Managing Diabetes After a Pregnancy
By Julia Kenney
Managing your diabetes after a pregnancy, while caring for a newborn, comes with unique challenges. However, planning ahead with a care team and relying on your support system can help you have a healthy, happy postpartum experience.
The postpartum period – the period of time after a person gives birth – is an emotional, exciting, and overwhelming experience. Having diabetes on top of that creates unique challenges for someone experiencing rapid changes to their body, recovering from pregnancy and childbirth, adjusting to life with a newborn.
Postpartum diabetes management is no small feat, but it can be done if you work closely with your care team – this includes healthcare providers, family, and friends. Dr. Sarit Polsky, the director of the Pregnancy and Women’s Health Clinic at the Barbara Davis Center for Diabetes, says, “You absolutely can have a happy and healthy pregnancy; you are just going to have to work harder than someone who doesn’t have diabetes.”
This article focuses on postpartum diabetes management for those with pre-existing diabetes, or who were diagnosed prior to pregnancy. For those who develop diabetes during pregnancy – a condition called gestational diabetes – find out more about postpartum management in our article on Understanding Gestational Diabetes.
Prioritize diabetes management
Your diabetes care team should be involved throughout the entire pregnancy process and postpartum recovery. The ADA Standards of Care recommends that people with diabetes work with a multidisciplinary team throughout the pregnancy process, including an endocrinologist, maternal-fetal medicine specialist, registered dietitian nutritionist, and a diabetes care and education specialist.
It’s common for people to engage less frequently with their diabetes care team after a pregnancy because they have a new baby to take care of. However, the postpartum period is one of the most important times to stay connected with your healthcare providers because the changes your body goes through after a pregnancy impact your blood sugar. Glucose targets are also more conservative (i.e., prioritizing hypoglycemia prevention) during this time to prevent lows while caring for a new child.
“While it may be tempting to relax diabetes glycemic management and goals,” Polsky advised, “we still recommend regular follow-up with the diabetes team for medication adjustments and monitoring of health,” adding that this includes regular screenings for diabetes complications during and after a pregnancy.
Whether you have a vaginal or cesarean section delivery, the recovery period may also impact your diabetes management. Be sure to work with your healthcare team to determine the best method of delivery for your health and the baby – and lean on your team for assistance and support during the recovery period.
Of course, not all pregnant people have access to a team of specialists, but do the best you can to build a team of diabetes and pregnancy care providers, along with a personal support system of family and friends, to support you after a pregnancy.
Insulin sensitivity and other medications
Because of the hormone changes associated with pregnancy and childbirth, insulin sensitivity changes throughout a pregnancy and during the postpartum period. You become more sensitive to insulin at the beginning of a pregnancy but gradually become more resistant in the second and third trimesters. According to Polsky, immediately after the baby and placenta are delivered, you become extremely sensitive to insulin.
To account for this postpartum sensitivity, you and your care team may need to reduce your insulin doses significantly. Your insulin dosing will likely need to be adjusted several times in the postpartum period as your insulin resistance increases overtime. Understanding these changes can help you and your care team plan ahead. It is recommended that you and your healthcare providers establish a plan for post-delivery insulin dosing about 34 weeks into your pregnancy, prior to the baby’s delivery.
“In my third trimester, my diabetes care team and I discussed how my insulin needs would change immediately after delivery and wrote down what my pump settings would need to be changed to. I tucked the paper into a folder and packed it into my delivery bag.” said Julie Heverly, diaTribe’s senior director of the Time in Range Coalition. “Thank goodness, because within an hour of my emergency C-section, the nurses came in and asked me to retake control of my diabetes. Immediately, we grabbed that sheet, reprogramed my pump and were able to focus on establishing life as a little family.”
Those with type 2 diabetes who do not use insulin may require changes to the dosing and types of medication they take during and after pregnancy. For example, the increasing insulin resistance during pregnancy may require someone with type 2 diabetes to start insulin therapy in their second and/or third trimester, and then immediately stop insulin therapy during the high-sensitivity postpartum period. Those with type 1 and type 2 diabetes may also need to adjust their medications that treat other diabetes-related health conditions such as high blood pressure and cholesterol.
Breastfeeding is recommended for all women postpartum, but especially for women with diabetes. Breastfeeding gives newborns vital nutrition and antibodies to boost their immune systems and helps you shed excess weight gained during pregnancy.
However, breastfeeding can cause frequent and sometimes dangerously low glucose levels. The carbohydrates found in breast milk are almost exclusively made up of lactose, a type of sugar that includes glucose. Milk production requires high levels of energy including glucose, which may cause your blood sugar to decrease.
“I was often hard on myself [when breastfeeding] if I had to stop in the middle for a low blood sugar, and sometimes I had to supplement with formula,” said Diane Scherer, diaTribe’s Director of Development, “I tried hard not to feel guilty, so I told myself that I was doing the best I could.”
Diane has had type 1 diabetes for 37 years and is a mother of three. “I believe I got better with each baby, to pay attention and be more attuned to my [own] body as much as my baby.”
Because of the energy required to produce milk, the American Diabetes Association recommends that people with diabetes consume at least 210 grams of carbohydrates daily while breastfeeding. While low-carbohydrate diets can be helpful for general diabetes management, these diets may not supply you with enough glucose to safely breastfeed. Make sure you can access glucose tabs or snacks to correct potential lows while breastfeeding or pumping.
“Before nursing or pumping, I would make sure I had a snack and a second snack nearby,“ said Heverly. “There were often bags of Twizzlers tucked into the arms of the chairs I nursed in.”
For more information, please see our article, “Breastfeeding with Diabetes: Benefits, Challenges, and Recommendations.”
Using birth control postpartum
Given the unique challenges associated with pregnancy for people with diabetes, taking birth control may be a part of the post-delivery plan to prevent any unplanned pregnancies.
For those who choose to breastfeed, birth control methods that use the hormone estrogen can disrupt milk production. It is recommended that you use non-estrogen contraceptive methods such as long-acting reversible contraception (IUDs and arm implants) or progesterone-only birth control pills. Learn more about your birth control options here.
Weight management is another important component of postpartum diabetes care. Your body goes through rapid fluctuations in weight during and after a pregnancy which can impact your medication and glucose management needs. Weight changes throughout a pregnancy are normal and even beneficial to the baby’s development, but the inability to reduce excess weight gained during pregnancy and excessive postpartum weight gain can lead to diabetes-related complications.
Breastfeeding can help reduce excessive weight gain due to the high amounts of energy required to produce milk. Maintaining a balanced diet and an exercise routine can also help you manage your weight once you’ve recovered from delivery. To help prevent excessive weight gain after a pregnancy, work with your healthcare team to learn about postpartum weight management strategies.
Finally, managing diabetes, a newborn, and recovering from pregnancy can take a toll on your mental health. The changes happening in your life and in your hormones can lead to feelings of stress, anxiety, and depression. According to the CDC, 1 in 8 women in the US who have been pregnant experience postpartum depression.
“Women should be forgiving of themselves; it’s a very challenging time,” said Polsky (director of the Women’s Health Clinic at Barbara Davis). “Do the best that you can and know that you’re not alone. There are other people to help you.” Leaning on your support system can help you stay mentally and physically healthy. Whether it is helping take care of the baby or helping you take care of yourself, asking family and friends for help is an essential part of postpartum health. If you are experiencing feelings of depression or anxiety, consult your healthcare providers to discuss mental healthcare options.
“I want to tell people to not be afraid to ask for help and to remember to put yourself first,” said Scherer. “Make sure to have easy snacks, water, and glucose tabs accessible, especially for those breastfeeding.”
Managing your diabetes after a pregnancy is challenging, but you can and will get through it. Your support system of healthcare providers, family, and friends can help you recover and stay healthy for your new baby.
To learn more about managing diabetes during and after a pregnancy, read Julie Heverly’s story, “How I Became Stronger than a Steel Magnolia.”