Everything I Wish I Knew About Postpartum with Type One Diabetes

Postpartum is a rollercoaster at the best of times, but layer on a long-term chronic illness that requires 24/7 ongoing maintenance? That’s what I call a fun time.

It’s not all doom and gloom though, and it’s definitely survivable, as proven by the thousands of amazing T1D women who have gone through it and come out stronger on the other side. Since I’m now wrapping up my first two months with a newborn (how?!), I figured it was a good time to look back on everything I wish I had known about postpartum with T1D and share my findings.

Diabetes will no longer your first or biggest priority (most of the time)

It might seem obvious that your newborn baby will be your biggest priority in postpartum, but it’s almost comical how quickly diabetes goes from being all-consuming in pregnancy to pretty much being an afterthought in postpartum. Unless I’m dealing with a severe low or an insulin pump issue, I fit diabetes tasks around recovering from birth and looking after my baby now.

Pro-tip: I was against getting an Apple Watch for the longest time because I didn’t want yet another thing beeping at me when my blood sugar was low, but I recently caved and got one to be able to see my Dexcom readings on my wrist while taking care of the baby. It’s been so helpful—I definitely recommend it to any other new moms! No more struggling to pull my pump out of my pocket or look at my phone to see how I’m trending while juggling a sleeping infant!

2. The first few weeks will have a lot of lows

Between the hormone drop that happens when your placenta comes out to the constant feeding in the initial weeks of having a baby, you’ll likely experience a ton of lows in the first two months (especially if you’re breastfeeding). In fact, I don’t think I’ve ever had another period of my life with so many lows. On average, I’d say I had about 5-6 moderate lows a day for the first month with my baby, many of which happened while actively breastfeeding or right after. It tapered off to approximately 1-2 lows a day in the second month, but that’s still quite a lot of lows to manage. Which leads me to point number 3…

3. Put snacks and diabetes supplies everywhere!

Before having a baby, I kept my low snacks and pump supplies in the same spot in the kitchen so I always knew where to find them (I also hate clutter). Now that I have a baby and have been experiencing more lows, I have snacks in every room of the house, every purse, my diaper bag, extras in the car…you get the idea! I also put together a small diabetes kit for my diaper bag which contains everything I need to change my site or do a manual injection while out and about. I wish someone had told me to do this before having my baby because there were many times that I finally got the baby to latch only to realize my blood sugar was low and nothing was nearby, forcing me to call for help or make the choice to wait it out. Don’t be like me and plan ahead now!

4. You might need to find new places to put your diabetes devices

I didn’t realize that my favourite insulin pump storage spot—inside my bra—was about to be out of commission once I had a baby. Wearing jeans was also not high on my list postpartum, so I quickly realized I needed to order some leggings and jogger pants with side pockets to hold my pump. Now that I’m eight weeks postpartum I find I can fit my pump into my bra again if I’ve recently fed or pumped, but it’s not always a sure thing and can be uncomfortable as my milk refills. I’ve also had times where my pump is in my bra and then I put my baby in his carrier where he quickly fell asleep, and it wasn’t until I needed to bolus did I realize there was no way to get to my pump without taking my baby off (the last thing you want when they’re finally sleeping). So far, pant pockets have been the solution for now.

Additionally, I’ve had to be mindful of where my insulin sites are placed on my body so they don’t get squished when wearing the baby carrier, which caused a kinked site at one point (and can just hurt when digging in).

My kinked site after wearing the baby carrier on top of it for a few hours

5. Turn off all unnecessary diabetes alarms

I’ll never forget the time I spent an hour rocking my baby to sleep, placing him in the bassinet (a dangerous task), and finally crawling into bed only to have my pump, my iPhone, and my husband’s phone all go off at the same time letting me know my blood sugar was quickly dropping. Cue the baby waking up and me wanting to throw my pump and all connected devices out the window.

On that note, I recommend turning off all diabetes alarms besides the ones you really need. For me, I turned everything off except the urgent low alarm, which you physically can’t turn off with the Dexcom G6 (or else I probably would have, lol). It’s a real shift from all the alarms I had on during pregnancy, but I’ve found they can be a real nuisance and are just not necessary in this new phase.

6. Pause on the prebolusing

Before baby, I was a religious preboluser, even before getting pregnant. It’s one of the things I credit for helping me get my A1c into the 5.0% range. But when you have a new baby, prebolusing becomes a real pain in the butt and has gotten me into sticky spots where I have insulin on board but didn’t eat in time/as much as I thought because the baby needed me. After a few lows caused by optimistic prebolusing, I decided it’s a tool that can be shelved (for the most part) until things are a bit more predictable.

7. Err on the side of highs, not lows

I spent most of my early diabetes years battling high blood sugars and as a result, I genuinely think it caused me to develop a bit of PTSD towards having highs because I would always get in trouble from my healthcare team (read more about that journey here). Because of that, throughout adulthood I’ve always preferred to err on the side of being low rather than high (for example, opting to bolus more aggressively if I’m not sure of carb counts).

However, now that I have a baby I’ve had to become a lot more comfortable with blood sugars that are higher than my normal range, solely because having lows makes it a lot harder to look after him and can create dangerous situations. I’d rather have my blood sugar go up to 10.0 after eating now rather than hover around 4.0 if it means I can ignore diabetes for a bit these days. I still handle any true highs and try my best to stay in range, but I don’t strive for the same level of control as I did before the baby came.

8. Newborn babies can and will grab pump tubing

Pretty self explanatory, but I was surprised that my baby could grab my pump tubing basically from day one, and their little hands have an insanely strong grip. As a result, I have to be careful where I put my sites and also be mindful of where my tubing is when feeding or holding him so he doesn’t accidentally rip my site out.

9. Schedule a six-week check-in with your endo before (or shortly after) giving birth

Transparently, I haven’t actually done this, but that’s why I’m including it on this list! I wish I had set up a check-in with my usual endocrinologist (who I love, by the way) before the baby arrived. I was seeing a special endocrinology team throughout my pregnancy and was surprised to discover they don’t offer any kind of follow up after you deliver, it’s on you to reach back out to your doctor and get something booked or else you’ll just be in limbo (at least at my hospital this was the case). With all the changes happening and the lack of attention you’ll be giving diabetes with a newborn, I think having a six-week check in with your endo to help you manage everything is a good idea.

10. Create routines and plan ahead whenever possible

The biggest tip I can give any new mom with diabetes is to try to create routines and schedules so you can automate things and not have to think as much throughout the day. For me, this looks like having a recurring weekly grocery order so I know all my key items are stocked up, prepping a few meals and snacks for the week on Sunday afternoon when the baby is sleeping, and aiming to change my pump sites on Wednesdays and Sundays so I don’t forget. Since eating well is especially key for T1D moms, I’ve found that creating some structure and planning ahead in this area has helped me continue eating healthy and managing my blood sugars as best as I can right now.

Bonus: Give yourself lots of grace and flexibility

Okay I lied, this is probably the biggest tip I’d give to any other new mom with T1D, and it’s something I’m constantly having to remind myself of. Having a new baby can be really hard. Diabetes is hard. Put them together and you’ve got a whole lot to manage. Transitioning from managing type one diabetes like a hawk throughout pregnancy to suddenly realizing you forgot to bolus for the meal you ate an hour ago can be emotionally challenging, and it’s easy to feel overwhelmed and mad at yourself. Since having my baby I’ve found myself in situations I never would have gotten into before, simply because I was always thinking about my health back then and I just can’t right now.

To illustrate this, in the past eight weeks I’ve gone 5+ days before changing my pump site several times, largely survived off of packaged snacks, forgot to pick up my insulin from the pharmacy for over a week, and have had more blood sugars above 10.0 than I have in the past two years. But it’s okay because I’m doing my best and my baby comes first right now. I still try to prioritize myself and my health, but I’m also working on giving myself grace and flexibility for the balls I drop in this phase. It’s okay to let things slide a bit on the diabetes side sometimes because it’s a lot to manage at the best of times. I’m proud of myself for keeping things somewhat under control and know that it will get easier to balance everything as the time goes on.

If you’re also a new mom with T1D or about to be, you’ve got this! It’s a lot to manage, but in some ways it’s nice to put diabetes in the backseat for a little while after prioritizing it for so long. I’m sure it’ll be a bigger priority for us all again soon, but for now just enjoy the time with your newborn!