Another Update!

I will start with the not-so-pleasant details: mainly, diabetes. I feel know that recently my self-care as far as blood sugar goes has been lacking at best. Although I am not in any immediate danger as far as highs go, it is the highs that have been haunting me. I stopped wearing Dexcom (and then my transmitter died, but that's another story). The highs are not ridiculous, but they are highs nonetheless. I want better and deserve better. More adherence to low-carbing as well as some old-school logging is needed. I am adamant about living healthfully with diabetes, having more babies, and enjoying life, daily, and in the long term. And maybe I am being too hard on myself. At the same time, however, I have done better, know I can do better, and wish to do better.

OK, on to the awesome stuff: 1. I got four! remote jobs (teaching, writing, editing in the sciences). They are perfect and I love working from home (although I hate waking up at 5 am to get shit done). Sometimes I wonder if I am taking on too much, but it is a good problem to have in my book. ;) 2. I traveled to Peru (just B and I) recently. It was great - and I did it while using a breast pump every 3-4 hrs. - which was a pain in the ass, but I was able to continue breastfeeding when I returned from the trip. Baby will be six months later in May, so I am happy and proud of that. I became a mom and things changed, but I did not lose my wanderlust, nor did I lose myself, while maintaining a commitment to do what is best for my relationship with my husband, as well as for my daughter. All this makes me happy. 3. Baby is awesome; I may be a bit biased, but she is so beautiful and smart :) I want another. Soon. A large part of my strong desire to keep vigilant about diabetes management revolves around my kid (and future arbitrary kids). I also realized, however, during my pregnancy with baby A, that I deserve it too. I deserve normal blood sugar as much as possible. I feel better in normoglycemialand and I want to expect to be healthy for decades, despite diabetes. I understand also the normality of the ebb and flow that diabetes is. I respect biology and know I cannot be perfect. However, having found what works for me (as far as maintaining very tight control), I would now rather always eat low carb and succeed more consistently BG-wise, rather than struggle to eat whatever and feel like a failure or be constantly on edge about my BG.

It is interesting to me, the evolution in self-care I have undergone in the last decade. This applies to diabetes management, emotional aspects of living with diabetes (as well as growing up in general), becoming a mother, and making non-traditional career choices. I am excited to see what comes next.

Hello 2017

I am back and happy to write an update on life, travel, baby, pets, diabetes and all that! Let's organize;

1. Life

A lot has happened, so I will touch upon just one major thing concerning my work. I resigned from my job. That's a biggie, no?? Somewhere in the late stages of pregnancy I started to question my resolve to drive for 4.5 hours, drop my daughter off at daycare for 10 hours a day, 5 days a week just to work a job I didn't love. To be quite honest, I was and am proud of my work as a researcher and I was a bit hesitant to resign because I have always worked hard to keep working and I know that many would probably think I have let a big career opportunity slide away, resigning after just a few months from a Harvard-affiliated position. Also, to be quite honest. I did not know at all as a first-time mom what it would be like to have a baby. Once I knew, I made the decision that was right for me. It is a little strange to stay at home most of the time, after months (make that years!) of dedicated work (career-chasing?) It is for sure a new stage in my life.

On that topic, I have just started pursuing part-time remote writing/ editing opportunities. I have amassed quite a few publications and feel that my experience will allow me to competitively apply for such work-from-home opportunities. Specifically I am looking at the available scientific/medical/technical writing jobs, but also more off-the-path positions, such as article writing, etc. What would be even more exciting would be to begin to steer my career into the diabetes realm. There are not many part-time remote opportunities that I am fit to apply for, so (as always) I am not sure what will happen in the future. Sometimes I wish that I could use my blog to attest to my writing skills for job purposes. However, this blog has always been a semi-anonymous adventure that is messy, un-spell and -typo checked, not very well thought out, unpolished, and thus generally unusable for such purposes. Also I break a lot of grammatical rules because my English teacher always said, once you know them all it's fine, because rules are meant to be broken! Not to mention the swearing, perhaps too-personal details, and verbal diarrhea on occasion ;) It is what it is. Life is always an adventure, no? I am also trying to pick up whatever freelance or contract work I can get, ranging from editing to translating (because I am fluent in Russian). I also looked into transcribing because I type about 80 words a minute, but it sounds kind of boring and like it just doesn't pay enough.

2. Travel

Funny thing. The name of this blog "My Life: A Long Trip with T1D" was always meant to have more travel stories in it! Since travel these days pretty much means getting everything together to get to the grocery store or to the pediatrician, B and I felt enough wanderlust to book an 8 day trip to Peru this spring! Just the two of us. Which sounds a little nuts maybe but I trust my mom's willingness and abilities to babysit for such an extended period and baby A adores her. The stockpile of breast milk in the freezer continues to grow. And I have arranged for my grandparents to live at our place to take care of our dogs and cat. I am so freaking excited. I know I will miss my daughter but I also know it's important to continue to do what you love, and we love to travel.

3. Baby

I just love her so much and she is so beautiful, smart and generally perfect (says every mom who ever lived I believe).

4. Pets

...Are neglected a lot of the time. But once the weather improves we are all resuming our hiking, which I know will please them to no end, so this is temporary. By neglected, I mean they are always fed and let out on time, but they are lacking training and exercise at this particular moment. I am trying to not give myself too much of a hard time about this, as I know they had it perfect before, and now it's just meh for them, but it will get better soon.

5. Diabetes

...Is on the back burner somewhat. I am wearing Dexcom to stay on top of it as much as possible and it helps a lot. My meter average is around 130 mg/dl and Dexcom Clarity reports an A1C of about 5.8%. I can be fine with that. It's weird not to be as obsessive over some highs as I was during pregnancy, but I am doing OK I think ;) I am still annoyed by some of the (what I presume are) breastfeeding-induced lows. These tend to happen during the night, in particular the early-morning hours, so again I am grateful for Dexcom, and as a result have been eating waaay too any sour patch kids (which live on my nightstand). New goals: schedule and eye and a dentist appointment in the near future. I have an appointment with a NP (who if I like her, will do my primary care) at the beginning of June. I just need the prescriptions and blood work really. We will see how that goes.

More to come, I'm sure.

Postpartum adjustments. aka taking care of a baby... and diabetes too

If you scroll back a few posts (back to 39 weeks) you would see in my Dexcom report that I used to calibrate my Dex about 5 times a day while pregnant. I also tested about 10 times a day on top of checking Dexcom obsessively. In fact I made diabetes the biggest priority of my life (as in a bigger priority than my job or anything else). I would bolus down a BG of 110 or 120 while driving, I would stash my insulin pen in my back pocket for quick access during work lunches. I would check my BG and bolus in public if needed. I would eat one smartie at a time to treat a 55 BG to ensure I did not shoot up too high. I would eat the same two options of breakfast and lunch each an every day to ensure I met my targets. Not to mention the part where I would download my two-week Dexcom history in preparation for every prenatal appointment. As a result, I stayed in the non-diabetic BG range aout 90% of the time throughout my entire pregnancy, achiving non-diabetic A1Cs in the low 5% range consistently, and generally felt very accoplished about my management. The work was worthwhile. I delivered a healthy baby girl at full term and experienced exactly zero complications related to diabetes during my pregnancy. In fact, my diligence (or obsession) paid off so much so that I felt I had a relatively normal and overall quite easy pregnancy and I can't wait to do it again. Overall, it was a very positive experience. Also, if I can do it, anyone can - I really believe that.

Now, almost 4 weeks after giving birth, things are quite a bit different. Let's back up to the day of the surgery. Within a few hours of delivery my BG was registering in the 80s and 70s consistently, which prompted the gradual lowering of insulin infusion in the IV drip. This escalated, and the insulin was shut off altogether (while the Dextrose drip remained) and my BG stayed in the 70s for hours without additional insulin (as the Levemir from the previous day was still doing its work I presume). These developments prompted my decision to go to 5 and 5 units Levemir split for my initial "return" dose instead of the 7 and 7 I originally planned upon. I also set my I:C to be 1:15 at first. Within the next day and a half - promptly after surpassing a BG of 200 for the first time in months, I re-set my doses to be 6 and 6 for Levemir with a 1:10 I:C, which was where they remained for a few weeks. (Aside; the hospital staff was excellent - just excellent - at letting me do whatever I needed to do, including using my own meter [which as I learned reads about 20 points higher than theirs] and insulin pens.) Currently, I am doing 8 and 8 Levemir and a 1:8 I:C, although I am now planning to lower the evening Levemir dose back to 7. Whew.

In the past 4 weeks there were night-time low battles - the only pattern I can identify is that sometimes I drop low after baby cluster-feeds and my milk supply is being replenished. All I can do is eat Pizelles, drink Capri Suns, or (my favorite!) eat giant sour patch kids to fix these lows. There was one night where I consumed about 30g or 40g of carbs uncovered and did not go high. There was last night where I only had to consume about 15g overnight to stay stedy in the 80s and then wake up at 62, but 15g is still too much for me to keep my basal dose. Things do not have as much of a pattern as they did during the pregnancy, which is annoying. But another reason for this lack of tight control is that I am not as diligent as I was during pregnancy at identifying the patterns, perhaps. I no longer freak out about a BG of 140. I certaintly do not calibrate 5 times a day. Seriously, I am lucky if I test two times a day! I have not downloaded my Dexcom history since the week before delivery. Also, after the past year of excellent control I never thought that I would be so relaxed about bouncing between 60-180 on many days, but.. I am. My food choices are well... not as strict as they were during pregnancy. And to be honest, I am ok with that.. for now.

I am still happy that I am not really hitting 200s ever. I haven't had serious lows.. yet. I am pretty sure any endo on the planet would be happy with my A1C right now (even if I would personally consider it too high). So it's not like I have completely gone off the control train - in fact my control is still much much better than all the years leading up to preparing for pregnancy. I guess I have just come to expect a lot of myself if you know what I mean.

Now, when it comes to taking care of my baby girl, I am much more diligent. Sometimes I have to put her down to check BG or take my insulin, or eat when I haven't in hours, but let's be serious - she rules the show and I wouldn't have it any other way (have I mentioned that I lucked out and it seems she is an easy baby? that I actually am getting enough sleep? that I am probably jinxing myself by writing this? that I am so freaking happy she is in my life?) I also feel that re-assessing my food choices and becoming more stringent in my control goals again is on my radar in early 2017, because I want decades of health for myself and for my family (which I definitely plan on expanding on).

Happy holidays everyone - best wishes for a very happy new year!

The Birth Story

11/24 - Thanksgiving

I spend the evening at my sister-in-law's enjoying good food and (gasp) a half a glass of red wine for what I think was the second time all pregnancy. I declare that I have absolutely no signs of going into labor and that the baby would definitely arrive by scheduled C-section on the 30th.

11/25

It is the day of my last prenatal appointment and before driving into Boston for the 3pm BPP and prenatal I spend the morning at home trying to clean but dragging my feet. I feel an intermittent but painless tightening of my abdomen at seemingly regular intervals, and at one point I start using an app to time these "contractions" but quickly stop and laugh it off because while uncomfortable I did not consider them painful. But they were somewhat on my radar as they did not go away after drinking water and resting. Another new and intersting symptom was that every time I used the restroom (which was a lot of times at almost 40 weeks pregnant) I felt the baby drop. It was a sudden sensation that I can only equate to a sudden stop when you are on an elevator, experienced only in your pelvis. This was indeed interesting, and I wondered if I should bring up these developments to my medical team at my appointment...

As I drive in for my appointment (about an hour and a half drive), I experience probably six or eight of these "fake contractions", this time accompanied by some lower back discomfort (or dare I say mild pain), which I attribute to the discomfort of the driving position. As I drive, I enjoy what will be my last snack as a childless person (diet Pepsi, almonds, and pork rinds).

I arrive at Beth Israel and we pass the BPP with flying colors. Although Dr. H is not there the day after Thanksgiving, Dr. S is (I like him too). My blood pressure is actually OK and we discuss some details of the scheduled section. He asks about labor symtoms and I casually mention the baby dropping sensations and tell him that I have been experiencing "fake contractions all day". He asks how many and I estimate about 20. He seems slightly alarmed by this information and suggests (my first) cervical check (which sucks by the way) before sending me home to New Hampshire for the weekend. "I am sure I am not dilated - these contractions don't hurt at all!" I declare. (Famous last words). He determines that I am 2 cm dilated and I get hooked up to the monitor to see if I am contracting. After about 15 minutes, the nurse encourages me to drink water to check if the contractions they are detecting might be an artifact of dehydration.They are not. In fact they are coming at 3-5 minute intervals and are starting to feel very uncomfortable, especially in my lower back. An hour passes an my cervical check comes back at 3 cm dilated. I am not going anywhere.

At this point the doctor and nurse are laughing at me because apparently I both have a high pain tolerance and also I am apparently in severe denial of the fact that I am actually in labor. I feel like I am in a strange dream when Dr. S decrales that I should definitely make my phone calls, head to L&D, and we are having a baby today. I oblige. We discuss vaginal breech birth. It is not recommended for first time moms. "It is not a good time to test your pelvis Maria. If this was your third the conversation would be very different". He also tells me that it is actually more difficult to deliver a smaller baby breech than a larger one. I am ok with the section - I could never forgive myself if something went awry because I did not do what (as far as I can tell) is safest for *her. As I go to the garage for my hospital bag and to make phone calls before checking into the hospital, the contractions pick up. They feel exactly like strong period cramps, they come at regular intervals, and I feel OK about it as long as I am pacing. I am still in disbelief. I take half of my regular Levemir dose and correct the adrenaline-induced BG of 130 mg/dl with a unit of Humalog.

I check in and we wait out some hours for the food to clear my system and for the insulin/ D10 drip to get me to the "sweet zone" (no pun intended). It takes some time to stop flatlining at 130 and get BG under 110. As a result baby's birthday is delayed until early next morning. Labor progresses meanwhile. Strong/painful contractions (I feel them and the monitor shows as such), increasing in length and intensity, although from time to time becoming irregular, but also some as close as 2 minutes apart. A lot of blood in the toilet. It is a good thing I did not drive home today.

I have them check one last time that baby is breech. "Nothing but a butt down here". I am only slightly upset that I am having a c-section. It is what it is - baby's position is not in my control I tell myself as I take my last look in the mirror that day.

11/26

Midnight. I am led into the OR while B waits to be brought in after they set up. (I should mention that the plan was for B to sit by my head at all times so he doesn't have to see anything.) I am suddenly very anxious and terrified as I am brought into the OR and I take my position for the spinal. I verbalize this. Thankfully the anesthesiologist is a pro and gets it in on the first try. As I lay down I don't feel much at first, just a little numbness, but that quickly escalates. Like a wild trip, I feel out of control of my body. I tell myself that since I am talking, I am breathing. The catheter going in tickles like crazy and I can't stop laughing. And then I think I panicked but only for a little while. I remind myself, as I lose control of my body and feel a lot of pressure on my chest that this too shall pass and surrendering the need to control is best for now. I hear suctioning. "Have you started? Where is B?" B arrives and sits by my head. He walked past the whole picture as they were cutting me open. This small oversight is the last thing on my mind.

It is around 12:20 am now. I don't feel anything, just pressure (as promised) and it is freaking me out that my left side is much number than my right. The sensation of trying but not being able to move my leg freaks me out a lot (for the record, it felt like my left knee was bent, and I tried to straighten it because it felt so damn weird, as the doctors assured me that my left knee was not bent at all). Shit shit shit. I say that a few times at least. "What is my blood sugar? I feel low" (Aside: I did have to pull Dex after all because they wanted to make sure it didnt interfere with their machines). It is 81, then 105.

Finally they are close and the spunky anesthesiologist grabs B's phone and takes pictures of Audrey's arrival. "There is the first poop!" the doc announces. The moments between the "baby is here" and the crying take forever. B is encouraged to go see (not part of the plan people!) and after the seventh suggestion he obliges. (B was a champ throughout by the way and 9 days after our daughter's birth I am more in love with him than ever before).  He shows me photos of her as I lay there and all I can say is "Oh my God. She is so so little".

11/26/2016, 12:47 am, 6lbs 11oz, 19.25 inches

"How is my placenta? Does it look good?"
"Yes, it looks good."

She gets a 9 and a 9 on the Apgars... Her blood sugar is normal during all the checks. (She never leaves my side, during the entire stay at the hospital.)

"When can I hold her?"
"About a minute."

And then I do. And nothing will ever be the same again.

It is incredibly hard for me to describe how surreal it is to be awake during your own surgery. They say about long trips (whether literal or figurative) that it is not the destination but the journey. I feel so proud of myself for everything I did before and throughout the pregnancy to have such a happy outcome. I still can't believe I am here. But the journey is just beginning I am finding.

Baby is here!

Audrey arrived at 12:47 am on 11/26/16. <3 Details to follow

Week 39

Today I am 39 weeks and 2 days pregnant. And I made it through the last week of work (although it seems my boss thinks one should spend their vacation time and maternity leave working from home but that's another story!)

If it wasn't the home stretch before, it certaintly is now and this week is flying by already. Monday was spent doing some deep cleaning, yesterday I spent the whole day driving around - first to catch up with my mom and then into down-town Boston for a BPP appointment. I also got my car washed and my hospital bag is officially living in my car now (what?) Today - I have more cleaning and a little shopping (and some cooking and baby clothes washing) to do. And tomorow is Thanksgiving already! Crazy!

I am feeling pretty good. My BP is still normal at home (yay!). I have almost no swelling whatsoever (yay!). And the other day I downloaded 90 days of Dexcom history and was pretty thrilled to see this (double yay!):

Given that 90 days is a long time I was so happy to see the average as well as the standard deviation! I tend to give myself a hard time about the occasional 150 mg/dl or a stretch of a few hours out of range but it was nice to see that overall I am extremely consistent and have normal blood sugar about 90% of the time - which is a huge accomplishment for any type 1 diabetic and it is certainly a huge accomplishment for me. I complained a lot over the years about my lack of determination, consistency, inability to achieve this. Honestly, I did not know this was possible. While (certainly) pregnancy adds motivation and diligence, I know this would have been impossible for me to achieve if I hadn't jumped on the low carb train so to speak some 18 months ago. A flat line averaging low 100s would have been an unachievable feat for one day, not to mention 90. I am so so thankful I found this way of doing things and I am never going back. My quality of life has improved so drastically this past year and a half, and my stress levels about blood sugar management are almost non-existent (even during pregnancy). I will have to go back and post about this way of diabetes management some more in the future. It thrills me to know there are many people who are achieving such results and I am one of them (when two years ago my A1C was 8.6% and I thought it was impossible or if possible somehow detrimental to quality of life). Everyone must do what works best for them obviously. This is what works for me, so I do plan to talk about it in the future, as it has been the single most life-changing thing (for sure in my diabetes life, but perhaps in my whole life as well). Also - I have heard that many have success with the "sugar-surfing" approach. Alhough I have not read this book, I have heard quite a bit about it and it made me wonder - do I also use sugar-surfing techniques in addition to my low-carb lifestyle? I think so. I definitely watch the CGM like a hawk most of the time and make very quick adjustements with a lot of micro-boluses or glucose corrections. I am just so grateful for the technology that allows people with diabetes to be healthier, and also for the internet where we can connect with others - for technical and emotional support and well as simply to share our stories, all of which are so important :)

OK, so diabetes is going well. As I mentioned before I am apprehensive about the post-partum period but I will just have to handle it as it comes.

Exactly one week from today, I will be checking into the hospital for my scheduled C-section (unless something exciting happens sooner of course). Actually, my last BPP and prenatal appointment is this Friday and I am slightly apprehensive because it will not be with my regular doctor so I can see someone who doesn't know my white coat syndrome history panicking at my in-office BP (especially with diabetes at 39+4 weeks pregnant!) My doc did say that he would give the other doctor a heads up. In any case, I would like to just stick to the schedule and deliver on the 30th (because these things can always be planned, lol). I will be relinquishing control of my diabetes management while I am on the operating table as well as for a short time thereafter. But I had my 90 days of Dexcom history scanned into the hospital records (my ammunition for doing my own thing after I am able to stand up again). I also "won" the right to wear Dexcom during the surgery for peace of mind, as long as it is on my arm, so above the sterile surgical field. My doc keeps warning me that it may not be accurate because of all the extra fluids that will be administered but we shall see.

I am definitely nervous (but accepting) about having surgery. It is nothing I have done before but there is a first time for everything. (And yes, I am still trying to get her to flip head down but I have come to peace with the fact that it may not happen. I still am happy we are going past 40 weeks so at least I gave her a very good chance of flipping if she was going to do so on her own.) Aside: B's co-worker told him a story of her own experinece with the version, where the baby's rib was broken in the process and she had to have an emergency section on the spot. While I know that such complications of turning a baby are rare, it is these kinds of accounts that made me chicken out of having her turned.

I am going to list the specifics of what I am nervous about so I can get it off my chest because blog=therapy.

1. Seeing and hearing her for the first time. I just want to know that she is healthy and OK. I know that all the scans have always shown her to be nothing but a healthy baby but I guess it's a natural fear that I won't believe it until I see it? I just want to hear her cry and hear the doctor say that she looks perfect. I want all the newborn screening tests to come back normal and I want to hold her and actually know that this whole baby thing is happening for real. OK? OK.

2. Slightly nervous about the anesthesia. BUT I am quite confident they will do a great job. In the off-case that something alarming happens I have confidence that they are prepared to deal with it. Repeat after me: the anesthesia and surgical details are out of my control.

3. Healing from the surgery. The big thing here for me will be not over-doing it. I will have plenty of help, but I am stubboornly independent and have a very very high tolerance for pain so I will need to remind myself to take it easy. Also, I am worreid about giant excited dogs bumping my incision (their noses are perfectly lined up to do so). My solution for that one is walking around with a pillow in front of my belly for the first week or so...

Surprisingly, I am not very nervous about the whole caring for a newborn thing. I have read exactly one book: Pregnancy, Childbirth, and the Newborn. It seems to have covered the basics, I pretty much remember everything I read and if not there is always the internet so good enough! I hear people do this all the time.

In other news I chopped off my hair! I love it. The girls at the doc's office yesterday were commenting on how I must be close to delivering because apprently "that's what eveyrone does right before they have a baby".

Happy Thanksgiving Everyone!!!

38 Weeks.

This week can only be summarized as: I don’t want to do anything anymore.

After today, I have exactly 4 days of work left until I take a week of “vacation” (read: clean, cook, and get a haircut) before my “official” maternity leave will commence on my due date of 11/28.

I am dragging my feet to say the least – at work, at home, you name it. I feel heavy and tired and my feet definitely hurt on the days when I have to stand too long. And I gained yet more weight. Even. More. Weight.

I am trying to keep my emotions steady. About everything – the (very likely) C-section, and recovery from said surgery, the uncertainty of being at my house next week (over an hour and a half from my hospital when my husband is at work, also over an hour and a half away), the fact that my boss is driving me up the wall, and the fact that I still can’t seem to wrap my head around that in all likelihood by the end of this month (one way or another) I am going to deliver my daughter and become a mom. I think the emotions are exacerbated by hormones and a lack of peaceful sleep.

Although my blood pressure is still fine (in fact it was even ok at the doc’s office last week), and there is what I would call only very minimal swelling in my ankles at the end of the day, the need to urinate even more frequently (many times a night), and not being able to find a comfortable position at night that doesn’t result in leg cramps, numbness in my hands, back pain, or just random bouts of insomnia where I feel like I can’t shut off my brain has made me feel like I am suddenly succumbing to the end-of-pregnancy suck. What a difference between now and two weeks ago. Two weeks go I had to remind myself that I am not allowed (NOT allowed!) to run to try to catch the train. Now there is just now way (NO WAY!) I am coming close to running for anything. I think I am starting to understand all those women who complained a lot of the end. All the memes about feeling like a hippo and the last month of pregnancy feeling like it lasts 1623 days or so.

Don’t get me wrong – I am not ungrateful. I am grateful that the only “problem” I have had so far is a baby who is stubborn and won’t turn head down. I am grateful that I was able to do such a fantastic job maintaining normal A1Cs throughout the pregnancy.  I am grateful that I have an awesome husband and a very supportive (albeit sometimes slightly overbearing but very well-meaning!) family (all of whom will be there for me as I recover from childbirth and figure out the whole mom thing). Despite the discomforts of going to term, I am so very grateful that despite having type 1 diabetes, I as of now appear to be healthy enough to expect to continue with this pregnancy past my due date.

Sigh. Only four more days of work. And then (unless something exciting happens sooner or baby decides to flip) another 11 days until parenthood – but who is counting? And happy World Diabetes Day (once upon a time I entertained the idea that I may potentially deliver on WDD, but here I am – 38 weeks today, still very pregnant, with the end almost in sight though).