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Tuesday, June 28, 2016

Mid-pregnancy adventures

It's hard to believe but at about 18 weeks I am approaching the half-way point in my pregnancy. I am jumping ahead a little and talking about the half-way point because I am not sure how much time to write I will have in the next month, due to my impending cross-country move.

Yesterday, I had my anatomy scan - a very detailed examination of physical structures in the fetus to look for abnormalities. This is also the scan where many find out whether they are having a boy or a girl. I have to say that studying birth defects for the last two years, in combination with being a "high risk" pregnancy as a result of having type 1 diabetes definitely made me feel nervous if not paranoid about all the possibilities. Knowing everything that could go wrong made it hard for me to convince myself that everything might just be perfect.

I drove the technician slightly insane I think. "Do you see all four chambers of the heart?" "Is the spine enclosed?" "How do they eyes look?" She must have thought I was a little nuts, which might be true. When all was said and done "I passed with flying colors", according to the attending high risk physician. The words "diabetes" and "growth scans" were thrown around quite a bit, but so was the phrase "great A1C".  More or less, diabetes was not in the picture. In addition to the relief from learning that the baby looked perfectly healthy, I was also happy that "high risk" or not, I have felt a deep sense of normalcy during this pregnancy so far. (Aside: diabetes did make itself known later in the day when I was in the 50s, sitting by the fan and trying not to over-treat the low while trying not to panic or pass out. But it didn't ruin my day, not even close.)

Perhaps the coolest thing ever was feeling the baby kick me very hard, and being able to see it  happen on the ultrasound (that moment convinced me once and for all that all the "butterfly flutters" and "twinges" I have been feeling intermittently for several weeks was the real deal). That and finding out that: IT'S A GIRL!!!!!!!

Tuesday, June 21, 2016

High and Pregnant - aka Carb-Counting Woes

Every time I eat out I am reminded of why I don’t most of the time (well, besides the financial reasons). 

In the last four months, my blood sugar has been over 200 mg/dL a handful of times, and all but one of them involved eating out. 

There was the French onion soup/ battered French fries/burger day. It was a good day. B and I spent the day shopping and walking around on a beautiful spring day, and had lunch at a fancy place. And even though we shared the soup and I removed half of the bread from my burger, those battered home-made French fries got me! I was stuck in the 200s for three hours, and was chugging water and rage-bolusing in the middle of the local market. 

Then there is BBQ sauce. I really like it. There is a great place nearby where we live and that is the place we always go to on any occasion that we do go out pretty much. The BBQ there is amazing, but between the sweet and tangy sauces, and the fried pickles, I tend to mis-estimate the total carb-count grossly. Not to mention the greasiness and protein load that doesn’t help the IR. Really, I can only do BBQ sauce responsibly if I make the meal myself, carefully spooning out the designated amount of sauce onto each individual rib.

Then there is of course the Chinese food. Every once in a while (maybe once a month) I get a craving for Chinese. I give into it maybe every third month. I regret it infinitely every single time. Again, sweet-sauce, fat load, hidden carbs = nightmare. But it tastes so good GRRR….

But those are rare occasions so… What irks me the most is when I try to be as responsible as possible and still fail miserably. 

Like this past Sunday, when I had to work, and decided to have lunch at Bruegger’s Bagels. Knowing that a 70-80 g carb count is a no-go for me, I carefully went over their menu online to choose responsibly. I settled on the Blue Burger sandwich – served on rye bread with cheese and apple cider coleslaw, and totaling 35g carb (for the whole sandwich, according to their website). I checked my BG before I even walked over there, and took a half of a unit of Humalog because I was 120 mg/dL. Upon receiving my sandwich and decaf coffee (my first try at drinking decaf – it was kind of gross; aside – I drink 1 regular cup of coffee with breakfast every day, but wish I could have 3 or 4 a day) I diligently bolused 3.5 units for the 35g carbs. I ate half the sandwich, went back to work, finished up there, and ate the other half after that (in an effort to delay the carb absorption). I thought there was what seemed like A LOT of quite sweet-tasting coleslaw in my sandwich, and I was starting to question whether I had taken enough insulin. Upon getting into my car to drive home less than an hour later, I was 154, and did not hesitate to bump another half unit, thinking I was good to go now. Upon arriving at Walmart about an hour later, I found that I was now 232. I bolused  a unit, did my shopping, and was still in the low 200s upon arriving home. I chugged water and we took the dogs hiking. Upon getting back I was finally 97, tossed back a handful of blueberries to stave off a low (as I still had IOB), and was a pretty 82 before dinner.

It’s frustrating because I did everything in my power to prevent the high. It wasn’t my fault that the person assembling my sandwich over-stuffed it with coleslaw. It wasn’t my fault that that day I was taking a Dexcom break (maybe that WAS actually my fault, but I like treating myself to a device-free day or two (or three!)) Anyway, back on Dexcom went that same day. 

I guess I can conclude that when eating out it’s just safest to stick with a Greek salad + chicken – my go-to – it always results in perfect blood sugar, because it’s low carb, so how off could I possibly be?

In other news, I have been stressed and busy. My anatomy scan is next Monday and I am excited and nervous. I have also been feeling the baby move, which is cool. At 17 weeks along it is very very subtle and quite inconsistent, but I can usually get him to move by poking at him or using a cold water bottle (I am already torturing my child) – JK. I will keep you all updated J

Saturday, June 4, 2016

First Trimester Summary & More

I have been waiting for what seems like forever to write this, and today I feel it's time. I will give you the whole story.

I will start at the beginning. Sometime early this year (or perhaps late last year) we decided that if a baby came our way soon, we were as ready as we ever would be. With B's dissertation defense approaching in the summer as well as his 30th birthday a few months later, we decided to "see what happens", assuming that with not particularly trying and the average time it takes to get pregnant, we may get there in 3-10 months or so.

I was shocked at the beginning of February when I found myself pregnant. I was also shocked a few weeks later when I lost my first pregnancy. Pregnancy loss sucks. Logically, I understood that it was common, it wasn't my fault, and that I had joined a club that was much less rare than diabetes. It was out of my control. Realistically, I felt that I did not have enough air in my lungs to sing in my car anymore. "Sing anyway" - my mother's words. There was a day some weeks after when I felt I had enough air again. I won't forget it, but it cannot steal my joy forever. I read a lot of stories and blogs online, finding community and feeling less alone. This is my contribution, in particular because when looking for stories of women with type 1 diabetes who have been through this I found about five, and I know there are many more. You are not alone.

I know myself well and I knew damn well that waiting any amount of time "for emotional reasons" wouldn't make a difference for me. So we took the same approach of not trying and not preventing, and on the first day of Spring, ironically exactly one month after my first pregnancy ended, I learned that I was pregnant again. It was emotional. I repeated the serenity prayer what seemed like an endless amount of times and focused on what I could control - namely, my blood sugar. The weeks leading up to the first scan dragged on endlessly. Logically, I knew that two losses in a row were not very likely, but realistically I felt doomed. Nightmares stalked me until the first appointment. I literally pinched myself when I saw the little tadpole with it's little heart beating away, measuring perfectly on schedule, 3 days after my 28th birthday. I pinched myself just as hard at my 11 week appointment, where I saw an actual baby. I was just slightly less surprised earlier this week at 14 weeks along (and officially in the second trimester) when I not only saw and heard the heartbeat, but also saw him moving around like crazy and sucking his thumb. (I have been calling him a he, but I will not know until later this month if that is actually the case).

"You know too much, that's why you worry" - my OB. Probably - it doesn't help when you study birth defects for a living. Knowing everything that could go wrong makes me constantly consider those possibilities. Pregnancy is risky business but I know it's one worth taking for me. I still worry, although I try not to. It's hard not to. But so far so good.

Arghh. Enough about All. The. Emotions. Pregnancy hormones don't help. It was an interesting experience these last few months. Today I am happy. Let me go into the actual pregnancy now.

Symptoms: I have been really lucky. I only threw up when I was real-people-sick (see Diabetes Goes Haywire ). As far as any nausea goes, mine was very mild. The one big symptom was constant exhaustion. They weren't kidding about that one. In fact, ever since week 11 or so I have been feeling so great it's hard to believe there is a baby in there! I am not complaining, I know I am lucky. Out of breath, round ligament pains are starting, crazy dreams (I actually enjoy all the dreaming). Other than that, I am hungry All. The. Time. And cravings - that's the real deal too. I cannot get enough fruit. Or ice cream. Earlier in the pregnancy, it was salty stuff, but for most of it I have been craving sugar.

Diabetes: I have made adjustments several times. At the very beginning I had to increase my basal doses and be more aggressive with my I:C. Around week 9 or 10, I had to suddenly change everything by decreasing basals and bumping my I:C from 1:8 to 1:10 for most meals. "So when does the insulin resistance start?" I asked my endo the other day. "Maybe it doesn't", he said. "I have had women for whom it never happened." (say what? I thought insulin resistance was a given.) But wait, this is diabetes we are talking about it. YDMV. Pregnancy - another perfect example of that. Those first trimester lows everyone talks about? Did not happen to me. Not even a little bit. I actually became convinced that people run low because they are attempting very tight control and just crashing because they are aiming lower? But then I thought, maybe it's just that YDMV. It seems that is always the case. In any case, I am happy with my management. I am hitting the targets I used to think were impossible 80-90% of the time, depending on how the week is going. I cannot be perfect, compensating for the dysfunction of a biologically-perfect organ, but I am doing the best I can and my best is good enough. Dexcom is a life-saver (literally). I am on top of diabetes care more than ever and always checking for patterns and ready to make adjustments.

Doctors: I have always read that there is "an endless amount" of doctor's appointment when you are pregnant with diabetes. I did not want that. I know that I can manage my diabetes better than anyone (may sound cocky but it's also true). I called my endo on two occasions, both times when I was sick for advice. In the end, his advice was futile and I did my own thing (not because he is not great, because he is the greatest, but at the end of the day I am the one managing this and seeing the whole picture). This is even more true with my high-risk OB. They wanted me to "fax" (fax!) them my "blood sugars" once a week. Interesting - how does this "fax' thing work again and where do I find one? The sheets they provided (where you check your blood sugar 4 times a day) seemed ridiculous to me. It's like when you go to the eye doctor and they ask "What is your blood sugar?" Like when? At this moment? How about instead looking at my Dexcom report for the last 3 weeks with all the standard deviations? Anyway. It seemed silly and like a waste of my time. I asked right away - "Is this required?" "No, of course not, we are just here to help", they said. "OK, great. I will probably not be 'faxing' my blood sugars in then, since it is not required. I will work with my endocrinologist if I have any trouble." Fast forward a few weeks when I get scolded by a nurse over the phone for "not sending in my blood sugars". "I was told this was optional". I can't even begin to describe the amount of condescending attitude I received during that phone call. Upon meeting with my OB, to which I delivered detailed Dexcom statistics and averages spanning weeks, she agreed that there was no need for me to provide them with more frequent updates, as long as I continued to bring my Dexcom summaries to my appointments.

I also opted out of any other things I did not feel were necessary for me, including a bunch of testing offered to "high risk" women, including the echocardiogram. That was actually her suggestion - "Maria, if we can see what we need to see at the anatomy scan, I am comfortable with you not scheduling the echocardiogram. With your control and no other health issues, I do not see why you cannot opt out if that is what you want." Yes, that is what I want. I want to feel normal and be treated like a normal person. Maybe I would feel differently if my A1C was higher, or if I had other underlying health conditions, but I feel that fewer appointments and less routine "high risk label" screenings is what is right *for me *for now.

I am glad that my doctors don't think I am a total ass (I hope). I have to advocate for myself though.  I remind myself that doctors may know a lot about medicine but they do not know a lot about me. "Hi, I am doctor X." "Hi, I am doctor M, but you can call me Maria." Some seem annoyed when I introduce myself that way, some chuckle and we go to a first name basis. The other day I asked about the induction at 39 weeks. "Is that standard protocol for everyone, or do you individualize your plan based on the particular patient?" We agreed that if my control remains excellent and there are no other issues, such as preeclampsia or macrosomnia, etc. there is no reason to induce early (Because I just love it when out-dated studies are used to apply blanketed protocols to all people with diabetes).

My endo - I had what will be my last pregnancy appointment with him this week. He reviewed my data, and said "I will see you 3 weeks after delivery." What? Delivery? (Is that going to happen that soon? That's like 5+ months away!) Anyway, either my endo hates me and doesn't want to see me ever or he trusts me to make my own adjustments. Let's just go with the latter.

So there you have it - my totally (or as much as possible) "hands-off" approach to pregnancy with diabetes. I think it's great when people go to lots of appointments, have CDEs, etc. if it is helpful to them, but it's just not right for me personally.

My last paragraph of this never-ending post;

Life: Life has been happening like crazy in between all this. My husband's defense is less than 6 weeks away. Two days ago I drove him to the airport to fly out to Boston-Logan to interview for "the dream job". He called yesterday afterwards. "How did it go?" "I don't know Maria. OK I guess. They were hard to read." Two hours later - "They just called and gave me a verbal offer. The paperwork is in the mail contingent upon graduation and obtaining secret clearance." Dream job landed. I pinch myself. In a little more than 6 weeks we are moving back to Massachusetts. We are crashing at my mom's (3 dogs and a cat in tow) while we search for a house, and hopefully move and get settled before our child arrives. I will interview for jobs with a pregnant belly (knowing that they are not supposed to discriminate but also knowing that they might). I will switch insurances and have a new team of doctors to "prove myself" to. I hope I get a chance to write regularly here, but if I don't it's because I will be working on selling all our stuff, and applying and interviewing for jobs (and maybe sewing a few swaddling blankets). Life is happening fast. And I couldn't be happier.