Second Trimester Stuff Thus Far

Well, I was about 1 day into my second trimester when my insulin requirements started to increase.  Thankfully, I knew this could happen and was expecting it, so it wasn't too much of a shock. Also, it means the baby is growing, so that's good!  It's still a little hard to see my insulin requirements increase so much, since for so much of my life I've equated more insulin needs to a failure somehow on my part (i.e. not exercising enough, eating too many high glycemic carbs, etc).  Even though that's total bunk in regular, non-pregnant diabetes life, that nagging "you're not doing well enough" feeling still happens every time my insulin needs go up.  It's an antiquated way to view insulin needs, that I can logically understand is stupid, but for some reason it's so ingrained in my psyche that it's still hard to see.  I just have to remember, that, pregnant or not, my body needs the amount of insulin it needs, and that non-diabetics use insulin on a regular basis (their bodies just happen to  make it), so why is it so bad if I need to use it too?  It's not. Get over it, Erin.

Anyway, when my insulin needs rose, it took a few days to figure things out. I ended up having to take lots of walks at random times of the day (usually at like 9:00 at night) to help get my blood sugar to come down, but I think I finally adjusted dosing enough to make it better . . . for now.  Apparently, this is going to just be the status quo until October.  If I'm lucky, I'll only have to make adjustments every week or every few weeks, but I know my insulin needs could potentially change on a daily basis, and while that totally sucks, I am prepared for that. I give serious props to women who do this while working full time! I feel like it's just a full time job in and of itself eating, taking medicine, adjusting, etc., I don't know how people do this with a full time job!

Other things that are happening:

• I'm getting larger.  I first noticed that, while my tummy wasn't growing bigger, my hips were expanding outwards, and I needed knew pants! My stomach is finally catching up to my hips a little bit, and while I haven't felt the baby move yet, it definitely feels like something is in there that isn't normally there. If I didn't know I was pregnant, I'd definitely think I had some kind of tumor going on.  Or a parasite family making a home in my stomach. (Shout out to La Famila Raul, C. Burns!) (that was an inside joke about parasites, just FYI) 
• My endo is still the bomb dot com.  They email back and forth with me once or twice a week and help me make adjustments to my blood sugars  And I don't have to pay for it. And they are my heroes. I love my endo and her PA!
• I had my first bout of morning sickness that ended really badly.  I was feeling a little nauseated, but knew if I ate breakfast, I'd feel better. So I proceeded to eat my oatmeal, only to throw it all back up again about 5 minutes later.  It was bad! I think it was a combination of things. I was having a really bad low (like in the 40s low) and going that low always makes me sick to my stomach anyway. Also (and this is gross) I was having some serious snot issues from spring allergies, and had massive amounts of mucous cascading down the back of my throat, making me feel gaggy, so that triple-threat combined equaled one yet-to-be-matched episode of upchucking. I feel for those who are constantly sick during pregnancy. Sheesh.

I just had both my monthly appointment with my endo, and my 16 week appointment with my OB.  My endo was absolutely ecstatic about how well things were going, which reassured me a lot.  I constantly feel like I'm killing my baby every time I have a low or a "high", but my endo said that I was doing perfectly and that I'm one of the best controlled Type 1s they had so far.  ( I should get some sort of award for that, or something, right?) My A1C was 5.1, which I guess is good, but to me it makes me wonder how can possibly still be alive and breathing with an A1C that low! When I told my dad he said "maybe you should be pregnant all the time, and that way it will be like you don't have diabetes!"  Um, not happening.  :)  My thyroid function is perfect for now, too, and they'll keep tabs on that monthly as well.  

My OB appointment was pretty low-key. We heard the baby's heart beat (156 bpm).  It totally freaked me out at first, because the medical assistant was having trouble locating it, but she found it and it was going strong.  She said she even thought our little fetus was moving around a bit, although I don't know how they tell that from just listening to the heart beat.  I have an appointment at 19 weeks when we will have an ultrasound.  While my OB is a high-risk OB, there is a doctor in the practice who is like the High Risk of High Risk OBs who's been practicing forever, so they are going to have him do my ultrasound just to make sure everything is OK so far. Hopefully we'll also be able to find out the gender at that appointment, too!

And then at about 24-28 weeks, I have to have a fetal echo done, where they will check out the little one's heart to make sure it formed properly.  With Type 1 diabetes, there's a chance that the baby's heart can be messed up, especially if you're uncontrolled, so I have to go get an ultrasound of the wee one's heart.  I'll get that done at the local children's hospital, which is where they have super special fetal echo equipment  apparently.  

And, that's about it so far! It's still a crazy ride, full of prescriptions and doctor's visits, and testing, testing, testing and more testing! And, I am actually looking forward to after this baby is born when I can neglect myself a little bit, and let me A1C run higher (and eat massive amounts of cereal--seriously you guys, cereal is all I'm going to eat after this kid is out of me!).  But, so far, so good! I'll keep you posted!

How Low Can You Go?

First Trimester Lows

At my first real appointment with my endo after I found out I was pregnant, I found out that my A1c had dropped from 6.2 to 5.6, which is actually considered normal! That was literally the first time in my life that I'd ever seen the words "normal" next to my A1C! It was a nice feeling! This drop was due to the fact that during the first trimester of pregnancy with  Type 1 diabetes, your blood sugar is just low ALL THE FREAKING TIME. Not like 70 low, either. We're talking 50s, here, people. Multiple times a day, every single freaking day.  If the first trimester exhaustion doesn't kill you, the lows pretty much do you in.  When I told another Type 1 friend of mine I was pregnant, she asked me if I was keeping all the Columbus juice vendors in business. SO MUCH JUICE DRINKING!  Seriously it was GALLONS of juice, all day, every day.  And glucose. And juice, and more glucose.  Sheesh!

I'm not sure about the exact physiology behind this, but my endo explained it this way: "Your baby is basically a parasite, and it's growing super fast right now, so everything you are consuming is going to it first and if there's anything leftover for you, you're lucky." And, apparently in Type 1, that translates to being low. All_the_freaking_time.

My poor husband.  He put up with so much during those months! I was seriously a zombie during the first trimester, and pretty much useless (except, you know, for the fact that I was gestating a human being inside of me). If I wasn't passed out on the couch from sheer exhaustion, I was fumbling about with "low-blood-sugar-brain" after fighting off a million lows during the day.  And night time was no better! My simultaneously blessed and evil CGM would beep all night long alerting me to my low blood sugar.  There were several times I had to keep myself from throwing that thing against the wall.  If I were being completely honest, though, I'd say having my beautiful Dex G4 literally saved my life a few times.  Being so low all the time made me get used to feeling low.  So, I stopped having symptoms of low blood sugar until my sugars were dangerously low (like 35).  Between the lack of low symptoms and my sheer exhaustion, I definitely would've slept myself right into a low blood sugar coma or something had that sweet little Dex not beeped at me to "wake-the-freak-up-and treat-this-low!"

Other First Trimester Things
In addition to the constant lows, the first trimester brought all the usual pregnancy things, like exhaustion, having to pee all the time, and a little bit of nausea.  Oh, and I did have two colds, the stomach flu, and an outbreak of cold sores (FIVE AT ONCE! My poor mouth! ) during the first trimester, so all of that overshadowed any of the nausea I was feeling.

The one thing that made the first trimester complicated, diabetes-ly speaking was that I developed a total aversion to foods that were healthy.  Like I said, I wasn't really sick to my stomach that much, and I could usually just stuff food in my face and that would make the nausea go away. But the food aversions were hard! I had a complete and total aversion to SALAD and pretty much anything leafy and green.  Which, you know, is not so great when you're trying to count your carbs and be a good diabetic.  I tried so hard to eat salad a couple of times, but even thinking about eating lettuce made me want to vomit.  It was weird.  Luckily the massive amount of carbs I ate at any given meal, in lieu of the healthy things I would normally have eaten, were off-set by my first trimester lows, so it wasn't so bad.  If I hadn't had all those lows, though, I would have been in major trouble!

OK! That's enough for one day!  If you didn't read the whole thing, basically you just need to know that First Trimester=More lows than you've ever had in your life!

And So It Begins . . .

This is another post about pregnancy and Type 1 diabetes, so if you're not into reading about either of those, consider yourself warned. :)

So, in my last post I talked a little bit about planning for conception with Type 1 diabetes, and how much of a pain in the you-know-what it was.  Turns out it was a piece of cake compared with actually being pregnant.

Initial Doctors Visits & Setting up My Treatment Team

I found out I was pregnant by accident, sort of. I actually got the stomach flu. Like, the I-wish-I-was-vomiting-instead-of-pooping-my-brains-out-for-three-days stomach flu. It was awful. I lost 5 lbs while I was sick, and have kept it off through my entire first trimester, and so far into my second. That, to me, is a little ridiculous, because before I got pregnant, my endo wanted me to try to lose 5 lbs, and try as I might, I could just NOT get if to come off.  Apparently all I needed was a teensy stomach virus followed by a pregnancy to do the trick! Sheesh! Anyway, I got better for a few days, and then about two days after I'd been feeling better I started to feel sick again. But it was a different kind of sick, and it made me suspect something else was going on, so on a whim I took a pregnancy test and it was positive!

I immediately called my OB and my Endo (this was on a Wednesday) and I had appointments for that Thursday and  Friday to confirm my at-home pregnancy test and to get my thyroid levels checked.  My OB took my A1c in the office, and said it was 6.2, which I was happy about. We talked about blood sugar goals, and who help would manage my blood sugars while I was pregnant. They were happy with my control and said that they'd leave things up to me unless things started to get out of hand and then they'd refer me to a maternal-fetal medicine group.

My first appointment with my endo was really fast, they just wanted to make sure my thyroid levels were  perfect, which they were, and we set up an appointment for a few weeks later to discuss how we were going to handle blood sugar management, etc.

Incidentally, at first my endo wanted to send me to a maternal-fetal medicine group to help manage my blood sugars. She said that this group has a bazillion nurses whose job is to go over blood sugar records and make adjustments for you on a weekly or bi-weekly basis.  I've heard of this group, and I think I had a friend see them when she had gestational diabetes, and it made me really nervous to go to them.  I know they'd probably be OK, but they are a big group, they (most likely) deal with Type 2s, gestational and and fewer Type 1s (simply because there ARE less Type 1s in the world), and it seems like they really like to micromanage your control. I didn't want to be treated like I had gestational diabetes or Type 2 diabetes, I didn't want them to make me see a dietitian (seriously, I know how to count carbs, people!) and  I was afraid they'd put me on a meal schedule or plan, and that was really scary to me. The Exchange Diet I had to use when I was a kid has kind of scarred me for life, and I was soooo nervous that if I went to that group I'd have 9 months worth of  a seriously rigid schedule to deal with. And if anyone knows me, they know that the more someone tells me to do something in a specific way or at a specific time, the less I am inclined to do it. Also, I really love my endo! She and her PA know me, they know my diabetes, they are compassionate and thoughtful, and I really wanted someone who was going to work with me to manage my blood sugars and not dictate to me how to manage things. I've had this disease for 20 years now, and it really gets under my skin when doctors treat me as if I don't know what I'm doing. I was scared that if I went to that other group, that's how things would end up. Does that make sense? Any way, I was scared.

But, after my first full appointment with my endo, when I was about 11 weeks along, when they realized how good my control was, I think they were more comfortable managing me. My A1C had dropped from 6.2 to 5.6  in a month (more on that in a later blog), and I was testing and adjusting things well on my own already. My endo decided that they'd be fine helping me manage things unless things got really wacky, and then they'd ship me off to this maternal-fetal medicine group.

So far things have been going well. I meet with my endo or her PA once a month, and in between visits, I upload my bloodsugars twice a week to Diasend for them to review and give me feedback on.  I'm extremely fortunate to have an endo that uses the latest and greatest in diabetes technology.  They use electronic medical records, to which I have personal access, and they have a system set up that allows me to e-mail them whenever I have questions or needs.  And I get personal e-mail responses back from them which is kind of unheard of.  Really, they are wonderful, and I think that is why this is working out so well so far.

The blood sugar goals my endo has given me are pretty tight. Even tighter than what my OB wanted, actually.  My endo wants my blood sugars to be under 90 pre-meals, under 120 at 1 hour post meal and under 110 at 2 hours post-meals. This is pretty hard to do, but so far I've been pretty successful.  The proverbial first-trimester lows have helped a lot of with that, but also making sure I'm not eating too many carbs at once, and getting some exercise after eating if I do have more carbs has helped a lot.  It's still scary. When I do have a "high" (which to me, right now is like 130 or 140 instead of 200), I get nervous that my baby is going to end up with six legs or something.  But, as a good friend reminded me once, I'm doing way better than people who smoke or do drugs or drink during their pregnancy, so at least I'm not doing that! Our bodies have an amazing way of protecting fetuses (yay for biology!), so as long as I'm doing my best, that's all anyone can ask for.

OK, that's enough for now! I'll be talking more about first tri-mester lows in my next installment. It will be riveting, I'm sure!