Heading Down the Home Stretch!

So, I'm not really into sports metaphors, but "Heading Down the Home Stretch" seemed pretty fitting in this case. Actually, I'm not exactly certain if this is a baseball metaphor or a horse racing metaphor (that's how bad I am at sports metaphors), but suffice it to say, I'm smack dab in the middle of my last few weeks of pregnancy.

And thank goodness.

So, here's what's been going on:

• I've still been having non-stress tests twice a week. These are still pretty stressful for me by the way.  Especially when the monitor they are using looks and acts like it's from the 1980s and is on the fritz all the time.  Sometimes it picks up my heart beat instead of the baby's and then I freak out thinking my kid's heartbeat is 70.  Sometimes the thing stops working completely and turns on and off at random and I swear it's possessed by angry spirits. But, in spite of how out-dated my OB's particular machine is, all the tests have shown that the Wee Carper is doing fine. 
• At about week 34 I had what will likely be my last ultrasound, barring some complication or fetal distress.  The baby was positioned head down (which she has been for a lot of my pregnancy), and it was confirmed - yet again - that she is a girl.  My OB isn't very good at giving me nice ultra sound pictures. We don't get the normal, cute pictures of her profile, or feet or hands. This last time we got (yet another) picture of her female parts, and a picture of her femur.  Oh well.  I've had about 4 or 5 ( I lost count) ultrasounds over the course of this whole pregnancy (maybe 6 if you include the fetal echo), so I consider myself lucky to have been able to see our little one in utero so many times.
• For most of my pregnancy the OBs have been telling me that they will probably induce me at 38.5 or 39 weeks, even if the baby isn't measuring big.  Theoretically, this is because there is a tiny bit greater than average chance of still-birth with diabetes (although no one has been able to tell me if this is diabetes in general, gestational, Type 2 or Type 1 specific . . . ).  But at my last appointment, everything was measuring so well, that the doctor said they will probably "let" me go until my exact due date, but no farther.  I still think it's rather presumptuous of them to tell me what they will "let" me do (as if they have control over my body), instead giving me my options, advising me with their expertise, and then asking me if that's what I want to do.  But, I do believe in modern medicine, and I trust my doctors, so even if I don't particularly like the semantics they use, I will take their advice on when it's time to get this kid out of me. Hopefully she'll be like both her mum and dad and arrive a few weeks early.
• Diabetes-ly speaking, things got super insane from about week 30-35/36 with the amount of insulin I was taking. I ended up taking SO MUCH FREAKING INSULIN that I had to change my pump out once a day.  That's about 200 units a day, people.  Which I guess is not uncommon during pregnancy, but I still can't believe how much insulin I was using! Right at about week 36 I started having tons of lows, and needed to cut my insulin usage back a bit. That freaked me out a bit, but then I did some research and asked around and realized that this was pretty normal. I've said it before, and I'll say it again: It has been a great blessing that Apidra has been running their no-copay promotion this year! We sure timed this kid right.
• Speaking of timing this kid right (like we really have any control over this . . . ), financially a diabetes pregnancy is a HUGE budget crusher.  We have been so incredibly lucky that this kid is arriving when she is, for the following reasons:
• We have stellar insurance through my husband's work, for which I am grateful every day.  Don't get me wrong, we definitely pay our fair share of premiums for it, but compared to a lot of other people's insurance, it is SO good at covering diabetes stuff.
• Apidra has been running their no-copay promotion.  With the increased insulin needs at the end of pregnancy, and our less than stellar coverage for insulin through our prescription plan, we would've been paying SO MUCH MONEY for my insulin.  As it stands, we haven't paid a dime. Thank you, Apidra.
• We hit our deductible and out-of-pocket-max before the baby will be born.  This means we will not pay a cent for my hospital stay. Thank goodness she's being born before Jan 1st!
• Again, with the timing of our baby, many parts of the ACA have been in effect. Much of my prenatal/well-woman screening was totally covered thanks to the ACA.  Also, I'm getting a breast pump for free because of the ACA, and the vaccines my husband has to get (TDAP, etc.) will be paid for because of the ACA.  And in a few months, when it's time, my birth control will be free because of the ACA.  Say what you will about that bill, and while admittedly it's not perfect, it's a damn good start and I'm already benefiting from it.
• And, of course, all the annoying regular pregnancy stuff is happening too. At about week 30 my feet and ankles started to swell.  A couple weeks later my hands and fingers started to swell (I especially notice when I'm trying to play the piano or text!).  And, even though my husband says I'm not as bad as some women he's seen, I definitely have a more pronounced waddle when I walk. Think emperor penguin.  Oh, and the crazies have all come out of hiding and started commenting on the size of my belly, asking me when I'm due, and just looking at me and saying "Wow!".  Seriously, filters, people!  

So this, will most likely be my last entry until after Wee Baby Girl Carper has arrived.  And who knows how long it will be before I get around to blogging about that, but I will try my hardest to, because I know there will be a lot that goes down at the hospital that someone who is planning a pregnancy with diabetes will want to know! 

Thanks for sticking with me until the bitter end! If I get super bored in the next few weeks before this kid gets here, or if something significant happens that needs to be written about, I'll post again. But if not, see you on the other side of parenthood!

Filters, Baby Showers & the Steel Magnolia Effect, Non-stress Tests: Or, things lately.

Filters
Yesterday was the first day all week that someone hasn't told me how big I am  Mostly, I think that's because I didn't see very many people yesterday. I only taught one family's worth of kids piano lessons yesterday, and those children are all extremely polite and well behaved. And also, it's never the kids that tell me I'm big, it's just adults! It's like people have never seen a pregnant woman out here before! Actually, I think that might be true for a lot of people, since there aren't a whole lot of people having babies in Columbus.  My personal perspective on how many women are having babies and how often they are having them is a little bit skewed because of The Church I belong to, and how valued children and families are in that church.  Also, my congregation is made up of a lot of young couples (because we live near a university), so when you put young couples together with a belief system that values children and families so highly, you get people who are breeding like freaking rabbits. All_the_time.  This is not a bad thing, it's just hard to remember that pregnancy is not quite as normal in the rest of my community as it is in my church community, so I need to learn to be more patient with people who may have actually never seen a largely pregnant woman, or who at least haven't seen one enough to not make it a novelty. Le sigh.

Baby Showers
I've been thrown two baby showers this summer.  The first was given by my sister-in-law and aunts when we were out west visiting family.  It was lovely! So many of my family members and best friends from college (who I still consider my closest friends, even though I don't live near them), were able to come. And it was awesome. It was so great to be around so many women who I admire and who have loved and mothered and sistered and friended me for so long!

I was also given a baby shower by some friends of mine from my church. I was blown away by how many people showed up and how generous they were with their time, talents, food making abilities, decorating abilities, and gift giving. I'm not a very emotional person on the outside, but if I looked like a deer in the headlights during that shower, it's because I was so overwhelmed with how cared for and loved I felt.

Another awesome thing about my baby showers was that no body, NOT ONE PERSON, told labor and delivery horror stories! I'm 31 years old, and like I said earlier, belong to a church where people are having kids all the time, so I've been to my fair share of baby showers in my life time. And let me tell you, people are REALLY awful about telling horror stories to soon-to-be moms about giving birth. I can't tell you how many stories I've heard about 3rd degree tears, the worst pain you've ever felt in your life, never having your nether regions be the same again, or what have you. Sometimes those stories were so bad that it made me never want to have kids.  So, I was fully preparing myself to hear all sorts of stories like these at my baby showers, but no one told them!

I kind of think it might be due to what I like to call the "Steel Magnolia Effect." If you've never seen Steel Magnolias, it's basically a movie starring Julia Roberts as a pregnant Type 1 diabetic who ends up dying after having a baby and it's really sad. Any way, that's pretty much most people's experience with anything diabetes and pregnancy related, but even when that movie came out, it was super out-dated. Pregnancy and Type 1 is much more common and much more safe these days. But, I think it might still be preventing people from telling me their birth horror stories, because they're worried that my birth is already going to be like Steel Magnolias.  Or, maybe people are just getting more considerate about those sorts of things? Either way, I'll take it!

Don't get me wrong, I'm still scared that things won't work out with this baby, too. And while at this point the biggest complication with a baby I could encounter would be something going wrong during the delivery (just like everyone else), and the chances of still birth for a baby of a Type 1 mom are only slightly above those of a "pancreas-typical" person, it still does scare me. And I won't stop being worried until this kid is out of me and she and I are home in one piece.  But, I think that is every pregnant woman's fear, so I think I'm pretty typical in that sense.  Any way, I'm just very grateful that no one told labor & delivery horror stories, because I worry about that stuff enough anyway.

Non-Stress Tests
I've started having non-stress tests twice a week. Basically they just slap a monitor on your belly, find the baby's heart beat, and record it for like 20 minutes. Or, if the baby is sleeping and doesn't move enough, then a really annoying nurse says, "Let's see if we can agitate the baby!" and proceeds to push hard on your stomach to try to wake the baby up and get it to move around. Sheesh. Next time she's going to get ninja slapped. But, all the tests (I've had 3 so far) have been fine. It totally freaks me out to have to listen to the baby's heart beat for that long, because it varies up and down so much, but I'm told this is normal.  Also, one time I heard (and felt) her having hiccups while listening to her heart beat, and that was pretty fun.

And that's basically it! We're just in a holding pattern now with diabetes stuff.  My insulin needs have increased a bit more (what's new there?), and I just had a three-week long fight with my medical supply company to get them to actually do their job and ship me some infusion sets for my insulin pump, but any diabetic person, pregnant or not, knows what that's like, so that's not really news. :)

Thanks for sticking with this super long post, friends! I'll keep you updated as more interesting things happen!

30 Weeks, The Vitruvian Man, and Waxing Philosophical

Well, I've officially made it 30 weeks, carrying a fetus in my uterus.  If there's one word to describe how I feel, it's this:

CROWDED

The end is approaching, and while it seems like it's coming to an end quickly, it also feels like it can't come soon enough.  I really just want the space in my thoracic cavity back.  I used to like being short, but it seems that being pregnant and short is a little more uncomfortable because there's just not as much room for the baby to spread out.  Even though she spreads out anyway.  I'm pretty sure she's constantly got herself in a spread-eagle/arms and legs splayed out like the DaVinci Vitruvian Man stance (see below).

(the Vitruvian Man)

But, things could be much, much worse.  One of the quirks I've developed with diabetes (and I think a lot of people who've had a chronic condition for most of their life feel this way) is the feeling that I'm always waiting for my body to somehow fail me.  I'm waiting on the next medical problem, the next complication, that day when a doctor finally tells me that in spite of all my hard work and expended effort, the disease has finally caught up with me and now something bad is happening.  I don't express this feeling very often, because I've worked really hard as a teenager and an adult to overcome my tendency to have "Worst-Case-Scenario-Thinking" about everything. It doesn't do you any good to think that way, and nobody wants to talk to you about anything, because you'll jump to the worst possible conclusion, so I've worked hard to get my brain to quit that kind of thinking. But with diabetes, those thoughts are always there, quietly in the back of my mind, taunting me.  I am actually FLOORED that up until this point, I have had no problems with this pregnancy and that this little life forming on the inside of me is doing so well.  Let's face it, if we didn't have insulin and synthroid and all sorts of other medical interventions, my genetics would NOT be being passed on to the next generation, and natural selection would've had its way about 20 years ago. But, MY BODY IS ACTUALLY DOING SOMETHING RIGHT!!!! It's a miracle.

So, deep thoughts aside, here is the latest on how things are going.  I've had two appointments today, with my endo and OB.

• Endo-My blood sugars are still great.  I am continuing to have increasing insulin resistance (totally normal in a D-pregnancy), but we just keep dialing up the insulin to match my needs. I still can't believe how much insulin I'm taking on a daily basis! And I am SO grateful that Apidra just happens to be running their "no-copay" promotion this year, the same year that I'm having a baby. Tender mercies, indeed! My thyroid function has remained stable, and my A1C has been so freaking good, that they didn't even bother to test it today.  I've had to start changing my infusion sites daily in order to get proper absorption, but apparently that's pretty normal, too.  So the tl;dr: everything is normal.
• OB- We had an ultrasound just to check on how the baby is growing.  The baby looks great! We got to see her wave "hello" at us, we saw her using her hands to play around with the umbilical cord, and we also saw her give me a swift kick in the gut! (she can pack a punch/kick these days!) The doctor took all kids of measurements, and said she is measuring exactly where they want her to be. She's in the 45th percentile, which means she's just a teensy smaller than average, which he was really happy with. With uncontrolled diabetes, there is the possibility that the baby will get too big, so they always worry about that and want to measure her to make sure she's growing appropriately. But, I am an extremely well-controlled diabetic momma, and the baby's measurements are reflecting that. She's weighing in at approximately 3.5 lbs! (Isn't it sad, that people are already obsessed with women's weight from the time they are in utero?--just kidding, it's an important measure at that point in a women's life).  Anyway, it was lots of good news.  I will start having non-stress tests twice a week starting at 32 weeks, and at that point, we'll just be marking time until this kid arrives!  Tl;dr: The baby is fine, everything is normal.

Well, that's about all so far. I'm sure I'll keep having more to say as we get closer to my due date! 

On Why I'm Glad I'm Not An Elephant

Did you know that elephants have a two year gestational period? TWO YEARS!

As I get further along in this pregnancy, and start to get bigger and more uncomfortable, as the doctor's appointments and the constant fiddling with carb ratios, correction ratios and basal rates continue, and as things just start to get annoying and old, I just keep telling myself "At least I'm not an elephant." Seriously, can you imagine trying to figure out basal rates for a pachyderm? Not to mention having to give birth to one? Not my idea of a good time!

So here's what's going on these days:

• Near Constant Insulin Adjustment- They weren't kidding when they said you'd be adjusting things weekly, if not more often! My basal rates are steadily increasing, and there's always some sort of insulin adjustment that needs fiddling with. Some of it seems super random, too. For example, the other week, I suddenly needed LESS insulin from 12-3am in the morning, because I kept having marathon lows. This seemed so odd, because everyone kept saying I would just constantly need more, which was true for all the other times during the day. But, for that one week, 12-3AM needed an adjustment! This kid . . . so fickle!
• Insertion Site Problems-So I started having some higher readings. Nothing too awful, but just days where I could NOT get my blood sugar under 100 no matter what I did. And, I finally figured out that my pump insertion sites (the skin/sub-cutaneous tissue where my insulin pump goes in and where the insulin infuses all day long) were starting to go bad on me after about 2 days, instead of my usual 3.  My endo said this is actually quite common in pregnancy, because after insulin resistance kicks in, you just start pumping SO much insulin into one site at a time, that the tissue just kind of gets overloaded and gives out and stops absorbing.  So, I've been having to rotate my sites more often now so they get some more breaks in between use. I'm supposed to try to experiment with using sites in other areas, like the sides of my hips/butt, my thighs, or on my lower back.  This is a problem for me, however, because I don't really have any fat in these areas, and it always hurts to wear my sites there.  Maybe this is TMI, but my back/thighs/bum have always been pretty muscular, and I don't really gain weight there, so there's not really a good "squishy" part to put a pump site in.  And putting a site into muscle not only hurts, but you don't get great absorption either.  So, we'll have to play around with that a bit. But, for now, changing my site out more often seems to be working.
• Slower Digestion- Did you know that when you're pregnant, your intestines and stomach actually get squished to basically within an inch of their life?! It's pretty crazy. Google it, you will be amazed.  But, that is a big reason why a lot of pregnant women have problems with indigestion or constipation or only being able to eat a small amount of food at a time, because literally everything is squished in there! Well, it turns out that this can also slow down digestion, which has been giving me some trouble with managing my blood sugars. If I eat too big of a meal, it takes FOREVER to digest and my insulin works too fast and I end up going low, and then a little higher later when it all finally does digest. It's annoying, but not too hard to work around, thank goodness! I just try to avoid eating too much at once (which is pretty easy, because it literally hurts to eat a lot at one time anyway!)
• Eye Problems-I had an appointment with my retinal specialist/ophthalmologist this week, and he noticed some more bleeding and leakage in the blood vessels in my eyes that weren't there before pregnancy. He didn't seem too concerned, and said that this is actually pretty common in Type 1's during pregnancy because of all the increased blood flow in your body that is a result of actually being pregnant.  He said the leaks were pretty minimal, that there's definitely nothing we'll do to treat them now because they're so slight, and that they will most likely clear up on their own after the baby is born.   He is going to follow me more closely, so he took a bunch of pictures of my eye during that appointment, and I'm going back in 6 weeks, and then again after the baby is born to get things checked out. It makes me a little worried, but I've had a few leaks before (20+years of Type 1 will do that, I suppose), and they've always cleared up on their own. Also, he's an awesome doctor, so I trust him, and he hasn't steered me wrong yet.  Seriously, I am SO blessed with doctors here in Columbus! I'm glad we stayed in this city long enough to have our first kid!
• The Baby-I also had an appointment with my endo & OB this week. My A1C is 5.1, my thyroid levels are perfect for pregnancy, and the baby is growing exactly how she should be, so it is all good news! I'm at 27 weeks now, and will be having another ultrasound at 30. Then, at 32 weeks I'll start going in twice a week to my OB for non-stress tests until the baby arrives.  

And that brings you up to speed! I feel like time is both creeping along and flying by! I have a ton to write about labor & delivery information, too, but this post is already super long, so I'll save that for the next post! Until then!

More Ultrasounds, a Fetal Echo, and insulin, insulin and MORE INSULIN!

Howdy All!

It's been awhile since I've updated, but we've been busy enjoying our summer! We went on a trip to see all of my family out west while I could still fly and be relatively comfortable with my growing fetus in the blissfully hot desert weather. I miss the mountains. Sigh.  And  I LOVE THE SUN!

But, I digress. This blog is about diabetes, not my love affair with the sunshine.

So, here's what's been happening!

1. We had another ultrasound because the doctor was not able to see all of the things he wanted to see at our 20-ish week ultrasound.  Also, at the last ultrasound, he saw what he thought might have been a uterine septum, which puts you at higher risk for early delivery, so he wanted to get a better look at that, too. Turns out I DO NOT have a uterine septum (thank goodness!), and the baby is growing perfectly and he was able to see all the anatomy he missed last time.  Specifically, he wanted to get a better look at her face to make sure her lips had formed and that she didn't have a cleft palate or lip or anything.  We saw her moving around like crazy, which he said was actually really good (even though to me it looks like she's having one crazy long seizure).  He said they actually worry when the babies don't move around like that, so he was very happy to see how active she was.

2. This week I also had a fetal echocardiogram, which is pretty much just a souped-up ultrasound that specifically examines the baby's heart. With Type 1 diabetes, you are more at risk for congenital heart defects, so they make sure you get one of these fetal echos at some point during the 2nd trimester. We had to go to the local children's hospital to get it done, since I guess they don't do it anywhere else around here. It is kind of amazing the amount of detail they can get of the heart, and all it's inner workings, even when the baby is so small!  It also shows how the blood flows in and out of the heart and they take all kinds of measurements of different parts of the heart and different heart beats. It was fascinating.  And, we also have good news to report from that! The cardiologist said the baby's heart looks awesome, and that she saw no problems and basically had nothing to report to us.  The actual scan took about 40 minutes, and then meeting with the cardiologist took literally 5 seconds because she had nothing to say. In this case, no news is definitely good news. She was really nice, though, if a little too touchy-feely, but she said if we had ANY questions or concerns not to hesitate to contact her again.  The baby absolutely did NOT like being poked so much, though. Every time the technician would put a little extra pressure on my belly to try to get a better picture, that kid would kick back! Also, she was moving around the whole time and I think it took a little longer just to get all the measurements they needed because the kid was so stinking active!  (This might not bode well for our future . . . we'll see.)

3.  So apparently, overnight, my insulin needs have skyrocketed! Seriously, it's like I'm injecting water sometimes.  I'm changing my pump set out about once every 1.25 days now. In my baby's defense, I do have one of the pumps with the smallest reservoir (only 200 mL, when most are 300), so that makes things more annoying, but still.  I had one night that was particularly awful and full of highs, so the next day I increased my basal rates by nearly half.  Nearly FIFTY PERCENT, people! In one day.  I'm so grateful that Apidra decided to run it's "No-co-pay" promotion the same year we are having are baby, because we are certainly going to save a lot of money because of it.

4. I have an eye appointment with my retinal specialist scheduled for a few weeks from now. Apparently they like to check your eyes out thoroughly at some point during a Type 1 pregnancy, and if there are any major problems (severe leakage from blood vessels, or any kind of bad retinopathy), they will reevaluate how you're going to actually deliver the baby. I've heard of other Type 1s with bad eye problems that had to have c-sections because I guess the pressure from pushing a baby out can make already damaged eyes even worse.  I'm not too worried about this appointment, since my last eye appointments have been so good, but I'll keep you posted on that too!

And, diabetes-ly speaking, you've been brought up to date!

Of course, there are all the regular pregnancy things going on too. I'm almost at 24 weeks and I'm getting gigantic a "really cute pregnant belly". Luckily, the baby is not measuring big at all (which can be a worry for people with diabetes), so that is good news.  It's getting harder to tie my shoes, bend down to pick stuff up, get up from lying down, etc., etc. But, I'm feeling this kid kick around on the inside, which is a little weird still. Lots of people have said how amazing it feels when you can feel the baby move, and while it is a little awe-inspiring, to me it's more awe-inspiring along the lines of "what the crap is that monster doing in my belly?!---oh wait, yeah, it's a human fetus."  Ben has actually been able to feel her kick, too, which is pretty cool. And I've noticed that she gets really still when I'm teaching piano lessons, or when I sit down to play the piano myself. I've got a 9-student teaching schedule these days, so this fetus gets to hear at least one lesson a day. I think it's kind of cool that she is listening (I think), because I hope that means she likes music or will respond well to it when she's no longer in utero, but I'm also a little horrified, because I don't want her to learn any my students' bad habits! So, I guess that just means until she arrives, I'll be making all my students practice extra hard so they sound better during their lessons. Seems fair, right? Or, maybe I need to play her a lot of good music, like Bach & Brahms instead of having her hear Skip-to-my-Lou or scales repeatedly. Over and over again. Day in and day out.

And on that note (pun intended) I'll end.  Thanks for sticking with me to the bitter end of this super long post!

It's a girl!

Well, I'm 19 weeks pregnant now, and we just had an ultrasound to check to make sure our baby was growing properly, and we were able to find out that "it" is in fact a "she"!  We're pretty excited!  Here are some notable things so far:

• Because Type 1 diabetics are more at risk for having babies with birth defects, my OB did an extremely thorough ultrasound.  We got to see all kinds of crazy stuff. Four chambers of the heart, both femurs, feet, arms and hands and he counted all the fingers! He even checked to see how many bones she had in her pinky, because apparently if you only have 2 pinky bones instead of 3, that, among other things,  is a good indication that the baby could have Down Syndrome.  We saw her kidneys, her spine, and even her cerebellum! So crazy! But she was pretty good at hiding her face, so we didn't see that yet.  She was moving around like crazy, which was so strange to watch, since I'm not feeling her move at all yet.  We are going to have another ultrasound in a month. I think he wants to get a better look at her face, and to double check a few things she was hiding this time around.  We also have a fetal echo scheduled for next month, too, so that will be cool to see her heart!
• Speaking of birth defects, I've started seeing the "high risk of high risk" OBs at the same office of OBs that I've been going to. He's been practicing for FOREVER and is actually really awesome. The other high risk OB I was seeing before will still be my doctor, but I think this guy is going to handle more stuff from now until I deliver, since he really knows his stuff. The only thing is, is that he can't deliver anymore because he recently was diagnosed with Parkinson's (I think?), so I'll have another person at the practice deliver me anyway. But he's doing all my ultrasounds now, and I really like him a lot.  Any way,  he told me that studies have shown that you start to really see a risk for birth defects when A1Cs are 8.3 or above.  Obviously you want to have an A1C as close to normal as possible, but knowing that my A1C was WELL under 8.3 put me at so much ease! 
• Insulin resistance has kicked in finally, and it has been quite trying to keep up with all the changes. It's nice, because I'm not so freaking low all the time anymore, but it's rough to have to adjust things every couple of days. And, my insulin needs have already increased so much! Sheesh! My carb ratios are all down to 1:4 or 1:5, and my basal rates have all increased too. I end up having to change my pump about every 1.5-2 days instead of every 3, so that becomes annoying. And I'm starting to run out of real-estate on my stomach to rotate my infusion sites! This will be an adventure!
• Speaking of changing insulin needs, I swear my little girl is already fickle.  I don't know if this is how the physiology works, and it probably is not like this at all, but I swear this little fetus just decides on a whim when she wants to suck all my calories from me, and when she doesn't.  Sometimes it's like she's making me constantly low and I can't eat enough food to keep both me AND my fickle fetus alive.  And sometimes it seems like she's saying "Naw, I don't want to eat today, so no thanks on the food, and, oh, here, have all this food back too." And then it's like she somehow dumped all the blood-sugar fuel she decided she didn't want anymore BACK into my blood stream and I'll randomly have highs.  I'm sure that's not how it works (anyone who knows anything more about how my blood sugar is used by her, feel free to pipe in), but it really feels like that sometimes!
• And speaking of feelings, some days are just HARD! Overall things have gone really well, I've been so lucky so far, and I have an amazing medical team, and my blood sugars are in great control, so I can't really complain.  But, while that is true, it doesn't mean it's not terribly hard work.  What is just a number or set of numbers to most people (A1Cs and daily blood sugar logs), is actually just a small output of data representing hours and hours and hours of work on my part.  Or hours and hours and hours of feeling like crap on my part.  When I have marathon lows for 6 hours, and then my blood sugar suddenly jumps really randomly high, that's 6 hours of my life that I spend feeling like crap, lying in a heap on the floor sometimes, balancing a careful amount of carb intake vs insulin intake in hopes that it will meet the needs of my growing baby. It's exhaustion from lows, headaches from marathon lows or rebound highs, and random walks at 11pm at night because your blood sugar just won't come down no matter how much insulin you throw at it. not eating when you're starving, or shoving food in your face when your so full already you feel like you're going to explode. So, while in general, things have been a lot easier than I have thought, and Type 1 and pregnancy isn't like Steel Magnolias anymore, it is disingenuous to say that "everything is a-ok."  But, that's usually the sound-byte I give people, because how do you explain all that other junk to someone who doesn't really understand? And, I don't want to be "that guy" who keeps saying "Oh man, my pregnancy is the worst and it's so hard, and you couldn't possibly understand." Nobody likes "that guy"  (or "that girl," rather), and most people are just genuinely trying to show interest and are caring about you, so you don't want to burden them with a full medical report! But, this is a diabetes blog, and I'm writing this for the enlightenment of other potential diabetic parents, so there's the truth! It's hard, but doable and wonderful, all at the same time!

OK, whew! long, sorry! Just one last thing:  Why on EARTH do people think it's OK to touch someone else's stomach just because they are pregnant? Would you go up to some random person on the street as touch their stomach if they weren't pregnant? No! It's creepy, people. Keep your hands to yourself! I've decided that if people want to touch my stomach, I'm just going to start rubbing theirs right back, and see how much they like that. Seems like a good plan, right?  

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!

A Big Announcement

I've been thinking a lot lately that I wanted to write a series of posts about this, but I didn't want to break the news to the internets until we were ready to share, but we are, so here goes:

I'M PREGNANT!!!!

That's right, folks.  Come October 18th (or probably sooner, since, you know, the 'betes is involved)  my husband and I will be welcoming a little wee one into our family.  

There is oh so much that has already happened that I wanted to blog about, but we just haven't felt like telling everyone and their dog yet. But since we're coming out of the pregnancy closet, you better believe I'll be blogging a lot about the whole process.  Having Type 1 diabetes and going through a pregnancy is kind of a big deal, and I know there is a rain drop's worth of information about it out there (although that is getting a lot better), so I really wanted to be able to add my experiences to those already available to help out anyone else who might be having questions about having babies along with having Type 1.  So here goes!

Conception Planning

Obviously I won't be going into any of the juicy details about conception in this blog, but I do want to stress how important, and how frustrating planning a pregnancy with Type 1 diabetes has been.  Obviously there's all the regular worries like the right timing, mom's health, etc, but there's ever so much more when you throw diabetes into the picture.  I had to make sure I had a fabulous team of doctors in place (endo, high-risk OB, etc.). I had to make sure I had good insurance coverage for extra doctors visits, the ridiculous amount of prescriptions I will need to have filled, pumps & CGMs, etc!  I had to make sure I was healthy and that my A1C was in an acceptable range. My doctor wanted it under 6.5 and as close to 6 as I could get it.  That took awhile. Incidentally, my doctor also wanted me to lose 5 lbs, which despite my best efforts didn't actually happen until I became pregnant, go figure (I'll talk about that in a later post).  I also had to make sure I had any other co-morbid conditions in check, which got a little crazy at times for me personally, since it seems like the more we got ready to have a kid, the more co-morbids I kept acquiring.  First, it was gluten intolerance, then it was SVT (a heart condition), and the latest one was Hashimoto's hypothyroidism (which I can't even remember blogging about, but it happened).  

Phew! And when it seemed like the stars FINALLY started to align for us, and I stopped adding other conditions to the heap-o-medical-problems I already had, we got the green light from my endo to go ahead and start trying to conceive.  And a couple of months later, we found out I was pregnant! My lowest A1C pre-conception was 6.0, but my A1C at conception was 6.2, and I'd say that I'd been in REALLY good control for a year before getting pregnant and in pretty good control for about 3+ years before getting pregnant. 

It's been a crazy ride so far, and I'm sure it will only get crazier, so hang with us, and we'll keep you posted on all the ins and outs of having a baby with Type 1 diabetes.  Crazy!

Super-random Musings on the Occasion of My 20-year Diaversary

Can you believe that twenty years ago this month, when I was 11 years old, I was getting super sick, and ended up in the hospital with a Type 1 diabetes diagnosis!  You can read my diagnosis story here if you're interested. I can't believe it's been twenty years! Sometimes it seems just like yesterday, but at the same time, it seems like a long time ago!

We have come SO far in 20 years! When I was first diagnosed, I was put on an exchange diet, I used a meter that took 2 minutes to give a reading and which required that you wipe the blood off the strip before you put it in the meter, I used Regular and NPH insulin (sheesh, I can't believe we thought that was "cutting edge" back then!) and everyone still operated under the assumption that diabetics couldn't eat sugar.

Twenty years later, I'm pumping, eating (pretty much) what I want, using a CGM, uploading my pump and meter readings via the internets to my doctors office, my insulin is much faster, and my 5 second meter seems like it takes an ETERNITY!

We've come far.

It's funny, though. When I was first diagnosed all the doctors said that they were certain that Type 1 diabetes would be cured in 5 years. And from what I understand, a lot of people hear that from their doctors upon diagnosis (even today!).  Is that something they teach them to say in med school or something? It's a load of crap, but I am hopeful that ONE day there will be a cure for this disease.

I am so grateful for all the medical care I've received over the years, and even more for all the people who've supported me and have helped me manage this disease! From my parents who financially and emotionally supported me, to my college roommate who crossed the Mexican border to bring back cheap insulin for me when I had no insurance! There have been SO many people, who have helped me out through the years.

And can you believe it, that 20 years later, I still haven't had any major complications? No amputated limbs, no readmissions for DKA, no neuropathy at all.  The smallest complication I've had was about 4 years ago when I had the teeny tinest of blood vessel bleeds in my eye that the doctor could barely pick up.  And it has gone away since then.  Healed itself right up!  I know I'm lucky!

And you know what? Even though diabetes really really really sucks sometimes, I just can't imagine that I'd be the kind of person I want to be without it. And I don't want to imagine living in a world without knowing some of the people I know because I have diabetes.

Here's to another 20 years!

Dexcom G4 Review

 I've been wearing my new Dexcom G4 Continuous Glucose Monitor for several moths now, so I decided it was time to write a review.  Also, I haven't posted on this blog in AGES, so it's about time it became active again! Sheesh!



So, here's the lo-down on the new G4!


PROS
1. Aesthetics

•  Design! It actually has some! Someone actually took a few minutes to make this thing approach sexy.  Granted, it's not iPod or smart phone sexy, yet. But compared to the Dexcom 7+ and the Medtronic weirdo shell shaped thing, the new receiver design is actually pretty pleasing to the eye.  As one who has been known to purchase a computer solely because the box it came in was very sexy, you can trust me when I say, this CGM is probably the sexiest one out there at the moment. 
• Color screen- The screen on the receiver is color now. The background is black and all the data is in different colors. White, red, blue. It's beautiful, and much easier to see in the sunlight. Also, the colors correspond to the action you should be taking (i.e. "red" means something you should deal with immediately, etc.). So the color scheme is pretty intuitive for anyone that's grown up in a culture where red means "STOP" or "DANGER".  

2. Accuracy

• Calibration- Compared to the Seven+ it feels like this little device has a super smart brain that is constantly thinking and adjusting based on the calibrations you're giving it. With the Seven+ it sometimes felt like it didn't give a crap about the calibration you just entered and just decided willy nilly how it was going to report your blood sugar. Not so with the G4!
• Accuracy- This thing is SUPER accurate in the "in range" levels and is a rock star in the "low" range. 

3. Range-The ranger on the G4 is way better than the Seven+. It is officially listed as 20 feet, and I've never had it loose signal on me once. I live in a two bedroom,  two story town house with a basement (so technically three stories that I regularly use), and I can set it in the living room and wander all around and up and down my house and never lose the signal. And, I've never once lost signal during sleep, which the Seven+ was notorious for doing, even if it was sitting right next to me on the night stand. This little transmitter can transmit through a mattress! Woot!

4. Dexcom Customer Service-I can't say enough good things about this company. They are not paying me to say this, and I'm sure other people have had different experiences. But, they have literally bent over backwards to help me out, and as anyone who's had to deal with a chronic illness knows, that kind of service is rare in the health care world. When I have to call Dexcom up for something, I almost look forward to it because I know they'll be helpful and they won't give me the runaround. 

CONS

1. Accuracy- While being super accurate for lows and "in range" readings, it still has a little bit of trouble when you're high. And it can still lag a little bit when you're either rising or falling fast, but I do think it does a better job at keeping up with speedy changes than the Seven+. Additionally, I think a lot of that has to do with the fact that it uses interstitial fluid to measure glucose, which (as all CGM users should know by now), has about a 10 minute lag time compared to a finger stick. 

2. Insertion- Insertion is not painful, and is exactly the same as the Seven+, but the insertion device still looks like an instrument of torture, and I'm sure that the intimidation factor on that thing has got to be keeping people from trying it. Maybe someone can get a designer working on that for the next generation? 

3. Physical Specs

• The battery life on the transmitter is only 6 months now. I suspect the reason for this is two fold.  First, while the Seven+ touted a year long battery life, I think many people found that it pooped out on them slightly early than that, especially if they used it all the time. Second, the G4 transmitter is MUCH more powerful (longer range) and I think that the shorter battery life has something to do with that. 
• The profile of the transmitter is slightly higher than the Seven+,which is kind of a bummer. It looks exactly the same, but it's a little thicker now, probably because of the more powerful battery.  The sleek profile of the transmitter against my skin was one of the things I loved about the Seven+, especially compared to the alternative "shell" from Medtronic, so I was slightly sad when I saw  how high the profile of the G4 was. But, it's still way better than the shell, and all the other lovely things it offers make up for it.

So, there you have it. I highly recommend this CGM, without any reservations, to anyone who is thinking about using CGM as part of their diabetes management. It gives me so much peace of mind to know that I can actually TRUST this little machine to do its job, and that in addition to giving me all sorts of helpful information about how my blood sugar reacts to food or life events, the G4 will keep me SAFE.  Here, here, little CGM! Right ho!

*Post script* Since writing this review, I have seen a number of other G4 users have issues with their receiver having parts of the keypad fall off or the cover to the USB charger fall off.  I haven't experienced this at all. I keep mine in the case that came with it and it's usually in my purse near me, not on my person, so I think I'm probably a lot easier on the receiver than people who wear it on their person all day. Just wanted to throw that out there.  I do think Dexcom has been good about replacing them because they realize it's a problem with their design, since the same thing is happening to lots of people.  If I'm wrong about that, someone please correct me. :)