Thursday, April 25, 2013

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!

Thursday, April 18, 2013

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!

Thursday, April 11, 2013

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:


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!

Saturday, April 6, 2013

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!