Blame it On The D

I’m partaking in this year’s Diabetes Blog Week. Each post this week will be based on a pre-determined prompt constructed by Karen over at Bittersweet Diabetes. You can participate by visiting her website.

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The Blame Game – Wednesday 5/17

Having diabetes often makes a visit to the doctor a dreaded experience, as there is invariably bad news of one kind or another.  And sometimes the way the doctor talks to you can leave you feeling like you’re at fault.  Or maybe you have a fantastic healthcare team, but have experienced blame and judgment from someone else in your life – friend, loved one, complete stranger.  Think about a particularly bad instance, how that person talked to you, the words they used and the conversation you had.  Now, the game part.  Let’s turn this around.  If you could turn that person into a puppet, what would you have them say that would leave you feeling empowered and good about yourself?   Let’s help teach people how to support us, rather than blame us!  (Thank you, Brian, for inspiring this topic.)


I feel like this topic could be an extension of yesterday’s post. After all, isn’t the crux of the whole healthcare debate whether or not we made some bad life choice and therefore got diabetes as a result? The moment I mention I have diabetes, the questions start. Is it bad? Can you eat that? Why don’t you just exercise more? Why aren’t you fat?

The questions were more prevalent when I was pregnant with Bean. I remember going to an open interview event for local doulas. By the time we got to the meet and greet portion of the afternoon, I experienced a whole lot of side-eyes and strange questions from a group of women supposedly interested in lifting each other up. This wasn’t to say all of them were like this – the two who had worked with T1 patients at my hospital just weren’t available on my due date.

I had meet & greets awkwardly cut off because I was apparently delivering at the wrong hospital in the area (it has a level 4 neonatal unit and is one of the best children’s hospitals). I wasn’t really high-risk (pretty sure diabetes classifies you as a high-risk pregnancy). I probably didn’t love my MFM and I should try a family practice physician instead (um, no, I love my MFM because she lets me do what I want and family practice would just refer me there anyway). Oh, and the kicker – is my child going to have diabetes too? (Sigh, no. She has just as much of a chance of developing it as your children do.)

Needless to say, I didn’t hire a doula and the experience soured me to ever seeking out their services for any future pregnancies. There isn’t anything wrong with wanting to use a doula during the birth process, but I didn’t see how she could have helped me in my unique situation. You could see it during the meet and greets; the minute I mentioned I had a high-risk pregnancy, the shields went up.

I don’t blame them for being scared to take me on as a client, but I would have appreciated the honesty over the judgment. A simple, hey, y’know, not sure if I’m the gal to work with you because I don’t know a whole lot about your condition would have worked better than doubting I actually had a condition.

Also, now I have this song stuck in my head…

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Approval

Conversations a woman with diabetes must face when considering getting pregnant.

OB/Gyn:

“Okay, so when do you plan to get pregnant again?”
“Whenever. My husband and I are prepared now, but any time within the next year would be ideal.”
“No, really, when do you want to get pregnant again?”
“If it happens next month, it’s fine.”
“Ohhhh – I see you have T1 diabetes. And your A1c is not quite where we’d want it to be for preconception purposes.”
“Yes, I’m aware of that. But I’ve been through this already and know what’s expected of me.”
“When did you deliver?”
“41 weeks.”
“Whoooaaa! You must have been really good at what you were doing and knew your stuff to let Dr. [MFM name] let you go that long. But, still, your A1C needs work.”
“Yes, I’m actively working on it (lady, get off my back)”
“Well, are you sure you don’t want another form of birth control/pre-conception counseling? We even admit women with diabetes who don’t have great control of their diabetes, but your’s seems almost there.”
“No, thank you. I know what the expectation is.”
“So when do you want to get pregnant, again? Because since you have diabetes, you are at a greater risk of miscarriage so we want that A1C to be below 6.0.”
“…”

Endocrinologist:

[runs through insurance provided check-list] “…And you are still on [form of birth control]?”
“No.”
“So are you using any sort of birth control right now?”
“I’m tracking my cycles casually, but no, not really.”
[Something incoherent about A1C not being where it should be, greater risk for miscarriage, blah blah blah, I stopped listening.]

Blood Sugars:

“Oh, you don’t have any hormonal birth control in place?? WOOOOOO HOOOOOOO! ALLLLL THE HYPOGLYCEMIA!”

 

Well… they did want my A1C lower.

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.

Building a Capsule Wardrobe for 2016

In with the old and out with the new.

2015 was extremely busy for my family and me. (Hence why this blog was essentially abandoned for a year.) I was tending to Bean’s growth and development, adjusting to the new sleep regiment (or lackthereof), introducing solids, switching daycares, switching CITIES, buying a house, selling a house… oh and dancing in between in my “spare time.”

When I was nursing Bean full time, I bought a whole “nursing” wardrobe, separate from my maternity and regular wardrobe. Clothes that were designed for easy access for emergency roadside feedings and stretched in various directions. When summer rolled around, I stopped using the winter nursing clothes and just started using my existing clothes. These items weren’t meant to be stretched, pulled, and Lord knows what else I did to them. My clothes needed a redux, but I didn’t want to replace the zillions of items I had overstuffing my closet with more of the same. And I didn’t want to use the clothes I had because they all screamed “I have an infant at home… but I’m also a ballroom dancer so here is some glitter.”

That’s when I decided to look into Capsule Wardrobes; or a mini wardrobe made up of really versatile pieces that you totally LOVE to wear. Off to Pinterest I fled, researching a variety of ideas, color palates, and motivation to only have 33(ish) articles of clothing and shoes in my closet at one time over a three month period.

My challenges and potential hang ups:

  1. The premise of a capsule wardrobe is to change it out every season/three months. This assumes that seasonal weather is three months long where I live. It’s more like 5 months of Winter and Summer, then 1 month each of Spring and Fall.
  2. I generally maintain the same lifestyle for a majority of the year. I go to work; I social dance; I go out to eat here and there. It is the small wrenches – like a surprise theme dance or impromptu formal event that I really wouldn’t have something specific in my closet for at that moment.
  3. Honestly, a super versatile  wardrobe is made up of a lot of black and white basics, so I had a hard time finding ones with colors I liked to wear.

Nevertheless, the closet needed to be cleaned out.

This is probably the lengthiest step – getting rid of (almost) everything.

I mostly followed the ground rules I read about:

  1. Take everything out of your closet and chest of drawers (still working on this) and begin to divide up your existing wardrobe.
  2. Separate into piles or bins: a) things you LOVE and would change into that second; b) things that needed to be donated; c) things that you could sell/consign; d) things that needed to be trashed; e) the maybe/Seasonal pile, which will be sorted after some thought.
  3. Loungewear, PJs, workout clothes, clothes you paint in are all exempt. I also added my ballroom costumes (duh), some dance practice clothing, dance shoes, and special occasion dresses for events at the studio to this list of exemptions.
  4. Some blogs include accessories and handbags in their capsule limit. I chose not to, but I will be culling the stock pile I have.

Once this is done, you narrow down your remaining items to 33 articles of clothing and shoes. If you don’t have 33-36 items of clothing by the end of this, you set a budget and go shopping for some basics. (Tip: after Christmas is a KILLER time to shop sales for capsule basics.)

The Purge was enlightening. I often clean out my closet, but very rarely do I actually try items during those mini purges. They were superficial and I only donated items I simply didn’t wear. Since pregnancy definitely changed how clothes and shoes fit me, I had to try on everything I hadn’t worn in several months.

I discovered the following:

  1. I had multiples of tank tops and camisoles in all colors. Seriously. There really wasn’t a reason for me to have 8 black tank tops in my closet, but I did. (Sad fact: only two of them actually fit me properly and could be worn by themselves.)
  2. I have a bad habit of finding a cheap shirt somewhere and buying the same shirt in three different colors without actually trying it on before buying.
  3. The camisoles from #1 made me feel like a sausage. (Thanks pregnancy!)
  4. The sentimental and souvenir t-shirts were the hardest to let go. Especially since the Disney ones were so expensive.
  5. My feet have grown since having a baby. At one point before pregnancy, they shrunk. A lot of shoes I hadn’t worn yet no longer fit me.
  6. I found one tank top hanging in my closet inside out and I don’t remember the last time I wore it. So it had to have been laundered and then hung like that for quite some time.
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EIGHT! Eight black tank tops!

 

Sell box on the left and Seasonal/Maybe pile on the right.  

Trash pile on the left and donate pile on the right (which got bigger after I took this.)

 

So many hangers. Current state of my closet. Still more work to do.

I still have some more work to do over the holiday and then figure out what was going into my Capsule for the next three months. But even if I don’t keep it to 36 pieces, at least all the items that do not fit or aren’t in good condition are out of my closet.

Where I am shopping for my basics and filler items:

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.

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]

Labor, Delivery, and Diabetes

So, I’ll try to keep this short. But we know that won’t happen. Nor will I withhold any details. I figure my story isn’t the typical “mom with diabetes” tome, so I might as well let y’all know what went down.

Let’s start on Monday, October 27th – right before M and I went to bed. In less than 24 hours, I was going to be admitted and induced because my docs couldn’t let me progress any further in the pregnancy, even though there was no indication that something was wrong. However – diabetes and stuff. But, at nearly 41 weeks pregnant, I was pretty much done giving myself insane amounts of insulin for meager meals and feeling like an emotional hot air balloon. I still cried before bed, mourning the fact that M and I weren’t going to be a twosome anymore and that our lives would be upside down for the next 18+ years. But, let’s face it – we needed that change. And I think we were more than ready for it. (Ask me that question now…)

At around 11:30 pm, I started battling heartburn really bad. Typical for me at this stage of the game. Except this felt like stomach acid was rising out of my throat with every minute. I ended up losing my dinner and whatever else was in my stomach at the moment, but I felt a bit better post-puke. Back to sleep I went after another quick BG check.

Then, at around 1:30 am, my water broke. But not just broke… more like a dam ruptured. I heard a very loud “pop” and, as my NST nurse predicted, out pours a ton of fluid. So, of course, I panic and run to the bathroom, waking up M in the process. I’m not really sure how I’m supposed to pack or anything because it seems that the fluid just won’t quit. M begins loading up the car while I jump in the shower. Or at least try to. My mind is racing because there was meconium in the fluid, so I feel like my time is limited.

I pop out of the shower and try to keep a calm head. But, here come contractions. Crap – that was fast. I’m going to have this kid in my hallway! Better change my infusion set. (Wait – what?)

Yeah – the plan was to change out my infusion set and go in with a fresh batch of insulin before heading into L&D for the induction. So my pump was nearly on empty and about 2 days old. I didn’t actually think I would need to change out my pump site while having contractions. 1st labor achievement unlocked.

M and I got on the road around 2 am. I continued to have fairly strong contractions in the car at around 2-5 minutes apart. (Yeah, that escalated quickly.) I called my parents (yes, at 2 am) to let them know the scoop and tried to focus on the fact that we weren’t going to be stuck in traffic on the way to the hospital. (Hooray?) Upon arrival, I stumbled out of the car with a small bag and slowly walked up to L&D while M parked the car. (I love my hospital, but not the parking situation.)

I checked in with the nurses station and waited for the triage nurse to take me in back for an exam. I start having contractions again as we’re walking back, but they insisted I still stand on a scale and try to pee in a dixie cup. (DEAR GOD, WHY!?) Yeah, the dixie cup wasn’t going to happen. Vitals taken, monitors hooked up, and contractions are still happening and getting worse. One of the residents I saw in the clinic quite often happens to be on-duty for the evening (yay familiar faces!) and lets me know that I’m already 4 cm dilated. Hooray! Give me the damn epidural. (M: Jen are you sure you want to do that now? Me: YES, damnit!) For the record, I wanted to progress naturally and med free up until about the half way point. Since I was being admitted nearly at that point already, I figured what the hell? I’m going to want to try and sleep for the rest of the evening.

Epidural was placed, monitors were hooked up and I was sitting fairly comfortable. The neat thing about my hospital is that when monitors are hooked up, the results are broadcast to all of the nurses stations on the L&D floor. This comes in handy if there is a problem with mom or baby. Turns out my birthing suite would be a popular joint for the evening. Sometime after the epidural was placed, E’s heart rate was getting hard to track on the monitors. The resident asked if they could place an internal monitor on her head – I was numb from the waist down, so might as well. E’s heart rate didn’t pick up, even after finding it on the monitor. Suddenly, I’m being pushed to my side, being given oxygen and a shot in my arm, and there are about 20 people in my room. Da fuq? E’s heart rate recovers, but I’m asked to stay on oxygen for a while to keep her stable. And then try to sleep and stuff. But I’ll need to wake up every hour to test my blood sugar.

Blood sugar-wise, the resident had me lower my pump basal rates to about 25% of what I had been taking in the 3rd trimester. It seemed a bit dramatic, but I figured they had their reasons. Labor is like running a marathon, and I didn’t need to be dropping low if I couldn’t eat anything. Turns out the basal reductions were a bit too much as I averaged around 140 mg/dl for most of the labor process. The residents didn’t really like that and kept asking me to correct with insulin on-board, but I had to explain what a terrible idea that would be to stack insulin without food being served. They generally agreed with my judgment, but justifying my choices every hour on the hour got annoying.

Morning arrived and the nursing/resident staff changed. The hospital delivered breakfast (chicken broth… ugh), which I couldn’t eat because I started feeling really nauseated. Blood sugars were still staying put at around 140, despite corrections, and now the staff wanted results every half hour instead of an hour. I’m not sure what this was supposed to achieve since I don’t tend to see corrections work until after about an hour. Add that I haven’t eaten anything substantial since, well, Monday’s afternoon snack, I was sleep deprived, and dehydrated… no wonder my blood sugars were being so stubborn!

E kept things interesting by having another heart rate decel at around 10:30 am… right as my mom was walking into my birthing suite. Awkward. More oxygen and side-lying for me as M runs out to get my mom back out to the lobby. I guess the memo about M being the only person allowed in my birthing suite during labor didn’t get communicated to all staff.

At around noon, I get checked again – I’m nearly 10 cm and 100% effaced! Woo hoo! Except, E is still sitting high and I’m not quite complete enough to start pushing. So the resident asks that I sit tight and labor down. We get a few practice pushes in, but it’s still pretty early to start things for real. So we wait. Again. Even with the epidural, there was a lot of pressure from the contractions. I’m also uncomfortable and really, really thirsty, and really just wanted to get the show on the road.

Another resident came in around 1:30 pm to examine E’s placement because there was concern she was facing sunny side up. (Face up, rather than face down.) After a failed attempt to try and grab E’s face, I started cramping up really bad. Like, split me in half bad. Where the hell was my epidural and why wasn’t it working? Naturally, E’s heart rate drops because I’m in a panic. Even with oxygen placed, I can’t breathe deep enough to stabilize her. So the resident says “Okay, Jen, we need to take you to the OR.” Cue ugly cry, more panic and another 20 people in my birthing suite. I hear M off to the side reassuring me he’s still nearby. Monitors are disconnected and I’m being wheeled off to the OR. En route, the anesthesiologist is giving me a massive dose of pain killers to prep my lower half for surgery, which kills the pain I was experiencing. But I’m still uneasy, to say the least. This wasn’t part of the plan. This isn’t what I wanted. I was so close!

E’s heart rate stabilizes in the OR, which doesn’t mean surgery yet. M joins me in the OR decked out in scrubs. The chief OBs aren’t optimistic because they still aren’t sure how E is facing. I was ultrasounded and examined again by multiple people (glad I’m not shy in that regard) and they decide to let me try practice pushing again to see if E’s heart rate can handle it. Nevermind that I’m completely numb from the rib cage down and the docs are all asking me to push. (Or in my mind, pretend to.) No dice. E is too high in the birth canal and her heart rate continues to drop after pushing. So – C Section it is.

E came out screaming at 2:01 pm. I saw her briefly before they rushed her off to NCIU. M followed her while they stitched me back up and wheeled me off to recovery. One of the chief residents informed me that this would have been a C Section delivery anyway as E’s cord was sitting right by her head. If I had pushed her out, the cord would have compressed all the way down the birth canal. Scary to think about now, so I’ve come to terms with how she was delivered. But I didn’t get to see her for a good four hours. The NCIU team wanted to keep her under observation because my A1C before delivery was one tenth of a point over what they want their pregnant diabetics to be sitting at prior to delivery. (Sigh.) Plus – there was the whole meconium thing.

I get transferred to my hospital room after about an hour in recovery. I was feeling pretty awful, nauseated, but still hungry and fighting the high blood sugars I was having during surgery. I decided to switch my basal back to my pre-pregnancy rates because I didn’t feel like the labor doses were sufficient enough. However, explaining my reasoning to the nursing staff was a pain in the ass; especially when they needed to record EVERY dose my pump dispenses upon every hour. I know this was just a way to cover their behinds because I was manning my own device, but the hourly checks while trying to recover from surgery didn’t allow much sleep. Plus E was delivered to my hospital room at around 7:30 pm that night. And I still couldn’t walk… and still hadn’t eaten anything all day. (Or when I tried, I threw it up.)

I’m not sure how the three of us survived night one. I’m pretty sure the pediatric staff asked if we wanted to give our daughter her first bath… at 1:30 in the morning. (Nope!) I was woken up again around 3 am to see if I could stand up. (I couldn’t.) My blood sugars finally started to regulate a bit and the night time resident finally said stop checking hourly. And by morning, I was allowed to have my first real meal in over 24 hours. (And I kept it down.) My feet and legs were about three times their normal size from all of the fluids and surgery, but somehow I managed to start walking around with assistance. And then eventually on my own. This made it a bit easier to tend to E and give M a break. We had visits from the grandparents here and there.

We were finally discharged on Friday at around 4:30 pm – which allowed us to sit in traffic… in the rain… on Halloween. Luckily, E slept through all the traffic. We’ve been surviving ever since. (With lots of coffee.)

Congrats on making it through this wall of text! Here is a photo for your trouble.

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Pregnancy Brain Is Real

Confession – I refill my little 150 ml cartridges without doing a full site change if I’m under the 3 day mark and my site is working fine. Since real estate on my “love handles” is limited, I can’t be changing my site every 18 hours – which is now how long it takes me to get through a full reservoir of insulin. (Yeah – imagine that… that placenta be crazy.) Plus – I’d be going through boxes of infusion sets faster than my insurance would cover them. So – I cheat.

Most of the time, I go through the second refill before the 72 hours is up and I’m in a place where a site change is appropriate. (I get especially lucky with site-free showers!)

Yesterday, for some reason, I refilled in the morning again and went about my day, assuming this was the last 24 hours I could have this site in place. I confirmed on my Prime history that my last refill was done on the 21st. (Tuesday.) It was now Thursday, so that means I could safely go through the day with this existing site and finish up the remaining insulin. Cool.

My blood sugars were fine up until the evening. My MFM changed my dinner ratio to 1:0.5 – I couldn’t fathom giving 80 units of insulin for a cheeseburger, so I opted for the “protein-style” lettuce wrapped cheese burger instead. And a few fries. (I still need SOME carbs here, people.) 13 units or so later and my one hour check was 84 mg/dl. Kinda low for an hour check – so I snacked to appease the 10 units remaining on board so I didn’t free fall into the 40s like I typically do.

Instead, I sky-rocket. So I correct. And correct again. And nothing. The BGs stay in the 190s-200s for a good two hours after multiple corrections, but I apparently have around 5 units on board, so I just have to be patient, right? Cue hormonal ugly cry before bed. I did kind of want sleep tonight, but I’ll be up obsessively looking at my CGM to make sure I’m coming down. I’m really mad at myself for screwing this up, even despite my best efforts to be “good” and eat something d-friendly. (To be honest, I didn’t really miss the bun.)

At around midnight, I start noticing my site is sore. Seeing as how I can only really successfully sleep in two positions these days, not having that one side to roll over on did keep my insomnia active. Well – maybe the site is bad and I need to change it. When did I insert this thing again.

I check Prime history again. I refilled on 10/23, 10/21… and 10/20. Monday. This site is from Monday morning and now going on over 4 days old.

Oh.

Midnight site change it is. I corrected, again, and saw a slow, eventual, downward trend occur before my imminent crash at 4 am. (More of a basal issue than anything.)

On the flip side, I only really have to care this much about a blood sugar in the 190s for a few more days. But I am really shocked that it took me this long to forget about a site change.

Still here.

Still pregnant. Woo.

For those keeping score at home, I was due 2 days ago. She’s got about 5 days left before we call in for reinforcements, but she seems really happy in there. At this rate, she’ll be in college before she’s actually born.

I know this isn’t the norm for PWDs. I’ve said time and time again that if I had a more conservative, c-section happy, OB, Meatball would have been born two weeks ago. (Via c-section.) My MFM attributes my successful blood sugar management to make her feel confident allowing me to spontaneously go into labor. However, now that I’m overdue, I feel like that micromanagement has completely bitten me in the ass since I’m facing an induction situation anyway. Which is what I wanted to avoid.

The Not-so-Glamourous Life of a Pregnant PWD

I realize that I’ve abandoned the DOC ship for a number of weeks, and I assure you that everything is fine. I’m (still) pregnant with a little under an estimated 4 weeks to go. (Give or take.) Baby Meatball is growing on track and passes her NSTs with flying colors at her twice weekly checks. I’m still working (ugh) and plan to until week 39 because I’m a masochist because I have a four-month work leave to take advantage of and want to spend as much time with Baby upon her arrival as possible. Though – the thought of “lounging” on my couch for two weeks watching Netflix sounds so appealing at this moment. (I say lounging loosely, as it’s pretty much uncomfortable to sit in any position at this point.)

Besides the usual pregnancy symptoms of heartburn, swollen feet, general fatigue, a sense of foreboding, and a tendency to want to eat ALL THE THINGS and then nothing at all, there are a litany of other joys of pregnancy that only someone with diabetes can understand.

1) Doctor appointment burn out: Seriously, I never want to see my OB’s office again after I’m done with this pregnancy. The nurses and I all know each other on a first name basis because my blood sugar records are usually the talk of the office on Wednesday. Since week 32, I’ve been heading to that office twice a week. Some weeks, it’s three times, however, that’s only because they’ll sneak in a growth ultrasound here and there. Don’t get me wrong – there is no mystery to how my kid is progressing and I really don’t have any “unknowns” which many first time moms probably experience. And if I do have a weird symptom pop up, I’m most likely going to be checked, ultrasounded, or monitored within a day of the concern. But yeah – the act of heading in to your doc’s office all the dang time is pretty draining. Especially when you are huge and still trying to work.

2) Striving for a “normal” delivery: The term normal is used very loosely here. Most moms will tell you that there is no such thing as a normal delivery and some ladies can get hung up on wanting the perfect birth – sometimes it happens and sometimes it doesn’t. I realized 3/4s of the way through this pregnancy that there were too many factors involved here that having that “perfect, magical birth” which so many doulas and midwives will write about was probably damn near impossible. And I was fine with that. I completely own the fact that I have a high risk pregnancy.

My biggest issue right now is trying to convince nursing and hospital staff that I can have a low-risk birth in spite of my complications. That I am more than just my chronic illness. The hospital we’re delivering at is pretty baby friendly, so long as you are low risk. I’ve been told this countless times in classes by nursing staff – sure, you can have a natural birth with little intervention… oh, you have diabetes? Oh well… um, yeah, expect to be wired up to everything possible. But there is no reason given other than I have a chronic illness. It’s a bit like when I was told at 22 that I had to be on all of these additional medications for “preventative purposes.” And when my lab work came back indicating all systems were normal, I was told to stay on them because there really wasn’t any harm in not taking them. Pshhhh. I’m prepped to advocate for myself and my child, but I really don’t want to have to fight while having contractions.

3) (Lack of) Sleep Training: Nothing will prepare a PWD mom for the many sleepless nights with a cranky newborn better than a cranky CGM. Obviously, this only applies to those who actually have one, but the whole lack of sleep and getting up in the middle of the night multiple times is pretty commonplace for me. I get up more often because of low and high alarms (all mostly legit) than I do because I have to use the bathroom. (But if it were a high blood sugar, I’d be doing that anyway.) And hell, it’s been proven that PWDs don’t sleep anyway, so I figure I’m pretty prepared for these every 2 hour feedings. (Both for me and for her, apparently.)

4) Shrinking real estate: Again, only really applies if you are a pumper/CGM user. I’m finding that as my belly gets bigger, the places I can stick an infusion set and CGM sensor are shrinking. It seems counterintuitive, but who wants to jam a 9mm cannula into really thin, stretched out skin? It’s like poking a hole in a balloon. No thanks. I also never thought I’d regret the placement of the tattoo on my left love handle so much.

5) A love/hate relationship with food: The average woman can gain up to 25-30 pounds during pregnancy. But let’s be realistic. Between the cravings, aversions, hormones and so forth, someone might want to dig into that pint of ice cream for breakfast, lunch, and/or dinner. (For some reason, ice cream just tastes better while pregnant.) Then there are those of us with broken pancreases who need to supplement our cravings with insanely large doses of insulin. Insulin costs a lot of money, so if I have to blow through 150 units in less than 18 hours, I really hope I get at least three meals out of it. And – I don’t really want to try and carb count an entire pint of Ben and Jerry’s. I guess I’ll have some quinoa. So not exciting. Whomp whomp.

Bonus #6) Burnout and Diabetes Fatigue: Probably the one thing I worry about the most. The moment that I deliver that placenta, I’ll stop caring about my blood sugars just because I’ve been micromanaging everything for SO LONG. The longer I run lower than usual, the more severe my hypoglycemia unawareness becomes. It doesn’t help that I want to chuck my CGM out the window on the way home from the hospital. (Not really – maybe just shut it off for a few days.) Besides, I’ll have a little person to take care of – who is going to have time to check me?