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The Specialty of Diabetes Care During Pregnancy

Aug 7, 2018
 

A patient who has had type 1 diabetes became pregnant after nearly 20 years of having type 1 diabetes. She reported her OB-GYN referred her to a specialty clinic for high-risk pregnancy, including diabetes in pregnancy. They worked in tandem to ensure her care was carefully managed throughout the stages of her pregnancy. She reports having had a lot of support and coaching from diabetes educators who were very knowledgeable in the challenges of diabetes management during pregnancy. She “went” on an insulin pump and checked her glucose frequently. “Throughout my pregnancy, my insulin needs continually increased due to resistance of the placenta and hormonal changes. We managed and adjusted the dose day by day.”

About a month before her due date, her OB-GYN called to alert her that her lab work was indicating a risk for complications. She recommended the patient come to the hospital for further testing. An emergency caesarean delivery was soon scheduled and the baby was delivered 3 hours later. The patient reports the OB-GYN did not notify the diabetes clinic specialists. The patient felt that the hospital was well-versed on how to manage her diabetes peri-operatively and 2 days post-operatively, but not long after that. As she was being discharged, she asked if she should resume her pump therapy and she was advised to, “just as you did before surgery.” She reports her OB-GYN who recommended this did not teach her that her insulin needs would be much lower, which she has since learned is typical postpartum.

As she stated, “Leaving our new baby in the NICU, I went home, still dazed and on strong pain medication. My sugar crashed repeatedly with severe hypoglycemia. Thankfully I was sensitive enough to realize it and correct it. I had to turn off my pump entirely in order to allow my sugar to stabilize. Finally. I called the diabetes educators at the specialty clinic and they guided me to calibrate new lower doses. Nobody told me as a patient what to expect post-partum. I trusted my doctor, and meanwhile the specialists were unaware I had given birth early.”

Her hope is to prevent other women from having to experience this. She asked us to remind health care providers of the importance for the team care doctors to stay in coordination and for patients to direct their questions to the “right person” who specializes in the topic.

Lessons Learned:

  • Understand there are different stages of pregnancy and different insulin needs during each stage. Teach this to your patients. Include the needs during labor, delivery, and post-partum.
  • Managing diabetes in pregnancy is a specialty. Make sure to discuss a patient’s care with all team members involved. including the patient who is the most important team member, every stage of the “game,” including what to expect every stage of the “game.”

Anonymous

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