31 Weeks: What free time?

This is my calendar for the next 4 weeks.  That makes 16 appointments.  There are 3 on the third...so many that I couldn't even fit them all in one day slot!  High risk pregnancies are major time commitments!

Looking Back: Second Trimester Notables

Weight Gain-  At 15 weeks I had only gained 1 pound, but after that steadily put on about 1 to 2 pounds per week.  In the early weeks I really craved citrus fruits like pineapple and grapefruit and oranges.  In the second trimester it was more like potato chips and ice cream.

That's me half-way through!

 Insulin Needs- Gradually increased.  Not basal rates so much as I:C ratios for bolusing in the beginning, but both increasing at the end.  Totally normal for pregnancy.  It happens in normal people's bodies, they just don't know it.  The more hormones that placenta makes, the more insulin required.  Pump sites needed to be changed more frequently because of the increase in insulin.  That was definitely one of the most annoying things for me.  Why is changing a pump site and refilling a reservoir such a chore?  The change from every 3 days to every 2 days seemed like so much more!

Blood Sugars-  Not too low anymore, but seemed to be fairly stable and within range most of the time until about 26 weeks.  A1c somehow held steady around 5.8 despite more 200's creeping in to the rotation.  If I had any readings over 240 however, I would give an insulin injection with a syringe for faster absorption to get the sugar down quicker.  Most of the highs would happen overnight and would take multiple corrections or an injection to bring them down.  After emailing my endo and changing basals and a dinner bolus ratio, things were back on track for awhile.

Sex of the Baby- 18 weeks was the big week.  I was ok waiting or finding out, but B really wanted to know...A GIRL!  Of course I would have welcomed a little boy, but the thought of a little girl made my heart swell and my eyes tear.  And then I thought of all the things I had experienced growing up and wished her at least the same moments of happiness and less of the moments of hurt.  B had thought all along it was a girl.  He said he was destined to be wrapped around her finger.  The rest of the ultrasound was great.  Baby Girl was measuring in the 35th percentile, so she wasn't bulking up yet due to my diabetes.  All the organs looked normal.

Fetal Echo-  My high risk OB(otherwise known as a specialist in MFM)  recommended Baby Girl have an echocardiogram of her heart around 22-25 weeks since babies of women with T1D are at a slightly greater risk of having a heart defect.  She cooperated and everything checked out ok without any real concerns.

Shower Plans- My mother in law was planning a shower at a tearoom with family and friends.  My mom was planning on having one 2 weeks later at a hall, also with family and friends.  I started registering for all kinds of things that I didn't think would fit in the house.

Eye Update- Another exam, dilation, and fancy pictures.  I was definitely disappointed to find out that my eyes had worsened since the first visit, but not to the point of needing treatment.  New microaneurysms.  More watching and waiting and following up.  As to be expected with diabetes and lots of growth hormones flying around during pregnancy, but I still felt defeated, hoping I would be in the small percent of cases where things remained stable.  The retinologist  reiterated that these things usually regressed after delivery.

New Worries-  Hoping I could breastfeed, investigating breast pumps and how to order one through insurance, thinking about changes in insurance plans.

New Excitements- Feeling Baby Girl kick around 18 weeks!  And sporting a serious baby bump.  Also, B worked on painting and setting up the crib and moved furniture to transform our office into a nursery.

    

Picture my mom painted

Baby Girl's pretty butterfly mobile

Looking Back: The First Trimester

I would have to say I was pretty lucky in the way of pregnancy symptoms at first, as in I barely had any!  I was really worried about morning sickness.  I had read of scary scenarios where people bolused insulin to cover a meal and then couldn't eat, or they couldn't keep it down and then had spirals of hypoglycemia while trying to choke down juice or glucose tabs.  Not a problem of mine!  I was eating like a champ and downing more carbs than I normally would have because my body required the energy most of the time to avoid a low.  My thoughtful hubby did get me a food scale for my birthday which made it much easier to count carbs and measure portions in conjunction with Calorie King.  Most "normal" (non-diabetic) people would probably have been a little upset with the gift, but my type 1 self was pretty pumped about it.  Around week 7 my appetite plummeted and I had a strange aversion to meat and vegetables that lasted about a week.  Then it was back to eating as normal.

As far as my insulin requirements, my basals were scaled back to prevent me from going low in between meals but my bolus ratios were almost immediately increased to prevent the after meal glucose spikes.  I felt like I was taking much larger boluses than I was used to, but in order to stay under 120 1 hour after eating my endo knew it was necessary.  Another big difference was that my endo team said in order to keep my blood sugar that low 1 hour after eating but to avoid a hypo at 2 hours, I should eat a small snack without bolusing about an hour and half after eating my meal.  In other words, we know we are overdosing you with insulin to keep the postprandial readings down so then you need to eat more to even out.  After a few days it was clear that it was working well.  Almost too well!  I had not seen numbers this smooth in years!  My next hemoglobin A1C reflected the efforts.  It was in the 5's which I had never seen since managing my own diabetes.

I had biweekly meetings with my endo during this critical period of organ formation.  This really helped me stay on track along with stalking and logging my blood sugars by testing upwards of 15 times a day and using my CGM data.  I found that after breakfast blood sugars were the hardest to control, so I started eating the same breakfast EVERY day.  Greek yogurt with fruit and almonds.  This seemed to keep me pretty stable and full from the protein and fat.  My overnight readings remained awesome and mostly stable according to my CGM, landing me under 100 each morning for fasting readings which is the goal during pregnancy.  I did have a good number of nights during the first trimester where my CGM would alarm me that I was low, so I would wake up and have a few sips of juice or a literal bite of a granola bar.  My endo loved those comments on my log sheet... he said he's never seen anyone be so specific.

All in all, we were off to a great start.  No icky pregnancy symptoms, no blood sugars running rampant, nothing too bizarre aside from the frequent need to eat to avoid a low. (What's a pregnant woman to do?!)  I did get some disappointing news after visiting my opthamologist in the first trimester also mandated by my endo.  He nearly flipped when I said I had not scheduled an appointment yet and I was only around 9 weeks at that point.  I went to my appointment expecting the usual exam of the front of the eyes, dilating drops, and then an exam of my retinas to make sure there wasn't any retinopathy present.  The last year my eyes had been clean with no evidence of diabetes.  My doctor examined my eyes and said she didn't want to alarm me, but she did want me to see a retinologist because she thought she saw a few microaneurysms.  Nothing to freak out about, right?  It's only possible bleeding in my eyes!

I made an appointment with a specialist and went in very nervous.  This time they took very fancy digital pictures of my retinas using a special machine and examined my eyes like usual.  The good news was that my eyes were in good shape for someone with diabetes for 27 years, but the bad news was that indeed there were a few microaneurysms in each eye.  No bleeding or leaking which is good.  Non-proliferative retinopathy is what he called it.  I was told that because of all the hormones and extra fluids in pregnancy that sometimes it could drastically worsen, but then usually regresses after delivery.  It could play a role in how my baby would be delivered.  If it did progress, there was a chance that a c-section would be recommended to save my eyes from the strain of pushing and ultimately rupturing a vessel.  But it could also stay at baseline.  All I could do was schedule a follow up appointment during the second trimester and see.  

I felt a little defeated.  Did I fail myself?  Was I going to fail my baby?  Was it something I did or all the things I didn't do?  I was scared and uncomfortable to admit that this was a complication of diabetes.  Why is that uncomfortable for people in this community?  Because it usually assigns blame to the person for not handling things appropriately instead of to the disease that causes it.  People are judged unfairly when they say they have complications whether or not they are controlled.  Control alone isn't always enough.

I went home feeling some anxiety, but still happy that the baby was healthy so far.  I tried to concentrate on my small miracle and keep my blood sugars happy without letting worry interfere.

Looking Back: Baby on Board!

When my husband B and I  found out I was pregnant I think we were both in shock despite knowing that this could actually happen.  For almost my entire adult life, I never really believed that I would be able to conceive.  (I probably attributed this to diabetes even though it's not a proven factor to inhibit fertility.  But everything in the world has a warning sticker on it that says, "If you are diabetic, please consult your physician before using this, doing this, eating this, etc."  Not to mention many uneducated people attribute random negative things that happen to you to diabetes.  I find this humorous.  More on this in another post).  But there it was, a gleaming blue plus sign that said I most certainly was pregnant. 

Cue a dance of joy in my head.  At that very moment, I was building a new tiny life inside of me despite doubtful thoughts and despite years of diabetes.  THIS WAS HAPPENING and diabetes wasn't stopping me.  Then I immediately became nervous.  I AM TYPE 1 DIABETIC AND PREGNANT!   How am I going to manage this so that my baby is healthy?  

 About a year before this I told myself I was going to get in shape and make my body a healthy environment for  a possible little babe.  We joined a gym and used it regularly.  I switched to a lower carbohydrate diet.  We bought lots of organic food.   For months I had been wrangling in blood sugars that were higher than recommended for conception.  Then I got a CGM.  This is my holy grail of diabetes management.  I wasn't afraid to run on the lower side anymore, because it would alert me if I was too low.  I could go to bed without worrying that I would be hypoglycemic in the night and not wake up at all.  I could track the trends of my blood sugar and concentrate on areas that needed improvement.   My first A1C after starting the CGM was nearly a full point lower than the last test.  Success!  

I absolutely love my endo team.  My doctor is a straight shooter and someone I can be real with.  He also has an awesome CDE who not only makes suggestions at a pace with which I'm comfortable, but allows me to have input in the decisions about my health.  A few more months of tweaking basals and boluses on my insulin pump settings and my A1C was nearly there.   Then finally we got the green light.

We found out I was pregnant a week or so before my next regularly scheduled endo appointment.  So after freaking out for a minute after seeing the plus sign, I took a breath and reminded myself that I would have a lot of guidance.  At that first appointment I found out my A1C was 6.0 when we conceived which was right on target!  My endo asked if I had noticed any changes in my management yet.  The only thing I could tell so far was that I was getting low much more often.  We scaled back on some of my basal rates which is par for the course of a diabetic pregnancy in the early stages.  Your body is so busy trying to build every little cell of the baby so perfectly that it uses a lot of energy!  I made an appointment for 2 weeks later and I was on my way!  It was a great feeling knowing that I was in control of all I could be and our little baby was taking up residence.  

That's What it's All About

My name is Jill and I've been a diabetic for 27 years.   Sounds like I am making a confession and in a way, I guess I am.  There have been many periods in my life when I've chosen to ignore diabetes and other times when I acknowledged it but didn't own it.  Then there were times when I felt I really held the reigns of this disease.  Despite my relationship with diabetes through the tumult, this life has been full of wonderful, emotional, affirming, and terrifying experiences alongside hundreds of thousands of needle sticks, pokes, and proddings.  

Two years ago I was in a dark place and diabetes was the main culprit.  I had a lot of anxiety about lows and sometimes I felt completely helpless.  I was also experiencing signs of early complications and the stress was negatively affecting my diabetes even more.  I was afraid of living a life marked by poor diabetes control and ultimately of dying too young to experience all that I wanted.  My husband was a great source of support, but I needed something more.  I also felt like I did not want to burden my family with my worries and I needed to find others who really understood these feelings.

After doing some google searches I came across a diabetes blog called Six Until Me written by Kerri Sparling.  Reading her words made me feel as if someone else was out there who understood.  I continued reading and researching and pretty soon I was fully immersed in the DOC, getting daily subscriptions to my favorite bloggers and laughing and crying along with them about all things diabetes.

Fast forward to now and you will find me 7 months pregnant with my first baby while experiencing the best diabetes control I have ever seen since diagnosis.  It was through the online community that I found the support of strangers with whom I shared so much just by reading their words.  This type of social connection significantly impacted my outlook on this ever- enduring disease, and I realized I could still learn a thing or two despite living with diabetes for more than 2 decades.

So while my initial reasons for getting involved in the DOC were sort of dark and self-centered, it's because of the DOC that I am living the healthy life I wanted and also starting a new one.  This blog is dedicated to all the people who live with diabetes directly or indirectly and need a place to come to laugh about it, cry about it, and just be real about it.  It's about living a healthy life despite an angry and unyielding disease.  It's about support and focusing on the finer points of life, not the sharper ones.  :)