Your insulin dose should be reduced to about a quarter less than the dose you were taking before you became pregnant to make sure you don’t become hypoglycaemic. If you treat you diabetes with insulin and are breastfeeding, you are at higher risk of having a hypo so you should keep a snack available before or during feeds. Your diabetes team should discuss all this with you before you have your baby.
You and/or your baby may receive some extra care and monitoring just after the birth if needed, and you will definitely need to stay in hospital for at least 24 hours, until the team are happy that your baby has healthy blood glucose levels and is feeding well.
Most women are able to have skin-to-skin contact with the baby just after they are born, and you should be able to keep your baby with you unless there is a medical reason they need to be admitted into intensive or special care.
If you were taking insulin before you became pregnant, you or your healthcare team will need to monitor your glucose levels regularly to check what dose you should be on now. Many women find it very difficult to maintain the levels of control they had before they became pregnant once they have a baby to care for and nights of broken sleep. Talk to your team about the level you can aim for.
"After I'd had my daughter and had started to breastfeed, I was struggling to manage my blood glucose so I rang up my own diabetes specialist nurse and she gave me advice over the phone." Zoe, mum of one
You can return to your previous medications as soon as your baby is born. But if you are breastfeeding, you need to make sure that any medication you are taking is safe to use.
Looking after yourself after the birth
Having a baby can turn your world upside down – especially if it is your first. While the baby is awake it can be difficult to find time for the most basic things in life, such as putting the washing on, let alone managing your diabetes regime. Disturbed sleep can also knock you out of synch and you may find it hard to stick to your usual routines for meals.
Keep sugary products within reach around the house so that if you are feeling hypo while the baby is feeding, you can reach it without disturbing your baby. This is especially important if you have had a caesarean as getting up can be uncomfortable.
There is no magic wand to make it easy to manage your diabetes when you have a newborn to look after. But it may help to spend time thinking about how you can make it work. Your baby needs you to be healthy, so it is even more important that you keep yourself as fit and healthy as possible – especially in the early weeks, when you may be at higher risk of hypos.
"Always remember to sort yourself first as long as your baby is safe. I found a few times that when I injected, my son cried – so I dealt with him and then forgot to eat and had a hypo. "Megan, mum of one
Keep a list by the door of things you need if you leave the housewith all your baby things – baby things such as nappies, wipes, spare clothes, toys and so on,your own medication or insulin, healthy snacks and log book. Set reminders on your phone so you remember to have snacks andmeals, check your levels or take your insulin.That way, however sleep deprived you are, you won’t forget the basics!
Parenting can be one of life’s greatest joys, but it is also highly demanding – especially in the early years – and if you have diabetes, you need to pay special attention to looking after yourself during this period. Getting enough sleep, plenty of activity and a healthy diet, as well as keeping to your diabetes treatment regime, will help you to get the most out of life and avoid becoming exhausted or unwell. Be realistic about what is possible, and don’t push yourself too hard.
"After my baby was born, I began to suffer with anxiety relating to complications with my diabetes. I didn't tell anyone about it for a while. But as soon as I plucked up the confidence to talk to someone, there was lots of support available."Maria, mum of one
If you have type 2 diabetes that was not treated with medication before pregnancy, having a healthy lifestyle after giving birth will reduce your need for medication.
Whatever type of diabetes you have, a healthy lifestyle will not just reduce your risk of diabetes-related symptoms – it will also make you feel more energetic and be less likely to develop all sorts of health problems, including cancer, heart disease, stroke, depression, arthritis and even dementia. And if you can instil healthy habits in your whole family, this will stand your children in good stead for later life.
If you do want to improve your diet or do more exercise and need support, talk to your GP. There are a number of ways they can help you, from helping you set goals to giving you a prescription for reduced-cost exercise sessions. More information can also be found at: http://www.nhs.uk/change4life/Pages/change-for-life.aspx
Diabetes may not just affect you physically – it can affect your emotional well-being, because it has an impact on so many aspects of life – more than ever during pregnancy and childbirth. If your experience of pregnancy or birth has stayed with you in some way, if you are struggling as a new mum, or if you are worried about ongoing health problems, get in touch with your healthcare team, the Diabetes UK helpline or our midwives at Tommy’s on 0800 0147 800 (Mon to Fri 9-5). We are here to help.
"Being pregnant and diabetic can be hard work but there is so much help available. I'd go to a clinic every fortnight which gave me the encouragement that I needed to get my blood glucose control even better." Hazel, mum of one
In the longer term
Keep an eye out for any signs of eye or kidney problems and if you are feeling tired or down, or worried about weight, talk to your doctor, as it could be an underactive thyroid gland – common in people with type 1 diabetes.
It might feel hard, but now is the time to put in place new habits that will give you the energy to look after your little one. Looking after yourself also means staying active (walking with your baby is great exercise) but recognising that you also need to rest and relax, to keep your stress levels as low as possible.
"Through the pregnancy you’re trying to really, really look after your diabetes and keep your control very tight. But then afterwards, you go back to just being a normal diabetic, and it’s really hard to motivate yourself to really keep going. You feel like you want a break."Laura, mum of one
Glibenclamide and metformin can be taken while breastfeeding, as well as insulin. Ask the team for advice if you are unsure.
Once you have your baby, the regular appointments at the diabetes clinic will stop, but you still need to keep on top of your care. After you are discharged from antenatal services, you will be referred back to your standard diabetes service.
If and when you decide to have another baby you will need to go back into preconception care.
If diabetes-related eye problems were diagnosed while you were pregnant, you will need to receive follow-up eye care for at least six months after your baby is born.
Don’t forget to think about contraception. It is possible to get pregnant again straight after having your baby – even while you are breastfeeding.
- NCC-WCH (2015) Diabetes in pregnancy, Management of diabetes and its complications from preconception to the postnatal period, Nice guideline 3, methods, evidence and recommendations, National Collaborating Centre for Women’s and Children’s Health
- NICE (2015) Diabetes in pregnancy: management of diabetes and its complications from preconception to the postnatal period, NICE guideline, National Institute for Health and Care Excellence
- NHS Choices. Benefits of exercisehttp://www.nhs.uk/Livewell/fitness/Pages/Whybeactive.aspx
- NHS Choices. Causes of underactive thyroidhttp://www.nhs.uk/Conditions/Thyroid-under-active/Pages/Causes.aspx.
- NHS Choices. Lactational amenhorrhoea method (LAM)http://www.nhs.uk/conditions/contraception-guide/pages/natural-family-planning.aspx#Lactational.
You will be asked to feed your baby as soon as possible after the birth – ideally within half an hour – and then every 2-3 hours until your baby’s pre-feed glucose levels reach a level that your care team are happy with.
The levels of glucose in your blood can directly affect your baby’s glucose levels when he is born.
ℹLast reviewed on September 1st, 2015. Next review date September 1st, 2017.