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!

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.

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?

The Sweeter Side of Pending Parenthood #dblogcheck

So, hey. Howdy. Hi. I thought I’d check in and let folks know I’m still alive. I was prompted to write after I saw a Twitter notification email about #dblogcheck day and thought, “hey! What a great way to get back into blogging.” Turns out it was two four days ago. Oh. Oops.

I’ve mostly been hanging around a chat board for the last, oh, month and half, which supports moms to be and such. I’ve run into a great group of ladies battling diabetes in some form; whether it’s T1, 2, or GD. Since we’re all collectively due around the same time, many of them failed their GTT recently and have now been thrown into the depths, somewhat blindly, of metering, diets involving low glycemic carbs, and 2 zillion doctor appointments. Since I’m kind of an open book when it comes to advocacy (I did blog for quite some time before the positive stick test), I do my best to offer real world advice when questions come up. And in turn, I’ve learned about what current treatments are for ladies with GD and T2, and what’s safe for pregnancy. (For example, Glyburide sounds a whole lot like NPH – and is just as volatile. Ugh.)

Personally, I’m feeling much more pregnant now that I’m nearly in the 3rd trimester. My MFM is very pleased with how I’m progressing, but that doesn’t mean I’m not taking more insulin than I ever have for meals… and I’m only going to need more in the next 13 weeks. My latest A1C is at my practice’s standard for non-PWDs, so that’s gotta say something, even though my 1 hour post-prandials are not in their target range. Let’s face it… they probably never will be. But – I always come down. Since the blood sugars aren’t a consistent battle, I can focus on things like Target screwing up my registry, washing and folding lots of little people clothes and putting them away, what to do about my back pain and expanding ribs, and feeling my little girl try to punch and kick her way out of my uterus. (Bananas still make her go crazy. As does sleeping on my side… sweets… breathing…)

I learned that my pump can give a maximum bolus of 25 units the other day. I may have to get creative in the next few weeks as I gave myself 24 units to cover my meager breakfast this morning. (And was still 141 one hour after the meal…) I half cried, half laughed when my MFM changed my breakfast carb ratio to 1:1.5. She told me some of her other T1s were on 1:0.5. In the back of my mind, I know I’ll get to that point, but I didn’t think it would be this early. Or that I’d be lucky and it wouldn’t happen to me. For the time being, I dial in my carb count and blindly hit “Act” twice to start the bolus without looking at the final number. I think I’d just freak out.

I feel like the 3rd trimester is when things can start to fall apart or go really well for me. Currently, my MFM is dead set on letting me carry to term and beyond pending nothing else is medically wrong. It’s a little different than conventional wisdom which basically states that if you have diabetes, you are getting induced any time between 37-39 weeks just because. I would love to be able to avoid to pitocin drip and I’m glad my MFM supports that. However, the little worries in the back of my mind still plague me. The idea that pre-eclampsia can knock me off my feet and out of the game is almost as scary as childbirth itself. Mostly because it’s something that just happens… with no warning signs or ways to prevent it or avoid it. Being the control freak that I am, I don’t know if I could handle it. And bed rest would bore me to tears.

Am I still dancing? Sort of. Back in May, I started working on a short foxtrot routine with my instructor for a performance in July (last weekend). As those 10 weeks progressed, I just got bigger and my lung capacity got smaller. Run throughs generally required a 5 minute break just to catch my breath toward the end. I think performing the routine at 26 weeks was a good idea. Any later and I don’t think I would have been able to handle the physicality of it. I also can’t turn without feeling dizzy or faint. (Yay equilibrium issues!) My exercise now comes from very limited, light, social dancing, and walking. I’ll be throwing prenatal yoga in there starting next week – hopefully. (I’ve been having a lot of trouble sitting as of late.)

Tomorrow, the hubs and I start interviewing doulas. We’re headed to a local event where you can meet a number of them at once and find out if any of them click with your birth plan. Our challenge is finding one who will help me through the first stages of labor naturally, but won’t try to push his/her ideals on us (or my doctors!) if we need medical interventions or when I call for my epidural. And as a high risk patient, I’m all about getting this kid out safely and sanely… even if it means throwing my ideal birth plan out the window at the last minute. If that person happens to exist, I’ll hire him/her on the spot.

Am I having a “normal pregnancy” otherwise? I guess; besides the litany of doctor appointments, blood sugar readings, screenings, and limited real estate remaining on my abdomen for infusion sites, of course. I hate maternity clothes and how expensive they are and if I could live in flip flops and yoga pants, I would. (WHY do the cheap maternity pants not have pockets!?) Our nursery is done, for the most part – namely because I didn’t want to deal with set up and building things if I were placed on bed rest later. I haven’t really gotten a ton of “snide comments” or “helpful advice” from strangers. I still visit Starbucks for a latte almost daily. (Half-caff of course.) No bizarre cravings – except I do enjoy the occasional doughnut and weekly trip to In n’ Out.

I can’t believe how fast this has gone. I’ve got less than 90 days left. On the flip side, I have less than 90 days left, and I’m just going to get bigger. X_x

Here is a sneak peak at her nursery, which I spent too much time making matchy-matchy. I don’t care – it’s adorable!

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Things I’d Never Thought About Until Now…

Now that my big announcement is out and I’ve been mostly open about my pending dive into motherhood this fall, the whole “pregnancy with T1 Diabetes” is really starting to hit home. And I’m constantly reminded about it every time my Dexcom BLEEEEEPPSSS with a low blood sugar alarm. This is a whole different ballgame, kids.

Let’s begin with why I haven’t been blogging as much as I should. Like every matriarch in my family, I’ve been “blessed” with knowing my child is growing inside me via morning sickness. (Scratch that – try “all-damn-day sickness.”) I’m on a collection of drugs that kind of take the edge off, but at 12 weeks, I’m still making good friends with my bathroom. (And not so good friends with food.) The challenging part here is keeping enough food down to keep my insulin needs balanced. Especially since throwing up dinner leaves me with an empty stomach and 6 units IOB. (Jamba Juice and I have become close recently.) Saddle the sickness with the ability to fall asleep at a moment’s notice and this blog is toast. (Mmm… toast.)

Despite all of the GI issues, my docs are relatively happy with my control. (HA!) They aren’t thrilled with all the lows I have, but I guess the alternative isn’t great either. (But I’ve had a number of those as well.) My medical team is actually just the high risk OB department that specialize in mommas with diabetes. They mostly work with GDs, but they are seeing an influx in pregnant T1s. (Right now, there are 12 T1s, with pumps, in the department and that’s the most they’ve ever seen.) I’m not doubting their experiences with T1 moms, but I find it comical that it appears not many T1s seem to use my hospital. Anyway – since my OBs are the only docs I see, they control my insulin pump ratios. Yes – the OBs. I don’t see a separate endocrinologist (though, there is one on staff in the department that I’ve met once), nor do I see my own endo until after my baby is born. The nurses on staff are all CDEs as well. Somehow, this works in my favor as I don’t have two different doctors giving me two different opinions on how my insulin should be working, and since all of my maternity care is 100% covered via my insurance, I don’t pay a co-pay. (That will come in handy later.)

There are some other finer points that I’m sure other moms-to-be don’t necessarily have to think about, but I do. Things like maternity clothes, for example. I can find some great deals on maternity pants online. Same goes for dresses. The thing is, none of these cheap pants have pockets. At all. Same goes for dresses, leggings, etc. Clearly, cheap fashion and pockets don’t mix and I’ll have to figure out something else for my gadgets. Or my favorite “issue” from this week – sensor and set placement during ultrasounds. I’m still placing my infusion sets on my lower abdomen because I don’t really have a “bump” yet. I needed to do a site change on Thursday, right before my NT scan and opted to re-place it on my left hip instead. It worked out because the set would have totally been in the tech’s way. Plus ultrasound goo and adhesives don’t sound like they’d play well with each other. Things like that!

Oye – is it October yet? I really want to meet this little bean who apparently likes sleeping upside down in utero and likes to consume all my food before I get a chance to process it. (Figures.)

In other news, I might start buying stock in all Orange Juice producers as I seem to go through 2 quarts every 4 days.

How Much Is Too Much Data?

I went to Sacramento’s version of TCOYD yesterday for the later part of the afternoon. (By the way, if there is one near you, I highly recommend going. It was only $20 and they feed you D-friendly catering with carb counts!) I was sitting in one of the forums on CGM technology and one of the questions asked stuck with me enough to break my blogging absence and write about it. (I promise… I have plenty to share… later.)

A CDE in the audience told the story of a patient who was diagnosed at the age of 8 and her parents put her on a Dexcom by the age of 10. From that point forward, the young D-ling obsesses over the spikes and valleys of her Dexcom graph; often sitting and waiting with a cup of juice in hand if her Dex showed a downward trend with a 120 mg/dl readout. “I know it’s coming!” the CDE repeated.

Panelists suggested the young patient wasn’t ready to have a CGM, especially if it was causing obsessive behavior. But I took to heart how many times I’ve checked my Dex in an hour while I was waiting for my high blood sugar to do something. Y’know, continue to elevate so I could justify a correction or see a downward trend so I can eat once more. And sometimes I become so obsessed with a stagnant high that I give up and correct anyway… which usually has detrimental results.

It’s very much like watching the Stock Exchange. If you’ve ever seen movies about Wall Street or watched brokers on the news shouting to “buy” or “sell” on the floor because people’s retirements are at stake… you know what I’m talking about. People can drive themselves nuts if they have a very aggressive portfolio to hopefully support their livelihood as an older adult. And then that fateful day comes when the market crashes and they lose everything. Gone. What now?

I can’t watch my portfolio… but I do study my Dex. Sometimes obsessively, and the consequences are a bit more extreme than losing your life savings. Especially now that my sugars have become more erratic.

On one hand, I’m lucky to have this technology at my fingertips. Last night, for example, Dex woke me up on 4 separate occasions for falling blood sugars. They were all legit… and sadly interrupted my already limited sleep. (Curse Daylight Saving Time!) But without Dex waking me up, would I have woken up myself? And when morning did come, I could see that this trend is becoming a regular occurrence, prompting me to reduce my carb ratio for my bedtime snack. (Never thought I’d ever see a 1:7.)

On the other, I find myself clutching my Dex for answers and finding frustration in the stable arrows. Yes – trending up or down arrows can mean trouble too, but those stable, do nothing, apathetic arrows really get to me. And I will hit that power button once… twice… four times… in one hour. Just waiting for it to do something. Am I really still 63 mg/dl and holding? Should I test AGAIN and treat? Or – it’s been two hours and I’m still holding steady at 180? Why won’t you start coming down?

So which is better? Is ignorance really bliss, leaving us powerless to our body’s trends? Or are we to take in as much data to educate ourselves, but while clutching a cup of juice and waiting?

PS: I did have a lot of fun at the conference. I got to meet Kerri, Chris, and Heather. And then listened to Manny and Adam (along with Kerri) give a real good push for the DOC and digital technology for diabetes. Way to go, y’all. And based upon all the photos that were taken of them, they are quite the celebrities. 🙂