#1021 Diabetes Pro Tip: Postpartum
Scott is joined by Jennifer Smith, a registered dietitian and certified diabetes educator, who shares her insights on Postpartum and type 1 diabetes.
You can listen online to the entire series at DiabetesProTip.com or in your fav audio app.
You can always listen to the Juicebox Podcast here but the cool kids use: Apple Podcasts/iOS - Spotify - Amazon Music - Google Play/Android - Radio Public, Amazon Alexa or wherever they get audio.
Key Takeaways
- Immediate Insulin Needs Drop: Upon delivery of the placenta, pregnancy hormones vanish, causing an immediate drop in insulin needs. Expect to reduce basal rates by roughly 50%.
- Prepare a "Postpartum Profile": If you use an insulin pump, set up a specialized "postpartum" profile before giving birth so you can enable it instantly after delivery.
- Ratios and Sensitivity Shift: Postpartum brings a return of insulin sensitivity. Pre-bolus times may drastically shorten, and insulin-to-carb ratios and correction factors will need quick adjustment.
- Nursing Lowers Blood Sugar: Breastfeeding, especially in the first few months, can heavily impact blood sugars. Eating a 5-15g carb snack before nursing or under-bolusing by 25% for a prior meal can prevent severe lows.
- Be Patient with the Fluctuations: Managing diabetes postpartum can feel like being newly diagnosed all over again due to the extreme variables. Prep meals ahead of time, stash snacks where you plan to nurse, and give yourself grace.
Resources Mentioned
Introduction and Series Overview
Scott BennerHello, friends, and welcome to the diabetes pro tip series from the juice box podcast. These episodes have been remastered for better sound quality by Rob at Wrong Way Recording. When you need it done right, you choose wrongway. Wrongwayrecording.com. Initially imagined by me as a 10 part series, the diabetes pro tip series has grown to 26 episodes.
Scott BennerThese episodes now exist in your audio player between episode 1,000 and episode 1,025. They are also available online at diabetesprotip.com and juiceboxpodcast.com. This series features myself and Jennifer Smith. Jenny is a CDE and a type one for over thirty five years. This series was my attempt to bring together the management ideas found within the podcast in a way that would make it digestible and revisitable.
Scott BennerIt has been so incredibly popular that these 26 episodes are responsible for well over a half of a million downloads within the Juice Box podcast. While you're listening, please remember that nothing you hear on the juice box podcast should be considered advice, medical or otherwise. Always consult a physician before making any changes to your health care plan or becoming bold with insulin.
Scott BennerThis episode of the juice box podcast is sponsored by Ascensia Diabetes, makers of the Kontoor Nextgen blood glucose meter, and they have an amazing offer for you right now at my link only, contournext.com forward slash juice box free meter. You can get an absolutely free contour next gen starter kit.
Scott BennerThat's contournext.com forward slash juice box free meter. While supplies last, US residents only. The remastered diabetes pro tip series from the juice box podcast is sponsored by touched by type one. See all of the good work they're doing for people living with type one diabetes at touchedbytype1.org and on their Instagram and Facebook pages. This show is sponsored today by the glucagon that my daughter carries, Gvoke HypoPen.
Scott BennerFind out more at gvokeglucagon.com forward /juicebox. At the end of this episode, which by the way, if you're a person who's like, oh, I'm never gonna have a baby or I'm a boy or whatever it is you're thinking right now, postpartum doesn't apply to me. These diabetes pro tip episodes are, I think, terrific. And I think they all go together. There's a lot to learn from listening to this episode because at its essence, it's dealing with huge variables which is what you'll find after you've had a baby.
Scott BennerSo it doesn't apply, but it does. You'll see. At the end of this episode, I'll tell you where you can find Jenny. I'll tell you where the rest the pro tip episodes are and what the topics are. And, anyway, I think you should listen to this one whether you're going to have a baby or not.
The Postpartum Reality Shock
Scott BennerAlright. Well, that took three minutes, which is probably two minutes longer than it took most of you to get pregnant. So here's Jenny. As time passes, I'm becoming more and more aware of a lot of pregnant women or women who wanna get pregnant, who have type one diabetes, who are listening to the show and who are enjoying like, there's a series back in the show with Samantha where I interviewed her every three months, like, during her pregnancy.
Jenny SmithYeah. I remember you mentioning her.
Scott BennerAnd that apparently, is making the rounds on the on the Internet and the way people listen to things. And, I just get a number of emails, and I'm sure you do as well, that are either that start off with, I can't I'm never gonna be able to get pregnant because I can't get myself together. And then they go, I can't believe I did it or I'm doing it, you know, like that kind of a thing. But then there's that the the rest of it that I guess we stopped thinking about because the baby's out. Like and I don't know.
Scott BennerThat's that's weird. So a person, in my mind, being a person who's never been pregnant and doesn't have that type one, that journey seems painfully taxing to me from going from not thinking you'll be ever ever be able to have a baby to figuring it out to then doing it, to having these insanely great a one c's while you're pregnant. And I don't know. It just feels like it would be super simple to just not abandon it, but lose sight of it after you have the baby because of all the things that happen after that. So
Jenny SmithAnd I I don't think it's that, I don't think it's that the good majority of women really think that they're just gonna just give it all. Like, all the work that I've put in over the past, you know, nine to maybe twelve months that they really did a lot of really good preconception management to kinda get there and managed, it could have been a long haul of, you know, nine to eighteen months, let's call it, of trying to really strategically nail things down. But and I don't think that if you've done that or even if you've come into pregnancy, maybe not where you wanted, but you really did an awesome job of mastering things and getting things taken care of through the pregnancy. By the end of pregnancy, most women aren't like, oh, I'm just gonna, like, throw it all in the basket, everything I learned how to do. But there is a big piece postpartum that, especially as a first time mother, is completely a 100% new.
Jenny SmithYeah. It's I mean, it is. It's like being thrown into, like, a new job in a country where you don't speak the language. They're like, here you go. It's all yours to, like, figure it out.
Scott BennerAnd by the way, the job will die if you drop it or leave it on
Jenny Smiththe Exactly. Or you're you're gonna kill a million people if you don't do it exactly the right way.
Scott BennerIt is how it feels, isn't it?
Jenny SmithThat's kind of what it is postpartum. I think a lot of the a lot of the up down comes in because you're trying to manage something a 100% new or the hormones that shift and change after you deliver can be a roller coaster of the fact. And for I mean, I usually say in a general sense, the first three months post delivery is gonna be kind of a rollery up and down mainly because especially if you're nursing or pumping to feed your child.
Scott BennerOkay.
Jenny SmithThe shift in hormones and the shift in how much you're nursing, how much you're pumping can drive things the opposite way that you would think that they might, which makes it very difficult to establish. I would have usually, like, overbolist for this, or I would have usually been really aggressive to nail down this now climbing blood sugar. But, oh, I'm gonna nurse in the next fifteen minutes. So I really can't do this strategy because otherwise, I'm gonna tank. So there's a lot that changes postpartum.
Scott BennerOkay. So not only so there are some people who enter pregnancy and already have that a one c that they need. But Mhmm. But despite that, whether you're a person who had to get there or you were there already, once you're pregnant, your insulin needs, they drastically change. I know it's not like trimester to trimester exactly.
Scott BennerRight? But there are times when you don't need as much as you think and times when you need so much more that it's hard to imagine how much more you need.
Jenny SmithRight.
Scott BennerRight? So now you have that in your head. You've been pregnant. You're you're having breakfast that prior to pregnancy took three units, during pregnancy took 12 units, and now you've you're holding the baby. You're thinking, is this 12 units?
Scott BennerIs it three units? Why does the weight of the world feel like it's on my shoulders? Like, you know, am I nursing? All this stuff comes together, and how do you do that? It's so you started by saying the hormones.
Scott BennerAnd I I only wanna spend a second on this, but, you know, I'm older and growing up, it doesn't happen much anymore. Like, society has really shifted, you know, in the way people are towards each other. And that might be harder for, like, somebody in their mid twenties to believe, but when thirty years ago, you know, stuff that you think of as a joke now is actually how people would think about women sometimes. Like, oh, you know, she gets upset or you know what time of the month it is or that kind of thing. Not giving any, like, credence to the idea that when your hormones are jumping on, it's really difficult to deal with.
Scott BennerAnd right. And and that women are in a particularly vulnerable situation because of that. So how you feel from a hormonal shift could be physically. It also could mean your your clarity. And I think what you said is just really important to remember, for first time mothers.
Scott BennerWhen you have a baby and they give it to you, it it does genuinely feel like someone just told you that the the fate of the world rests in your hands. And you don't understand what to do, but if you mess it up for certain, the universe won't exist anymore. It really feels like that.
Jenny SmithAnd some people have really awesome babies that are, like, the easiest. They just they sleep when you'd expect that they nurse beautifully. They sleep again. Like, they don't have any, like, major poop problems. Like, you know, you just have this, like, what you would call, like, I have no trouble with my my perfect baby, blah blah blah.
Jenny SmithAnd then there are women who just don't. Like, some kids are just not
Scott BennerThey're not easy.
Jenny SmithThat type of an infant as a newborn. And I think when you have diabetes too, then it brings in management again of something that's completely new. I don't know. Should I do this? Should I try this?
Jenny SmithIs the doctor right? You know, am I gonna do this wrong to my child, blah, blah, blah. And then there's diabetes in the picture and the timing of insulin and the timing of adjusting and remembering to change your pump site or to actually take your basal insulin injection. I mean, there's a world of scheduling difference that comes into the picture Mhmm. Postpartum.
Scott BennerAnd I would imagine too, and this is just me imagining, but if you live for nine months with an a one c in, like, the low fives, there's gotta be a part of you as a type one who's just like, wow. I want this for the rest of my life too. Right. And now you feel like if it's going away, now it's another failure on top of I don't understand why this baby throws up all the time or, you you know, like, I I'm sure people are like, oh, yeah. Like, I've everyone's heard the joke about, like, the baby peed on me one time.
Scott BennerYeah. That's fine. My son couldn't hold down food for months until we figured out what to give him. And and the culmination of it was quite honestly Kelly holding him at her grandfather's funeral when basically it felt like somebody took a half a gallon of spoiled milk and dumped it on Kelly because it just came out of him like that at a funeral. And she had only been a mom for a little time and it's hard.
Scott BennerAnd it so it's fun to talk about, like, oh, the baby peed on me or it throws up all the time, but sometimes it throws up at a funeral. And and Yes. And you're hormonal, and your grandfather's bed.
Jenny SmithRight. And now your CGM is going off because your blood sugar is skyrocketing because you're stressed out about said incident.
Scott BennerYep. And that's what I was gonna say. My wife didn't have type one diabetes, so then all that other stuff that goes on top of it. Yeah. So so what do you so is it similar?
Immediate Insulin Reductions Post-Delivery
Scott BennerLike, could you sit down and make a flowchart? Is it similar for people at at least at some core level, or is it going to be different for every woman?
Jenny SmithThere are similarities as, you know, we talk about in our in my the pregnancy book that I co wrote. It's there is enough similarity just like in pregnancy. I mean, everybody's gonna have some shifts and changes that are a little bit different, very specific to you, just like diabetes is very specific person to person. But postpartum, yes. I mean, the transition typically as soon as you have delivered and the placenta has been delivered as well, it's it's like the placenta, which is the major, like, functional hormonal unit.
Jenny SmithOnce that's gone and baby is out, the hormone shift is like a drop off a cliff. It's like, it's gone fast.
Scott BennerMhmm.
Jenny SmithWhich is the reason that we usually say based on where you were at this point in pregnancy just before delivery in terms of insulin use. If you didn't know where you were pre pregnancy, so you could see how much things shifted up by the end of pregnancy, then we usually recommend adjusting basal rates down by about 50%.
Scott BennerWow. Okay.
Jenny SmithThat's the that's expected. It could be a little less. It could be a little bit more person to person again may differ, but that's a baseline adjustment. So if you've never been told what to do and nobody's directing very well, expect that postpartum, you should cut your basal's by 50%. Another really good idea is to most women know when their due date is.
Jenny SmithSo if you're using an insulin pump, especially, set up a profile that's called postpartum.
Scott BennerOkay.
Jenny SmithBecause as soon as you deliver, all you have to enable do is enable that.
Scott BennerWow. That's that was gonna be my question. Like, you're saying, like, placenta comes out, you take a deep breath and go, I need my pump right now. And and that's it. 50% less.
Jenny Smith50% less. Yes. Wow.
Scott BennerMhmm. So that placenta is please forgive me if this is ham fisted, but it's the it's the equivalent of a giant sausage cheese pizza sitting in your stomach that somebody just reaches in and takes out all of a sudden. And now you don't have that impact anymore.
Jenny SmithCorrect.
Scott BennerWow. Okay.
Jenny SmithYeah. I don't know
Scott Bennerif anybody's ever seen a placenta, but it is very close to a cheese pizza when you look at it.
Jenny SmithThey're they're very interesting organs. I mean, they're and the the cool thing is that your body creates it for one purpose, and then it's gone. It's not like your heart, which is like you know, it's always there for your whole entire life. It's like your body makes this thing just like it makes the baby, and then, oh, it's all done. It's only got this, like, nine month life.
Scott BennerThat's it. I was just thinking this I it's funny you said that because I was just thinking the same thing. Like, why can't we just tell our body to make another heart? Yeah. Like, I mean, if it can do that, it could at least, you know, vacuum or something.
Scott BennerYou know?
Jenny SmithIt could at least also make another pancreas man if we can make it right.
Scott BennerI mean, why not? I'm not a doctor, but somebody should get on that.
Jenny SmithI entirely agree.
Scott BennerYou imagine if you just had a panel on your back and you flip the switch and then nine months later, your body just spit out an organ? Yes. There you
Jenny Smithgo. Exactly.
Scott BennerHad a little slot on your side. I don't know why this is impossible. Probably because of science, but nevertheless. Okay. So, baby comes out.
Scott BennerWe're all like, oh and and on, taking those weird bloody pictures that people take in the beginning and everything. And then I change my basal rate. What am I gonna see next? My does the body begin making milk at birth, or does it even start prior to that? The remastered diabetes pro tip series is sponsored by Asensia Diabetes, makers of the Kontoor Next Gen blood glucose meter, and they have a unique offer just for listeners of the juice box podcast.
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Scott BennerWhile supplies last, US residents only. Touched by type one has a wide array of resources and programs for people living with type one diabetes. When you visit touchedbytype1.org, go up to the top of the page where it says programs. There, you're gonna see all of the terrific things that Touched by Type one is doing. And I mean, it's a lot.
Scott BennerType one at school, the d box program, golfing for diabetes, dancing for diabetes, which is a terrific program. You just click on that to check that out. Bold for a Cause, their awareness campaigns, and the annual conference that I've spoken at a number of years in a row. It's just amazing, just like touched by type one. Touched by type1.org, or find them on Facebook and Instagram.
Scott BennerLinks in the show notes. Links at juiceboxpodcast.com to touched by type one and the other great sponsors that are supporting the remastering of the diabetes pro tip series, touchedbytype1.org. When you have diabetes and use insulin, low blood sugar can happen when you don't expect it. Gvoke HypoPen is a ready to use glucagon option that can treat very low blood sugar in adults and kids with diabetes ages two and above. Find out more.
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The Impact of Nursing on Blood Sugar
Jenny SmithThe way that it should happen again, everybody's a little different in what happens. But what should happen is a a first milk is created. It's called colostrum. Mhmm. And, essentially, that's very short lived in production before milk comes in.
Jenny SmithIt could be a short lived, you know, few days. It could be twenty four hours before your milk comes in. But that milk is a very like, it's very simple form of nutrition for the baby. It's kind of what the baby is in need of right here and now. And there's not much of it.
Jenny SmithSo it's not like if you were to pump it, you're gonna get, like, six ounces of it.
Scott BennerMhmm.
Jenny SmithJust not that's just not what you would get. Right? So but in that simple form and with the loss of the pregnancy hormones, now you have this sensitized system that was resistant leading up to this point. Mhmm. And so therein also lies some mental shift.
Jenny SmithThe shift of, you know, nearing the end of pregnancy coming you know, pre bolus isn't fifteen minutes. It's sometimes forty five minutes by the end of pregnancy in order to have good flat after meal blood sugars. Well, now you have to completely flip that switch and it's back to maybe I need ten minutes. Maybe I need no pre bolus in the early couple of weeks post delivery.
Scott BennerMhmm.
Jenny SmithSo not only is it that your basal shifts, but it's also that your ratios shift, your insulin to carb, your correction factor, your pre bolus time. So there's there's a major transition.
Scott BennerRight. You just become a completely different person with type one diabetes just like that. And and so is it similar to but more drastic to getting your period, like, being that, like, there's that you know what I mean? I don't know if it works for everybody, but Arden's three sometime now that she's on birth control, she's more like two different people during the month. But and and the and it can be it's drastic for us.
Scott BennerYou know, she can go from a unit an hour to two units an hour, Basil, depending on what time of the month it is. And it but it doesn't flip like a switch. It's not like but I can see it happen. It happens over hours and maybe a day, but it doesn't happen. It's not like at 03:00 she's like, I just got my period and everything changes immediately.
Jenny SmithRight.
Scott BennerBut is it that just blown up much more? Because, I mean, what are you really talking about? So for people who don't know, like, it I go into pregnancy. I just said I. I go into let's just say I'm pregnant.
Scott BennerAlright. I'm pregnant. I have type one diabetes.
Jenny SmithLet's see if you're a lady with long curly hair.
Scott BennerI'm a lady. I have type one diabetes. I get pregnant. My basal rate is 1.5 an hour. In the first trimester, is it how much does it go up?
Scott BennerA lot?
Jenny SmithIn the early weeks, typically, we a good round estimate is if you know the percent of increase you've had in the days before your cycle starts, if you've taken enough notice and you have a rise and you offset it by a percent of temp basal or an extra basal dose or whatnot, you can expect those early weeks of pregnancy, typically up to about six, seven, eight weeks, that you're gonna have an increase in insulin need that's pretty similar. It might be more dramatic than that. It may be less, but you're going to have a ramp up as your body is increasing its production of now pregnancy hormones to sustain the pregnancy in furthering along.
Scott BennerOkay. So I should have said my my bolus was one so that we could keep track. Right? Let's say I'm one. Usually, when I get my period, I'm two.
Scott BennerSo then we're gonna say in the first six to eight weeks of pregnancy, I'm probably gonna be more like two, more like I have my period
Jenny SmithCorrect.
Scott BennerIsh. Exactly. Right. And then from there, it goes it goes up again?
Jenny SmithSo end of first trimester, most women notice either a plateau
Scott BennerOkay.
Jenny SmithOr they notice a bit of a dip off in their insulin needs
Scott BennerAnd come back down.
Jenny SmithFor just that end of the first trimester. Usually, we say on average, it's about it starts at about eight weeks, goes through about twelve, maybe even forty weeks, which is that very early second trimester start time period. Okay. Of sensitivity, you may have needed to back off of your pre bolus time again a little bit. You may have gone down slightly in your baseline basal needs.
Jenny SmithJust more sensitivity around meal boluses and kind of almost feeling like things have sort of stabilized. Like, you have a little bit more wiggle room. Like, I could eat three chips in between and not actually bolus for it because it doesn't seem to do to me.
Scott BennerRight.
Jenny SmithOr right? And then second trimester, again, a little bit of a nudge up potentially in early second trimester, but a little bit more stability up until about eighteen weeks. Eighteen to twenty weeks, we kind of refer to it as the the slow roller coaster climb. So if you imagine you're at the bottom of the roller coaster to begin with Mhmm. And now around eighteen to twenty weeks, you start that slow, like, click click click up the roller coaster hill.
Scott BennerYep.
Jenny SmithAnd that kinda progresses. You increase in resistance along the way all the way up until about thirty five, thirty six ish weeks.
Scott BennerJust a steady climb.
Jenny SmithIt's a steady climb. And initially, in the second trimester, it's on average expect to make some tweaks to things about every two weeks, give or take
Scott BennerGotcha.
Jenny SmithIn basal as well as insulin to carb ratio, as well as the pre bolus time continues to lengthen. Your correction factor may need to get more aggressive. But usually by the beginning of the third trimester
Scott BennerMhmm.
Jenny SmithThat's the most resistant time.
Scott BennerOkay.
Jenny SmithAnd up and through, like, thirty four to thirty six weeks.
Scott BennerAs you're talking, I'm literally I have a piece of paper in front of me, and I'm just kind of moving a pen as you're talking, like, trying to make a graph of what to understand. And especially now, it's gonna grow up every two weeks. So I know this isn't mathematical, and I'm not telling anybody that if you started with one unit the day before you got pregnant, but where can somebody end up who started at one unit an hour? Where could they end up at thirty five weeks?
Jenny SmithSo insulin needs on average double or triple from pre pregnancy to the end of pregnancy or what we would consider just pre delivery time, which is about by thirty six weeks. By thirty six weeks, we reach again this sort of, like, plateau place
Scott BennerMhmm.
Jenny SmithWhere, again, some sensitivity can start to come back. Some women's basal needs start to dip off just slightly, shouldn't be aggressive or heavy. In fact, it's a time period that if you are having aggressive changes in your insulin in terms of drops in need, it's a time to check-in with your provider. Some of it can be relevant to placental failure. And so it's a time, again, if things change drastically that you would check-in.
Jenny SmithBut otherwise it's expected. A little bit of a nudge down, a little bit of increase in sensitivity kind of creep back in before you actually deliver. But on average, you know, how much to adjust? Like I said, most women either double or triple their needs from pre to about that thirty six week point.
Scott BennerAnd so I now you have the baby and you could be going from this mindset on three units an hour back to one. Yeah. Back to one all
Jenny Smithof a sudden. Exactly.
Scott BennerAnd on top of that, all the sensitivity around meals has changed. And and you're telling me nursing is gonna drop the blood sugar?
Jenny SmithNursing for most women who have good milk supply and are able to, you know, pump or nurse completely without you know, most women experience, especially in the early weeks, usually about the first eight to twelve ish weeks post delivery, notice some shifts down in glucose after nursing, during or after. If if your child nurses for a lengthy period of time, you could notice it during the nursing session itself. Some women notice it only at certain times of day
Scott BennerMhmm.
Jenny SmithVersus the whole day, you know, having to consistently pay attention every nursing session they're eating, you know, like, two glucose tablets or having half a juice box or something like that. I mean, our recommendations are once you once you are a few weeks out from delivery, kind of baby by that point has some typical sleep, wake, poop kind of patterns. You're probably still nursing about every hours, maybe a little lengthier overnight as long as your baby's nursing well during the day Mhmm. Or feeding well during the day. But, you know, most often, if you're gonna nurse in the aftermath of a meal, a good recommendation is to take the bolus dose down.
Scott BennerOkay.
Jenny SmithOr count carbs but under dose by, you know, 25%.
Scott BennerSo it's dramatic enough that if I eat I keep saying I. If if the lady eats before nursing, that meal won't need as much insulin because you're gonna need some of that meal. So that means if you're not planning on eating and you're going to nurse, you need to eat something going into the nursing.
Jenny SmithTypically, going into nursing or during the nursing session to prevent a low. Yes. And it could be anywhere. It could be simple. It could be five grams of carb.
Jenny SmithIt could be as much as 15 of carb. It just depends. And that's where, you know, looking at things like insulin on board. Yeah. You might not be bolusing and nursing directly after, but if it's still, like, within two or three hours after you've bolus, you still have some active insulin from that bolus.
Scott BennerAnd we tell people I I at least I I say and I know I feel like you agree. Having active insulin while you're exercising is a pretty sure way to make yourself low. Yes. But and so I'd wanna avoid active insulin during nursing as well.
Jenny SmithOr plan for it with a plan
Scott Bennerfor it with snack. And the other thing is there too, if you can go negative insulin and get through exercise without dropping, you can't do that with nursing. So nursing's more taxing on your body than some forms of exercise. Is that fair? Like, is there a correlation to think about it in there or no?
Jenny SmithI guess there's some relation to think about it. Think, like, I I was thinking of overnight. Right? Where for the most part, moms, dads, they're tired at night with a newborn. Many people are.
Jenny SmithAnd if that's the case, you're likely going to bed at, like, 09:00. Like, you nurse your child, and you're like, okay. I'm going to sleep because I'm gonna be up again at, like, midnight, 01:00 to do this all over again. You may have eaten dinner at like 07:00. You're going to bed.
Jenny SmithWell, you're well into basal insulin by, let's call it 11PM, right? So anytime you're gonna nurse after that, and you're only on basal, and I experienced this myself for both my kids, Basal overnight, if I even if I had it at all and I had Basals while I was nursing kids overnight in those early months, it was, like, near nothing. Mhmm. My basal was, like, point two, point two five overnight. It was already down to almost nothing.
Jenny SmithAnd if I nursed and didn't still have something minimal like, I actually made these, what are called, like, lactation cookies. They're made with, like, oats and flax and peanut butter and stuff that helps with lactation, blah blah blah. But I made them so they were each about five grams of carb. But they were nice because I could eat it. It had some stability to it.
Jenny SmithIt wasn't just pure glucose. Mhmm. So it had some stability. And so I'd usually eat it as soon as I started nursing or something like trail mix, some nuts and seeds with a little bit of, like, dried fruit in it. Something that was no more than about five or 10 grams of carb.
Jenny SmithAnd that helped with the stability component with rather than and always die.
Scott BennerWell and so this is another time, you know, where the the food choices you make are going to make things easier for you too. You you can't Yeah. And, you know so it's gonna you're gonna have a different scenario going into nursing if you're like, hey. I know what to do. I'll have a handful of this and a little bit of that, and that's gonna work out perfectly.
Scott BennerBut on Thursday, when you're like, you know what I'm gonna do? I'm gonna have ice cream before I nurse. There's gonna be a diff all everything about ice cream still exists there in your diabetes. Okay.
Jenny SmithIn fact, those kinds of things, you know, as we know, ice cream typically should cause a bit of a rise possibly later fat. Mhmm. And then how much have you ate, know, two spoonfuls probably not, but like the whole, you know, pint of it probably. So
Scott BennerSo you're telling me that there's a way that I can get I can have ice cream far enough out in the future ahead of my nursing where I could balance that fat rise against the nursing. You know, there are some lunatics that listen to this podcast that are gonna try that. I saw somebody online this morning who's trying to stay a 100% in range till they get to their endos appointment and they're doing it. And I'm like
Jenny SmithThat's awesome.
Scott BennerI'm like, oh my god.
Jenny SmithThat's a lot of I mean, that
Scott BennerYeah. I don't know. I don't do that. So I for Arden, I I think they just get they're they got a little like I just wanted to see if
Jenny Smiththey're More power to them. That's I what?
Scott BennerI wanna tell people too. I it no. It sounds difficult in the beginning to have a baby, but if you wanna know how good you will get at it at some point, here's a great example. About two minutes ago, there was a bang in Jenny's house that was so loud. I thought the world was coming to end.
Scott BennerShe didn't flinch. She didn't stop talking.
Jenny SmithIt
Scott Bennerwas that's what happens. Eventually, you just become a steely eyed missile man. She just did not move. She's just
Jenny SmithOh, because there are bangs all day in my house. I mean, when you work, you know, from your own home office and you have children in your home, I'm sure there will be more bangs. I don't know what they're doing upstairs, but they are having fun.
Scott BennerIt was So it was just a great example of how you do become really great at parenting after you've had kids for a while. I swear to you, you
Jenny Smithdid Resilience.
Scott BennerI don't it it's almost like you didn't hear it.
Jenny SmithDon't pay attention. Sometimes oh my gosh. Sometimes, like, felt like, I have a big sign that my husband made for me. It's outside my office door, and one side says, quiet zone, mommy is working. And the other side is, mommy is done.
Jenny SmithYou may enter and be loud is what it says. Well, you know, when I'm working, it's still always in the quiet zone. Well, you know, with an eight and a four year old, they know what the sign says, but that doesn't always still click into place.
Scott BennerSo It does not overwhelm what they want in their hearts at that moment. That's for sure. No. I listen, Arden's
Jenny SmithThat's funny.
Scott BennerArden's gonna be 17 in a couple of months. Wow. Ain't that crazy? And I saw her go into where my wife was working the other day. She looked at me like she was six, like, hey.
Scott BennerWatch this. Slides into Kelly's chair, sits on top of her and goes, mom, can you rub my head? Kelly's, like, you know, reaching around for the keyboard and everything. So it will it will you won't always feel overwhelmed. How many people do you I I don't I'm not gonna say how many people, but I mean, do you see women generally able to stick to their diabetes goals after pregnancy?
Scott BennerOr should they expect it's gonna get out of whack and they're gonna have to do some work to get it back? Like, how does that usually go?
Jenny SmithI I see that you should expect that there's going to be fluctuation that you will have to learn to adjust to. Mhmm. I myself, I had to learn to adjust because, you know, as much as I know clinically and professionally, the experience itself speaks volumes about what you need to transition through. And so I think every woman postpartum should expect that things are going to be a little bit wonkier for a bit of time. I mean, some things that I think helped me transition were I prepped some meals and froze them
Scott BennerMhmm.
Jenny SmithPrior to baby coming. Whether you have diabetes or not, that can be really, really helpful. Some of those kinds of things. I also had snacks planned. I had I mean, while you end up sometimes nursing your child wherever is comfortable.
Jenny SmithMhmm. You know, planned places, you know, in the baby's room, in your bedroom, in a comfy chair in the living room, just some things that were, like, easily reachable that I didn't have to, like, call to somebody to bring me. And I just had glucose tablets and some juice boxes, some, like, trail mix and that kind of stuff sort of set multiple places around. So, I mean, there's some planning that you can do ahead of time, but the diabetes management piece of it, it kind of learn it as you go. I mean, I'd say that about the women that I work with through pregnancy, if I had to estimate, I'd say about fifty percent of them end up sort of sticking with me a little bit longer postpartum just because especially the the new moms, you know, ones that already have one or two kids, they're like, I think I got this, you know.
Jenny SmithI'm good.
Scott BennerThanks. So does being pregnant with type one give you an advanced so what do I wanna say here? There are so many times when I'm making this podcast that it occurs to me that success with diabetes hinges a a good deal on your desire to be successful and your ability to feed that desire with effort. Does that make sense?
Jenny SmithYeah. Absolutely.
Scott BennerAnd so you you you get pregnant and then it becomes like this thing we were talking about in the beginning, this of this feeling that you are in charge of the universe all of a sudden. And I will tell you too, and I mentioned it sometimes. When I talk to adults who didn't have particularly well managed, like, teen years or whatever, a lot of them have a through line. They started to care more about themselves or they started caring more about another person. Like, want and then they wanted to be healthier because they wanted to be in this relationship or because they wanted to go to do something or, and the baby falls in that category to me.
Scott BennerLike, I wanna I'm going to do this so that the baby can be healthy. And the the number of women I've talked to who were living really unmanaged lives with type one diabetes and then are all of a sudden four point eight a one c's. You you know what I mean? And eating, like, a lot because they're growing a baby. It happens.
Scott BennerI just see it a lot. And so I always kinda think personally as a person who's never gonna have a baby and hopefully never have type one diabetes, there's something about that motivation in there that that, I guess, the fight in postpartum is to not I don't know if it's something you can stop. But for all these things that are going to happen to you postpartum, to try to still whittle out a little bit of your energy or effort to devote to your blood sugar.
Jenny SmithAbsolutely. And I think a good reason there too in terms of diabetes postpartum is glucose management still translates into that time period for the sake of the child even though they're no longer growing Mhmm. In you and your blood sugars aren't as direct of an impact postpartum if you are nursing and you are not managing your glucose as optimally as, you know, would be helpful, those higher glucose levels are going to impair your ability to make enough milk.
Scott BennerOkay.
Jenny SmithIf left high, your ability will be decreased. You will also be more dehydrated. As you nurse, it takes fluid out of you if you're not putting it back, and glucose levels are also trending high. That in and of itself is also gonna make your glucose management more difficult.
Scott BennerDoes it change the milk itself?
Jenny SmithTo a degree. I mean, ago, we don't talk about this really much anymore. Although I have heard some women who've asked me, should I just, you know, pump when I'm really, really high and then dump it? Because I've been told that that high sugar milk is really bad for my baby. I mean, overall, increment of right now, my blood sugar is high because I ate something and didn't really have the right carb count and I'm knocking it down.
Jenny SmithShould I not feed my hungry child right now? Absolutely not. Go ahead. Feed your child, nurse your child, pump, whatever. Don't get rid of the milk.
Jenny SmithYour body works really hard to make that milk. Don't get rid of it. Mhmm. But the goal is to have more sustained levels that are still in target so so you're able to continue to make milk.
Scott BennerMhmm.
Jenny SmithAnd that the amount of milk sugar that's in that that breast milk is stable. Right? That it's stable and at the level that it's supposed to be protein, fat, carb content of milk changes as the milk as the baby's kind of needs change through the growth cycle.
Scott BennerYeah.
Jenny SmithSo you want that amount of natural carb in there to be appropriate. If you're sustaining blood sugars, you know, well above one eighty, you can guarantee that your milk is richer in carb, not by, like, loads and gallons. Mhmm. But overall, you're supplying your child with bits more carb. And in a tiny growing body, a little bit can be a lot.
Scott BennerOkay. That's it just occurred to me, like, we talk about undiagnosed people can, their urine can smell sweeter. Their breath can smell sweeter. I was like, I wonder if it could happen to the milk too. That makes sense.
Scott BennerSo, much like most of this about diabetes, sustaining low variability is always just very important. No bouncing around, you know, that kind of thing. But if you just threw like, say you were a person who had the baby and it's like, boom. I'm going back to my nine a one c. That milk would be tainted in some way.
Scott BennerNot Yes. Yeah. It's not perfect is what we're saying.
Jenny SmithOkay. It's not perfect. Right. I mean, you know, is any milk perfect? I don't know.
Jenny SmithBut Yeah. I mean, if you're sustain if you're sustaining these really elevated glucose levels, that's not a benefit. And you're going to I mean, for the most part, you're going to have difficulty maintaining milk supply. You are.
Scott BennerIt made me wonder when you were talking about long term. What about people who I you know, sometimes you see people, like, nursing a two year old. So it it for people who do that, should they expect that that hit? Like, your body never gets used to that. Right?
Scott BennerLike, you're gonna get that blood yeah. That blood sugar hit's gonna come forever if you no matter No?
Jenny SmithActually, no. In fact, after about three to four months postpartum, there's a stable enough nature to the milk supply and to what your body or your baby is demanding that for the most part, things stabilize
Scott BennerWow.
Jenny SmithA lot easier after about three to four months. In fact, I nursed my kids well after they were a year old. Mhmm. And in fact, I think they were both almost two. I mean, it wasn't all day.
Jenny SmithIt was, like, for bedtime and for nap time by the end. So it wasn't really that they were probably even getting very much. But, usually, post a year, you're typically not going to see that hit. And the big reason, especially after about six months to a year, is because now your baby is starting to eat.
Scott BennerOkay.
Jenny SmithWhile milk supply is still considered the main nutrient up to a year of age, some kids start eating really, really well
Scott BennerRight.
Jenny SmithAfter six, seven, eight months. And so you may see a decrease in the amount of nursing that goes on as the baby becomes more interested in food and takes in less, especially the overnight. Many women, you know, might have a really great child who just sleeps all night, and so they might only nurse once or twice maybe or on need. You know, some women nurse on need during the day. But those those sessions are not typically going to cause the drop in blood sugar that the early three months will cause.
Scott BennerI wanna make sure I'm I didn't misunderstand something. So there is it a balance between you might not be using as much and your body's becoming very good at making it? Or is the like, at first, I thought you were saying, like, the same lady's body that can make an organ knows can figure out how to make milk without it being, like, a tax on the system. Like, is there some of that and some of it not being Correct.
Jenny SmithThink it's a mix. Yeah. Honestly, because for the most part, like I said, about that three to four month mark, I would say the women that I get to work with well past the immediate postpartum time period, they find a lot more stability Mhmm. In their glucose even though they continue to nurse beyond that point, then then the lactation or the nursing sessions don't have the hit that they do initially.
Scott BennerI got it. Okay. Thank you. Just a quick little parable while I or while I ask you to think if there's anything that we haven't talked about. Let me tell you that I was interviewing somebody recently, who said that they were listening.
Finding Balance and Establishing Routine
Scott BennerDid I interview this person or was I talking to them? Doesn't matter. I was conversing with a person who said that they're pregnant now. They're listening to episodes of the podcast about pregnancy with you in them while reading the book that you wrote and did not connect that you were the person from the podcast. They didn't realize the person that wrote in the book was the person talking on the podcast.
Scott BennerThen all of a sudden, it hit them one day. And she was like, oh my gosh. It's the same Jenny.
Jenny SmithThat's awesome.
Scott BennerSo that was really cute. I wanted to tell you about that. I almost just texted the team. I'm like, I'm gonna tell her that while we're recording the postpartum episode instead.
Jenny SmithYeah. That's awesome. Yay.
Scott BennerThought that was really cool. Anything we didn't say that we should have?
Jenny SmithOh, I'm trying to think. You know, the only other thing that we didn't really touch on while it should be considered is depending on how you're feeling postpartum. I mean, most women have like this. I give you restrictions up until about six weeks post delivery when you're gonna have your check-in with your OB and blah blah blah and make sure everything's healing well and you're okay. And then they kinda like check you off and you can drive again or, you know, if you've had a C section or you can get out and start running again or whatever.
Jenny SmithAnd I think that's a piece to consider in the mix with diabetes because we know what exercise So now you not only have exercise coming into the mix, but you've also got nursing coming into the mix and all these insulin changes that you're trying to make. So one of the big things that sort of fits here is if you have maternity time, not all women do, but if you do have maternity time, use your maternity time to try to establish sort of a route like a routine or a schedule. And some of that's gonna be dictated by the baby, obviously. But even regular for you, trying to get your nutrition in timely through the course of the day. You know, once nursing is a little bit more regular, the baby's awake and nursing times are more you can fit it in or around the meals.
Jenny SmithAnd exercise is a big one of that. If you're going to start exercising, try it at a similar time of the day to kinda get a feel for how does this work, you know, what can I get away with, what's too much, what's too little? Because I think that just brings in the whole, like, I feel good enough to go and, you know, take a three mile run, but what's this gonna do? I don't know. Let's try.
Jenny SmithI
Scott Bennerhear you. So it it's not dissimilar to it is interesting as you're talking about it. It really feels like postpartum's a lot like just being diagnosed but having way more information about diabetes.
Jenny SmithRight.
Scott BennerLike like, what if what if somehow magically I knew the things I knew but never had to put it in a practice and then all of a sudden there was a a newly diagnosed person here? I'd be able to roll with the variables much better because I have better tools. And so you're going to go from having diabetes, maybe not doing it as well, learning how to do it really well or already knowing how to do it well. And then it's gonna feel like you're diagnosed again and you're taking care of a baby at the same time and all your variables changed again. I'll tell you I'll tell you this is giving me a different feeling for first episode of season seven two thousand twenty one was with a woman named Jill who was diagnosed as she got pregnant.
Scott BennerSo she was pregnant for the first time and had type one diabetes the first time. And I am now talking to you thinking I had a lot of empathy for I might not have had enough, like hearing about all this. Know?
Jenny SmithThat's a whirlwind of change. Not only is she pregnant, but now she's pregnant with something she has no background to managing. And she's gotta learn how to manage it through the variables of pregnancy as they shift and change. I I would imagine that postpartum was probably a lot more difficult for her than pregnancy was.
Scott BennerI wonder. She's she's, active on the Facebook page. She looks like she's doing terrific. She actually also was misdiagnosed type two, diagnosed type one. It's a fascinating story.
Scott BennerYou have to go listen to it if you haven't heard it. Let me
Jenny SmithWhich episode is it?
Scott BennerI'm actually gonna look right now because I don't know. I've, I think I'm at the point now where this I've done so many of these.
Jenny SmithCan't I know you're like, I don't know what episode. Have to stretch
Scott Bennermy head. Hold on. Let me look real quick. It is called wait a minute. That was January 2021.
Scott BennerI'm looking. Why do I not see it? It would be it would be helpful if I knew what year it was. Now that I know what year it is, I'm I'm getting down at it's called wine, beans, babies, q.
Jenny SmithUh-huh.
Scott BennerIt's episode Why'd
Jenny Smithyou come up with these names?
Scott BennerIt's episode four twenty five. Well, she was misdiagnosed as type two. So, you know, she still went on a wine vacation with her friends. Gotcha. Beans, I forget.
Scott BennerBabies because she was pregnant, because she was told she could go she could she was told she could get pregnant by a person who told her she had type two diabetes. And then she got pregnant as she found out she had type one diabetes.
Jenny SmithAh.
Scott BennerAnd a doctor with the last initial of q set her straight. That's where all that comes from. And you you just made I can't remember what the beans were. Damn it. It's a good episode.
Scott BennerShe's really lovely. Yeah. But I know her because she reached out right in that moment. Like, she found the podcast, and she's like, I don't know what to do. I just found out I am pregnant.
Scott BennerI have a baby, coming, and I have type one. So I was like, well, after you figure this all out and have that baby, you gotta come on the
Jenny Smithpodcast because Yes.
Scott BennerWhat's the hell of a story. Anyway, she's terrific and and so are we've covered this pretty well. I like this a lot. Awesome. We did a little, like, personal chatting at the beginning, so we didn't get to do one other thing I wanted to do, but I'll just put that on my list for
Jenny Smithanother day.
Scott BennerI thank you very much. I somehow find it delightful that your kids were much noisier than normal while we were talking about having a
Jenny SmithOh, and this was one child.
Scott BennerOh, oh, really? That was just one
Jenny Smithjust the four year old. The other one's at school.
Scott BennerOh, oh, oh.
Jenny SmithI can imagine he is so my mom came my mom came this past weekend to visit for my birthday.
Scott BennerMhmm.
Jenny SmithAnd she brought them a ring toss game, which has like, it's like a wooden base, and then it's got, you know, the things to, like, throw the rings over. And I'm expecting that either the whole thing was lifted up and dropped on the floor or the ring toss was being thrown from a larger distance, and maybe all the rings at one time were being thrown.
Scott BennerHow much of this do you think is the part of the country you live in? Is your mother prepping them for beer pong later? Is do you think that what this could be? I think it could be. I don't know.
Scott BennerWho knows? I I swear to you. It felt like two adults lifted up your dining room table and dropped it from about eight inches off the ground. Yeah.
Jenny SmithAnd the funny thing is, it was like like you said, I didn't flinch because it was like a background. Like, I don't it's just a background noise.
Scott BennerI thought I thought I'll have to bleep myself out because here was the thought in my head. Did she not hear that? Because you didn't blink. It was fascinating. Anyway, ladies, have a baby.
Scott BennerGet through all this. And one day, you'll either be as good at this as Jenny or as numb as Jenny is. I'm not sure how to put it.
Jenny SmithYes.
Pro Tip Series Directory
Scott BennerFantastic. I want to thank Ascensia Diabetes for sponsoring the remastered diabetes pro tip series. Don't forget, you can get a free Kontoor Next Gen starter kit at kontoornext.com forward slash juice box free meter while supplies last, US residents only. If you're enjoying the remastered episodes of the diabetes pro tip series from the juice box podcast, you have touched by type one to thank. Touchedbytype1.org is a proud sponsor of the remastering of the diabetes pro tip series.
Scott BennerLearn more about them at touchedbytype1.org. A huge thank you to one of today's sponsors, Gvoke Glucagon. Find out more about Gvoke HypoPen at gvokeglucagon.com/juicebox. You spell that gvokeglucagon.com/juicebox. I hope you enjoyed this episode.
Scott BennerNow listen. There's 26 episodes in this series. You might not know what each of them are. I'm gonna tell you now. Episode 1,000 is called newly diagnosed or starting over.
Scott BennerEpisode 1,001, all about MDI. 1,002, all about insulin. 1,003 is called prebolus. Episode 1,004, temp basal. 1,005, insulin pumping.
Scott Benner1,006, mastering a CGM, 1,007, bump and nudge, 1,008, the perfect bolus, 1,009, variables, 1,010, setting basal insulin, 1,011, exercise. 1,012, fat and protein. 1,013, insulin injury and surgery. 1,014, glucagon and low BG's. In episode 1,015, Jenny and I talk about emergency room protocols.
Scott BennerIn 1,016, long term health. 1,017, bump and nudge part two. In episode 1,018, pregnancy. 1,019, explaining type one. 1,020, glycemic index and load.
Scott Benner1,021, postpartum. 1,022, weight loss. 1,023, honeymoon. 1,024, female hormones. And in episode 1,025, we talk about transitioning from MDI to pumping.
Scott BennerBefore I go, I'd like to share two reviews with you of the diabetes pro tip series, one from an adult and one from a caregiver. I learned so much from the pro tip series when our son was diagnosed last summer. It really helped get me through those first few very tough weeks. It wasn't just your explanations of how it all works, which were way better than anything our diabetes educator told us, But something about the way you and Jenny presented everything, even the scary stuff, that reassured me that we could figure out how to deal with this and to teach our son how to deal with it too. Thank you for sharing your knowledge and experience with us.
Scott BennerThis podcast is a game changer. Twenty five years as a type one diabetic, and only now am I learning some of the basics. Scott brings useful information and presents it in digestible ways. Learning that pre bolus doesn't just mean bolus before you eat, but means timing your insulin so that it's active as the carbs become active took me already from a decent 6.5 a one c down to a 5.6 in the past eight months. I've never met Scott, but after listening to hundreds of episodes and joining him in his Facebook group, I consider him a friend.
Scott BennerListening to this podcast and applying it has been the best thing I have done for my health since diagnosis. I genuinely hope that the diabetes pro tip series is valuable for you and your family. If it is, find me in the private Facebook group and say hello. If you're enjoying the juice box podcast, please share it with a friend, a neighbor, your physician, or someone else who you know that might also benefit from the podcast. Thank you so much for listening.
Scott BennerI'll be back very soon with another episode of the juice box podcast. Jenny Smith holds a bachelor's degree in human nutrition and biology from the University of Wisconsin. She's a registered and licensed dietitian, a certified diabetes educator, and a certified trainer on most makes and models of insulin pumps and continuous glucose monitoring systems. She's also had type one diabetes for over thirty five years, and she works at integrateddiabetes.com. If you're interested in hiring Jenny, you can learn more about her at that link.
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