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

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.

#WordlessWednesday Surprise: Our Thumb-Sucking Baby

#Dblogweek - Day 5

 

5/20 - Wildcard: My Day in Food

Some people track every bite they eat, some might not remember at lunch time what they had for breakfast or if they even had breakfast. For one day, document everything you or your loved one with diabetes eats and drinks. The good, the bad, the ugly, the proud, the ashamed, the...whatever. We promise not to judge!!

Breakfast: During the week - it's a variation of the same thing... Because I have a long commute and eat in the car - at 6 am. Typically, it's a 2 egg + cheese breakfast sandwich on either a low-carb wrap or pita (10-15 g carbs tops), or more recently it's actually been a bagel thin (~20g carbs). Also, sometimes I make low-carb waffles (http://alldayidreamaboutfood.com/2011/11/almond-flour-yogurt-waffles-low-carb-and-gluten-free.html) - and I totally don't follow the instructions, I just mix everything together at once, and I never have xanthan gum, and it still works out!
These are even lower-carb - about 7-8g depending on the size you make them, so I usually like to also add a teaspoon of jam in there and usually 1 fried egg with cheese... And there is always a cup of coffee with heavy cream - YUM! I pre-bolus religiously for breakfast, and these ones are almost guaranteed to produce a straight line :)

Snack: Around 9 am or even earlier, I like to have a Kind Bar. I like the Nuts+Spice ones, because they are lower carb - about 10g net carbs only, and they are very BG-friendly for me. Recently, I learned they have a bunch of new flavors and the one pictured below is my favorite right now - you can really taste the mocha!

Lunch: Most of the time lunch is salad + protein (~12-15g carbs). If it's not loaded with carbier veggies like tomato and carrot, I might throw in some croutons... On the left is one with steak, and on the right in one with chicken. I like my salads to be "Greeky" which means feta cheese and olives. I make my own dressing and I am obsessed with it (1:1 EVOO: red wine vinegar + S+P, oregano, and garlic power to taste). Alternately, I bring my dinner leftovers. Pictured below are Brussels sprouts, spinach,  and kielbasa. Sometimes, there might be some french fries too or something, but not too many (bringing up the carb-count closer to 20g in that case)...

Snack: By the time I am back from work around 2:30-3PM I am ready for a snack. Lately, I have been eating ice cream. I bought those small Breyer's vanilla and chocolate cups (11g carb each) and I like to have 2 of them with almonds or berries (totaling about 25g carbs). Alternately, I have plain yogurt with berries and nuts (~20-25 g carbs) - it's huge - I will do like 1 cup yogurt + 1 cup berries lol. Sometimes, I mix it up - for instance yesterday, I had a piece of toast with kielbasa, mustard and pickles and then 1 Breyer's ice cream cup (altogether working out to 25g of carbs).

Dinner : 6 pm(ish) and I am ready for dinner. This is most variable. Sometimes, I like to have breakfast food - e.g. toast, scrambled eggs. Other times it's a standard protein + veggie + starch (usually 1/2 serving of starch for me though) - on average I would say 25g of carbs here. Yesterday (for today), I made Crockpot chili with turkey and black beans. It has been forever since I have had chili, and I estimate about 130g of carbs total in the pot, and I *think the pot is about 8 cups so when I try it later tonight I will try bolusing for ~15g of carbs per cup and see how that goes. I will probably add sour cream or shredded cheese to it and have it with a small piece of toast (maybe garlic toast) - OK Kelley - you have made me crave chili and garlic bread!!! I am hoping this will work out to be about 25-30g carbs...

Snack? (I eat a lot don't I? lol): Most of the time I don't have this snack, it really depends on when I had dinner and if I feel hungry. Last night, I had about 12g of SmartFood white cheddar popcorn. I also was running a bit low so ended up having a couple of squares of white chocolate to keep my bg stable overnight.

And there you have it - a day in the life!

#Dblogweek - Day 4

The Healthcare Experience – 5/19

 

Most people who live with a chronic illness end up with a lot of experience when it comes to dealing with healthcare. How would you improve or change your healthcare experience? What would you like to see happening during medical visits with your healthcare team? How about when dealing with your health insurance companies? What's your Healthcare Wish List or Biggest Frustration? Today is the day to share it all!

My two biggest frustrations are: 

1. The need for prescriptions when it comes to things like fast-acting insulin. Seriously, why must I have a prescription? If I am able to buy Humulin R and N OTC, I feel like there is absolutely no reason I shouldn’t be able to purchase my Humalog and Levemir. I feel that way about many drugs that require a prescription, as well as supplies, such as CGMs, pumps, etc. Maybe it’s the libertarian in me: ”Stop babysitting me and let me do what I want! I can think for myself and it’s my life - Waaa!” Then again, without a prescription, my drugs couldn’t be billed to insurance. And this brings me to my biggest woe. 

2. Mandated health insurance. Many don’t realize this, but mandating health insurance coverage allows drug companies to set whatever prices they want, because insurance will have to pay. (In turn the resulting high prices drive insurance limitations of what they will and will not cover, ensuring continued patient dissatisfaction.)  If prices were set by the free market, they couldn’t possibly be as high as they are when health insurance is mandated, because individual consumers simply cannot afford to pay that (really, it’s simple supply and demand economics)! Case in point: when I lived in Spain in 2009 – 2010, I paid much less from my supplies without health insurance than I did in the U.S. with what was considered very good health insurance – about $20 for a vial of insulin in fact. That, and Lantus did not require a prescription. Recently, I met someone who travels to Canada to buy their Humalog for - you guessed it - $20 a vial! Again, maybe it’s my libertarian leanings, but I advocate for freedom of choice (to have or not to have insurance, and by extension more choice in what you can use, and hopefully affordability, driven by the free market).  

So less mandates, please – whether it’s about health insurance coverage or what does and what does not require a prescription. And that’s my two cents.

#Dblogweek : Day 3

 

5/18 – Language and Diabetes

There is an old saying that states “Sticks and stones may break my bones, but words will never hurt me”. I'm willing to bet we've all disagreed with this at some point, and especially when it comes to diabetes. Many advocate for the importance of using non-stigmatizing, inclusive and non-judgmental language when speaking about or to people with diabetes. For some, they don't care, others care passionately. Where do you stand when it comes to “person with diabetes” versus “diabetic”, or “checking” blood sugar versus “testing”, or any of the tons of other examples? Let's explore the power of words, but please remember to keep things respectful.

So I fall into that category of people that doesn’t pay very much attention to language when it comes to diabetes. I personally could not care less if someone calls me a “person with diabetes” or  a “diabetic”, whether it’s “checking” vs. “testing” (honestly, I never even considered why anyone would have anything against the word “testing” but some people are more sensitive to these things and I respect that.) I do tend to specify “I have type 1 diabetes”, I don’t normally say “I am a diabetic” or “I am a type 1 diabetic”, but it honestly doesn’t bother me in the least if someone says that about me, because: 1. It’s true; 2. I don’t think they are trying to offend me; 3. I am just not one of those people that gets all caught up in semantics.

I have seen many people addressing the fact that when it comes to diabetes, it seems that there are a lot of jokes (often uninformed ones) that revolve around it. To be honest, it used to bother me, but not so much anymore. No, it’s probably not very educated to say something like “Eating all that cake will give you diabetes”, and I certainly do address comments like that, but I just don’t get all worked up about it. I guess I am just one of those people that doesn’t take myself or life too seriously, because if I did I think I might go crazy J The thing is if someone is intentionally trying to be hurtful, of course it bothers me, but when it comes to diabetes jokes, I honestly don’t believe most people even realize that their comments could be considered offensive. Because type 2 diabetes, so much more prevalent than type 1, is closely associated with diet, metabolism, and weight, and that is what is portrayed in the media, I don’t think I can hold any kind of grudge against people who are misinformed about diabetes as a result... I mean, I don’t claim to know much about asthma or epilepsy, so why would I get all worked up if someone doesn’t know about diabetes? (By the way, I mention asthma and epilepsy because these are two conditions that I know of where patients are sometimes referred to as “asthmatic” or “epileptic”, and there are probably some others that I am not thinking of right now…)

Anyway, I don’t think that not caring too much about language that revolves around diabetes is that big of a deal. If someone is saying misinformed stuff, I will usually correct them. If someone appears to be intentionally hurtful, I will give them a piece of my mind. However, in most cases, I have not found anything anyone has said about diabetes or having diabetes as offensive, just maybe misinformed.