 15- to 20-minute walk — and keep in mind, just like you would with exercise, how much insulin is on board,” advises Smith.

“Blood sugar lows are most likely going to occur either during or at the end of a nursing session, so you can prevent those in a few ways,” adds Smith. “This is most noticeable in the first month of nursing.”

Strive to prevent those nursing-related lows with either of the following:

  • Have a small snack of 8 to 12 grams of carbohydrates while nursing. Snack choices should be low enough in fat or protein that it doesn’t delay digestion.
  • If you’re nursing immediately before or after eating a meal, you could reduce your meal bolus by 15 to 25 percent.

The longer you breastfeed, the more your milk supply stabilizes, along with blood sugars.

“Around 3 to 4 months postpartum, your milk production stabilizes and your baby has adopted a more regular schedule around feeding,” says Smith. “They’re also sleeping more during the night, which means you’re nursing for less time overnight, too.”

Around this time, you may find that some nursing sessions do still consistently cause your blood sugar to drop but other times of day, nursing sessions do not.

“For example, your post-lunch nursing session — or pumping session — may consistently drop your blood sugar but your baby’s bedtime feeding in the evening may not.”

Around this time, you may also notice that your insulin doses need to increase because your milk production has stabilized which means your body is simply not working as hard to produce milk. This is normal, and something to keep an eye out for if you’re nursing your child beyond those first 3 or 4 months postpartum.

“Around 6 months postpartum, your milk production may decrease because your baby is starting to get some food from solids,” adds Smith. “While milk is still their primary nutrition source, their feedings might get shorter, so you’ll notice your insulin doses may need to increase a bit.”

You do NOT need to “pump and dump” your milk because of a high blood sugar.

“The amount of sugar from your blood that actually makes its way to your breastmilk is so minimal,” explains Smith. “There is absolutely no reason to dump vital breastmilk just because of a high blood sugar. Go ahead and nurse your baby, even if your blood sugar is high at that time.”

Instead, the only time to be concerned about your blood sugar levels and the milk your baby is consuming is if your blood sugar is persistently high, over 200 mg/dL for days on end. This means your baby is getting more sugar than it needs, but it also means you are not getting enough insulin.

Work with your diabetes healthcare team to get your insulin doses fine-tuned to ensure your blood sugars are mostly in a healthier range.

Drinking water as a nursing mother with T1D is crucial!

“Hydration is so important for any woman breastfeeding their baby,” emphasizes Smith. “Producing breast milk relies on pulling water from your body, so you’ve got to drink a lot of water every single day to ensure you don’t become dehydrated, and this affects your blood sugars, too.”

Becoming dehydrated as a person with T1D can lead to higher blood sugar levels because the less fluid there is in your bloodstream, the more concentrated the glucose becomes.

As a mother with T1D choosing to nurse your baby, consuming plenty of unsweetened fluid every single day is a critical part of your daily self-care.

Use formula as needed; it’s okay!

“There is so much pressure today to “exclusively breastfeed” your child and women who don’t are often made to feel as though they’ve failed. The most helpful thing I did in my second pregnancy that I did not do in my first was use formula in addition to breastfeeding,” says Ginger Vieira, co-author of Pregnancy with Type 1 Diabetes.

Your newborn will still get all the benefits of your breast milk while also taking a bit of pressure off of you to produce everything your baby needs to consume.

Continues Vieira, “Breastfeeding is so much more work than it looks like. It’s exhausting. You don’t quite realize how exhausting it is (and how much it affects your blood sugars) until you’re done and things settle back to ‘normal.’

“Especially with your second child, there’s so little time for pumping in order to leave your baby with grandma. Supplement with formula as needed! Take some pressure off yourself. It’s okay! A happy mama = a happy baby!”

The pressure of diabetes management postpartum certainly comes with less emotional woe and guilt than while your child was actually growing inside you, but the work it requires still persists, of course. The transition from pregnancy diabetes management to postpartum diabetes management can be overwhelming.

Remember that even prior to pregnancy, adults with T1D are at least 3 times more likely to experience depression and anxiety than our insulin-producing peers. And this really isn’t surprising considering the non-stop demands of the disease you’re trying to juggle on top of the demands of everyday life.

Then, add the demands of that adorably cute newborn on top of it all and you have an easy recipe for mental health struggles.

Postpartum depression and anxiety are two very common experiences for a mother and something anyone should anticipate regardless of your mental health prior to motherhood.

Some signs and symptoms of postpartum depression and anxiety include:

  • Frequent crying without specific cause
  • Constant feelings of irritation, anger, and resentment towards those around you
  • Not feeling a bond with your baby
  • Not feeling any emotion in particular
  • Feeling noticeably worried or overwhelmed
  • Feelings of rage
  • Feeling hopeless
  • Unable to eat or uninterested in eating
  • Unable to sleep
  • Wanting to sleep all day

“It was extremely difficult, and it still is, trying to manage my sugar levels postpartum and with a small baby,” says new mom Sarah Sodre on Instagram. “My baby is 3 months old and it’s hard getting even a glass of water with someone who can’t even hold their own head, much less getting my insulin shots.”

“It’s especially hard because I was so careful during my pregnancy,” adds Sodre, “and it’s tough seeing my numbers go back up after so much time doing my best and getting good results. Hopefully, it will get easier soon, and now I have an extra reason to take care of my health, so I’m sure I’ll manage to get it right.”

PLAID also reports that women with T1D tend to feel “abandoned” after their child is born — going from having a team of medical professionals constantly checking up on them to having very little contact or support postpartum.

If you weren’t given enough information on how to manage your blood sugars around new variables like breastfeeding, the dramatic swings from high to low can come with a sense of failure.

The very first step to dealing with postpartum depression or anxiety is to identify and acknowledge it. Realizing that you haven’t actually morphed into an angry mother, but instead, are struggling with something very real and very common, will be invaluable.

And then, reach out to either your primary care physician or your OB/GYN for help. This is a hugely immense change in your life! It’s okay to need help.

Samantha Leon welcomed her son Harrison in early 2020. She’s lived with T1D for 2.5 years, and is 25 years old. She continues to learn more about juggling T1D as a new mother. (Find her pregnancy interviews on the Juice Box Podcast hosted by Scott Benner, starting here.)

Samantha Leon and son Harrison

Ginger: What have been the biggest challenges for you postpartum?

Samantha: The hardest part of managing my blood sugar levels during pregnancy is the guilt I felt when they were out of range. I was in a constant state of anxiety about my levels staying 70 to 130 mg/dL during my pregnancy. If I went above 130 mg/dL at all, I would feel and worry that I was hurting my baby and extremely guilty for doing so. It did not happen often, because I became very good at managing my levels and learned how insulin and carbs affected me… but with the pregnancy hormones, sometimes my insulin needs changed, or my pump failed, or my carb count guess was off.

Now that you’re in the “postpartum” stage, how are things going? How have your insulin needs changed from before delivery to now?

Things are going okay. My insulin needs have definitely changed. They changed immediately after giving birth and seem to be constantly changing now. I have been struggling a bit to figure things out and fine-tune my settings again. With my hormones getting all adjusted again, I am just doing my best. It is difficult to give diabetes the attention it needs while also being on mom duty. I have noticed that I put diabetes on the back burner more often than not because it’s easier to ignore it than to take the time and effort to fix it. I like to think that I am not ignoring it to the detriment of my health, but that is probably not 100 percent true. I know I need to work on paying more attention and putting the effort in when needed.

Does it feel like there’s less pressure to attain perfect blood sugar levels now, or does it feel like a new version of challenges trying to manage diabetes around your new baby, breastfeeding, and work?

Yes, yes, and yes! Less pressure, for sure. It’s been a challenge for me to find the balance between baby, work, and diabetes (especially in a pandemic, when my husband and I are in quarantine).

What has breastfeeding and blood sugar management been like for you so far? Were you offered any helpful guidance from your healthcare team?

I only breastfed for a little bit, but when I did… my blood sugar levels were not affected. I did not notice any post/during feeding lows. I stopped breastfeeding because mentally, it was too much for me to handle. Baby, work, diabetes, and breastfeeding was too much, so one had to go.

You’re definitely not alone there. Breastfeeding is so much harder than it looks! How about mentally and emotionally?

Mentally and emotionally, I am a work in progress. We co-sleep and contact nap (when needed), so when my son is going through a rough patch, it can be exhausting. I also work full-time from home, so trying to get my work done between baby stuff can be difficult. I work at night a lot. I am often tired and when diabetes is not being nice, it can be overwhelming. Luckily, my husband is a great support system and will let me cry and vent when I need to.

What is one thing you would want to share with soon-to-be moms with T1D about postpartum?

Give yourself grace. You are starting a new way of life and it will take time to get adjusted and get back in the groove of things. Ask for help when you need it. Remember that you have to take care of yourself because otherwise you won’t be able to take care of your baby to the fullest.

Thank you, Samantha. Congratulations on your first pregnancy and welcoming your son into the world!

If you feel like you’re struggling emotionally or physically, speak up and ask for help. There is an abundance of resources available for every stop along the way!

Books

  • Pregnancy with Type 1 Diabetes by Ginger Vieira & Jennifer Smith
  • Balancing Pregnancy with Pre-Existing Diabetes by Cheryl Alkon
  • Six Until Me pregnancy blogs by Kerri Sparling

Podcasts

Breastfeeding