Navigating Pregnancy and Type 1 Diabetes

Hi readers! Just a quick aside to mention a great Kickstarter project that you may wish to support. Particularly if you have type 1 diabetes, are female, and plan to have a child some day. (Or if you already have a child… or are partners with someone who will have a child… etc.)

Before even trying to have Bean, I read a really awesome book by Cheryl Alkon called “Balancing Pregnancy with Pre-existing Diabetes: Healthy Mom, Healthy Baby.” It helped me realize that having a baby as a person with diabetes was possible and attainable. The stories included were inspirational.

Now, two lovely ladies named Ginger Vieira & Jennifer Smith want to add another book to our resources; focusing on the nitty gritty of pregnancy with type 1 alone with more prominent focus on the science and biology of what our bodies do during pregnancy.

However, they’ve hit a road block with publishers. Apparently the market for books about pregnancy with type 1 diabetes is too small to publish a book for.

So they have decided to self-publish the book with the help of Kickstarter. They are currently 2/3 of the way to their goal. If you have a couple bucks that you don’t want to use for your daily coffee run, consider backing this project.

Pregnancy with Type 1 diabetes is a bit of a cluster. So the more resources we have to support us (and potentially educate an old school obstetrician), the healthier we and our babies can be.

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Date Nights – Or Why D-Parents are Heros

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BSM Dining Hall – the place of many food stand offs with my parents.

I had a mentor growing up. She was someone who my parents met at a “families with diabetes” camp when I was around three years old. She also has Type 1, was a nursing student, and living life in the 80s as best she could with her new normal. I had a lot of interaction with her throughout my childhood, but she eventually moved away to travel and finish her education. We kept in touch via annual Christmas cards for almost 30 years.

She came to visit me a few weeks ago because she needed to be in the area for something. It was the first time I had seen her, in person, since I was about 7. Obviously a lot has changed since then, but we picked up conversation straight away based on the letters, emails, and cards we have sent.

People like her are important to me because they help fill in the gaps of what it was like to grow up with diabetes in a time where there were no glucose meters, continuous glucose monitors, and online support groups on Facebook. Since I was diagnosed at such a young age, I don’t remember much about the early years. I’ve heard pieces – I was in the hospital a lot, I was on a nasty regiment of Regular and NPH insulin (which doesn’t work for a picky eating toddler), I had a litany of doctors with terrible bedside manner, I didn’t have a glucose meter until 1985. (And was diagnosed in 1982.)

During her visit, she shared some more useful, though, humbling, information about my parents. When she met my parents at camp, they were both at the end of their rope. And I say this with an emphasis on “end.” I’m sure, somewhere in there, my brother was born, but I was definitely the special needs kid with high demands. This probably involved trying to make me eat something after the insulin had been injected and failing, causing hypoglycemia induced hospitalizations. Testing ketones by squeezing urine out of diapers. I’m not sure if they had to ever boil the test tubes of urine for sugar content, but I’m sure that was brought up at a doctor appointment. Nothing they did worked. (Though, I was surviving, so it didn’t all not work.)

The kicker bit of information: either one or both of my parents were with me at all times. I was never in someone else’s care for more than one hour. No vacations, no date nights. My mom was a stay-at-home-mom by default.

Camp gave them some new ideas and perspective. They were introduced to many nurses and staff members to help them realize that I could be normal and have a normal childhood, but I needed some extra help. More importantly, my parents needed a break.

My mentor offered to baby-sit numerous times while I was at camp. My parents always declined. Each year, my mentor was suggest it again, and my parents, again, declined. Finally, when I was five years old and on my 3rd year at this camp, my mentor suggested that I stay with her one evening… and three other nurses on staff who all happened to be in the same general vicinity. My parents thought about it and accepted. Yes. It was only a good idea for my parents to have a date night if I could have 4 nurses or nursing students (two of them with Type 1) look after me.

It wasn’t for a weekend away. Or a vacation in the Bahamas. It was a dinner date about 20 minutes away. Maybe 2 hours max.

I reflect on this now because I have Bean, who is approximately the age that I was when I was diagnosed. She’s inherited the pickiness from both her father and I. (Also, she’s a toddler.) She’s very active and happy. It’s easy for me to just call up a babysitter and say hey are you free for a few hours… it wasn’t that way for my parents. For at least 4 years.

 

 

Procrastination

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Yes. I know. I’m aware that I signed Bean up for this and need to take her to get blood drawn. But, considering she crocodile-rolls at the mere sight of a changing table, good luck trying to find a vein in her arm to draw a vial of blood. (And last I heard, Quest isn’t the greatest for pediatric blood draws.)

I keep meaning to call our hospital lab… but. Yeah. I’m about as enthused about taking her in as I am about finding out my latest A1c. (Silver lining – at least I’m not trying to get pregnant right now.)

Someone motivate me.

Postpartum Diabetes Challenges

There is something to be said about the hoops T1s jump through to maintain a healthy pregnancy.

The countless doctor appointments and tests.

Scrutiny to what you ate 3 days ago that made your blood sugars spike and drop uncharacteristically (while suffering from pregnancy brain)

The assumptions and misinformed medical staffers.

All of those ultrasounds that measure your peanut larger than he’ll actually be born. (Not a unique problem to PWDs.)

And then you have baby and all is right in the world because all of your hard work has paid off and you have this awesome little nugget in your arms who will unconditionally love you. YAY! Time to leave the hospital.

Wait…

Oh, no one told you that you actually are coming home with TWO children? A real-live newborn and a cranky chronic condition which just spent the last 10+ months being micromanaged and now wants to party like a college freshman on spring break? Welcome to the next stage of your pregnancy with diabetes care: the postpartum period.

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In addition to “normal” bits of new parenthood, like sleep deprivation, baby blues, and healing from childbirth, we have a whole set of unique challenges to consider.

Your blood sugars will be shit. 

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Thank those postpartum hormones and the fact that you no longer are sporting a placenta. Sometimes it comes as welcomed relief to those who were burned out by the constant testing and dosing. (Meh – #BGnow 180, #zerofucksgiven #sleepneeded) For others, it means downing a juice box every hour while 70 mg/dl seems to be your weekly average. But suddenly, a rebound of 320 shows up.

Tip: Write down your pre-pregnancy insulin doses and keep them in a safe, but easy to find, location. Once the placenta goes, so does your need to take 150% more insulin than usual. (Usually.) Having these doses handy will at least give you a starting point. And if it’s still too much, you can adjust with your medical pro from there.

Remember that these WTF blood sugars are temporary. I know it’s probably hard to go from super mega control to… not in a matter of 12 hours. But in the grand scheme of life with D, this is a small blip on your A1C’s radar.

Keep a basket of goodies near you at all times.

There are a ton of Pinterest posts about “nursing baskets” to keep handy if you are breastfeeding your baby. (Also applies if baby likes to nap on you after a bottle, etc.) These baskets generally have burp rags, a bottle of water, something to read, the TV remote, your phone, breast pads, lanolin, a blanket for baby, snacks… pretty much anything you would want in arms reach if stuck under a sleeping/nursing baby for several hours.

I would add for us PWDs: a glucose monitor with an extra vial of test strips, a full bottle of glucose tabs or your low treatment of choice, snacks you can eat with one hand and have a ton of protein (because oh, God, you will be hungry all the damn time), your continuous glucose monitor, if applicable.

For snacks, I liked anything with peanut butter, almonds, cheese and crackers, high protein granola bars, and my lactation cookies.

Refill your supplies before baby comes – or set up Auto-refill.

It’s one thing to have a screaming newborn and surviving on no sleep. It’s another to have to make an emergency stop at CVS with said screaming newborn because you don’t have any test strips. Of the three companies I have for refills, all of them have some sort of automatic refill option when your insurance says you can reorder. Medtronic automatically sends me my supplies and then invoices me, for example. Make this one less thing you need to think about.

Double check that all of your scripts are current as well. I went through a long process with Medtronic at year-end because my prescription authorization expired and no one could get a hold of my endocrinologist.

The Baby will still be there if you need to treat a low.

The baby will also probably be crying. And that’s okay. This was probably the hardest thing to do during postpartum – remembering to take care of me, even if Bean was screaming. Because I am no good at parenting and picking up a screaming child if my blood sugars are under 50 mg/dl. I was home alone with Bean quite a bit before returning to work. There were plenty of low alarms and times that I had to set her down for 2 minutes while I found a juice box. It’s fine. You are responding to baby’s needs by being able to actually respond to her needs in about 3-5 minutes. (And not drop her/fall with her.)

Disclaimer: Nope, still not a doctor. Consult one if you have more specific questions.

Diabetes and Breastfeeding (Part 1)

Disclaimers:

  1. I’m a huge fan of non-starving children. How you choose to feed your kid is up to you. After Bean was 8 months old, I combo fed with formula for daycare and breastfed at home. But I like breastfeeding and I’m still offering breastmilk to Bean (now 14 months old). I’m trying to throw as much information out there as possible, given that the PWDs have a unique set of challenges.
  2. I’m not a lactation consultant or medical professional. If you have more specific questions about your current situation, please consult one of these individuals. My suggestions below are based on advice I received as a new mom, the good ol’ internet, a couple books you can find in your library, and several other random sources. 

This post is going to be the first of several because it’s just a HUGE topic to cover.

Where to Start?

Congrats! You are pregnant and are looking forward to breastfeeding your new baby. Cool.

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First, get the notion out of your head that if you have Type 1 diabetes, you can’t breastfeed. Or you’ll automatically have low milk supply, or have sugary milk, or [insert other discouraging misinformation.] There are plenty of women who have pre-existing diabetes and successfully breastfeed their children. If breastfeeding troubles arise, diabetes can be an easy scapegoat. It usually is in other situations – why make this an exception?

So where do you start now that you’ve made the decision to breastfeed?

  1. Find a network of support. Let’s be real – breastfeeding in the first several weeks of life can be, heh, difficult. (And that’s putting it lightly.) I probably would have quit breastfeeding cold turkey during week 5 if I didn’t find a network of women to help answer my questions or keep me entertained in the wee hours of the morning during growth spurts. This network can be an online forum, Facebook Group, an in-person support group for breastfeeding moms, anything… Just make sure you find something.
  2. Find a good Lactation Consultant. See if you hospital has a referral system or an in-house LC. See if they make house calls or can visit you in the hospital/birthing center soon after birth. Interview them before baby is born, if possible. Ask your mom friends or local area groups for recommendations. Ask a doula collective for recommendations. Make sure you are comfortable with her.
  3. Find a La Leche League chapter near you and go to their meetings. Yes, before baby is born. These chapters are usually run by volunteer LCs or just super savvy moms. LLL can be a little “preachy,” so if that’s not comforting to you, check with your hospital to see if they have a weekly support group for new moms. Bonus: going to a support group after the baby is born will get you out of the house with the baby for fresh air and adult conversation!
  4. Bookmark Kellymom and Infant Risk Center on your phone. These were my most searched websites when Bean was a newborn. Particularly if I just wanted to know if something was normal.
  5. Download Lactmed or the paid version, MommyMeds. Helpful when trying to figure out if that OTC drug or supplement is compatible with nursing. (These are the iTunes links.)
  6. Pick up The Womanly Art of Breastfeeding. Check it out at the library first, if you’d like. I preferred my own copy because spit up happens. I didn’t read this book cover to cover because the tone was a little too “lactivist” for me. (No, your kid will not have a lower IQ if you formula feed…) BUT, it was a good manual to have on hand for troubleshooting a problem. And the tearsheets in the back are helpful.
  7. Expect that your blood sugars will be crazy during those first several weeks. Between cluster feeding, growth spurts, figuring out your new insulin rates, and sleep deprivation, your days of super tight control from pregnancy will be long forgotten… for at least a little while. I’m pretty sure I went through 3 gallons of orange juice each week for two months. Breastfeeding will burn calories similar to running around the block a few times. Treat your food and insulin intake as such.
  8. Learn to treat a low with one hand. Just… trust me on this. Juice boxes are super handy. Practice now.

 Baby Gear To Consider

Far From Silent

Silent night, holy night… 

Not really. Bean’s sleep patterns are about as erratic as my pregnancy blood sugars and keeping up with this blog.

Since it’s a particularly SLOW time at work, I figured I would check in. Say Happy Holidays and whatnot.

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By the way, I haven’t been completely out of the diabetic online community loop. Most of my time has been spent in Facebook groups helping future and current sleep-deprived moms on everything from eating carbs while pregnant (which is a huge undertaking) to breastfeeding. And of course, throwing my signature dry humor around to those who need a swift kick in the pants.

But the more and more I speak to these moms, the more I realize that there is a lot of missing information out there about being a mom with diabetes. So, between the holidays and the quiet space I have at work, I’ll post a few tidbits of information which I’ve learned over the past 14 months+. Maybe I’ll return to blogging in 2016? Well, let’s not get ahead of ourselves – I keep saying I’ll get back into dancing full time again, but that hasn’t happened.

Anyway, here is a photo for your troubles.

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Have a great holiday!

Musings of a New D-Parent

Just a random assortment of new mom w/D thoughts.

1) Between Bean’s middle of the night wake ups, my cranky CGM, and my leaky boobs, I get approximately 3 solid hours of sleep per night. My Dawn Effect is very confused.

2) My postpartum A1C was much better than expected. I also still spend a fortune on orange juice.

3) I have gotten more “No Delivery” alarms in the past 4 months than I have since I got on the pump in 2006. These alarms usually come when Bean is screaming at me for some reason.

3a) Bean also screams when I have hypoglycemia, a really high blood sugar, or when I have just finished a giant bolus to cover the meal I will eat cold 20 minutes later.

4) I’m really happy coffee has a minimal effect on my blood sugars.

5) Questioning my endocrine system because my hair is falling out in chunks? Nah – that’s just postpartum hair loss. I’m surprised I don’t have a bald spot.

6) I can’t keep up with the latest trends to keep Bean from getting diabetes. Though, we are going to try some Baby Lead Weaning, so I’m kind of excited to watch her gnaw on a rib when she’s older. She’ll probably also get some toast. Or a waffle.

7) My endocrinologist suggested we let Bean “cry it out.” Is that grounds to find a new endocrinologist? (An aside – I’m not opposed to it when she is much, much older, because… toddlers. But she is 5 months old, dude.)

8) Bean’s first word is probably going to be “high” or “juice,” or “meh.” (That last one is totally a word.)

9) I was reminded about TrialNet at my last endo appointment. Apparently I can test Bean for T1 markers, and later have her participate in clinical trials if markers appear – just needs a blood test and a lifetime of worry.

10) I’ve used my CGM or pump as a flashlight to check on my sleeping daughter more times than I can count.

11) I qualified for a free upgrade to the Dexcom Share system since I bought a new receiver in February. Handy, since I seem to have my phone near me than I do my Dexcom receiver.

12) Bean’s room is a black hole for CGM transmissions. I can leave Dex in any room of the house and go anywhere in the house and the signal still works. Except in her room.

13) If Bean is laying on me, or nursing, her diaper will always leak on the pocket housing my insulin pump.

14) When I say that I’m having a crappy pump day to M, I have to be more specific.

15) Thrush is a pain in the ass (or boob?) and just another fun thing to manage as a mom w/D. I assume because I’m a sugary sweet individual, I’m more prone to these infections.

What Goes in a T1’s Birth Plan

I figure I would throw this out there because I spent weeks looking for things to put into a birth plan for Bean and I. A lot of templates didn’t really put my preexisting condition into the mix, nor would it have fit.

My original plan was always to have a medicated birth. However, I wrote the plan thinking I would be admitted not in active labor and induced. That wasn’t the case, so my plan was slightly altered.

When writing your own, please understand that this is a rough outline for your ideal birth situation and shouldn’t be the only way it could happen. Bean’s birth didn’t follow my plan at all. In fact, a lot of things happened that weren’t planned; except we were both healthy and alive in the end.

Names and details are removed. Some of the vocabulary is unique to my hospital. “Golden Hour” refers to the hour immediately after birth.


Goals: A safe and sane delivery of our baby girl with a feeling of “normalcy” despite the high risk nature of the pregnancy.

Delivery Room Visitors: M will be the only labor partner allowed during labor and delivery. Visitors may be allowed in after the “Golden Hour” or up to the discretion of the parents.

Permitted post-birth visitors: [list visitors here] (i.e. Baby’s immediate family members)

Medical Devices: Jen would like to wear her insulin pump and continuous glucose monitor (Dexcom) throughout labor and delivery. She would like to use her own meter and supplies to control her blood sugars.

  • If Jen becomes incapacitated and is unable to administer doses, or needs to remove the devices for an unplanned C-Section, please consult the insulin pump for her current basal and bolus rates rather than her medical chart. (The dosing has most likely changed since it was recorded.)

Early Stages of Labor

  • Jen would like to use a birthing ball, position changes, massage, and walking to alleviate early labor pains. If a suite with a birthing tub is available, it would be preferred, but not required.
  • Jen prefers intermittent fetal monitoring to allow for movement and position changes.
  • Jen would like to progress without medication for as long as possible. Jen will ask for an epidural when she is ready. Please do not offer it in the meantime.
  • Jen will consent to an IV lock, but would prefer to drink fluids initially.

Late Stages of Labor and Delivery

  • Only essential medical staff and M in the room during delivery please. (e.g. no observers, medical students, etc.)
  • Jen would like to tear naturally rather than have an episiotomy.
  • Jen would prefer not to have forceps or a vacuum intervention be used unless labor is too far along for an emergency c-section and/or Baby’s life is in danger.
  • M will cut the cord after it has stopped pulsing. Immediate skin-to-skin for baby and Jen, unless Jen is incapacitated. Offer skin-to-skin to M as an alternative.
    • Jen and M will be donating baby’s cord blood to a cord bank. Please collect paperwork when appropriate.
  • Baby will receive all routine treatments (e.g. Vit K, Hep B vaccine, eye gel, etc.) and tests after Golden Hour bonding or when appropriate.
  • Jen would prefer that she and baby are not separated and post-delivery care be administered in the birthing suite. In the event of a NICU visit, M will go with baby.
  • Jen prefers that expressed breast milk or breastfeeding be used to treat any possible baby hypoglycemia. Please do not offer formula without consent or without trying breast milk first.

Post Delivery

  • Please involve M and Jen in as many diaper changes and baby baths as possible.
  • Jen would like to meet with a lactation consultant to help establish breastfeeding.
  • Jen and M would like to have baby’s feet and hand prints stamped for a baby book. They will provide a piece of cardstock for this.

Post Delivery Insulin Pump Settings

For reference, here are Jen’s pre-pregnancy pump settings.

[insert pre-pregnancy pump settings here]

Like Me

My endocrinologist sent me a note today reminding me that I was due for a litany of blood work, including a post-pregnancy A1C. So I guess five months is a bit too long to avoid my diabetes. And this blog.

I won’t say I’ve been having a ton of issues, but my diabetes care has definitely taken a backseat. You can’t really blame me – I have been a little busy.

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Yup – Bean is going to FIVE MONTHS in a little over a week. So far, we’ve experienced sleeping through the night, sleeping less than 2 hours in a night, leaky diapers, first smiles, complete meltdowns, squeals, giggles, screams, sniffles, colds, RSV, an ear infection, and an allergic reaction to one of the antibiotics she was given to treat it. She can sit with [lots] of assistance, rolls over, and sticks everything into her mouth. She is a very petite, but very happy little girl.

I’ve been asked a few times if she’s “showing any signs” of being like me. As if I don’t have enough to worry about. (Like, my own blood sugars for example.) But no – she’s doesn’t seem to be following in her mom’s health footsteps.

It doesn’t mean I’m not trying everything possible to keep that trend going, however. I’m still feeding Bean breastmilk exclusively. She gets bottles of pumped milk at daycare and then nurses when I’m with her. We haven’t gotten to a point where her demand is higher than my supply, so we’ll probably continue beyond my 6 month goal. I honestly hate pumping with the fire of a thousand suns. But if I have the supply to sustain her, why stop offering it to her? Especially if doing so can eliminate some risk.

We haven’t started offering solids yet because she’s not ready, nor interested. However, I’ve been exploring skipping gluten-based cereals and breads until she’s at least a year old. Research is mixed – so I’m undecided. I was definitely going to skip rice cereal and find other means to get her the nutrients she needs… because rice is a pretty sugary, empty grain for anyone. I suppose we’ll cross that bridge when we need to. Sweet potato and avocado seem way more fun anyway.

I’m sure I’ll get to a point where I’ll start checking her blood sugar in her sleep every so often, just to ease my mind. Some day she’ll understand why those juice boxes in the fridge aren’t for her. And why mom now has to hide all of her infusion sites on her back. (Seriously – she can always find them with her knees!) For the time being, we’ll proceed as normally as we can.