Question about sliding scale

[myarnton1]

Hi all, just a quick question. I have been told that if I am put on a sliding scale during labour, I will be kept in hospital longer (post birth) even if baby is well, to prove that I can control my bs when back pumping. Is this true?
I'm trying to weigh up pros and cons of going on sliding scale or staying on pump and I am down to this last decision maker so thought I would ask. I can't see why switching back to pump after sliding scale would be so difficult if I am switching back to my pre-pregnancy basals and bolus anyway

 

[azure]

I've never heard of that @myarnton1 but I kept my pump on in labour. Did they explain why? It makes no sense as, assuming you have a normal delivery, then surely the sliding scale would be removed soon after anyway. They generally check baby's sugars over a day or two anyway, so you'd be in for that reason anyway so I can't see why you'd have to stay in longer than that. They could watch your sugars/control while baby is being monitored. It's not like you have the baby and can leave an hour later.

Yes, you go back to pre-pregnancy basal, etc, but I found I needed to reduce my basal and also change my ratios as I could eat more carbs for the same insulin in those early days. Post-delivery hypos are common so err on the side of caution and always keep Lucozade literally at arm's reach, plus have lots of snacks available.

 

[myarnton1]

I've never heard of that @myarnton1 but I kept my pump on in labour. Did they explain why? It makes no sense as, assuming you have a normal delivery, then surely the sliding scale would be removed soon after anyway. They generally check baby's sugars over a day or two anyway, so you'd be in for that reason anyway so I can't see why you'd have to stay in longer than that. They could watch your sugars/control while baby is being monitored. It's not like you have the baby and can leave an hour later.

Yes, you go back to pre-pregnancy basal, etc, but I found I needed to reduce my basal and also change my ratios as I could eat more carbs for the same insulin in those early days. Post-delivery hypos are common so err on the side of caution and always keep Lucozade literally at arm's reach, plus have lots of snacks available.

To be honest with you, she did briefly say why and I am rattling my brain to remember but can't. This wasn't from a consultant but from a type 1 friend who was told by hers when she was pregnant. Yes, that's what I thought is that the sliding scale is removed straight after and I will go back to pumping on lower dose basal and bolus ratios. I assumed that they would want to check my bs while they are still monitoring babys, like you said.
Did you need to reduce basals etc. to less than what they were before pregnancy? I have already started stocking up on full fat coke lol, as this is what I find best to treat my hypos. Thanks

 

[catapillar]

I was on a sliding scale a couple of weeks ago and getting back in control of blood sugars has been more than a bit of a challenge.

The insulin dose I was put on wasn't anything like my usual dose. In addition I was recieving IV dextrose, to balance of the insulin I was getting. I think all the dextrose has made it difficult to get my sugars back in control. My sugars definitely feel a lot more difficult to move and also a lot more fragile. I don't have any just given birth hormones to contend with, but I have had two episdodes of unconcious hypos since I was released from hospital, including one where I was woken by the paramedic cannulating me for the second round of IV dextrose.

If you've got an alternative to sliding scale that might be a viable option, really think about whether that would work for you. Sliding scale takes all of your control, both of your insulin dose and of your dextrose intake. And your going to be left feeling a bit out of control from all the hormones post natally anyway.

 

[azure]

To be honest with you, she did briefly say why and I am rattling my brain to remember but can't. This wasn't from a consultant but from a type 1 friend who was told by hers when she was pregnant. Yes, that's what I thought is that the sliding scale is removed straight after and I will go back to pumping on lower dose basal and bolus ratios. I assumed that they would want to check my bs while they are still monitoring babys, like you said.
Did you need to reduce basals etc. to less than what they were before pregnancy? I have already started stocking up on full fat coke lol, as this is what I find best to treat my hypos. Thanks

Interesting experience from @catapillar above. That made me glad I kept my pump on!

If it was a Type 1 friend who told you, then that may have just been her experience. Ask your team what exactly would happen if you had a sliding scale and then at least you'll know for sure

I personally didn't find keeping my pump on any problem at all. I'm so used to it and to testing my BS that it was really no different. My BS stayed very good, and my pump didn't distract me or stress me in any way whatsoever - not even during the actual delivery.

One thing I did find was that some of the midwives were more experienced with Type 1 than others. My first one was telling me how she was going to be testing my BS every hour and I stopped her and told her that I'd be controlling my diabetes unless there was some reason I couldn't and that I was perfectly capable of testing my BS! So be prepared for people trying to take over automatically.

I don't remember exact dates but I kept my basal at pre-pregnancy the first day or so while I was seeing how things went, then I gradually reduced it down to very roughly 75% of my pre-pregnancy rate. It then stayed at that rate for months, then has increased gradually back to my normal basal now my baby is a toddler.

You may want to swap the coke as you could be drinking a lot and the caffeine won't benefit baby. The post-delivery hypos are mad! I had Lucozade with me but had to buy more! The first few days after delivery was like being cured! I was having hypos on a small basal, eating plate loads of carbs with smaller boluses - oh, if only that could last!

Don't forget the snacks. I found flapjacks good - both to top up my BS after a hypo and for eating when breastfeeding. My DSN said to have 10-20g of carbs per feed approximately. We're all different so you should see what works for you, but I found having that figure in mind was useful. Take LOTS of testing strips! I was testing very frequently.

 

[myarnton1]

I was on a sliding scale a couple of weeks ago and getting back in control of blood sugars has been more than a bit of a challenge.

The insulin dose I was put on wasn't anything like my usual dose. In addition I was recieving IV dextrose, to balance of the insulin I was getting. I think all the dextrose has made it difficult to get my sugars back in control. My sugars definitely feel a lot more difficult to move and also a lot more fragile. I don't have any just given birth hormones to contend with, but I have had two episdodes of unconcious hypos since I was released from hospital, including one where I was woken by the paramedic cannulating me for the second round of IV dextrose.

If you've got an alternative to sliding scale that might be a viable option, really think about whether that would work for you. Sliding scale takes all of your control, both of your insulin dose and of your dextrose intake. And your going to be left feeling a bit out of control from all the hormones post natally anyway.

Thanks for sharing that. I have only been on a sliding scale when I was on MDI and didn't find it too difficult to swap back but it is probably a lot different now with the pump! Maybe that is why I would be kept in longer is because I must show them that I can control my BS with my pump before leaving.

 

[myarnton1]

Interesting experience from @catapillar above. That made me glad I kept my pump on!

If it was a Type 1 friend who told you, then that may have just been her experience. Ask your team what exactly would happen if you had a sliding scale and then at least you'll know for sure

I personally didn't find keeping my pump on any problem at all. I'm so used to it and to testing my BS that it was really no different. My BS stayed very good, and my pump didn't distract me or stress me in any way whatsoever - not even during the actual delivery.

One thing I did find was that some of the midwives were more experienced with Type 1 than others. My first one was telling me how she was going to be testing my BS every hour and I stopped her and told her that I'd be controlling my diabetes unless there was some reason I couldn't and that I was perfectly capable of testing my BS! So be prepared for people trying to take over automatically.

I don't remember exact dates but I kept my basal at pre-pregnancy the first day or so while I was seeing how things went, then I gradually reduced it down to very roughly 75% of my pre-pregnancy rate. It then stayed at that rate for months, then has increased gradually back to my normal basal now my baby is a toddler.

You may want to swap the coke as you could be drinking a lot and the caffeine won't benefit baby. The post-delivery hypos are mad! I had Lucozade with me but had to buy more! The first few days after delivery was like being cured! I was having hypos on a small basal, eating plate loads of carbs with smaller boluses - oh, if only that could last!

Don't forget the snacks. I found flapjacks good - both to top up my BS after a hypo and for eating when breastfeeding. My DSN said to have 10-20g of carbs per feed approximately. We're all different so you should see what works for you, but I found having that figure in mind was useful. Take LOTS of testing strips! I was testing very frequently.

Good idea I will ask my team at my appointment tomorrow, I'm trying to prepare myself for if I did have to go on the sliding scale.
I find that lucozade takes a while to bring my BS back up and sometimes I have to drink a whole bottle of it and that's just at - maybe 3.2, I don't think it works well for me. I could get the caffeine free coke though. Didn't think of that one!
Do you have any snack ideas for when breastfeeding? I would like to lose the weight I have gained during pregnancy so don't want to be eating too much. If you eat the snack while breastfeeding, did it prevent the low in time? Or did you go low And then come back up?
I have 200 strips packed in my hospital bag lol

 

[azure]

@myarnton1 I wouldn't worry about losing weight. Breastfeeding is good for that The important thing is to eat well for you and baby. If you do that and breastfeed, your body should reset itself back to your normal weight without you even trying Breastfeeding needs an extra 500-700 calories a day.

I used to have my favourite flapjacks as snacks. Also, a glass of milk and/or a biscuit. A banana was also good, along with things like dried fruit. I chose things that I could keep in the cupboard and stock up on.

Early on in breastfeeding I often used to have a few swigs of Lucozade and then eat my snack. I found the mix of fast glucose and slower glucose worked well. Keep Lucozade/glucose drink or tablets by your bed and by where you're going to feed (and all round the house for convenience) along with a non-perishable snack, and then you'll be fine I had a little tray I stocked up that I could reach from my favourite chair. Even later on in feeding when I might not need a snack at every feed, I found it reassuring and convenient.

Good luck for your appointment tomorrow

 

[tigger]

Sounds odd. I've had 2 labours on sliding scale and one on the pump. Afterwards your sugars are haywire anyway as a result of the hormones and none of this is helped by being in hospital and not in control of what you eat or when you eat. I was just told we had to stay in a minimum of 24 hrs to monitor the baby. Good luck!

 

[myarnton1]

I am going on the sliding scale, my team think my insulin resistance is too much, so they have advised to be out in the sliding scale. Especially as I may be needing steroids as baby is large and may be coming even earlier than expected.
@tigger thanks for the reply. I totally agree that being in hospital doesn't help with the food and it is stressful being there too. Which labour did you find easiest on sliding scale or with the pump?

 

[tigger]

@myarnton1 in terms of diabetes management there was no difference. Both were fine as I'd set my basal at 50% as recommended by my DSN. In terms of comfort it was much better to just have the pump than an extra canula in my other arm and being strapped to an additional machine. My hospital policy was sliding scale only as the midwives weren't comfortable dealing with pumps but I managed to slip under the radar due to it being Christmas day.