Type 1 at 30

It's the Blood Sugar Roller Coaster!!!

2011-11-18T10:40:00.000-06:00

Weeeeeeeeeeee!!!!

Blood Sugar Roller Coaster!

Xander's Arrival Story Part 4

2011-11-07T10:50:00.000-06:00

That first night after Xander was born was tough. Xander spent most of it in the nursery because none of us had had any sleep in what seemed like ages and I needed to recover. As exhausted as I was, I didn’t sleep well at all. A c-section is major abdominal surgery and I was seriously uncomfortable as a result, the nurse had to wake me up frequently to check how things were going, my blood sugar was trending low, and I was still throwing up like nobody’s business.

At one point, determined to get at least a little sleep, I asked the nurse to please put me on a dextrose drip. This nurse (who was not my favorite in general!) actually seemed hesitant, and then said that it would mean taking me off of the pitocin for a while. It was suddenly clear to me why I was still throwing up. I told her to switch it anyway and we could just switch back once my blood sugar was up, because being constantly in the 50s and 60s very simply isn’t healthy. She made the switch, my throwing up slowed down, and my numbers started to rise. (I also wasn’t in a rush to get back on the pit, because it was really just supplemental to what my body would do naturally to return the uterus back to normal.)

After that, everything was manageable again. I had lows, especially since I didn't feel up to eating full meals right away, but I could hold food and drinks down once I was off the pit the next morning. Other than having to ask for a lot of juice and soda, diabetes kind of dropped into the background again for the rest of our hospital stay.

Of which I am glad, because we had other things to focus on.

Xander was healthy, and seemed just so perfect! At 8 pounds 10 ounces, he was on the bigger side of normal (but was actually smaller than I was when I was born). The other common risk when a mother has diabetes is that the baby’s blood sugar can drop right after birth. Xander’s was described as “borderline” on the first test, but they simply fed him and all of the following tests were normal.

Chad, Xander, and I were Tired with a capital T. There were times when it took me 10 minutes to test my blood sugar because I would fall asleep 4 times before I finished. Seriously, I’m not exaggerating! Really! Chad has a little story about one time when I was going to put my glasses on, but I paused with the glasses suspended a few inches away from my face… and just dosed off in that position for a minute. When I came to, I just finished putting them on like nothing had happened.

But like I said, all three of us were tired. Chad was trying to feed Xander a bottle on Xander's second night and was just nodding off repeatedly. The nurse told him that if we’re going to give him bottles, “We can do that. Don’t try to be a hero. Let us keep him in the nursery, and you get some sleep.” I imagine this must have been a relief to him since I really couldn’t do much that day after Xander was born. Having a C-section makes even walking to the bathroom and back hard work, much less changing diapers and bouncing babies. Chad was suddenly thrown into the task of taking care of both of us. We let Xander go for the night and finally got some decent sleep.

To sum up the timeline: We went into the hospital Friday evening, Xander was born Saturday (August 13th) evening, and we left the hospital Tuesday afternoon. The entire experience was exhausting, but the results were so worth it.

Going home... Please focus on how cute Xander is and not on how
aweful I look when swollen and without makeup!

In The Meantime...

2011-11-03T10:42:00.001-05:00

I'll talk more about the initial adjustments when I give you installation four of "Xander's Arrival Story," but let me tell you, delivering a baby is like hitting "reset" on your insulin needs. I still need far less than before pregnancy, let alone compared to needs during pregnancy! But it's all in flux. My one month average blood sugar? 116. My most recent one week average? 145.

Can you tell by looking at those numbers that I started back to work almost two weeks ago? Yeah, pretty clear what's thrown a wrench in the gears. I've had a few 200+ numbers sneak in there during work hours. I finally took 20 minutes this morning to look at time of day averages and adjust my overnight basal rate and up the insulin on my breakfast and lunch I:C ratios. With both a baby and work to keep up with Time to get this under control.

I only have one set of organs, after all. It's kind of important to take care of them!

Xander's Arrival Story Part 3

2011-11-03T10:08:00.001-05:00

I'm finally posting the next installment. I think I'll make a goal of posting the last installment by the end of this upcoming weekend!

They mentioned starting me on pitocin very early in the game because I wasn’t feeling any contractions, but I really wasn’t interested in that stuff. Contractions started not long after they got me all hooked up to the monitors, and I told the nurse that I didn’t want pit as long as my body was laboring on its own. I settled down to try to get some sleep, but I really didn’t get much at all. I’m guessing I had maybe an hour total, considering the disruption of contractions and nurses. Overall though, early contractions were not bad.

In the morning, the nurse pointed out that my contractions had gotten further apart and I was on a time-crunch since my labor had started with my water breaking. This hospital, like most, had a policy of doing a c-section 24 hours after that happens.

I was terrified of the stuff because of what some mothers had told me about their experiences with it, but agreed to the pit... but only after tears and a phone call from my own doctor. Long story short, I believed that pit was Xander’s best chance of being born vaginally.

Once I agreed to pit, I also planned on getting an epidural before contractions got intense. The pit didn’t “hit me” like I’ve heard so many women say. I could tell the contractions were picking up, but they still weren’t bad. After a while, at a point when the contractions were getting slightly harder to manage but not so bad that a contraction would prevent me from staying still, the anesthesiologist came to see how I was doing. He’d talked to me about the epidural the last evening and I really liked him and the way he talked to me. He obviously believed epidurals were a very good thing, but I didn’t feel pressured or talked down to when I expressed concerns. I decided this was a good stage, so he went to get what he needed for the epidural.

This was more scary and disconcerting than painful. Had I felt the same pain in my arm, it would have been an “ouch” moment. But when it’s going into your spine, it’s an, “OMG, needling in my freaking spine!!!!” moment when your lizard brain starts screaming. Your spinal cord is, after all, essential to your body working correctly! I had to struggle not to squirm, but once it was over it was worth it. My legs grew comfortably warm and I was actually more comfortable than I’d been in at least two months!

But they continued to up the pit, and that was about the last time I was 100% independent in managing my blood sugar.

There was a drawback to these interventions, and I’m convinced it was most likely caused by the pitocin. I started puking, which meant I couldn’t keep any sugar down when my glucose levels went low. At first I struggled to keep up, with marginal luck. At some point though, they hooked me up to an IV drip for a bit, and things smoothed out.

Worse than that, Xander’s heart rate dropped whenever I threw up. It lasted long enough at one point that a group of nurses came in and started manipulating me, turning me from one side to the other, and then finally putting a sensor on Xander’s head (so they wouldn’t lose track of his beat). That was truly scary. It also would have been truly painful, if it weren’t for the epidural. Vaginal exams before the epidural were, by far, the most painful experience of my entire labor. Putting the sensor in surely would have been even worse, especially considering it took multiple tries to get it in place.

I believe I labored for a total of 22 hours. Nearing the end of that, the doctor on call double checked and found that Xander still had not dropped, and my dilation hadn’t progressed well. I had a brief amount of time during which I could wait, but the chances of things not ending in a C-section were now extremely slim.

The doctor and a nurse stood there waiting for my decision, and practically all I could think of was how completely wrong it was to have to make such important decisions at a time when I was so utterly exhausted that I probably couldn’t have decided which flavor of popsicle to eat anymore. Chad asked them to leave for a minute, and both he and my Mom said they thought it was the best decision. I think I probably asked them a couple questions, and then I agreed.

And things were set in motion.

Everything was something of a blur from this point on and, once I was in the operating room with the anesthesiologist starting to deliver that cocktail of meds, my memory is very spotty. I know I couldn’t move myself to the table on my own even though my epidural was a “walking epidural,” because I was just so exhausted and had barely been able to shift my pregnant body around even before labor. I’d carried in my Dexcom, which I clutched in one hand, but had given my meter to my husband. He was sent to a room to get into scrubs and was soon over my shoulder. The anesthesiologist was over the other shoulder, and he described everything that was happening to me. He told me what to expect, which was mostly changes in pressure. I do recall that when he told me they were about to pull the baby out, I expected one sweeping motion but instead felt a lot of digging and manipulating before he was pulled free. I remember hearing his complaining voice and I remember him being shown to me, but I was so exhausted and drugged that I could barely see him. Chad went with Xander for the weighing and examination, as we’d discussed he would do if Xander couldn’t be immediately handed to us. Being sewed back up was slightly painful and the anesthesiologist asked if he could give me more anesthesia, warning that I wouldn’t remember the remainder of the procedure.

I’m pretty sure I wasn’t actually knocked out from the last dose, but my next memory is of being in a patient room, and being asked if I wanted to hold my baby.

To follow, recovery and first days with Xander…

Xander's Arrival Story Pt. 2

2011-08-30T17:36:00.000-05:00

Part of why I scheduled an induction for Xander on his due date was because I wanted to give him the chance to arrive both naturally and in his own time (without passing his due date). As I mentioned, it was a hard decision when faced with the likelihood of a C-section no matter what we tried. I went home, put my feet up until my afternoon work shift, and texted Chad. He agreed with my choice, which made me feel a little more secure. I went into work at 1 and said goodbye to my coworkers for a time, since I would begin my maternity leave on Monday... giving me a chance to rest for a few days before delivery.

Or so I planned!

That evening, Chad picked up a couple movies from a Redbox and dinner from Macaroni Grill. I chose Eggplant Parmesan since there are urban legends about that dish inducing labor, even making one restaurant famous for their Eggplant Parmigiana Babies! I ate half of it, put the other away, and relaxed on the couch... propped up on cushions with my feet as high as I could get them comfortably.

But, when you're as big as a whale, nothing is very comfortable for long. I shifted repeatedly, which was honestly quite an effort. At one point a struggled to shift my weight and move my legs... and something suddenly didn't feel the same. I heaved myself off the couch and hobbled to the bathroom, and I knew by the time I closed the door that my water had broken.

I used the restroom, tried to calm myself down. I was nervous as hell, and a little scared. As soon as I felt I could hobble to the door without flooding the floor, I did so. I opened it and said, "Ummmm. My water just broke!"

Chad answered with something like, "Are you serious?!" and appeared at the bathroom door with wide eyes and half-eaten ice cream bar in his hands. I really wished I had a camera to capture that!

So I directed him to the list of things that still needed to go in my overnight bag, called the labor and delivery department to confirm that water breaking means I had to come in immediately (I'd hoped to labor at home for a while if not induced), called my mother, got a couple little things myself while also managing my broken water mess, and soon we were on our way... and driving through a mild thunderstorm.

After getting checked in, in a gown, and set up on monitors in bed, I had Chad bring me my bag of diabetes supplies so I could refill my insulin cartridge. I probably had enough, considering they don't let you eat anything during labor at that hospital, but I wanted to be positive. I also reduced my basal rate by half... and there were several times when I took it down to 25% or even 0. I really managed my own blood sugar and was never bothered by a nurse about it. Quite different than what some other mothers with diabetes have reported! It really went pretty well as long as I labored without any interventions. I sometimes went low, but was allowed to eat popsicles to bring it back up. That worked just fine. It really wasn't until interventions came into play that I couldn't handle it 100% on my own. But for that first night, I was fine and happy that Xander's time was approaching based on him and my body being ready, not based on a deadline... whatever the end result might be.

To be continued...

Xander's Arrival Story

2011-08-20T10:02:00.002-05:00

Things have been a little busy around here, and I anticipate that this story will take at least two or three posts, but please let me make a little jump to the end and introduce you to the newest sweetie in my life, Xander!!!

I suppose the facts give away a little of the story I'll be telling, but Xander (short for Alexander, pronounced "Zander") was born on August 13th, weighing 8 pounds 10 ounces. He's an absolute bundle of sweet.

He, his daddy (Chad), and I have been doing pretty well... Especially since Chad is taking two weeks off to enjoy his new son and avoid me having 90% of the sudden new-baby responsibilities, and also because my wonderful mother has been visiting and helping on a regular basis. I'm definitely having post-partum depression issues (this was expected, considering that it's so common and I'm more prone to depression than most), but honestly, things are actually good despite that. I have a wonderful support system.

Now, on to...

Xander's Arrival Story

It's been a while since I posted because, first, I was just too exhausted from late-pregnancy to have much energy even for blogging. I started working half days to help my extremely swollen feet/ankles/legs and to get more sleep. It was only swelling though, as both my blood pressure and urine tests showed no other symptoms of pre-eclampsia. I started seeing my blood sugar plummet too, but every test showed that the baby was just fine.

On Friday August 12th I went for what I knew would likely be my last prenatal visit with my OB. I was 39 weeks and 1 day, putting me in the zone where she'd want to induce if conditions were right... only they weren't. My cervix showed zero signs of preparing for delivery and Xander had not dropped. She said that, since things were looking so healthy and I was being was so closely monitored, she was willing to give me a few more days (but not past my due date) to see if things would progress on their own... though she sincerely doubted they would and, in fact, anticipated a C-section even if labor started naturally (and even more so if we induced without any further natural progression). I told her that yes, I wanted to give my body the chance to do things on its own. But she wanted a plan of action. The options: Schedule a c-section or schedule an induction (which was likely to end in a c-section). It was actually a harder decision than I expected since I didn't want a C-section, but I was being told that I would likely just go through labor and end up with a C-section anyway. Still, I decided to schedule an induction on Xander's due date, August 18th.

To be continued...

This is Why I'll Have a Secret Stash of Juice

2011-07-27T11:47:00.001-05:00

My number one complaint about my OB is that I always have to wait on her. At my appointment yesterday, I sat an hour in the waiting area and another hour in the exam room. Nearing the end of this, I was getting really weepy about the fact that I'd gone from feeling uncomfortably puffy before my arrival to feeling like I was dragging around dead weight below the knees.

Seriously, if you're going to make pregnant women wait around two hours for an appointment, at least provide some way for them to prop their feet up a bit!

But as I struggled just to stop crying, I had to stop and think... Wait... This is the time of day when, at the office, I keep my Dexcom in plain sight to watch for sudden drops in blood sugar... only I'm taking a couple days off from Dexcom. (I can't really put it on my belly anymore, and it doesn't seem to work as well on my lower back. Frustrated, I'm taking a break before I try again.)

I tested and saw a 59. I dug for starburst in my purse and unearthed three of them. I ate them and then caved into the voice in my head that told me it would not be enough and ventured out to the front desk to snag a sucker. A few minutes later, I tested at 55 and went back out to the desk for some hard candy. My OB was out there looking at my chart by that point, so I said I just needed to grab some candy for my blood sugar. Her nurse practitioner overheard this and said, "Do you need some glucose tabs? I have a stash, because my husband is diabetic." I gladly accepted three tabs (they may be gross, but they're faster than most candy) and headed back into the exam room.

My OB entered and declaired, "Well dear, first things first, you're carrying the wrong thing to bring your blood sugar up!"

I was starting to break into a sweat but, struggling to seem together, I said, "I always have glucose tabs in the car, but candy is usually fine. I just forgot to put more to my purse, is all."

Then she surprised me with, "Wellllll, shouldn't you eat something like peanut butter?"

Um. Wait. What? I'd assumed she meant I should have had glucose in my purse instead of candy, since it's faster. I'd thought that was a little bit nit-picky, but whatever. This, however, was just... wrong.

"Well, no," I said, as respectfully as I could. "Peanut butter would help keep my blood sugar up once I have it up, but it would take forever to raise it. It's mostly fat and protein." (Not to mention, it took about 30 carbs and a temporarily reduced basal rate to bring me back up to a BG of 99. Even if peanut butter were an appropriate choice, 30 carbs of it would be about... 8 tablespoons? That's half a cup of peanut butter! As much as I love the stuff, I'm pretty sure that'd make me puke!)

She answered with a simple "oh," and went back to my chart.

And that, my dear friends, is part of why I'll have a secret stash of clear juice in my bag while laboring in the hospital. Even among medical professionals, there's misinformation regarding diabetes (or at least information geared more toward type 2). I feel pretty strongly that I need to be able to handle things myself, when it comes down to it.

Week 36

2011-07-22T12:11:00.000-05:00

Now at 36 weeks, we're looking at less than a week before we're considered full-term! Wow... There were times when this pregnancy felt like it was taking forever, but suddenly it seems like the end is right around the corner!

We had our last visit with the prenatologist Wednesday, and the news was pretty good. The baby is estimated at 7 pounds 8 ounces and is measuring at slightly more than a week ahead. He's measured a week ahead from the beginning, so this isn't bad news at all. His abdomen is measuring a little big around, but not to a concerning extent. The prenatologist's assessment: "He's a big baby, but in the normal range. C-section is a possibility, but I consider you a candidate for vaginal delivery." Honestly, that's a pretty great assessment! I went into this knowing that a C-section is a more likely when the mother has diabetes, so to hear the prenatologist say I have a shot at a vaginal delivery feels like a triumph!

But the best part of visiting the prenatologist, other than hearing that the baby is healthy? Getting to see the kid.

Aren't 4-D pictures just wild? I bet when he's born, we'll be able to put this picture up next to him and tell that it's the same baby.

Diabetes in Pregnancy:

My prenatologist warned me that, after all the insulin increases you have to do during pregnancy, you often hit a point near the end when your needs suddenly decrease. (Common knowledge medical opinion says it's due to the placenta breaking down, but my prenatologist thinks the baby is simply using more genergy/glucose at the end.) I suspect I'm there. I had a fairly bad low last night, and I seem to be struggling to keep my numbers up this morning. Most (but not all) of my post-meal numbers are also lower. If today continues to look that way, I'll be making some changes to my settings tomorrow.

Frustrating Pregnancy Stuff:

I went for so long with very few of those usual physical pregnancy complaints. Now, I'm really catching up on the swelling! My legs, ankles and feet have gotten worse and worse, with yesterday being so bad that I weighed in 13 pounds heavier at my OB's office than I had only 9 days ago! The nurse practitioner says it was surely almost all from swelling. I put my feet up higher and longer than usual last night and the difference was pretty significant in my feet and ankles, though my calves were still very swollen. My feet probably won't swell much today since I stuffed them into compression socks and tennis shoes this morning, but I can already see my ankles growing despite the socks.

Sometimes in pregnancy, major swelling is also accompanied by other symptoms that point toward pre-eclampsia. Luckily, I don't have either of the other two biggest indicators: High blood pressure and protein in my urine. The doctor ordered some labs, including one that requires me to do the ever so fun 24-hour urine collection, to be absolutely sure. I'm not too worried about the results, but I certainly don't mind making sure everything is OK.

Conflicting Opinions in Pregnancy:

Another frustration is contractions. Ones I really don't even feel. But when I go for my twice-weekly non stress tests, everything goes great except that I'm having contractions. Sometimes it's just a scattered few, and that's not a big deal, but sometimes they're more regular or frequent. A nurse mentioned to me that some doctors wouldn't consider even that a big deal, but my OB does. Even though my cervix is closed and long (that means it's neither dilating nor thinning out in preparation for dilation), I've been given shots of brethine to stop the contractions a couple of times.

That. Stuff. Sucks.

The nurses warn you that it might make your heart race or make you feel out of breath. It makes me feel way worse than that. (I'm very sensitive to stimulants, and a nurse confirmed with me this morning that it acts very much like a stimulant.) They also warn you that it can make blood sugar go high. I could tell a difference with that, though it wasn't anything I couldn't keep a handle on.

But if I need to do something I don't like to keep my baby is safe and healthy, I'll do it. Thing is... I have this gut instinct that I don't need the brethine, and that my body isn't doing anything it shouldn't do right now. And brethine does come with some risks. Using it to stop contractions is an off-label (though extremely common) use of the drug, and the FDA has recently added a label to it that warns against using it on pregnant women for an extended period of time. So even though these shots are pretty short-term, I don't like them.

But my gut doesn't have a medical degree, or decades of obstetrical experience. My gut only has "instinct."

Then I mentioned the brethine to my prenatologist, and he immediately shook his head and said, "No, they shouldn't be giving you brethine now. Those contractions are normal. They get your body ready for labor." (This totally matched my own understanding of Braxton Hicks.) I said that it seemed that regular contractions seemed to be what concerned my OB enough to give it to me. Again, he shook his head. "You're not feeling these contractions? Trust me, you'll feel them if they're a problem."

OK, so now I have two conflicting medical opinions and a gut instinct to work with. Oh, and fear. What if I turned down brethine and the baby is born too early? Or what if I accept the brethine and keep my body from getting ready in time for labor, or what if the drug has a direct negative effect on the baby?

I wound up deciding that today's NST would be the last one during which I would accept brethine for these contractions alone. I told the nurse that if I had contractions, to express to my OB that I realllllly don't want to take it unless it's reallllly necessary. I told this nurse, who has worked with me a lot, about the above conversation with my prenatologist and also that I'm really at the point where I feel like I should deny consent for the drug but am also hesitant to butt heads with the doctor who's going to deliver my baby. The nurse said that would worry her, too. As I watched the monitor, I saw a couple contractions... but they didn't seem at all regular. The nurse took the sheets up to my doctor after the test had run long enough, and she came back down saying I could go. "And I didn't tell her that you didn't want the brethine. I said that your prenatologist had told you you shouldn't take it anymore." It sounded like my OB didn't fully agree with that statement, but she was wasn't worried enough about the current contractions anyway.

That nurse is awesome.

And, though I plan to talk to my OB about it when I see her, the brethine might not be an issue anymore, anyway. I'll be two days away from "full term" at my next test, and the nurse said she'd be surprised if I'm given it again at this point.

Foods I've Been Digging

2011-07-10T22:30:00.004-05:00

So, between diabetes with ever-increasing insulin resistance due to pregnancy and just typical pregnancy stuff, some things about my diet have changed. Here are some things that I've really been digging and that seem to work well for me...

Strawberries. Freaking yum! These are also one of the lowest-carb fruits so, as long as my blood sugar is at good levels, I can pass through the kitchen, grab one, and nom it without thinking of insulin. I couldn't do that with, say, a slice of apple.
Raw veggies. Baby carrots have been really nice to snack on, even without any dip, though I do have to bolus a little for them if I'm having more than a couple. Celery? If I'm willing to take the time to cut it up, this is one of those no-insulin snacks for me. Or if I want some peanut butter without a ton of carbs, this is a better option than crackers or toast. And for our weekly RPG nights, I usually grab a bag of raw broccoli and cauliflower at the store and dump it in a bowl with a little side of ranch. I do bolus a little for this, but it's mostly a good nosh-all-night kind of snack.
Those little single-serving snack packs, the kind that are usually marketed for being 100 calories. If I want something junky, these keep me from going overboard.
The turkey burger from Carl's Jr. No fries, just the burger. For some reason, of all the fast food options I've tried when just desperate for fast food, this one has been the kindest to my blood sugar. No spikes, and no fat-related rise later on. Awesome.
Peanut butter. This is a comfort food for me, it's not high carb, and it's about the right amount of fat (good fat!) and protein that it helps smooth out sugar rises without causing a fat-related rise later on. I've been eating a lot of this stuff since getting pregnant.
Low fat milk instead of skim. I love milk but, sadly, lactose is one of the faster-acting sugars out there. But add a little fat to a meal and that helps chill things out. I also made this switch early on because I kept being told I wasn't gaining enough weight. This was an easy way to add some fat and calories.
Vanilla Soy Slender. When I want milk but my blood sugar isn't doing so great, or if I just feel like drinking a big glass of milk without all the carbs, I'll drink this stuff. It's only 4 carbs a cup, and it totally satisfies my milk cravings.
Diet Rite, especially the funky flavors. In addition to being diet (and therefore carb free), it's also aspartame free and sodium free. The cola is decent, but I love picking up their funkier varieties, like tangerine or cherry cola.

These have all been good choices for me. Maybe they aren't all the best choices I could make (I could surely be better off without any fast food or junk), but they work.

Two things I'll soon be adding, with hope that they also "work for me," are prunes and watermelon. Prunes are just to help keep things closer to normal now that I'm at a point where my digestive system is naturally running more slowly, and the watermelon is an experiment to see if it helps with swelling (something I was told and have read a couple places online). I figure that, even if it does absolutely nothing for my swollen ankles, at least it's a good summer time fruit that's very low in carbs.

But honestly? I can't wait to be able to eat real pizza again!!!

Things are mostly typical.

2011-07-08T15:36:00.000-05:00

Most of my pregnancy complaints these days fall under "typical," rather than diabetes-related.

People making random comments about how big I am? Check.
Swollen ankles? Check.
Too tired to take the stairs if there's an elevator available? Check.
Carpel tunnel symptoms when I wake up in the morning? Check.
Peeing all the damn time? Check. (Though, this was also a common complaint of mine when I was an untreated diabetic!)
Hard to get comfortable in bed? Check.
The kid keeps kicking me in the diaphragm? Check.

(But, did you notice the significance of that last one? He's kicking my diaphragm, not punching it. He turned! He's no longer breech. Yay!)

That is definitely not to say that I don't struggle with my blood sugar. My insulin to carb ratio for breakfast and lunch have almost doubled, and my Friday night blood sugar seems to be just about uncontrollable.

I've started doing non-stress tests twice a week, which means I go to the hospital and lie there with all of this stuff wrapped around my belly:

These sensors monitor the baby's heart rate (and apparently my uterus). Every time the baby moves, I push a button that tells the nurse on duty to watch my baby's heart beat. They're looking for the right level of increase in his heart rate. If this ever shows that he's not reacting normally, it could indicate that he's no longer getting what he needs from my placenta.

This can take anywhere from 20 minutes to an hour, and the first time I was there for almost two hours because I was having contractions more frequently than my OB wanted. The nurse gave me a shot to stop them and I had to wait around for 45 minutes to make sure it worked. (These were just braxton hicks contractions, and I couldn't even feel them, so it wasn't a huge deal.)

With these tests twice a week, a weekly visit to the OB, and a twice-weekly visit to the endo, I have a minimum of three appointments a week, often four. I'm doing my best to schedule them so I don't have to take so much leave, but I'm definitely not going to have as much paid leave as I hoped for my maternity leave!

Kind of a Big Difference...

2011-06-24T11:22:00.000-05:00

I've mentioned before that my husband Chad decided to start watching his blood sugar after we established that he was having low blood sugar episodes, and that his fasting numbers weren't quite where he'd like them to be. Mostly, he checks when he wakes up and whenever he feels weird. But for the first couple of days, he did the whole shebang. He tested before meals and two hours after meals, as I was taught to do.

So after one of those meals, he tested on his handy but very simple Relion meter, and....

Holy crap!!! We had a moment of panic before I said, "Wait... turn it over."

Yep, confirmed... it had been upside down.

There's a pretty big difference between 201 and 102!!!

Home Stretch

2011-06-17T10:44:00.000-05:00

Things have been going well. My insulin-to carb ratios have been going up, up, up... but with only 9 weeks left, I'm in the home stretch. It's not so bad seeing those doses climb knowing that, by sometime in August at the latest, they'll come right back down to normal (or even lower, for a while!).

Things are really about to get busy... Up until now, I've had an appointment with my OB about once every 2 weeks (plus occasional drop-ins just to get weighed), an appointment with my endo once every 2 weeks, and a total of 3 appointments with the prenatalist. Now, those appointments with the OB will go up to once a week, and we'll be adding in twice weekly non-stress tests and a weekly bio-physical profile at her hospital.

Jeebus!!! So much for keeping some vacation time saved up for maternity leave.

Most women do get a little more attention later in the pregnancy, but I have so much because it's getting close to the point when the placenta could start breaking down due to my higher than average glucose levels. (We are, however, starting it a couple weeks later than my OB would normally start since I've been well-controlled.)

C-section was a big topic of discussion at the last appointment, too... and it didn't have a lot to do with my diabetes/placenta. It had to do with the fact that this kid is breech. My OB didn't discourage me getting into positions that make it easy for him to turn and she said she'd probably be willing to do an E.V. at 37 weeks (though she has some concerns about it since there's potential to hurt the placenta), but she did tell me not to get my hopes up too much. He's never been in a totally-head down position (that we know of from the ultrasounds), and he's been head-up for quite a while, which makes her suspect he's pretty determined to stay where he is.

And yikes, I can testify to that! He has some favorite places to kick or head-butt, and he stays there and does it so often I swear I get sore from it! When he starts working away on my right side, sometimes he's like, POW! and I jump and yelp. I'm always torn between applying pressure to encourage him to move a little more toward the center, or just tolerating it in case he's trying to do a somersault and turn head-down!

I certainly hope he flips so we have a shot at a vaginal delivery (my OB said breech = automatic C-section at her hospital, which is pretty typical), but I'm reminding myself that the important thing is that he arrives safely. I also find it slightly easier to tolerate the idea of a C-section now that it's for some reason not related to the big D. This is something that could happen to any mother and baby, and there are very few OBs left who are OK delivering a breech baby without a C-section (though midwives assist in this all the time, so a C-section isn't really always necessary).

In any case, we've also started doing some of the fun preparation for baby's arrival: putting together big items from the baby shower and filling in the gaps by buying essentials we weren't given. (We certainly never expected to be given every essential, but we simply waited until after the shower to see what we'd still need to spend money on.) This also means spending yet more money on top of medical expenses, so I've been doing a ton of comparison shopping. I managed to find a great used breast pump for an awesome price on ebay, I downgraded from the nice and super-cutesy baby bottles to plain and boring but highly-rated and inexpensive bottles from the same manufacturer. I've also created a "shopping list" on Amazon that we'll print and take with us for price-comparison when we go to Babies R Us to take advantage of the 20% off deal you get on any items from your own registry.

Phew! Baby-having is hard work even without having to watch your blood glucose like a hawk! Thank goodness decorating the nursery is more fun than bolusing...

Glucose Tabs and Tight Ropes

2011-06-02T11:40:00.003-05:00

Wandering through the produce section of Walmart Neighborhood Market, I felt a little bit funny. I glanced at Dexcom and saw a 75. That's not far from low and Dex hadn't been having the most accurate day, so I thought I'd better make sure. I pushed my cart out of the way near the deli counter, where a lady waiting for her order started to eye me as I fished through my giant purse, and got my meter case out. I opened it up, inserted a strip, and tried to pull the lancer out of its elastic.

The cap popped off and went flying, bounced off a shelf, and rolled under my cart. Dang it. I put the lancer down... and it rolled off the meter case, bounced through the slots in the metal grocery cart, and landed underneath. The nosey lady stared hard.

I heaved a sigh, started to move the cart out of the way, and the meter case flipped off of the produce I'd balanced it on and into the cart.

I glanced at the nosey lady and felt extreme annoyance. At this point, I knew testing was only a formality. I'm clumsy when I'm low, and now I was getting both frustrated and irritable.

I moved my cart, gathered and assembled everything, and tested. 55. Not a number that makes me panic, but not a good number at all. I fished the last four Starburst out of my purse and unwrapped and ate them as I contemplated buying pretzel crisps and hummus. (Pretzel crisps, yes. Hummus, not today.) I didn't feel good at all, but just moved slowly and tried not to let my instinct to eat sugar for survival convince me to pile donuts and cookies into my cart.

Almost 15 minutes later, Dex buzzes and flashes a 44. I've started to sweat and I definitely feel worse. I should feel better by now. I abandon my trip to the cracker and cookie aisle and make a B-line for the pharmacy, where I know there's a bench.... and a water fountain. I'm powerfully thirsty (something that normally accompanies a high, but whatever). I sit a minute to let myself hit the 15-minute mark and test again to see a 57.

Not. Good.

I don't have anymore candy in my purse, but there was a further point to heading for the pharmacy bench; it's immediately across from the diabetes supplies.

I grab a bottle of glucose tabs and, sweating on the bench, struggle to tear the plastic off of the cap. I'm starting to feel a little embarrassed... Am I going to have to ask someone to open this for me? I'm not that bad off! I finally make a dent and tear the plastic back in a ribbon, get the dang thing open, and eat three tabs in rapid succession before I stick the jar in my cart and drink deeply from the fountain.

Oh glucose tabs, you may be chalky, but you are a sight for my tired, hypoglycemic eyes.

Finally content, I sat on the bench and spent at least 10 minutes (which felt more like an hour) dabbing sweat from my face and hoping I didn't look or smell too awful. But no one seemed to be paying attention to the pasty, sweaty pregnant lady on the bench, so I figured I was probably good. Then I started wondering... would people notice if I passed out on the bench? Would they assume I was some weirdo who had fallen asleep and just let me get worse? Even though I was sure I would be OK, I fingered the medical alert charm hanging from my neck to make sure it was visible.

Once I started feeling human again, I made myself stay on the bench a few more minutes for good measure. 55 is not the lowest number I've ever had, but this was by far one of my worst lows. It felt horrible and it had been persistent. It had actually made me worry for myself and my baby. It reminded me that the necessary tight control I've been keeping for the health of my baby includes some danger. When you're keeping your numbers this low, you don't have very far to fall when your numbers start to drop. Tight control is also a tight rope.

Sickity Sick-Sick

2011-05-29T11:24:00.000-05:00

Friday night, I started wearing out well before our D&D game was over. Half snoozing on the couch, those still conscious took pity on me and another couch-snoozer and shut the game down. After everyone went home, I went to bed. I eyed my Dexcom, unhappy to see a 175, and tested... Yep, high. I bolused, but not too aggressively since I was about to sleep, and settled down for sleep.

Sort of.

My stomach started to rumble and my blood sugar would not go down. If Dexcom wasn't beeping at me, I was waking up to try and find a better position for my stomach or to drink water, pee, and try to get a handle on my blood sugar. I finally got up around 7 am with a headache, bolused again, checked for ketones (negative) just because I had so much time trying to get my numbers down that I had to wonder, and really started trying to hydrate myself. I then went out on the back patio with a big glass of water and a small cup of coffee. It was a tiny bit warm, but not bad... then suddenly I had the "sweats" that I normally associate with a low blood sugar (but I certainly wasn't low) and had to run for the bathroom. (Sorry for the TMI!)

Ohhhhh, I was sick! That explains so damn much.

(As a quick detour for anyone going, "OMG, listeria!!!" No, the symptoms were not a match and there hadn't been any time for an "incubation period" since I'd only just had deli meat that day at lunch and listeria takes at least 2 days to manifest symptoms. Plus, Chad got the same symptoms later in the day and hadn't eaten the deli meat I had eaten.)

I know that my blood sugar tends to run high when I have any kind of stomach upset, so I cranked up my basal insulin by 50% and sat inside in the nice air conditioning and felt sorry for myself until my blood sugar was under control again. My stomach discomfort went away quite quickly, thank goodness, so I made a healthy but easy breakfast for us when Chad got up. I kept feeling exhausted and headachy, I attempted and failed to nap, then I finally gave in and took some Tylenol. Unfortunately, this meant turning off Dexcom for the rest of the day. CGMs just don't work with Tylenol in your system, and Tylenol is all a pregnant woman can take for everyday pain.

Night-night, Dexcom:

I dislike not being able to see what my blood sugar is doing at a glance, especially since pregnancy has made things so unpredictable.... It. Was. Worth it.

I ended up feeling well enough to go to a birthday party for three good friends of mine. I did, however, tell Chad to just go ahead without me because I knew I was going to take a looooong time getting ready with so little energy. I felt pretty decent most of the evening, though I was tired and spacey and never got rid of my headache 100%. Chad and I ended up leaving at the same time despite our plans that I'd head home early and he'd probably stick around. Right around the time my headache was coming back, he said his stomach had been rumbling and he got the sweats. Either he caught the same bug from me or we'd both picked something up from the same source and his immune system had simply held out a little longer than mine.

I went to bed with a headache again, because I just wasn't willing to take Tylenol and keep Dexcom turned off overnight. My blood sugar had crept back up during the evening and I had to bolus not long before bed.
I really just wasn't confident that my BG would react predictably. Luckily, this one wasn't a constant headache but one that only throbbed with added pressure or a lot of movement. It only nagged me whenever I rolled over, so I could actually sleep.

I'm feeling a hell of a lot better this morning. My head still hurts with pressure (like when I sneeze, OUCH!) and my BG was a tiny bit above my below-100 fasting target when I woke up, but I'm just taking it easy and staying hydrated.

I was kicking myself repeatedly over those high BG numbers that first night, but this is yet another example of how you can do everything right and diabetes will still screw with you. It's a manageable disease, but that doesn't mean pure dedication is going to keep it in check every single day. Sometimes things just happen.

Flying in the Face of the APA

2011-05-27T13:36:00.005-05:00

I've officially decided to do something that flies in the face of an American Pregnancy Association recommendation.

I'm going to eat cold cuts and deli meat. And I'm not going to heat them all until steaming first.

Right now, the majority of you are having one of two reactions:

1. Most of you are saying, "Uhhhh, what's wrong with cold cuts and deli meat?"
or
2. A few of you are thinking, "Ohhh, but there could be bacteria, and that could be bad for the baby!"

It's not that widely known (you'd be amazed by how many blank stares I've gotten when turning down cold-cuts in the past few months!), but yes folks, pregnant women are advised by the APA to avoid eating deli meat (any cold meat that hasn't recently been heated to at least a "steaming" temperature). The theory is that there is a slightly higher chance of food poisoning with meat that's stored and eaten cold, and if that food poisoning were caused by listeria, it might also cross the placenta and make the baby sick (sometimes dangerously so).

Is it that listeria infection is rampantly common? Nope. About 2,500 Americans get it a year, which is 0.0008027371616142571% of the population. Then, is it because pregnant women are more susceptible to listeria? A little bit, due to weakened immune systems. 27% (about 6750 people) of those 25,00 Americans who get listeriosis each year are pregnant and, since there are about 6 million pregnancies a year in the States (and just assuming that means roughly 6 million women are pregnant a year), then about 0.11249999999999999% of all pregnant American women get listeriosis. I know that looks like a big number with all those digits, but it's actually tiny. It would round to 0.1%.

Holy crap, I did math!!! And I'm reasonably sure I did it correctly!

Anyway, my point is that there's a pretty slim chance of contracting listeria, and then it might not even cross the placenta to my baby.

But during the work week, what have the chances been that I would forget or neglect to pack a lunch and end up buying fast food which raises my blood sugar way out of the pregnancy target range? I'd say those fast-food high numbers have been happening about 80% of the time, lately. I've tried a dozen different methods to get myself to pack a reasonable lunch, and I beat myself up over every high number, but to no avail.

But before pregnancy, and before my resulting (self-imposed) deli meat ban? I'd say I made my lunch about 75% of the time, which generally meant throwing simple, pre-made foods into my little lunch cooler with a baggie of veggies and/or fruit. There were always some sort of deli meats in there, often as part of one of those little lunch combos I call "lunchables for grownups."

So I've made the decision based on the statistics around a possible danger for my baby vs. a verified, daily danger for my baby. My OB harps on about my blood sugars at every single appointment, but she has never once, either in person or on the dos-and-don'ts list I was given, said that I shouldn't eat deli meat. No, not all OBs are as concerned about listeria as the APA. My OB is pretty chill about "restrictions" in general. Tylenol in indicated doses, up to two servings of caffeine a day, up to two servings of nutrisweet a day, hair dying is allowed in a well-ventilated area, etc. And what she always emphasises with me is: good blood sugar levels, above all else!

If throwing a lunchable-for-grownups in my lunch bag every day keeps me away from Sonic and therefore keeps my blood sugar down, so be it.

Well, That's Embarrassing...

2011-05-19T09:21:00.001-05:00

I don't use any fancy pump accessories. I didn't get the "thigh thing," the "waist-it," or any kind of special clip or case. I just use the clip that came with the pump and I have a couple "skins" (which I got for free) in case I'll be doing something that is more likely to knock my pump around.

Typically, I do one of the following:

I put it in my pocket. Most of the time, this means it's visible. I do, however, have a couple dresses with pockets that allow me to hide the pump entirely by running the tubing through a tiny hole just inside the pocket. (I just cut a hole big enough to run it through then dab some "no fray" on the edges.)
Clip it to the underside of the front of my bra. I'm busty, so this normally hides the pump-bump entirely if I'm trying to go for a more sleek fashion look. (When I do this, I first slip the pump into a little fabric pocket I sewed myself [some people use baby socks!] so it doesn't get all sweaty against my skin.)
I clip it to the side of my underwear, slightly toward the front or back so I don't have a "lumpy" looking silhouette. This is what I almost always do when wearing a dress to work. (This also happens to be how I always wear it when I sleep.)

So, as usual, I had my pump clipped to the side of my underwear yesterday since I was wearing a dress. No problem. I really don't even notice it. But then all of the sudden, there was a tiny little...

Snap!!!

And then things just felt a little different. I continued walking and felt my pump slowly drooping... Huh, odd... Oh, crap! The elastic in my waist snapped!

It normally wouldn't have made much of a difference, but the weight of my pump kept inching it downward, and I had to keep trying to subtly pull it back up.

Droop, droop, droop, subtle hike! Droop, droop, droop, subtle hike!

At least, I hope it was subtle...

Nice. Who'd have thought my underwear would matter that much?

Luckily, it wasn't long until lunch, so I just slipped out to the Dollar General and bought a pack of underwear. Problem solved!

San Antonio and the Death of Dex

2011-05-16T09:39:00.000-05:00

I spent a long weekend, out of my usual routine and either walking far more than usual or sitting still far more than usual, without Dexcom (a continuous glucose monitor). And I was just fine.

You see, last Wednesday night (or early Thursday morning!), Dexcom vibrated to wake me and tell me I was low. I felt OK, but tested... and I was 90. Perfectly fine. So I calibrated Dex and laid my head back down to sleep... only to be startled awake by an incredibly shrill BEEEEEEEEEP!!!!

I've seen other D bloggers complain that Dexcom is too quiet and won't wake them up at night. Yeah, I don't have that problem.

I grabbed it and saw that Dex was initializing, and then that it had recovered a session. Okayyy... I put Dex back on the nightstand and settled back in, trying to relax...

BEEEEEEEEEP!!!!

Initializing and recovering again!

I went through this two more times before I turned Dex off and got out of bed, wide awake. 3:30 am. Great. No way I could get back to sleep, as wired as I now was.

I called the Dexcom service line as soon as business hours arose and they confirmed that, yeah, something pretty bad had gone wrong with the receiver, and they wanted to just replace it to be safe. They offered to overnight it, but I asked them to wait and send it so it would arrive Monday, since I was leaving town early the next morning. (They were, by the way, extremely awesome and offered to just overnight it to where I was going. I didn't really feel secure about sending it to a hotel when I surely wouldn't get there until well after delivery.)

Friday morning, after stopping for the #7 breakfast at Cafe Antigua (this particular meal is both incredibly delicious and miraculously easy for me to bolus correctly!!!), Chad and I made the long Trek down to San Antonio for my grandmother's memorial service. As a straight shot, it's about an 8 hour drive. It's much longer when you're pregnant and need to make frequent stops to use the restroom and stretch your legs. The drive wasn't bad though (especially since Chad was awesome and happily drove the whole way!), and we met up with my family on The Riverwalk when we arrived.

I had few blood sugar issues. I went low twice over the weekend, but neither time was bad at all. I probably went a little higher than I might have with Dexcom once, but it wasn't really out of my typical range, either. Basically, I just tested more often... A lot more often. And it was fine. But still, there's so much that Dexcom gives me. For example, I ate most of a sugar free fried pie and felt like maybe I'd given myself too much insulin for it. We Dexcom, I could have just kept glancing to make sure my blood sugar wasn't dropping. Without it, I tested like 45 minutes after eating to make sure I was going in the right direction at the right rate (I was), but I still felt kind of paranoid until the two-hour test. And with Dexcom, I didn't feel the need to test my blood sugar before sleeping. I just glanced to make sure it was in the right range and fell asleep with confidence that it would wake me if I went too low or too high. Without it, I tested before sleep (a good thing too, as I was a little low at that test on Saturday night) and still worried as I fell asleep... In fact, I let myself run a tiny bit higher during some of the weekend than I normally would while pregnant and with the safety net of a CGM.

Things have been fine, but I'll be really happy to see that Dexcom box this afternoon!

"Diabetic"

2011-05-10T11:10:00.000-05:00

I'm definitely not militant about saying "person with diabetes" instead of "diabetic." I don't care much if people call me diabetic (either as a noun or as an adjective). I try and respect that others might not like it and at least won't refer to anyone as "a diabetic" unless they've called themselves that.

But, I'm beginning to really see why some people dislike the very word "diabetic."

When I visit my OB, it's like diabetes labels everything about my pregnancy... in a way that I don't think is accurate.

For example, she keeps saying "diabetic placenta." I know that what she means is "the placenta in a pregnant mother who has diabetes," so I'm not offended or going to go on about how a placenta can't be diabetic.... but I feel that calling my placenta "diabetic" feels like calling it "broken down and incapable of supporting a baby properly." And that isn't true.

It is true that a placenta is more likely to break down too fast in a mother with diabetes. I definitely won't deny that, or deny that it could happen in my case. But the placenta does not break down faster simply because you are diabetic. It breaks down faster in the presence of higher than average glucose levels. Therefore, a very well-controlled diabetic mother might have a perfectly healthy placenta that is in tip-top shape all the way through pregnancy.

I accept that I am at a higher risk of needing interventions, but I dislike such suggestions (however unintentional) that I and my baby are doomed merely because of my diagnosis.

So, I now kind of get why some people dislike the word "diabetic." I understood already that it comes across as a label, which many people dislike, but now I also get that it suggests a state of being more than "with diabetes" does, and a "diabetic" state suggests poor health. Whereas, plenty of people with diabetes are actually healthy.

I am continually fascinated by the power of words. Thoughts shape language, but language also shapes thought.

Diaversary: Celebrating the Best Bad News of My Life

2011-05-04T23:07:00.002-05:00

Yesterday was my one-year diaversary, and how did I celebrate? With cake! Yummy, sugary, properly-bolused cake!

Chad was awesome. I was feeling crumby from an earlier low BG and I tried extra hard to look all pathetic and tired and pregnant on the couch while I said I should eat cake for my diaversary. So Chad went to the nearest market with a bakery and brought back both red velvet and carrot cake!

They're individual slices of cake, but still just huge! I bolused (generously!), made marks in the icing to indicate how much I would eat so I wouldn't get carried away, and thoroughly enjoyed my treat. Chad had some of what I didn't eat and we still had plenty of cake leftover. That's how big these stupid (but tasty) slices of cake were! Supposedly two servings, but really more like 4.

And this was a little celebration, as far as I'm concerned. We weren't celebrating diabetes, we were celebrating the diagnosis and the fact that the disease is about as under control now as it could possibly be. (But let's not fool ourselves. There's no such thing as 100% control when it comes the the big D.) One year ago, I got the best bad news of my entire life.

My blood sugar behaved with the cake, and I went to bed feeling pretty much OK about life. Yeah. Life is pretty good.

Looking Like a Baby!

2011-04-27T23:11:00.000-05:00

We had our second big ultrasound appointment today, with the perinatologist (an OB who specializes in high-risk pregnancies). Everything is still looking healthy and on-track, and we were happy to see some fat on those cheeks since he was just a skeletal little thing last time!

Look at that! He's holding his knees up to his chest with one arm, feet sticking straight out in front of him. Definitely my favorite shot from the ultrasound session.

Starting my 24th week tomorrow, I can say that things are going very smoothly so far. My blood sugar definitely goes out of range, but it's overall not too bad. But the baby is doing great, and the pregnancy itself is treating me pretty well. *knock on wood* I haven't had much swelling, blood pressure is as awesome as always, and I feel fine. I'm tired sometimes, more apt to sit down when I might otherwise be fine standing, and occasionally slightly uncomfortable due to the belly.... Those are my biggest physical pregnancy complaints these days, other than blood sugar being harder to control.

The baby has been busy kicking and karate chopping my insides. It's not just taps anymore! Sometimes there'll be a massive thump I'm just like, "DUDE! Whoa! Chill out!!!" If I lie on my right side, he seems to act up with lots of kicking the lower right side and punching the upper left at the same time! There have been a couple times when I was slightly amazed at how clearly he was changing position in there, and other times I'd start just feeling lots of pressure in one spot (usually lower center). Seeing that image I posted above, I wonder if he was trying to stretch out his feet in front of him whenever I felt that!

I'll admit... I'm not very prone to sentimentality and great big gushing emotional shows. I've had women tell me that pregnancy is "magical." Sorry, I feel no magic in my uterus. I have, however, begun to enjoy the growing evidence that there's a tiny little living person inside of me! Life and reproduction are so amazing and cool. And I don't feel some mystical bond to my child that some women say they feel during pregnancy, but I am completely delighted when he kicks (unless I'm trying to sleep!) or responds to pressure on the belly. I'm not an emotional gusher, and I'm really uncomfortable when other people gush over me right now, but it's still an incredible experience that I'm appreciating.

(Related to the whole lack of emotional gushing, I just recently retook the Myers-Briggs personality test and scored as an INTJ, which is sometimes referred to as "the scientist" or "the system builder." This more reserved aspect of my personality is actually very heavily covered in all of the INTJ descriptions I've read, which made me feel a little less like a freak for not being ooy-gooy over pregnancy and babies!)

Who are You Calling Little?!?!

2011-04-21T21:58:00.004-05:00

So not D related, but I just had to rant about this a little bit.

One of my "buttons," as my husband would call it, is when people don't take me seriously. Sometimes this is clearly intentional stuff like being openly disregarded (do this, and you'll see what I look like when I'm irate!), but I'm also pretty sensitive to language and subtext. I know full well that people don't have to be intentionally mean to have a negative effect on a person, a situation, or even a society.

As a result, I just absolutely couldn't stomach someone I barely know referring to me as "a little mama" in the workplace.

I totally let it slide the first time, telling myself that this person was trying to be sweet and friendly. But then she kept saying it, and every single time I envisioned myself as a toddler playing with a baby doll. "Little mama" just doesn't fit the image of myself that I try to believe in: a strong, smart, responsible 31 year old woman who made a significant life decision with her husband, and who is now going through a lot of work to bring a healthy human being into this world, whom I will then help guide through life.

I'm positive she meant well, and she probably doesn't quite picture me as that toddler with a baby doll, but every time she called me "little mama," it just didn't seem possible that she felt any respect for me.

I realized that I needed to find a polite way to get her to stop calling me "little mama." It's not appropriate in a work environment, it's not appropriate with someone you barely know, and... it's really not that cute or clever anyway. My husband and my parents have the most leeway with me when it comes to terms of endearment, and I'd have shut that one down pretty quickly!

I didn't want to have to go to her office and say, "Hey, by the way, I'd appreciate if you didn't call me little mama anymore," but I wasn't entirely sure how else to do it. Until I just did it.

Her: Oh, here, I'll let the little mama past.
Me: *smiling* You know, I'm really not that little.
Her: Yes you are! (Believe me when I say she was not endearing herself to me with this comment!)
Me: Well, and I'm a 31 year old woman.
Her: *awkward pause & stare* You are not 31!

I suspected, during the awkward pause, that she was realizing that I felt like she was talking down to me. However, I also knew the mention of my age would open up a mode of escape for her: a change of topic. It seems like almost all women over 40 assume I'm much younger than I am (most women younger than that and most men either guess my age pretty accurately or just never comment on it), and I do look fairly young. I'm well aware that, at this stage in life, this is a disadvantage for me in the workplace. (I'm also aware that, in the future, it might become an advantage.) Add to this the fact that I am only 5'2", and I'm at a double disadvantage when it comes to making a serious impression in the workplace.

By the way, when she said "yes you are!" to my comment that I wasn't that little, I almost wigged out on her ala Edward from Full Metal Alchemist:

But in all this, my mind was incurably boggled! First of all, how did she ever think this cutsie term of endearment would be appropriate with a professional peer she barely knows? Even if I'm younger than her? Even if I were much younger? Second, why did she make yet another comment related to my stature after I said I wasn't "that little?" She's on the taller side of average for a woman, but surely she's aware that some short people are self-conscious about their height (if you don't "get" that, watch the above video again! :p ). At that point, I felt like she was being genuinely rude, even if she didn't intend to insult me. It was like pointing out someone's big nose, wide hips, or other physical feature that is the opposite of what society idealizes. (So, thanks lady.)

Really, are people so clueless?

Prenatal Visit - Labor/Diabetes Discussion

2011-04-21T11:21:00.001-05:00

I had another prenatal appointment yesterday. These appointments are really much less eventful than you might think. I step on a scale, pee in a cup, get my blood pressure taken, and let the nurse use the doppler to hear & count the baby's heartbeat. When the doctor comes in, the only physical thing she does at all is measure my belly. Otherwise, she usually tells me that we'll start increasing monitoring before long and then answers questions I have.

This time, she said we'll start weekly monitoring at 32 weeks (I'm currently at 23), provided there are no signs that it's needed earlier. She said this will most often involve going to the office, having me lie down, and hooking up a monitor that will let me watch the baby (for between 30 minutes to an hour). Every time he moves, I push a button and the monitor will record his heartbeat. She said that if he's healthy, the heartbeat will speed up during those times. This is, from what I've read, a "fetal non-stess test." The point of this is that if my placenta starts to break down too early (not uncommon in diabetic women), they'll start to see signs that the baby isn't doing as well as he should. That could signal the need for an early induction. Early induction is something I want to avoid, but this is one of the few likely diabetes related scenarios that I knew early on would be a valid concern. Possible large baby? Not an excuse for early induction. Baby not getting the nutrition he needs to survive and grow? That makes total sense. Induce away, doc.

I also finally asked for a few more details on handling my blood sugar and insulin during labor. I've heard of some doctors and hospitals letting mothers with diabetes manage everything themselves, as long as they let the nurses know what their blood sugar is on a regular basis. But I've heard of others that want to take the management away from the patient the moment they walk in the door, putting them on an insulin drip and possibly a glucose drip.

But my OB's reaction when I asked, "Will I get to keep my pump on during labor," was:

"As apposed to someone taking it away from you? Of course." She clearly thought it was an odd question, so I clarified that I'd heard of other patients not being allowed to manage their own diabetes during labor, that some hospitals demand an immediate insulin drip instead. She looked slightly aghast and said, "I see no logic in that at all! No one's going to do a better job taking care of that than you. The nurses will ask you for your blood sugar periodically, and we'd have to take over if you were unconscious for any reason, but that's it." (I said, "In a case like that, you feel free!")

We discussed a few details. For example, she'd normally tell someone on injection therapy not to take their long-acting insulin during labor since blood sugar is more likely to go low than high. In my case, I'll reduce my basal immediately and watch to see if it needs to be turned off entirely. Like many hospitals, this one doesn't allow women to eat after they've checked in for labor and delivery. She confirmed that if my blood sugar goes low, they can give me "something like a popsicle." (I still plan to stash a juice box or two in my bag, just in case. Hospitals are busy places, and I want a back-up in case it takes too long for the nurses to respond to a buzz.)

She also asked how long it takes to change my infusion site, in case I had to have an emergency C-section, "because if it's on your belly, we'd have to remove it and that might disrupt your insulin delivery at an inopportune time." We agreed that the easiest thing would be to wear my infusion site and continuous monitor sensor someplace other than my belly for the last week of pregnancy. That way it won't even be a concern if I end up needing a c-section.

Which reminds me of yet another doctor's appointment I need to arrange: A check up with my opthamologist. The perinatologist recommended that, though my control is good and my retinas looked great last time, I should go ahead and get checked out before having the baby. If I have developed retinopathy, the opthamologist might recommend against vaginal birth if there's much risk of retinal detachment. Pushing only adds pressure to the eyes, which isn't smart if your retinas are ready to detach! I fully expect to be told my eyes look great and pushing would be safe, but it's best to know for sure.

Touche

2011-04-16T11:15:00.002-05:00

Chad decided he wanted a testing kit so he can watch is blood sugar for a few days, since he's had a couple moments of what felt like crazy-low blood sugars (we tested during one of those moments once and it was something like 46!). He also had a fasting blood sugar on the upper side of average when our GP tested it 8 or 9 months ago, and I think it's smart for anyone with any risk of diabetes to test their BG once in a while. So I picked up a Relion Micro and box of 50 strips. This was cheaper than if I'd just gotten him a vial of strips for the Freestyle I have but no longer use, or if I'd picked up strips to let him use my spare One Touch Ultramini (if I could find the damn thing!).

(I'm normally not one to promote Walmart, but their Relion meters and strips would be an great option for someone with diabetes and no prescription plan. This is actually the second Relion meter I've ever purchased. The first one served as a back up when my very first vial of strips ever ran out well before I could get the refill covered by insurance. Later, I mailed it to someone I'd talked to online who didn't have insurance and was having trouble affording strips for the meter she already had. When Chad said he thought he might want to keep a meter with him to test for lows, I didn't blink an eye at picking up another Relion. Even if he never touches it again after a few tests, it's such an affordable backup to have around.)

When I got home, we got the meter set up. He did the settings and learned the buttons while I set up the lancer and little meter case then nommed a PB&J sandwich. ;) Finally, he was ready to do a practice test.

He's seen me do it hundreds of times, and he's tested out of curiosity at least a couple times before. The only direction I gave him was to wipe off his finger with an alcohol pad because he hadn't washed his hands since eating a granola bar an hour before. Of course, his response was perfect:

"I was just going to lick my finger. Isn't that what all the pros do?"

Touche, Chad. Touche.

So he did his test and we watched the meter count down.

Me: 114? And you ate that bar an hour ago? Yeah, that's a good number."

Chad: Funny, I totally knew exactly how to test, from watching you.
Me: Yeah, on the forums, we'd call you a Type 3 Diabetic. Diagnosed as the spouse of a diabetic.
Chad: Haha! That's good.
Chad pulls the used strip from the meter and holds it up.
Chad: So, now I throw this on the floor or leave it someone else's car, right?
Me: *Grinning.* You've learned well.

Touche again, Chad. Touche again.

Wouldn't Bet Money On It

2011-04-15T16:31:00.000-05:00

Man. Last night, we went out for our four year anniversary. Just a nice dinner at a nice local Italian restaurant. I ordered foods I thought were fairly easy to bolus for, and I had extra glucose tabs and starburst in my purse since I planned on getting some sort of pasta and bolusing generously for it. My theory? If I'm going to eat a high-carb meal (while pregnant) on a special occasion, I'd rather start to go low and have to snack/treat. Much better than risking my blood sugar going high and spending an hour hour two trying to get back into range. With the bolus I gave, I expected a decent post-meal number followed by a late evening of snacking on sugary things to keep from going low.

My body had other ideas.

Maybe it's because my blood sugar was going low when the meal began (so my body decided to throw some glucagon into the mix?), but Dexcom buzzed at me as we sat over our empty plates discussing some of our favorite Star Trek episodes (and some of our least favorite retcon moves in the Trek universe). I pulled out Dex to see what he was telling me. I was still at a decent number, but I had double arrows pointing up. As I was confident I had enough sugar with me if things backfired, I bolused a little bit.

Repeat.

Repeat.

Repeat.

My blood sugar went over 200, despite a generous beginning bolus followed by several smaller boluses meant to try and keep things from getting any worse. I did a little bouncing around in that range for a good hour or so... before double arrows pointing down. I was prepared for this, though. We were home by then, so I drank 25 carbs of juice, still ended up low, and topped myself off with four Starburst (17 carbs).

So, yeah, that didn't go quite as planned.

What frustrates me about this is that, pre-pregnancy, I don't think that would have happened. I occasionally treated myself to properly-bolused servings of pasta, and the post-meal number was rarely a surprise. But while pregnant, there's no telling how food will act in my system. Even if I know the exact carb count in a food, and even if I ate the exact same meal yesterday, I wouldn't bet money on the outcome. The best I've been able to do is avoid things that are really high fat or high carb, which is probably part of why everyone at my OB's office doesn't seem especially thrilled with my level of weight gain.

WTF, BG?

2011-04-11T22:25:00.000-05:00

WTF? I haven't eaten in like four and a half hours! Where is this coming from?!

(It has to be fat from dinner, but it normally doesn't sneak up suddenly like this. )

Stress and Camping

2011-04-10T20:12:00.001-05:00

I had two interesting experiences with diabetes this week.

First, I got to see what real stress does to blood sugar. I know I have a hard time keeping things in range when I'm living more stressful days, but I had a car accident on Thursday evening. It was minor, absolutely no injuries and we all drove away. A fender bender essentially, except the vehicle in front of me was an SUV with a much higher bumper than that of my sedan. That meant her bumper hit and bend my hood, which was quite a dramatic effect in the moment. I handled things pretty well, all things considered. I had a few seconds of shock, but then I was the one out of the car checking to make sure everyone was right, calling 911, and guiding everyone off the road per the dispatcher's instructions. It wasn't until the situation was under control that I started getting emotional about it.

But that doesn't mean my body wasn't responding to the perceived danger. First, a sudden and frightening impact. Then, taking charge of an emotionally charged situation (effectively crisis management). And finally, dealing with the immediate aftermath.

I wound up staring down a 230 on my glucose meter, after all was said and done. (This is an ESPECIALLY unhappy number then you're pregnant!!!!) There could have been no standard carb or insulin explanation. This was purely my body gearing up for what it perceived as a fight or flight situation. That glucose was produced so I could run from a predator, or face some form of physical struggle.

It's actually pretty impressive. It's not at all good for someone whose body can't automatically deal with excess glucose that doesn't get used, but it's a response that could really and truly assist in saving your life or livelihood if you faced a real, physical threat.

We also went camping this weekend, and I have to say that my diabetes was slightly more baffling than usual. I should have taken pictures of my Dexcom readings, with the crazy ups and downs. I even changed my infusion site mid trip, even though I changed it immediately before leaving home so I wouldn't have to do that, because I started thinking that maybe the site I'd chosen on my leg had weird absorption issues. That change may have actually helped, as I had fewer spikes after that, though I also suspect that I was still fighting some continued stress over my car situation. (Long story short, the car could absolutely be repaired to top form, but the repairs might exceed the value of this rather old car, which would mean my insurance company would declare it a "total loss." I'd rather just get it fixed if I can, since it's actually an incredibly reliable car, and I'm not sure what that will mean financially.) I think, as the weekend went on, I relaxed and my glucose levels started getting back to normal.

It was interesting to change my site right in front of people. Other than medical staff, it's just been my mom and my husband who've seen it. But in this case, it's like I had a little audience. I did avoid doing it in front of a larger crowd that included people I didn't know very well, but I didn't mind a couple friends watching. I enjoy educating people, and these were both smart and kind people that I love. Liz, who has seen my pump plenty of times and watched me go through this treatment journey from the very beginning, seemed a little surprised at how small the actual site ultimately is. Between having always seen it hooked up to the pump and watching it come out of a relatively large plastic applicator, I imagine it ends up looking like not much at all when it's just been popped in! Shannan, who had already asked lots of questions and asked to see my pump and infusion site, asked about using up one of those big plastic applicators every three days. "Yeah," I said, "this is not an environmentally friendly disease!" (Which is totally true. I recycle all the plastic bits I can, but those applicators count as a self-contained "sharp" and so can't go into recycling. The same is true of syringes, pen needles, CGM applicators, and lancets. These are all medical waste to be disposed of as sharps.) I think Chad kind of enjoyed having them see that, too. He seemed a little bit proud as he commented that I do it all the time, and my fear of needles is just gone now.

I felt like a did a good job with food. I made easy-to-count choices. Like for breakfast hashbrowns, we went with the variety that comes in a "patty." No measuring necessary. Anything that offers portion control makes life easier!

Handy Tip

2011-04-02T18:28:00.001-05:00

Walking around the Medieval Fair is great for your blood sugar. Show up high, eat falafel, leave at a beautiful 81.

2011-03-28T22:46:00.000-05:00

A conversation with Dexcom, with a sensor on its last legs:

Me: 152.
Dexcom: 208?
Me: No. 152.
Dexcom: 255?!?!
Me: No! 152!
Dexcom: OMG! OMG! 283!!!!!!! OMG!!!!!!!!!!!!!!!!!!!!!
Me: No, I said...
Dexcom: ??? (Translation, "OMG, I'm so freaking confused my circuits just almost exploded!")
Me: Sigh... OK, I think 8 days was this sensor's lifespan... *stop sensor*

Sugar: The Bitter Truth

2011-03-27T22:17:00.000-05:00

I've been posting this video on Facebook and message boards, and discussing it with the one friend who was interested enough to watch the whole thing, so I thought, duh, I should post it on here, too.

It's about how sugar is metabolized and why fructose in particular is so bad for you. It's not really about diabetes (though he touches on type 2 diabetes), but about how anyone's body (with insulin, natural or not) would work with sugar. It's long and there is a point at which is gets pretty sciency (but not so sciency that I, as a layperson, couldn't get the gist of what he was saying), but I think it's fascinating.

Since the actual sugary "sweets" I eat are limited (though not eliminated) by how I choose to treat my diabetes, and since regular soda is almost non-existent in my little personal bubble, the primary thought I had was: Should I reconsider how I treat lows? If juice is available, that's what I normally use. My theory is that it helps replace some of the fruit nutrients that have been reduced now that I don't drink juice just to drink juice... But it's a ton of fructose with zero fiber. Could changing my low treatment perhaps reduce my triglycerides? My cholesterol is in the "safe" range for a non-diabetic, but maybe that could be part of a plan to get it down to "safe for a diabetic" levels without having to take statins later.

Honestly, really interesting stuff. It's much more revealing than the news reports that just tell you that sugar becomes belly fat and that makes you insulin resistant.

The Short and Long Haul

2011-03-18T10:49:00.003-05:00

Things are still going pretty well. My blood sugars are mostly within range, with those not in range not lasting long at all (except for one amazingly stubborn high a week ago, which was a slight mystery. DO NOT WANT!). I met with my endo yesterday and we adjusted my basals slightly to help me avoid going low right at the beginning of lunch and dinner, like I have been, though I still went low by dinner yesterday. I'll give it another day or two to see if the change is enough before I lower it even more.

It feels really good when you have it under control, but I've learned not to get too pleased with myself. Next thing you know, my hormones will change and I'll be looking at another mystery number. In any case, it's probably only a matter of a couple weeks before the usual insulin resistance of pregnancy will kick in, and I'll have to keep upping my insulin over and over to keep things in check.

I also went for a weigh-in at my OB's office yesterday. All I do on these visits is give the nurse my blood sugar records, then step on the scale and let her write down what I've gained. Then the nurse tells me when to come back for another weigh-in. The general routine if everything is going well is to weigh every two weeks. If there's some kind of concern (usually no weight gain), then they have you weigh again in only one week.

I'd gained two pounds in two weeks. My thought was, "Well, that's more gain per week than what my OB and I want me to average, but it is still within what she said is healthy."

But the nurse's reaction was twofold. First, she exclaimed, "Two pounds! You did good!" Then she looked at my chart and said, "I'd better have you come back in next week so we can make sure you're still gaining."

I asked why, and she explained that I've only gained about 5.5 pounds total in three months. So I said, "But the doctor said last time that I was right where I needed to be, and I've gained two pounds since then, in only two weeks. Her exact words were 'You've gained three and a half pounds, so we're winning!' and said anything from a quarter of a pound to a pound a week is fine."

The nurse seemed a little confused and was looking over my chart and pointing out numbers in a scattered sort of way, and then said, "Five and half pounds in three months? Is that good? Is it because of your diabetes? Is that why it's good?"

I was just kind of at a loss, because I'm pretty sure it has nothing to do with diabetes (though gaining too much would probably make things harder to control). I was annoyed and tempted to say, "It's good because I'm already fat!" but that's really true, either.

But luckily the nurse practitioner was there, took a look at my chart, and said standard procedure was fine. I could wait two weeks.

I'm also always surprised by the different reactions to my blood sugar that I see from different medical professionals. When you're insulin dependant, weird things are going to happen with your blood sugars no matter how on top of them you are. Pretty low lows are one example. When someone like my endo or a CDE sees, say, a 46, the reaction is a calm, "Do you know what caused it?" followed by any discussion of how we might be able to prevent that situation again. When anyone at my OB's office sees it, including my OB, they give me a shocked look and say, "What happened?!?!" with a slightly panicked voice. I'm always slightly tempted to blink and say, "I'm insulin dependant. That's what happened." People who work with T1 diabetics on a regular basis see a number like that as serious, but not in the least bit surprising. People who don't work with T1s on a regular basis see it and picture me teetering on the edge of death from some kind of bizarre twist of diabetes fate.

And, for me, 40s are rare and really really sucky, but not terrifying. At those levels, I'm still physically and mentally together enough to treat myself. I couldn't do algebra, hold a complex conversation, or go for a brisk walk, but reaching into my purse for glucose tabs or walking to the kitchen for juice? Not a problem at all. (And I do so ASAP, before I get to find out how functional I might be in the 30s.)

On the flip side, my OB doesn't even bat an eye at the frequent 60s I've been having before meals, but my endo sees frequent lows of any level as a concern. "It is too early int he game for you to risk letting yourself become desensitized to lows. You do not want that." Slightly different perspectives and priorities. My OB is primarily concerned with the health of me and the baby during my pregnancy, but my endo looks forward at the decades to come, during which I will still have diabetes (barring medical breakthrough) and have to live with any consequences that may come due to my habits today.

I'm in this diabetes thing for the long haul.

First Major Ultrasound

2011-03-14T15:06:00.002-05:00

We had the first ultrasound today, other than the quick peek they took at my first prenatal visit when the baby was about the size of a peanut. It was totally fun to watch, but let's get the big part out of the way first:

The doc said, "Everything looks great." *sigh of relief*

The size is right, resulting in an estimated due date at August 15th. That's a mere 3 days earlier than the due date my OB gave me based on the date of my last period. He did a great job of explaining what he was looking for regarding abnormalities, and confirmed that everything he saw pointed toward normal development. He wants to see me again in six weeks so he can get a better look at the heart after a little more development, but said it currently looks great, too.

On to the fun stuff: It's a boy!!! I had actually suspected as much, because I noticed some of my body hair getting a little more noticeable and remembered my mom commenting that she'd noticed darker hair on her face when she was pregnant with my brother. I guess it's all the testosterone it takes to turn a boy into a boy. It'll have some effect on the mom, too. Chad and I really didn't have much preference for gender (I've always said I'd love to have one of each), so the cool thing about knowing it's a boy is that we can really start working on names and pick out some boyish stuff for the registry.

He was a mover, too! He kept kicking those little feet and thrashing those little arms, especially when the tech tried to get him to open up a hand. This matched right up with his over-activity at the last OB's visit, while the nurse tried to get a count on his heartbeat. He was just pushing himself all over the place!

We did have a little diabetes gem with the doctor.

Doc: So, tell me about your diabetes? How long have you had it?
Me: I was diagnosed in May, so less than a year.
Doc: Uhuh. And they thought it was type 1? (Sounding skeptical.)
Me: Yeah, I was making hardly any insulin at the time of diagnosis.
Doc: That's interesting, because you're not the typical age to get type 1. (Sounding even more skeptical.)
Me: Well, I'm not the typical age to get type 2 either, which is probably why my doctor decided to test for the type.
Doc: And who do you have as your endocrinologist?
Me: Dr. K.
Doc: Good. (He finally sounded satisfied here, so I guess he trusts her judgement.)

After the doctor left the room, Chad gave me a patronizing look and said, "Are you surrrrre you're type 1?" I could only shake my head and say, "Yeah, like they pass out type 1 diagnoses willy nilly to 30 year-olds."

This stuff is part of why I advocate; my pet cause is telling adults to never take it for granted that it's type 2 based entirely on age. It's actually not uncommon for adults to get type 1 (just not as common), but even a lot of medical professionals are really quick to assume type 2.

Oh, and those 4D pictures? Cool, but also kinda creepy.

(They seem to be extra creepy at this stage, because a baby doesn't have much fat at 17 weeks and so looks a little skeletal.)

Camping with Diabetes

2011-03-06T13:01:00.000-06:00

I camp. At least once a year in the fall, and sometimes a spring trip as well, with a very large group of friends. In fact, we have our Spring camping trip coming up next month. I thought I did a post about my first experience camping with diabetes last year but see it nowhere. Suffice to say, I ate a lot of candy to keep from going low from the added activity (despite using temporary basal rates), but everything went really well... especially since I have a camping buddy with T1 who told me ahead of time to bring more stuff to treat lows than I thought I'd actually need. Best. Advice. Ever.

But one of the tougher aspects of camping with diabetes is that I love to cook while camping, and I also love to sample the stuff my foodie friends create over the campfire. I bring a cast iron skillet and a heavy dutch oven and get creative... But last year, most of my creativity had to happen at home before heading out to the wilderness. I ended up taking a lot of stuff that was already portioned in baggies with the carbs written on the outside. I also made sure to know exactly how much my bowls and mugs held to aid in carb counting. Like I always make an awesome vegetarian chili, so I counted up the carbs for the entire pot as I put cans and seasoning packets into a container, then divided to find out the carbs in one cup of that chili... and found out which of my tin mugs held about a cup, so I could easily portion myself a serving of chili without breaking out the measuring cups. (Knowing exactly how much fit in our various sized mugs was also completely invaluable for sampling other people's goodies and making an educated guess at the carbs.)

The plastic baggies are an awesome camp cooking tool actually, especially since I usually only have the motivation to make one really fancy camping meal per trip. I like to relax while I camp, too. Though I will usually sizzle up some turkey sausage and other goodies on the skillet once Chad is awake too, I like to have something simple and tasty to eat when I first get up. My solution is to bring plastic baggies of interesting home-mixed oatmeal in a plastic baggie, usually a recipe from Lipsmackin' Vegetarian Backpackin'. All you have to do is pour in some hot water and let it sit for a few minutes. These are already portioned for one (though some of the recipes in the book need to be cut in half), so I just wrote the carbs on the outside of the baggies last year. There are lots of other variations on this, including instant rice, mixing batter for breads or skillet cookies, etc. (I know there might be health concerns when eating out of hot plastic, so the baggie could also just be used to transport the portioned dry ingredients before mixing it with hot water in a bowl.)

One thing I miss is the ease of campfire pancakes, though. For a couple trips before my diagnosis, the perfect solution for easy pancakes was Batter Blaster, pancake batter that's dispensed out of a whip cream style can. (These also make for great entertainment, as someone always wonders why you're putting "whip cream" on a skillet!) But it's been impossible to find the whole wheat version, plus the carb counting based on the diameter a pancake is spotty at best (as I proved to myself a couple weekends ago with diner pancakes and a blood sugar of over 220). I also don't like mixing batter in a bowl while camping because it's just too messy, so I didn't consider making my perfectly portioned whole wheat recipe last year. This year, my plan is inspired by the Bisquick Shake n Pour canister. I'm saving and washing one or two squeeze dispensers like the ones my usual reduced sugar jelly comes in. I'll put the dry ingredients for two portions into the bottles at home, add the wet ingredients at the campsite, shake the hell out of it, squeeze the batter onto the skillet, then divvy half to Chad and half to me. Tada! Perfectly portioned whole wheat pancakes without a bunch of hassle and carb counting at the campsite. I think it's going to be awesome.

Prenatal Visit #3

2011-03-05T13:22:00.007-06:00

My third prenatal visit went well enough. The best part was when the nurse was trying to get a count on the baby's heart beat with the Doppler. We heard it clear and strong last time, but I really got a kick out of it this time because the baby was on the move! She'd find the heart beat, then it would just vanish and she'd be like, "Oh, you're just gonna kick away again, huh?" and start moving the Doppler. This went on for a good 5 minutes, and she asked, "Are you feeding this child sugar or something?! It won't stay still!!!" It just makes the baby a little more real and interesting to know (s)he's moving around so much in there, even if I can't feel it yet.

The heartbeat was good, my belly measured at 17 weeks (I'm at 16 weeks), and I gained an appropriate 1 pound (in about two weeks). I asked her at what rate I should gain since I'm already overweight, and she said it's the same as with any woman: anywhere from 1/4 pound to a pound a week. She said 1/4 pound a week would be ideal, and I said that I'd really like to avoid gaining more than I need, so I'm going to think of 1/4 to 1/2 pound a week being right on target. I don't feel like I need to worry too much, actually. I let myself eat more than before pregnancy, but I think I keep things reasonable simply because diabetes means I can't mindlessly eat half a bag of chips or something. I'm very conscious of every little thing I put in my mouth, so I don't think this is going to get away from me.

There was an interesting moment where that gulf I sometimes feel between me and someone without diabetes opened up. My blood sugars have been mostly good, but I had one really crumby day on the two-week log I brought with me. My OB asked about the high I'd had after brunch, and I explained that I'd had pancakes at diner without nutritional info, and I could really only chalk it up to those pancakes being higher in carbs than the "average" I looked up for their size (plus the fact that non-wholewheat pancakes tend to cause a bit of a spike for me, anyway). She continued to look at that day and noted that I'd gone quite low (42, I think) after that high. "And what happened with dinner?" I had to pull my food log out for that one, because nothing about it stood out in my memory. It turned out to be a meal I made at home with a known amount of carbs and a pretty reliable track record, but I went up to 160-something afterword. But when I'd started eating, I was still in the 60s while recovering from that 40s low. So I said, "Nothing happened, I knew the carbs in that meal. I probably just went high because of the low. My body can still have a glucagon reaction to a low sometimes."

She looked up and blinked in a way that made it clear she was really processing this statement. That's when I felt that she was looking at me over that gulf. I realized she probably technically knew this stuff, that the body makes glucagon to bring up a low blood sugar and that function isn't 100% gone in diabetics, but she's never lived it. That 160s blood sugar was barely a blip on the radar for me because the cause was clear, so I just bolused to bring it down and moved on. But as someone who is neither diabetic nor an expert in diabetes, she just saw a number and wondered what I did to cause yet another high. She didn't see the pattern like I did without even trying.

I'm no expert in diabetes when you compare me to a veteran who's had it for years or a specialized health care provider, but managing type 1 diabetes for the past 10 months made me the expert in that room even though I wasn't the one with the medical degree. It's amazing to look back to the first week after diagnosis and remember how little I really understood about my new treatment. I've come such a long way in less than a year.

Yet another appointment... but a good one.

2011-03-03T11:54:00.000-06:00

I had a appointment with my endo yesterday, and all was well. Since getting pregnant, I always feel like my blood sugars are doing horribly, but when we look at them, I usually realize they're not nearly as bad as I think. She confirmed this and said I'm doing great. I'm out of range every now and then, but they aren't terrible numbers and I always bring them right down.

I asked that they go ahead and do an A1c every other visit since my OB simply isn't interested in learning to use Fructosamine results. My endo simply said that's fine, but the nurse seemed a little baffled that my OB is so insistent on having an A1c every month when she knows I have an endo who's in charge of the diabetes side of my care. She seemed practically flabbergasted when I told her that my OB had commented that she might want to make changes to my pump settings at some point. I shared in her annoyance (because it felt good!), but I really just chalk this up to the fact that OBs normally working with mothers who get gestational diabetes. In those cases, I'm sure it's almost always the OB who's in charge of that care. She's just used to it.

My endo said toward the end of the appointment that she thinks I'm doing great, especially "for a true insulin dependant diabetic." I smiled and said, "Well, I suspect I still get a little help from my pancreas." She said, "You know, I think you're probably right, and that's really great that you still have some back-up for pregnancy." I then mentioned to her that I sometimes suspect I'm actually a late-stage 1.5 or LADA, because I'm pretty sure I had symptoms for a couple years before diagnosis. She said with both type 1 and type 2 in my family history, she wouldn't be surprised at all. We then chatted a minute about how easy it is to misdiagnose a diabetes, especially by assuming someone must have type 2 if they're adult of obese. I really am very lucky that the GP I went to not only tested my blood sugar in the first place, but also bothered to run tests to figure out what kind of diabetes I had once it looked inevitable.

I have a visit with my OB this afternoon, and I'm hoping it goes just as well. I forgot to pay attention to my weight at the endo's office yesterday, so I'm curious to see if I've gained anything this time. I hope I've gained at one or two pounds so she doesn't have me coming in for weekly weigh-ins again... That was way annoying.

Moving Along Pretty Smoothly

2011-02-25T16:55:00.000-06:00

I'm at 15 weeks, and I've been feeling better lately. Not super fantabulous, but better, and I'll take what I can get! I'm not getting random nausea anymore, I've had days of good moods, and I actually have some focus and energy every now and then (though I'm still more tired than before pregnancy).

Blood sugars haven't been bad. Some weirdness and randomness continues and I'm not always in range, but they're not bad and I've started stressing a little less about them. I still see them as vitally important, but I'm able to just bolus and go on without freaking out if I'm a little high. (I did, however, have a recent restless night due to highs followed by lows. I'm so glad to have Dex keeping an eye on my glucose levels while I sleep, but sometimes I want to just throw him across the room!)

One annoying blood sugar trend I've been dealing with is slightly low blood sugar immediately after eating. More often than not, I'm right around 70 when I eat lunch or dinner. So I bolus and eat, then watch my blood sugars drop little by little for a while, probably 30 minutes, and then it finally starts coming up. Normally, no big deal. 60s aren't bad when you know you have carbs about to kick in. But once in a while, it'll keep dipping into the 50s. I'm not OK with 50s. (On those occasions, I eat a small amount of fast-acting carbs then bolus for them once my bood sugar started on an upward trend.) Because of this trend, I've started limiting the recommended 20 minute wait between bolus and food to if I am 80+ (or 90+, if my blood sugar is on a downward slope).

I do have a "baby bump" now, and will likely be wearing maternity pants to work pretty soon. I'm still doing the rubber band trick for now! Other people's reactions remain the most interesting part of pregnancy for me. My mom got excited when I told her I'm almost ready for maternity pants, for example. I also have a very sweet coworker who has made doe-eyed comments about my belly. "Aw, Mama!" or, "It's beautiful!" So, very sweet, but it still makes me feel very self-conscious! I hope it's not too regular of an occurrence for the rest of the pregnancy.

The one weird thing that gets my anxiety up a little is I feel like there's a little tension between me and my OB regarding my diabetes monitoring. First off, she commented that she might make changes to my pump settings if she sees things imy blood sugar she wants to change. I just said, "OK," but the truth is that I really only want my endo (and me) to make those calls. Anything she asks me to do, I'm going to fax to my endo for approval before implementing. It's not that I think my OB will make bad calls, but rather that I have a specialist whose entire career is centered around the management of my disease. She's the one who's most qualified to help me manage my blood sugar.

Second, after I decided that, fine, I'll do a monthly A1c test for my OB's preference in addition to the twice-monthly fructosamine tests that my endo feels are far more useful during pregnancy, I got a little attitude from her staff because I said I'd rather do the test at my endo's office instead of the OB's office (and then the results would get faxed to my OB).

(On the phone.)
Staff: Dr. L wants you to come pick up a slip and go to the lab to do a hemoglobin A1c.
Me: Just an A1c?
Staff: Yep, just a hemoglobin A1c.
Me: I go to my endocrinologist's office next week and they'll draw blood for a fructosamine test anyway, so I'll just call and ask that they also plan to do an A1c. And they'll fax it to you.
Staff: *with clear annoyance* Dr. L doesn't know how to follow the fructosamine tests.
Me: Yeah, I know, that's why I just said I'd have them also do an A1c at the same time. I'd really rather get stuck once.
Staff: *sigh* I'll tell Dr. L that's what you plan to do.

The honest truth is that I also don't want to get stuck at my OB's lab anymore than I have to. They bruise my arm every single time, and it definitely hurts more than when I have blood drawn by the nurse at my endo's office. Plus, getting it done in one visit means I don't have to spend the extra time or gas that it takes to go to my OB's building and wait around to have my name called at the lab. This pregnancy takes up a lot of time!!!

2011-02-16T13:46:00.000-06:00

I had a visit with my endocrinologist today and, as usual, she made me feel like I'm moving forward on the right path. We made a slight adjustment to my early morning basal insulin to get my fasting BG down a tad, but she didn't feel any other changes were warranted yet. I had some "highs here and there," yes, but they didn't follow a pattern and I never let them last long.

But the best part is that she made me feel about a million times better about not gaining weight. I think I managed to gain a couple pounds if her scale is the same as my OB's, but she (and her nurse) seemed slightly confused about there being any concern. Aside from only being 14 weeks (tomorrow) into my pregnancy, she commented that much weight gain isn't really necessary as long as you're eating enough and eating well (and taking prenatals). She also agreed that it's not relevant to my diabetes management since we know what my blood sugar is (and it's nowhere near high enough to prevent me from gaining). Maybe that was just an off-handed comment on my OB's part, but if she expresses that concern again I'll ask her to please confer with my endo.

I also went ahead and mentioned that the hormones have been a nightmare for me emotionally, because my counselor felt that both of my doctors should know that that's going on. She wasn't at all surprised considering my history of depression and commented that some women feel the best of their entire life, and others just ride an emotional roller coaster. She confirmed that I'm doing everything to take care of myself (including staying on my Wellbutrin), but it honestly just makes me feel better when someone acknowledges my depression with understanding and acceptance. I definitely feel pressure to be happy for everyone, because that's what people expect from a pregnant woman, and I've already had one person I'm close to insist that this "isn't normal," that this is a "wonderful time" and I should be happy. I'm certain she said this in an attempt to get me to step up my attempts at treating depression, but the last thing I want is to feel abnormal (and guilty) for not being deliriously happy. Happy about having a baby? Yes, I am. But happy, as in mood and attitude? No, I am not. And I feel like I have to apologize for it at every turn.

That said, at least my anxiety over my weight has been alleviated. Really, I'm just not going to stress about it unless it actually looks like it's becoming problematic.

No. More. Food.

2011-02-14T10:18:00.000-06:00

I'm pretty sure I'm hitting the phase in pregnancy where I start slowly becoming more and more insulin resistant. At the same time, I've been "trying to gain weight" for the past few days and need to rule out the possibility that it's the higher fat in my food that's causing the change. So today is a good, angelic food day. A high fiber muffin and skim milk for breakfast, cheese for snacks (provided my blood sugar doesn't head downhill), and a salad (with chicken) and reduced fat cottage cheese for lunch. Dinner might not be quite so angelic, but it's primarily late afternoon when my blood sugar gets higher than it used to.

Speaking of, I'm totally fed up with my own weight-gaining attempts. My first thought was, "Gaining weight? That means larger meals, more carbs, and more fat." So I attempted this, and can I just say: "Puke!" OK, no actual puking, but a strong desire to puke. Let me also say "Holy freaking crap!" regarding how my blood glucose reacts to high fat these days! It's always caused a rise at the 3 or 4 hour mark, but not like this!

So, I'm moving on to what I think is a better plan anyway: More snacks that I already know work for me. More cheese between meals at work (along with carrots), and more no-sugar-added ice cream in the evenings. Or crackers and hummus (because, YUM!).

If this doesn't do the trick, I'll go to a dietitian at the diabetes center for a plan. I don't want my next weight gain plan to include blood sugar battles like the first one.

More and more female friends are surprised my OB is at all worried about the lack of weight gain, particularly other women who were overweight going into pregnancy. One friend only gained 3 pounds through her entire pregnancy, and her OB was just fine with it. I probably need to gain more than she did, but still, I've decided not to stress about this. I'm going to assume the baby is just fine until there's reason to believe otherwise.

My Chubby Brain is Blown

2011-02-10T15:54:00.001-06:00

Never before, in my entire life, have I been told to gain more weight. If anything, I’ve always been told I need to lose a few pounds. I’m overweight, and have crossed the line into “obese” a couple times. But now? I'm an overweight pregnant woman.

So, it’s just so utterly baffling to this chubby chick that my OB tells me I’m not gaining enough so far in my pregnancy.

Me? Not gaining enough? Unheard of!!!

Oh. Wait. That was before I had to count carbs and avoid too many really high fat foods.

I’m not restricting carbs or calories at all, except that I don’t choose to sit down and eat three breadsticks then order and eat a giant bowl of pasta with artery-clogging sauce. One breadstick and half a giant bowl of pasta (then maybe another half breadstick!) will do, thanks. And that’s usually already more calories than I’m “supposed” to eat in one sitting.

I am not a conservative eater by any means and, though I know better than to “eat for two” and double my food, I’ve felt sure that I've been eating more calories a day now that I’m pregnant. I mean, I'm always hungry!!!

The nurse (or medical assistant?) who wrote down my weight at today’s weigh-in at my OB’s office said, “Just half a pound. You’re going to have to come back and weigh again next week.”

"Really?!" I said. "This is just the first day of my second trimester. I thought a lot of women don’t gain in the first trimester!”

“Maybe if you’ve gained two or three pounds by next Thursday, she won’t make you come back in. Just go to Braums every night until then!”

Braums is a regional fastfood burger and ice cream joint… really known for their ice cream. A twinge of annoyance passed through me as I remembered my last stubborn high blood sugar that happened despite a carefully calculated bolus. “Yeahhhh, that’s a little tough for a diabetic.” I got a look of sympathy, but no further suggestions.

I’ll be trying to add in more calories, but there will be no milkshake prescription for this mother-to-be. How frustrating that I need to gain weight right when blood glucose control is both more important than ever and more difficult than ever.

Not. Fair.

Tantrum

2011-02-08T15:49:00.003-06:00

I was wandering the supermarket, which means that I was thinking about carbs. By the time I wandered onto the "lunchbox" aisle, my thoughts had begun to turn sour. All of those adorably portioned carby goodies stared at me. Cookies, crackers, little crunchy bread sticks that come with their own suspiciously shelf-stable fake cheese dip, boxes containing cute little 100-calorie pack snacks.

A friend's old criticism bubbled to the surface of my memory... People think those 100 calorie packs are a good idea, but they're not. They're still not healthy, and you can just take a portion out of a regular sized box.

I (and she) did not know that I was diabetic at the time (I'm fairly sure it was already developing then), but now I realize that individually packaged snacks make it easier to eat snacky stuff with diabetes. No counting crackers necessary, just grab a pack and punch the listed carbs into the insulin pump.

But my slightly sour thoughts didn't lead me to find this fact interesting. Instead, I found it infuriating. Other people eat straight from the box of crackers, no counting, no calculating. That's how almost everyone else does it. Why do I have to do it? Why do I? Why me?!?!

The words rang in my head with the sort of angry, distraught tone I used as a child, the one that I felt certain would illustrate to my parents just how grave an injustice it was that I couldn't do what I wanted to do, the one intended to pull at heart strings, infuse guilt, and drive home just how incredibly strong my emotions on this subject were.

Whoa.

I was so taken aback by this inner tantrum that I stopped right there in the aisle. Where had that come from? I normally don't ask "why me?" when it comes to diabetes, because I don't think there's any kind of answer other than genetics. It occasionally strikes me as very strange to think of myself as diabetic, because I spent so much of my life without serious health concerns, but it usually ends there.

And all because I miss eating out of a full box of crackers? I'll admit that I am readily frustrated by anything that makes simple tasks like eating more complicated, but was it really this that inspired the strongest emotional reaction I've had to diabetes in quite some time?

It's no secret that I'm under a lot more stress than usual and that my mood swings more easily, because I'm pregnant. Maybe it was this added volatility. Maybe I was really throwing an inner tantrum over my pregnancy being 100 times more complicated due to diabetes (as in "oh my gosh this is complicated," not "this pregnancy is full of complications"). Or maybe this tantrum was buried deep beneath the conscious logic and practicality I've held to since diagnosis. Maybe that was my inner child finally shouting loud enough for me to hear her, finally striking that exact tone that would make the adult me stop, pay attention to her, and reconsider.

Only, dear Inner Child, I cannot reconsider diabetes. I'd gladly change this for you if I could, because I agree, diabetes isn't fair. It does suck. And that big box of crackers? I do want to blindly eat fistfulls of them on the couch without even thinking.

*tantrum*

Prenatal Visit #2

2011-02-04T10:18:00.003-06:00

I had my second prenatal visit yesterday, exactly at the 12 week mark. Chad went with me and we got to hear the baby's heartbeat! I loved that we got to share that. His excitement just encourages my own. :)

This time I met with my doctor instead of primarily with her nurse practitioner, which is who handled most of the first appointment. All of my labs looked good, except that the proteins in my urine were in the upper range of normal for pregnancy. She said there's not much I can do about that other than generally taking care of myself and my kidney's. My A1c was 5.6, which is awesome and totally thrilled her because, at first, she looked at an older lab result that was 6.1. I'm pretty stoked about a 5.6, myself.

She took a look at my blood sugar and I had a couple post-meal numbers that were higher than she wanted, but most of it looked great. Her guidelines are slightly looser than my endo's as she's OK with up to 135 after meals (and my endo wants under 120). She indicated that I should definitely stick to my endo's guidelines, but that she just wasn't worried if I came in a little over 120 sometimes. So, cool, that's good to know even though I'll still aim for below 120.

Talking about the possible effects of diabetes on my pregnancy, she wasn't discouraging. She commented that there is a "slightly higher chance you'll have a C-section, but that does not mean you will have one." She also said that placentas tend to "age faster" in diabetic mothers, but that has to do with higher blood sugar so the better I control it the better off my placenta will be. Because of this, and probably because I'm statistically at a higher risk of a lot of other things just based on my diagnosis, I'll be having more ultrasounds than average and they will all be with a doctor who specializes in "fetal medicine & maternal medicine."

The only slight concern she seemed to have was that I've lost half a pound rather than gaining anything (though I'm betting I may have been a tad less hydrated than usual). I'm supposed to go by next week just for a weigh-in, and I'll be faxing her my blood sugars every week now. She commented that she may "tweak the settings" on my pump if she has any concerns... I didn't say it, but any "tweaks" she tells me to make are going to go through my endo before I apply them! It's not that I don't trust her, it's just that it makes the most sense to have the doctor who specializes in my disease treatment make the decisions on that treatment!

In other news, I have new prescription coverage that only covers three glucose test strips a day for type 1 diabetics. Three!!! My endo's office is pretty sure they can get "prior authorization" for more, especially considering my pregnancy, but I'm still just aghast that they wouldn't automatically cover at least six (preferably eight) a day for a type 1. Do they think we never need to know our post-meal numbers? Or that we never have low or high blood sugars that need to be confirmed with a test before we treat? Do they honestly not know what it takes to manage type one diabetes? I mean, wow.

The Logistics of Pumping with a Growing Belly

2011-01-30T12:57:00.002-06:00

I realized recently that I won't have as much fatty space on my tummy once my tummy starts to get big, so I'm going to have to start using other areas for insulin infusion sites just so I can "rotate" my sites sufficiently. Dexcom sites are only supposed to be on the abdomen, technically, so I figure I may eventually have to put all of my infusion sites on other areas if I want to keep my Dexcom in "regulation" areas. (Plenty of people put Dexcom in other areas, but I seem to do OK rotating it on my abdomen so I haven't tried anything else just yet.)

So when I changed my site yesterday, I decided on the upper area of my butt cheek. I've done this before with success, but it's still a little tough. I use the Inset 30 infusion set, which works really well for me but takes two hands when removing the applicator.

First I started with the left side, and I decided, no, this is way awkward. So I went with the right side and that was fine, but I still really had to reach in order to make my left hand available to remove the applicator.

"Crap," I thought. "When my belly is huge, there's no way I'll be able to put this back there by myself. Putting it on the back of my arm means no second hand, too. That pretty much leaves the sides of my belly and the thighs, and my thighs are actually pretty muscular."

So, what? Have Chad help almost every time? I told him I'd probably be needing one of his hands and he agreed with a laugh. But I really like being able to change any time I want, lickity split. So I think my next order for supplies will be for the regular, straight insets.

I've heard they tend to kink more often than the 30s, but they're supposed to be easy and totally one-handed.

I was tempted to try the stainless steel Contact Detach set, which the local Animas trainer said is just a teeny little metal needle you push in instead of a cannula with a fancy applicator, but I have nickel allergies and have reacted to some "stainless steels." (Stainless steel isn't guaranteed to be nickel free, just to contain so little of it and to contain it well so you're not supposed to react.) So, inset it is.

And the long tubing this time. I figure the longer tubing will allow me to cross the tubing over my big belly if I have to in order to hide it someplace tricky, like in my bra!

Better Than Therapy

2011-01-27T15:22:00.000-06:00

Going to the endocrinologist is good for me. I don’t just mean it helps me stay healthy, I also mean that it helps me stay sane.

I’d gotten reasonably zen about diabetes management, especially since I was doing really well. Then I got pregnant, and zen immediately slipped from my grasp. My control on my blood sugar suffered, not due to any lack of effort or education, and my stress went through the roof in response.

In a zen state, I’d have said, “OK, my blood sugar is going higher than it should. All I can do is what I can do. Crying and feeling guilty just wastes energy.” But I was not in a zen state. You see, not only was I hormonal and dealing with life changes, but I was also reading blogs, forums, websites, and books on pregnancy with diabetes. Everywhere I turned I read about all the horrible things that can happen if your blood sugar is high, and a high blood sugar seemed to pretty much be anything out of that super tight range for pregnancy. I seemed to absorb other women's obsession or anxiety over this, as if I didn't have enough of my own. Though my endo’s office had called me back right away with my new blood glucose goals (under 100 before eating, under 120 two hours after), it was the internet that made me scared of higher numbers. Not even counting the occasional and mysterious 200+ number that happened even when I did everything by the book, I felt like a horrible mother who was actively mutating my own baby whenever I decided to indulge in a treat (say, a small ice cream?) and came in somewhere closer to 150 two hours later.

*cue internal freak-out and self-guilt-trip*

But visits to my endocrinologist have put things in perspective every time, so far. Never once has she criticized me, never once has she told me that a number is dangerous, never once did she suggest I need to try harder. No. She even told me the first time I came in with numbers that upset me, “I’m not worried.” She doesn’t worry, she deals. “Numbers like these will happen, but we need to figure out how to keep them from happening too often.” Then we’d discuss a game plan.

Yesterday’s visit with her was fabulous. I handed her a sheet with numbers that were much improved, but definitely not even close to perfect. We were both on the exact same page about how to fix them, and she made some adjustments to my morning basal and evening I:C. She said that I was really doing well overall, and I walked out feeling not like I had failed with those less-than-perfect numbers, but that I had done a great job of improving them and was leaving with a plan to make them even better, maybe even get them in line once and for all… Well, once and until my insulin needs change again! Damn hormones!

In Which I Lament the Loss of My Turkey Sandwiches

2011-01-21T09:48:00.005-06:00

Pregnancy food restrictions make me realize, sheesh, simply eating with diabetes is nothing. Yeah, you have to figure out carbs and either avoid or account for high fat, and you may find certain foods that don't work well for you individually, but you can still more or less eat anything.

Let's count out anything diabetes related first and take a look only at the four pregnancy related food restrictions that bug the hell out of me:

No deli meat. At least, not unless you heat it up to the point of "steaming" first. It's more likely to have listeria, a bacteria (that causes food poisoning) that's pretty deadly to an unborn baby. (From what I've read, the chances of it happening are incredibly low, but the consequences are so dire that the risk isn't recommended). By extension, cold meats that you wouldn't think of as "deli meat" are similarly restricted. No more turkey pepperonis as my mindless, carb-free snack on the couch. I tried microwaving them first, as I have tried with cold cuts for sandwiches, but the texture becomes way gross.
Big or predatory fish, including tuna, is to be avoided or limited due to higher levels of mercury (recommendations from different sources vary, but one serving a month seems common).
Anything with raw eggs, including Caesar salad (traditionally, the dressing will have raw egg). The chances of salmonella is the problem here. I still eat Caesar salad on occasion though, because I love it so very much, because I think salmonella is a crap shoot (I've heard about more outbreaks from vegetables, like spinach, than from pre-made products like dressing!), and because raw egg is in more foods than you're likely to expect. Ever had a really high-end frosted cake, like at weddings? You may have eaten raw egg in the frosting. Good mayo or aioli? Raw egg. Eggnog? Raw! Eggs Benedict? Raw egg in the Hollandaise sauce. I won't even go into the many desserts. Unless you're allergic to egg (or are a vegan), you probably have no clue how to completely avoid raw egg. In the grand scheme of things, I doubt a Caesar salad with properly handled dressing is more dangerous than simply not being vegan.
Soda. I'll also include caffeine in general here, but aspartame (ick!) in diet soda is also a general concern for women who didn't avoid it before pregnancy. These are not on the universal "don't" list, and my own OB says that having one or two a day is fine (though some OBs recommend against it entirely, and any visibly pregnant woman drinking soda or coffee is probably going to get some uninvited advice!). My biggest issue with this one is iced tea... I love the stuff! It's my drink of choice when dining out, and I've started carrying Splenda in my pocket since not all places offer it (neither the pink or blue packets are recommended during pregnancy). But since I start my day with a cup of tea or coffee, no refills for me. (On the soda front, Diet Rite is a sanity saver. It has neither aspartame or caffeine. I keep some in the house at all times, if I can.)

There are a million other little restrictions. Soft cheeses that aren't pasteurized (unpasteurized cheeses don't seem as common as the APA seems to think, though), unwashed produce, sushi with raw fish (understandable, though Japanese women continue to eat it!), undercooked or rare meats, etc. etc. etc... Add to this anything that causes my blood sugar to spike (which is somewhat unpredictable these days), like pizza or white rice. Eating "not good for your blood sugar" foods on rare occasion isn't so horrible... until you're pregnant. (Then it's both bad for your baby and filled with guilt and stress.)

Those don't sound so terrible, right? I didn't think so either... until I realized it counted out most of my convenient lunch options. No deli meat sandwiches has been the biggest issue, for my lunches. Also, the little pre-made salads you can buy in stores usually have deli meat in them. We don't have a break room here at work, and I probably wouldn't stay if we did (psychologically, I just need to get away from work for an hour), so this leaves very few no-cooking options for me. Combine this with the fact that I've had like, zero energy or motivation (due both to typical pregnancy fatigue and to some depression), and that results in lots of fast food lunches. Not nutritious, but at least it means getting out for a little while, almost no effort, and not consuming something on the kill-your-baby list.

Diabetes? It's not easy to live with, but it's not so bad on the diet front. It didn't eliminate my convenience foods at all. Convenience foods come packaged with a nutrition label, and I just opted for the versions that helped avoid blood sugar spikes (like whole grain Lean Pockets instead of the non-whole grain ones). But pregnancy? It's thrown a major wrench in my lunchtime convenience. I have to figure out a super-low-effort solution. Maybe zap a Lean Pocket before I leave for lunch? Use bagged salad and veggies on Sunday to make a week's worth of little salads to eat along with my lunches? Keep chicken salad around for sandwiches? I have to figure it out, because I do think fast food makes me feel more like crap.

It's just awful timing. Depression has been a major issue for me lately, and this makes me lethargic and supremely unmotivated. I need a new game plan until I'm able to pull myself out of this emotional mess.

Melodramatic Dexcom

2011-01-09T16:18:00.001-06:00

Here's how things go sometimes:

Dexcom: BUZZ BUZZ! You're blood sugar is 15 million and 20! You're going to DIE! You're going into DKA!!! Oh my god!!!!!!!!!!!!!!!!!!
Ping Meter: BEEP! Eh, you're at 160. Just take some insulin.

Dex, I love you, but you're a little off base and melodramatic once in a while.

Diabetic Super Star!!!

2011-01-06T16:31:00.001-06:00

OBs and their staff are all probably somewhat familiar with diabetes, but primarily gestational. I felt ever so slightly like a diabetes super star at my OB's office yesterday, with my fancy equipment and good control.

First, while I was giving my health history to the nurse, my Dexcom vibrated in my pocket. I glanced, saw a 68, and wondered if I should wait until the questionnaire was over (68 with a steady line isn't so horrible). But then I thought, wait, she's a nurse, she's not going to be the slightest bit phased if I check my blood sugar. So I said, "Don't mind me, I'm just going to test. My CGM says I'm low." But outside of the diabetes community, I guess "CGM" doesn't mean much.

Nurse: Wait, what told you? You mean you feel it, right?
Me: No, my continuous glucose monitor buzzed. (I placed it on the desk for her to see as I dug for my meter.)
Nurse: OH!!!
Me: There's a sensor that takes my glucose levels all the time, and it's not as accurate as a meter, but it'll tell me what range I'm in.
Nurse: And what? Did it beep?
Me: It vibrated, but it can beep too.
Nurse: Wow, like a phone!
Me: Yep. At night I can set it to beep, but I keep it quiet during the day. It's GREAT.
Nurse: No kidding!
Me: (Lancing my finger.)
Nurse: Jeez, you do that like it's nothing! I'd probably still be squirming!
Me: You get used to it. It doesn't hurt much. Oh, 64. Not too bad. (Pulling out glucose tabs.)
Nurse: Oh, those are HUGE! I'd just drink pop!

It was kinda fun. And I was amused by the idea of a nurse being scared of a little lancet, when nurses have been jabbing me in the crook of my elbow with bigass needles for months, now!

Then the nurse practitioner (who handled this appointment, though I got to chat with the doctor a couple of times) asked if my endocrinologist had me keeping a log, because they'd like to see my numbers as well. When I showed them to her, she was clearly overwhelmed by the abundance of information. It does, after all, also include all of the food I'm eating. She showed me the chart they use.

Me: I'd be happy to just transfer my numbers onto here for you at the end of they day, if that'd be easier.
NP: That would be great. Does is match what Dr. Kennedy has you doing?
Me: That's the testing schedule I already use.
NP: And then... AM insulin and PM insulin... But you... That's not how you do it.
Me: No, that chart's not set up for a type 1.
NP: No, it's for gestational. They only take insulin once or twice a day. Maybe you could put... Hmmm...
Me: I could just look at my total daily dose for the day on my pump and put that down?
NP: Sure, that's probably as close as it gets. Now, I'm not sure what Dr. Kennedy has told you to do, but what we normally tell our gestationals to aim for is a fasting number below 90 and never anything above 135.
Me: She has me at a fasting below 100, then below 120 two hours after a meal. Do you want me to ask her about the below 90 goal?
NP: No, no, 100 is fine, and I love the 120.
(Later, while she's explaining that they don't induce diabetic mothers early unless there are signs that it's necessary...)
NP: Or if it looks like you're growing 10-pounder already, we might need to start discussing it. But seeing your numbers, you're doing great. Honestly, for as little time as you've had diabetes, I'm very impressed. You take better care of yourself than most of our gestational patients, that's for sure, and she rarely ever puts them through early induction.

So I felt pretty stinkin' good about the pregnancy and about myself as I left. I felt like, yeah, I am doing well! Not only am I not having those unexplained 200+ highs anymore (those were total WTF!), but I've also really gotten my numbers into the ranges my doctors want. At worst, since adjusting my lunch I:C, I've had a 122 after a meal. That's pretty badass!

I am starting to suspect the trademark lows of early pregnancy may be approaching. I had two slight lows like an hour before meals twice yesterday, and an almost-low that I headed off today. If I have another day like that tomorrow, I'll fax my numbers to my endo and see what change she recommends.

Yay! It's about time I started feeling good about this. :)

2011-01-05T13:58:00.001-06:00

When I don't have all the facts, I tend to worry, anticipate the worst, and fill in gaps with educated guesses that lean toward the pessimistic. So when I finally face reality, 9 times of 10 I'm going to be relieved.

I should have kept that in mind as I went to my first prenatal appointment today.

Everything went really well, I was not made to feel like my body is a liability, and I was reassured that I'd be treated as an individual case rather than "a diabetic patient." Most importantly, they will not induce me early unless they see evidence in the baby or pregnancy that induction is needed.

Rock. On.

From reading books and websites, and from talking to diabetic women who have gone through pregnancy, I heard so many stories about interventions that probably weren't necessary, or simply pregnancies/deliveries that were super medicalized (not my cup of tea). Even from the people who were upbeat and encouraging, I there was still some message of, "Here's what's in store for you, like it or not." After a while, I stopped reminding myself that it's all good information to have, but that every woman and every diabetic is unique, as is every medical professional. I honestly started thinking, "Why did we bother? If my body isn't trusted to do what it was designed to do, maybe we should have just adopted." But, since the medical professionals I'm working with are willing to treat me instead of my label, I feel pretty confident that I'll be allowed to have as normal/natural an experience as my individual case allows.

That's all I ask. Thank goodness we have interventions available to us when they're needed, but let my body do what it can do on its own.

Oh, and I got to see the baby! I had been told we'd just hear the heart beat on this visit, but they did an ultrasound. (S)he was like a little peanut with a tiny flutter for a heart! Wow!

It Looks Easy, Until You Look Closer

2011-01-04T15:41:00.003-06:00

I recently had a moment when the gulf between me as a type 1 diabetic and someone else as a non-diabetic widened significantly.

A coworker started trying to figure out a food alternative for me. She'd planned on pizza for a staff lunch, and I told her I couldn't eat delivery pizza and would just go pick something up for myself. (Pizza isn't on some diabetic no-no list, but it's a tough food that doesn't work out for me.) She immediately said, "Well, what can you eat?"

Enter another complication: my own fear of being an imposition. I'm pretty much never going to say, "Let's get such-and-such food instead of pizza," in a situation like this, so I ventured, "Where are you ordering from? I can look at their online menu and see if they have something like a good salad."

But she had no clue where she'd order the pizza from yet, and really just sought after a more general answer that would basically let her order like, "Hi, random pizza joint I picked about 5 seconds ago? I'd like three pizzas, and do you have any salads? OK, yeah, send a salad."

So I explained, "Well... it's just that I have to know what I'm getting, because I have to know how many carbs are in it."

So she asked again, "Well, what can you eat?" And I think, fine, I'll give you a shot. And I attempted to explain what, to me, has become a subtle and mostly quick process...

"There are a lot of factors, but it helps if it's not both high carb and high fat. It's even better if it's not either." Already her eyes started to glaze, probably from trying to think of convenient foods that are neither high carb or high fat. "But the most important thing is that I know how many carbs are in what I'm eating, so I have to be able to either look up the nutrition or order something simple enough that I can make a really good guess based on the portion size."

Her eyes glazed further, and I knew it was time to stop. She was staring at me across this great gulf of diabetes management that suddenly made me feel rather... separate and different. I don't really expect others to know what my food and insulin involve, but I also didn't expect someone to look utterly at a loss when told the basics. (And, honestly, I also wonder if she thought I was intentionally being difficult.) So I let her off the hook (the hook she'd asked for!) with, "I can eat almost anywhere. If you just tell me where the pizza's coming from, I can pick something else off the menu."

But she backed off of that hook even further with, "Why don't you just go pick something up?" To which I gladly agreed.

The fact that this woman knew I'm diabetic and had eaten meals (which includes testing and bolusing) with me before yet seemed baffled by the simplest explanation of how I choose my food reminded me that, when I was first learning this stuff, I was so impressed by the people with T1 diabetes that I've known; they made all that stuff look so easy! But the truth is that they'd simply incorporated it into their lives. The decisions and calculations that were so new and awkward to me were just a part of their routine, so I had no idea how much went into them. Had they started explaining everything to me (before it applied to me), maybe I'd have glazed over.

As I've said many times, diabetes management is doable. I can do it, and you can do it if you have to (and I know some of you do!). But it's still complicated and difficult, and even those people who make it look easy have a hard time of it once in a while.

(I wonder how my coworker would have reacted if I'd mentioned fast-acting carbs vs. slow-acting. Her head might have exploded right then and there!)

WTF?

2010-12-30T09:39:00.003-06:00

A lot of pregnant women with diabetes discover lots low blood sugars in the first trimester. Then the numbers start to rise until their insulin demands skyrocket later on. It's a common pattern.

So far? My body's like, "screw common patterns!"

Like last night, I was craving seafood fried rice something awful. I often make my own brown fried rice with fresh veggies, and a very small amount of oil at home... But that's so not what I was craving! I wanted oily, over-seasoned, totally unhealthy fried rice with a mix of oily seafood including unidentifiable bits that are probably squid or octopus, but maybe not. You know the stuff, if you've done a lot of oriental food joints! So we slipped down the road to Thai House and I ordered up that giant plate of Seafood Fried Rice.

But that's a lot of carbs and fat, so I was very deliberate about this. I looked up the average carbs for shrimp fried rice before it arrived, evaluated the food when it got there and determined it probably didn't have as much seafood in it as the average shrimp fried rice and bumped the carbs almost all the way up to what a cup of what nothing but rice would be, delivered an 85/15 combo bolus (going closer to the 50/50 I was taught usually makes me go high), carefully spooned a two-cup portion onto my plate (in two piles, until each looked like the size and shape of my over-turned 1 cup measure), and dug in.

I suspected, if anything, that I'd go low. I'd definitely erred on the high side of the carb count because I did not want to go high. I feel, right now, that having to drink a box of juice to head off a low is worth avoiding highs.

But by the time we got home, probably only an hour later, I'd spiked to over 200 and dexcom was showing me a straight upward pointing arrow!

I had a lot of insulin in my system and had only eaten a short time before, but I just couldn't stare at that and do nothing! I took another very small bolus and didn't allow myself to slug out on the couch. I didn't feel I could exercise (I felt pretty crumby), but I tried to keep moving around and working on this little gift project for some friends.

And within like another hour, my blood sugar was perfect.

What?

Yeah. This one may have been extreme, but these spikes and drops are my common pattern right now, and they are killing me. It tends to happen even when I do everything right by choosing foods that have a good balance of healthy carbs, protein, and healthy fat (unlike the seafood fried rice!) and waiting 20 minutes between bolusing and eating.

FRUSTRATING.

It seems like I'm slowly eliminating foods that are mysteriously worse than others (goodbye fried rice), and relying a lot on foods that have the least spike (hello salad with protein and fat, but no cheese, because for some reason shredded cheese is totally gross to me right now). I'll get this figured out... and then it'll probably all change!

Endo Appointment Number One, Down

2010-12-27T15:51:00.000-06:00

I met with my endo and thought it was fairly productive. I just hope this whole every-two-weeks schedule continues to be useful through the pregnancy!

The main issue was a few unexpected highs I've had, for which she also did not see a pattern. One was an infusion set preblem, the others were all after foods with carbs I thought I knew. I'll be keeping a food journal and testing some of my basal rates. In the meantime, she's having me adjust my nighttime basal rates to nudge my fasting blood glucose under 100.

I'll be counting every carb and watching my numbers like a hawk. I'm hoping things are going to get better on their own, because I've actually had weird weeks before where my glucose just makes absolutely no sense and then goes back to normal. I guess being pregnant doesn't exclude me from the "WTF?" qualities of this disease.

Merry... Merriness! (And not so merry highs.)

2010-12-25T19:19:00.002-06:00

Merry Christmas, or whatever holiday you choose to celebrate!

Our Christmas day has been quiet and lazy. We spent Thursday night with Chad's family, and last night with my parents. The baby received it's first gifts from Chad's mother (diapers, wet wipes, and a box of gender-neutral linens). The two big gifts Chad and I received were Rock Band (from my parents), and vent-free gas logs for our fireplace (from Chad's parents). Two awesome practical gifts I received were a Waterpik from Chad (because even my dental hygienist said it's tough to floss my teeth!) and a food scale from Mom. There've been many times where I had to do some tricky stuff to figure up serving sizes while counting carbs, and this will really help me measure the stuff that's listed in grams.

I also had a Christmas Eve gift I did not want: A bad infusion site and a blood sugar of over 280.

see more Lolcats and funny pictures

Normally, something like that frustrates me. While pregnant, it makes me question every single little action I've taken all day, blaming myself for the high blood sugar that could do harm to the baby. Even though I logically know that no pregnant woman with T1 diabetes is safe from mistakes or accidents, it sure makes me feel like a failure. And though I've read that an occasional, brief high blood sugar won't hurt the baby, I can't help but feel that it's really horrible at such an early stage. After all, women with diabetes have an increased risk of miscarriage. Even though she'll probably be understanding and simply talk to me about future prevention, I'm embarrassed for my endocrinologist to see that BG number on Monday.

But on the flip side, my numbers are normally fabulous and I've done a good job of avoiding the things that really give me trouble. On the whole I'm doing a great job, but a high like that makes me wonder when I qualify as not doing a great job. One high? Two? Ten? Once a month, once a week, once a day? I know there's no set answer, but I fear crossing this imaginary "line."

So far, no crazy symptoms, diabetes related or not. My blood sugar hasn't started going low like it apparently does for most, and I haven't started having the typical morning sickness. My mom told me last night that she never had much morning sickness, so I'm hoping I take after her in that respect!

No mystery food cravings or aversions, though I'm definitely more hungry than usual. I'm trying to avoid the whole "eating for two" thing while still letting myself have a little bit extra. Everyone has to gain weight while pregnant, but the fact is that I'm already overweight and need to keep my weight gain to whatever range my OB will recommend.

I do know that I need to start getting more active again, too. My walks have become less frequent as the days have gotten colder, so maybe it's time to keep sneakers at the office and go walk the treadmill during lunch.

Will there ever be a cure?

2010-12-19T15:38:00.002-06:00

Will there ever be a cure?

It's a hot topic on D forums and blogs. I think I most often see people say something like, "Probably, but not in my lifetime."

I'm not a naive and wishful thinker, but I'm not as jaded as a lot of veteran PWDs yet. I haven't heard the repeated "just 5 more years" from multiple doctors. In fact, I haven't heard that even once from a doctor (and I'm glad, because I don't think there's any way they can promise something like that right now).

My point is, I think it'll happen. I don't actually know when, but I wouldn't be shocked at all if it happens in my lifetime. (Not shocked, but ecstatic!) If an actual cure doesn't happen, I am confident that diabetes care will be improved so significantly that it will almost be as good as a cure. Maybe we won't get our beta cells back, but maybe we'll only have to give ourselves one or two injections a day to achieve healthy, steady blood sugar levels. (I'm looking at you, SmartCells Inc.) Or maybe someone will figure out how we can be given new beta cells that our immune systems won't attack on sight. (Russia, bravo for fearlessly exploring that frontier! And you scientists at Washington School of Medicine, keep it up!!!) Or maybe after the artificial pancreas becomes a reality that can be continually improved upon, someone will also develop an even faster acting insulin to pair with it, and that artificial pancreas will be developed to the point where it can function real-time based entirely on the rise and fall of blood glucose (with no need to enter carb values or temporary basal rates).

I just see so many promising ideas. Any of these could be the development to change the lives of PWDs forever. Maybe no one is going to hand me a pill that will cure my diabetes next year, but I do think I'll be given some life-changing treatment options in my lifetime.

Balancing Indulgences and Blood Sugar

2010-12-19T11:22:00.003-06:00

One aspect of pregnancy that I'm finding a little bit challenging to balance so far is the food. I try and eat mostly healthy food that treats my blood glucose well, but I also think there's no problem with a little indulgence (pregnant or not, diabetic or not). If I were pregnant and not diabetic, I'd just treat myself while making sure I don't overdo the "eating for two" thing. But when that giant cookie is staring me down in the store, even if I've been very good all day, I have to take pause and wonder, what will it do to my blood sugar? Is it OK if I'm a little out of range a little of the time, or am I a bad mother if I don't make every possible effort to stay in range, such as passing on every cookie I see? And if I can tell I'm just going to "have to" eat a baked goodie that day and I know it's better to have that cookie (which also happens to be organic and vegan) than get back to the office and end up eating a damn donut or two or three or ten, can I time my insulin just right to avoid the spike?

In that particular instance, I got the cookie, bolused for half of it and gave the insulin a few minutes to get in my system... then got weak and ate all the cookie and bolused for the rest with what turned out to be miraculously perfect blood sugar results later! (That could certainly be a fluke, but I'm thinking of stocking up on a few of those for the next time I have an uncontrollable urge to eat a giant cookie!)

On the other hand, I gave into a craving for popcorn shrimp last night and, because a combo bolus hadn't worked for them at all once before, I did a regular bolus. This sent me a little low, then higher than I felt at all comfortable with during pregnancy. Cue rage bolus, which happened to slowly bring me back down into range and hold me there.

Balance is so important. I need to keep my blood glucose down, but that doesn't mean never indulging. It means, rather, that I have to find the indulgences that don't destroy my efforts. Big fraking vegan cookie containing more carbs than I typically consume in an entire meal? Win. Reasonably sized plate of popcorn shrimp? Lose. Duly noted.

On an only vaguely related note, I'm having to correct a couple bad habits like not bolusing before I disconnect from my pump in the morning. My evening basal rates are so low that disconnecting doesn't seem to make an ounce of difference, but my morning basal rates are almost 4 times higher. If I take my shower in the morning, my BG goes up. It always has. My endo recommended I bolus before a morning shower, but even then I only gave myself a tiny bolus and corrected the difference later for fear of going low in the shower. But now that my range is so much tighter, I can't afford to slack on the bolus. It's either that or shower while connected, which I've never liked at all. Bolus it is.

Life's Never How You Picture It.

2010-12-18T13:57:00.001-06:00

I haven't been to either of my doctors yet, but I've made appointments with both (already well over a dozen with my endo!) and spoken to my endo's nurse. My blood glucose goals are now below 100 before meals, and below 120 two hours after meals.

I'm actually very close to those goals even when I don't quite meet them (and I've just made a change to my insulin pump's "target" that should finally nudge the less than perfect numbers under), and I've managed to get my spiking blood sugar to chill the hell out. Primarily, I'm figuring out that I need to have a little more protein and healthy fat with my breakfast (when things are most likely to spike), and the same true to a lesser degree with lunch. Dinner is never a problem. If I eat pretty well, my evening numbers are always fabulous.

I can totally do this.

For the most part, I feel pretty good about things. I had one night where I felt very sorry for myself... I was realizing that this pregnancy isn't going to be "what I always wanted." Not that I've ever been the "daydream about pregnancy and babies" type, but I always had a basic picture of how things would be:

I'd enjoy my pregnancy, dealing with whatever minor inconveniences (like morning sickness) come my way and feeling a little like an earth goddess as I bask in the miracle of creating life and letting my body do what it was designed to do. Then when delivery came around, I'd labor at home for as long as I could, go to my hospital, and labor naturally until my doctor said, "It's now or never for the epidural." (You see, though I fully believe the female body knows how to do this stuff on it's own, I'm way too much of a wimp to accept the level of pain that comes with pushing!!! :p )

That's not the picture I see before me now. I'll probably have something like 20 or 30 doctor appointments between now and then, tests that aren't normally done on "healthy" mothers, there's probably no way any OB will let me carry to full term and labor when my body decides to do it naturally, and there's likely to be much more monitoring and a higher chance of a C-section. It's like my body is a liability instead of a miraculous tool for creating life.

Sounds crappy, doesn't it? But it's the most bleak view (short of imagining all the things that could go wrong will go wrong). I totally let it get to me the other night and I cried all over Chad. (He's so sweet.)

But now, I'm realizing that everything's been pretty normal so far, so and I don't have a reason to believe that everything will be horrible the second I set foot in a doctor's office. Yes, things are likely to be more medicalized than I want. I accept, grudgingly. But I can't focus on that; I have to keep it all a part of what supports me and a healthy baby. Just like diabetes management isn't the focus of my life, but part of what supports it.

I'm also looking into having a doula, a trained professional who is there to support mom, dad, and baby through pregnancy and delivery (and sometimes for a while postpartum). I think it would both help me focus on the wonderful things that are happening, and stay more informed and in charge during delivery.

As everyone says, the thing that counts most is having a healthy baby in the end. I agree with that, but I also believe that is most likely to happen if the pregnancy and delivery are no more medicalized than actually necessary. (Thank god we have OBs and the interventions that are sometimes necessary, but the US has both incredibly medicalized births and some of the worst birth statistics of the industrialized countries.)

I'm saying all this like I'm afraid I'll be swept into an O.R. the second I arrive at the hospital, but the truth is that I'm going to do everything humanly possible to keep my blood sugar normal and my OB has never given me the impression that she's big on intervention for intervention's sake. For all I know, she'll support me in my desire for normalcy to every extent she is able. I meet with her nurse practitioner on the 5th of January, so I'll have a better idea then of what is in store.

Bolusing for Two!

2010-12-12T12:01:00.002-06:00

I'm not sure I've ever mentioned that, before I was diagnosed with diabetes, my husband and I had been trying for a baby for over a year. Not like, counting cycle days and taking my temperature to catch the moment I ovulate then calling my husband home for emergency baby-making, but we weren't preventing... and, being a little older than most first-time parents, I was starting to wonder if it wasn't time to start "really really trying" when I discovered we had to stop until I had my blood sugar under control. Not an easy thing to be told.

And then, about a month and a half ago, my endo told me it was safe to start trying again.

Well, my body apparently agreed with her!

Friday, I was sitting at my desk at work with a pile of tissues and couple boxes of cold meds when I thought, "You know, I was supposed to start my period yesterday." It's not so weird for my period to be late once in a while, but I realized that I was about to pop more cold meds when it was possible I could be pregnant... So I decided I'd pick up a pregnancy test during lunch just to make sure everything was cool before I took my afternoon dose.

It was funny, sitting there eating my lunch in my car with a pregnancy test sitting on the seat next to me. I hadn't picked it up because I thought I was pregnant, rather because I wanted to make sure I wasn't going to pickle a baby with cold meds, but it still gave me some of that giddy nervousness. "I totally could be," I thought several times. "It... feels like I could be."

But that still didn't mean I expected to see two lines begin to form almost instantly! I stood in the bathroom with my hands covering my mouth as the "result" window began to color even before the "control" window was touched. "Holy crap, holy crap, holy crap!!!"

I made myself stop watching it until the two minute mark, then began my "holy crap" chant all over again.

I mean, HOLY CRAP, guys!!!

I held it in all afternoon, tempted to call my mom or post to a message board... but I couldn't until I told Chad, and I had to tell him in person! So once I was home, he got an early Christmas gift and we were soon on the phone with our families.

Things I've observed so far:

I don't "feel pregnant," yet I do. I think there was a tiny little part of me that already knew.
I'm excited... But others seem to be more excited for me! My theory is that this is because they aren't the ones who are going to swell up over the next 36 weeks then spend many painful hours squeezing out a baby that's going to change everything forever! (It's all going to be worth it, but let's face it, there's also plenty to be scared of and it's only Chad and me who have to face the scary parts.)
Girls squeal. :)
Though I don't get to enjoy the quirkiness of pregnancy yet (the belly, the cravings, the "glow"), I do get to "enjoy" all of the restrictions! I have a cold and am on no cold meds (real Sudafed is supposed to be safe, but isn't recommended this early). I'm developing a cold sore, but I'll just be picking up some lemon balm chapstick for that (it looks like Abreva and a couple oral meds are "category B," but I see enough discouragement online that I'd want to ask my OB first).
People like to joke about alcohol, tell you not to drink alcohol, or say it's so said you can't drink alcohol. I just wish they'd stop talking about alcohol! (Not because it makes me miss alcohol, but because it pisses me off that even those "jokes" are basically telling me what to do instead of assuming I'm an intelligent enough woman to make my own sound decision based on medical research.)
So far, I haven't run into any, "Are you going to die like in Steel Magnolias?!" or, "Your baby is going to be HUGE!" or, "Diabetic women shouldn't get pregnant!" One friend asked if pregnancy might improve my diabetes, and my grandmother-in-law simply asked how it would affect things, and then asked if the baby would get it since I have it (a valid question, to which I said the baby couldn't catch it from me, but that there would be a small chance [1/100, in our case] of developing it later since it's genetic). But from everything I've read, I probably will run into some of the more fearful comments. I won't let it get to me, and I'll educate anyone who seems to be saying it out of concern but blow off anyone who seems to be saying it as a criticism.

So far, I'm most frustrated with blood sugar spikes. I have to get those down, which means avoiding problem foods (why the hell did I eat that piece of delivery pizza?!?!?!) and giving myself plenty of time between the food bolus and eating. I'll be making appointments with my doctors tomorrow, so I'm sure my endo will either have some more detailed advice or refer me to the CDE who specializes in pregnancy at her hospital. I know the target numbers for pregnant women tend to be pretty low (I read in Balancing Pregnancy with Pre-Existing Diabetes that a common goal is no higher than 120 an hour after eating!!!), so I've gone ahead and reduced my overall target number a little bit... It seems like a good start.

OMG guys, this is going to be wild!

(And, for the record, I really think I wasn't getting pregnant before because my body knew it wasn't healthy enough!)

Back on Track

2010-12-07T11:41:00.000-06:00

It feels good to be back on track.

And that highest peak wasn't actually as high as it looks, according to Ping.

My weekly average, according to Ping, is also back to 125 (it was creeping up into the 130s, which isn't so bad except that I'm trying reallllly heard to keep things closer to 120 while trying to conceive).

But I'm not going to get cocky about it. Things are good, but they'll only stay that way if I keep a close eye on my BGs, count the carbs in those game night snacks, and watch for troublesome foods and habits.

Oh yeah, and watch the pizza. Two plus slices of delivery pizza, with the crust dipped in garlic butter, is not beneficial to my BG numbers no matter what combination bolus I've tried! But half an Amy's pizza, without additional fat like garlic butter, seems to be an acceptable indulgence. (One slice of delivery pizza, with no garlic butter, also seems to be reasonably acceptable with a combo bolus... but it's sooooo hard to stick to one slice!!!)

Too Good to Last

2010-12-01T10:40:00.001-06:00

Despite having a lot of insecurities, I also tend to be very proud of the things I do well. Just recently, I got into a very comfortable, pleased-with-myself state of mind regarding my diabetes care. I do this stuff really well. Not only was I on top of things, but I significantly improved my morning numbers by myself, through two morning fasts and two basal adjustments. I was coasting for a couple of weeks on numbers that never seemed to rise much above 140. Things were... too good to last. :(

Yep, that's a 286 staring back at me. The past week, maybe two, have sucked. That's the second 200+ number I've had, and possibly the highest number I've had since starting intensive insulin therapy (certainly the highest since they got my initial ratios close to what I needed).

What the hell?! Things have been running generally higher, as they always tend to when hormones change at about the middle of my cycle, but worse than usual this time... and the past couple of days have gotten even worse... then a 286 for this morning for the exact same breakfast and bolus that went over perfectly yesterday morning?! And I thought, hmm, maybe it's the infusion set or site, but no! Everything appears fine, and my correction bolus is bringing my BG down at a rate that I would expect. Bad insulin? Well, it seems to work just fine on correction boluses, and I've had a couple mealtime boluses with perfect results... but I may try a new batch if things continue to look bad.

I may uncover some underlying reason, but until I figure it out, I'm just using a stronger basal dose and watching Dexcom like a hawk... and believing my fellow D bloggers more and more when they say things like, "Sometimes, this disease just makes no sense."

------

On a related note, while waiting for my BG of just over 200 to come down last night, I was talking to my husband about having read that a lot of PWDs tend to have some control issues, maybe even some OCD. I totally get that now. If I'd grown up putting so much importance in a number on a screen multiple times a day, feeling like that number is a pass or a fail, I'd probably have some sort of control issue, too.

My First Scare with Diabetes

2010-11-11T22:33:00.000-06:00

I had a really weird encounter with possible diabetes once before in my life.

It wasn't me.

It wasn't a relative.

It wasn't a friend.

It was... My cat.

Meet Ali (pronounced like "Ollie"). She's an adorable, spunky, defiant, hyper little princess of a cat.

She's also one of my favorite photography subjects, so excuse me while I indulge a little.

But back in September of 2007, we noticed over the course of a couple days that she was barely eating or drinking and had became less hyper... then less spunky... and she finally didn't even have the energy to be defiant, so we knew something was very wrong. I got up early to take her to the vet and Chad pulled her out from under the bed and put her into the carrier with no more objection than one of the most miserable meows I'd ever heard from her. It broke my heart.

The drive to the vet was horrible for me, and filled with tears. Could it be cancer? FIV? Leukemia? Should I have taken her in earlier? Was it now too late for her?

She had no symptoms other than the lethargy and lack of appetite. The vet ran bloodwork and said that her blood sugar was higher than usual. A urine sample also showed slight ketones.

The diagnosis: diabetes.

She stayed at the vet overnight to make sure the insulin dose the vet chose was OK, and the next day they taught me how to give her insulin and sent us home with a vial, box of syringes, and special diabetic food... and one still lethargic and unhappy cat. She was slightly better than before, but all I could get her to eat were a few bites of her favorite people-food (turkey cold cuts). Over the next three days, she continued to get worse and worse even though I did everything the vet had told me. I spent a lot of time on the Feline Diabetes Message Board, which was full of helpful and knowledgeable people who told me about glucose monitoring (not something vets push with diabetic pets), diet, etc.... and they started telling me that things with Ali just didn't add up. She didn't have high BG numbers, she was getting worse despite the insulin, and she had never had the classic symptoms of diabetes. Several of them told me to take her back to the vet, and I agreed once I realized she was definitely getting worse, not better.

I went back to the vet 4 days before her 1-week follow-up visit was supposed to happen, armed with a little log book of glucose readings. A different doctor (at the same clinic) ran bloodwork again and, this time, what stood out was her astronomical white cell count. She was absolutely septic, and the vet was amazed she could even lift her head. She was put on IV antibiotics, taken off of insulin until there was evidence of real need for it, and kept for a couple days.

When we visited her, we could tell we were finally on the right track. She was moving, struggling to get to us, and very vocal. When we brought her home, she was almost her old self... only very, very thin and much weaker.

But that IV wrap came off only moments after we got her home, she chowed down on food, fought with renewed strength against being fed antibiotic pills, and slowly regained her normal weight and spunk... And defiance!

On our follow-up appointment at the vet, I was once again armed with a little log of totally normal blood sugar numbers... and insisted they refund me for all of the diabetic supplies (which they did). She was a happy, healthy kitty with a happy, healthy pancreas. Her blood sugar was merely elevated from such a horrible infection (that's common).

And thank goodness, because testing her blood glucose was not an easy task!

Something rather sweet was, after she came home from her extended stay at the vet, she became incredibly affectionate. She snuggled every chance she got, and she never wanted to be away from us. We think it made her a sweeter lap cat, to this day.

But don't underestimate her... There's a reason we don't let her be DM in our Dungeons and Dragon's games! She is, at heart, a fierce killer!!!!

Rocks fall, everybody dies!!!!

Hind Sight...

2010-11-07T12:02:00.004-06:00

I'm pretty sure that I actually had diabetes for a couple of years before diagnosis (which has also lead me to wonder if I have 1.5 or LADA rather than plain type 1). There are a couple reasons I'm so sure of it, but I won't go into it right now.

So, knowing what I know now, I look back at so many things and shake my head. Getting up in the middle of the night to pee, when I never had before? *shakes head* Having days when I absolutely couldn't quench my thirst? *shakes head* Eating tons of food and feeling physically full, yet still ravenous? *shakes head*

One thing I've been thinking about lately, because I've been considering going on a Diet with a capital D, is when my husband talked me into doing South Beach with him. As we did phase 1, which means no carbs other than most vegetables (and beans, I think?), I started out hating it... but then I got to the end of the week and felt so much better! In fact, look at the following portion of an entry about South Beach from my now-defunct livejournal:

"I think this is a good experience for me, because I've never known what it's like to not eat grains. Seriously, I don't think I'd gone a whole day without some sort of grains since infancy, and I tend to eat a lot of them. Now, without them, I'm amazed to discover the beneficial changes in my hunger patterns. I've never in my life understood people who claim they "just forget to eat," because I'm normally thinking about food an hour after I finish a meal and my blood sugar drops not too long after that (even though we're pretty good about sticking to whole grains most of the time). Now? None of that."

And there are other entries in that general time period about how I'm ALWAYS STARVING. I think my body was already unable, in 2008, to really regulate my blood sugar levels. Doing South Beach gave my body a respite from allllll the carbs I was normally eating, and my blood sugar must have been lower than it had been in a long time... So I felt better. (This makes me think about the fact that, back before the days of extracted insulin, people with type 1 diabetes were put on a "starvation diet" that was very high in protein and pretty much zero-carb. This allowed them maybe another year or two of life.)

And I never went to the doctor about it, even though I knew more about diabetes than the average person. To be honest, I often had the thought, "Maybe I'm pre-diabetic." But pre-diabetes? You can fix that through diet and exercise. Oh, little did I actually know!

Awkward Moments with the 'Betes

2010-11-06T16:31:00.002-05:00

Low blood sugar while shopping plus discovering you forgot to refill your glucose tabs means getting stared at by little old ladies while you rip into a package of juice boxes without even trying to get through the line and pay first (with the full intent to pay after, of course).

Lady, STFU.

-----------------------

Me: *tests blood sugar*
Coworker: That's not... for... diabetes?
Me: Yeah, it is. I have type 1.
Coworker: Oh...
*insert awkward pause here*
Coworker: Well, thank goodness it's at least not type 2.
Me: *blink*
Coworker: Isn't that the bad one?

----------------------

Various people at various times with various sugary treats: "Here, would you like a... oh wait, you can't eat these, can you?"

-----------------------

For no reason other than seeing me and knowing I'm diabetic: "How's your blood sugar? Are you OK? I have food if you need it. Do you need to test?"

-----------------------

Former coworker seeing going-away cake on my desk: "Now, you know you can't be eating these things anymore."

Yes, diabetes sure has its fun moments. And while we're at it, why don't you check out this video on the Big Blue Test, in honor of World Diabetes Day, coming up on November 14th? Every time it is viewed, money goes to help give insulin to children who need it.

Victory!

2010-10-26T09:24:00.001-05:00

Less than six months after diagnosis, I had another appointment with my endocrinologist yesterday… And it was full of awesome!

It addressed a lot of things that have been frustrating me since my diagnosis. The most obvious issue is wanting to be healthy and have my blood glucose under good control, and I found out that my A1c has come down to 6.1!!! That’s down from 13.4 when I was diagnosed!!!

*happy A1c dance*

Another huge issue for me is being in control of my own health... and I don’t necessarily mean “in control of my health despite diabetes.” I mean something more along the lines of, “In control despite the fact that my life now contains a menagerie of medical professionals telling me what to do.” I am so glad those medical professionals are there, and I know I could not have gotten so under control so quickly as I did if I hadn’t followed their instructions to the letter, but I couldn’t help but feel that they were in control of my health... and sometimes, I was waiting and waiting for confirmation on a change that I already knew I needed. So I thought, once and for all, that I was going to ask my endo for official sanction to make adjustments to my treatment myself. I went armed with a bookmarked copy of Pumping Insulin and lots of explanation as to why I could safely and effectively make my own decisions. When she asked if I was still working with my CDE, this gave me the opportunity to explain that I was still working with her, but I wanted some more freedom to make my own changes.

“Oh yes, absolutely!”

Oh. OK. That was easy!

She gave me some guidelines for making decisions, told me I can fax her numbers anytime I need help, and said she was completely comfortable with me making these decisions.

*happy victory dance*

And another biggie… Something I was sure I wouldn’t hear her say considering the numbers I was showing her included two highs over 200 and one bad low of 43 this past week… She told me that it’s safe enough for me to go ahead and start trying for a baby whenever my husband and I decide to!!! (She understood that last week was a weird one for me, and said, "With type 1, it's never going to be perfect.")

*happy baby dance*

I feel like I’ve reached important goals and blown hurdles right out of my path. Life is good, and I believe I have the ability to shape my future the way I see fit instead of around my disease.

Not the Only Villain

2010-10-23T18:25:00.007-05:00

Sometimes I forget that I struggle with more than just diabetes. There's also chronic depression. And, honestly, I forget it largely because I'm so much happier than I was about six months ago. I have a job I like more, I have a career goal and am working toward it, I no longer feel crappy because of undiagnosed diabetes, and getting diagnosed with diabetes has honestly given me a lot of perspective and direction in life.

But chronic depression isn't a direct result of the state of your life, it's a direct result of your brain chemistry. (Though it's admittedly also affected by the state of your life).

So when I started feeling almost weak on my feet, unsteady, and almost unwilling to take the next step and then another, I kept repeatedly checking Dexcom and my meter to see what my blood sugar was doing. I really felt that it must me low or plummeting, but how could two separate meters and a CGM be wrong? I did eventually sink to the 70s at one point and, still feeling awful, I opted to go ahead and drink a juice box since I was slowly moving downward...

But that juice box and my rising blood sugar did not help the way I felt. Searching for my stupid devil horns in boxes we still haven't unpacked since the move was an effort in that my hand barely wanted to move items aside, and my knees wanted to let me sink to the ground. I should have known what was going on when I finally lay in the middle of the floor because I didn't even want to drag myself to the bedroom or couch to lie down... That's something I used to do all too often, when things were much worse in life.

And when friends arrived to pick Chad and me up for Ghouls Gone Wild, I found myself almost in tears over wanting to go enjoy the parade yet knowing that I would not enjoy it and quietly blaming myself for letting some sort of mysterious diabetes symptom keep me from having fun. Walking three or four blocks? How would I put one foot in front of another so many times if I barely had the energy to move from one room to another in my own home? Standing there for an hour watching floats and costumes, many of which are very cool and impressive, how could I focus on anything like that while trying not to freak out about the crowd and the noise? I'd have to stay home... but maybe I shouldn't stay home alone--because what if something was really wrong with me--but how could I ask my husband to also stay home because of my disease?

That irrational argument against asking Chad to help keep me safe is what caused my confusion to lift. This was not some mystery symptom of diabetes, this was a far more familiar companion: depression.

Oh yes, hi, I know you all too well. I had not thought to look for you, because you are not the greatest villain in my life anymore, but I recognize you. You are sneaky, conniving, and cunning. You caught me off guard, but I am much better equipped to deal with you now. You know what I've learned from my diabetes? Management, and the acceptance of What My Life Is. I'm always diabetic, but I keep my blood sugar under control without despair at the thought of having to do test after test, bolus after bolus... and the thought that diabetes will still throw me a curve ball every now and then. Likewise, I am always dysthymic but will keep my depression under control without despair at the thought of having to manage it for the rest of my life... and that you will still throw me a curve ball every now and then.

But neither will get the better of me ever again. Period.

This is one of the many positive ways that diabetes has impacted my life; it's made me better equipped to face long-lasting struggles and not feel like I'm struggling. It also caused me to go to counseling to help adjust to the changes in my life, which has taught me how to look at my thoughts from the outside and recognize that I am not my thoughts. (An odd concept, I know, but it made perfect sense as I recognized that totally irrational thought.)

So hi, depression. I acknowledge you. Now I'm going to manage you, and this time, I am going to get the better of you.

Brownies = Better than Pigs.

2010-10-03T10:49:00.004-05:00

Brief attempt to be healthy at the Target food court:

A turkey & provolone sandwich, please. What? The only sandwiches you have left have pork?

Ew....

I'll have that bigass brownie.

*bolus*

The Eye Exam

2010-09-21T19:41:00.005-05:00

I finally got to an ophthalmologist today. It'd been a long time since my last eye exam anyway, but I also needed to get my eyes checked for retinopathy. Oh boy, and I thought eye exams were fun before! There's nothing more pleasant than having your pupils dilated as wide as possible and then having the world's brightest frakin' light shone directly into them!

And I learned another diabetes factoid: Diabetics' eyes dilate slower than those of non-diabetics. Huh!!! (It has to do with higher sugar in the irises, but he didn't explain any further.)

The second worst part of the exam wasn't even the eye drops. It was that he'd been saying "good" every time he looked in an eye... until he started looking at the retinas. At that point, he was silent... which I couldn't take as a good sign. (Honestly, I started getting a little scared at this point.) After shining that Brighter Than The Fraking Sun Light in every corner of my eyes, he grabbed his little standard light scope thing again and said, "I need to take another look at this one spot in your right eye." Um, GULP?! So I stayed quiet through some more shining, peering, and eye-watering until he stopped, flipped the lights back on, and said, "I see one little spot in your right eye from when your sugar was out of control that's going to heal up, but you essentially have no retinopathy." Then he started writing in my chart.

Ummmm, not a good enough explanation, Doc. "So, is this spot like the beginnings of retinopathy that's stopped now that my sugar is down?"

So he righted the situation by putting his pen down and actually explaining things. He described how retinopathy starts: Basically, your eye isn't getting enough oxygen and starts to grow new blood vessels in your retina to try and make up for that, but those vessels are fragile and tend to break or burst. That's when the real problems start, because blood in your eye and damage to your retina is bad. (mmmkayyy?)

(In fact, really bad retinopathy can even cause retinal detachment.)

"I can see a spot where there's damage from that lack of oxygen from when your blood sugar was out of control," he said. "It's like a tiny little scar, but it's going to get smaller and smaller. You don't need to worry, you just need to keep control of your blood sugar. And watch your blood pressure, too."

It immediately became my goal to get rid of that damned little spot. Next year, I want to hear him tell me my retinas look perfect.

And then I drove home wearing those cool, granny-sized, plastic "sunglass lenses" tucked behind my glasses. Yeah. SEXY.

Diabetic Super Hero at the State Fair

2010-09-19T14:23:00.006-05:00

I went to the State Fair on Thursday evening. And about the State Fair, let me say:

OMG Funnel cake and fried cheese!!!!!

Neither of which I ate this time around. I opted, instead, for fried shrimp on a stick. Not significantly healthier than fried cheese, but I could judge the carbs much more easily. I may not have been able to even resist the fried cheese though, except I made sure not to go hungry.

Me: Let me eat something before we go, so I don't eat a bunch of junk.
Chad: Will it bother you if I eat a bunch of junk?
Me: Nope. In fact, I may have a bite of your junk... Oh my god! I did not just say that!!!
Chad: Oh my god! I am so tweeting that, right now!

So, after about 5 minutes of uncontrolable laughter, I ate a whole-wheat Lean Pocket and we left for the fair.... which involved sitting in a very long line of cars, and then standing in a very long line of ticket-buyers.

But I had one of my proudest diabetic moments in that long ticket line. A girl, probably around 18, was walking up and down talking to people. As she got closer to us, I heard her say, "Do you have any candy? Anything? My friend's blood sugar is getting low."

At which point, as she turned away from someone with a look of clear concern, I made a B-line straight for her.

Me: Your friend's blood sugar is low?
Her: *With her face brightening.* Yeah!
Me: I have glucose tabs.
Her: Oh, great! Hey, *whatever her name was*, hey! She has glucose tabs!

We walked over to a group of teenage girls and the group parted as one stepped forward with both of her hands held out in a gesture of questioning, and with an expression of embarrassment on her face.

Me: Is it your blood sugar that's low?
Her: *nodding*
Me: *Pulling out my tube of glucose tabs.* Here, I have glucose.
Her: Oh my gosh, could I have one, please??? I mean, two... I mean, can I have...
Me: Of course, here.

I plunked a few tabs into her hand, received thanks from her and her friends, and I smiled as I walked back to Chad... who welcomed me back with a fist-bump.

I don't know if she was actually diabetic or just having a serious sugar crash, but I felt so awesome for being able to help. Like a diabetic superhero!

Don't Knock the Bad Habits

2010-09-15T09:58:00.006-05:00

You know, bad habits get kind of a bad rap... But I've found that some bad habits have occasionally been what's needed just to keep me going. Like for a while, I almost totally stopped prepping my skin with alcohol before shots. But OMG, I was so completely sick of shots at that point! But that bad habit, which I knew plenty of other veteran diabetics did safely enough, made the shot process more tolerable during that difficult phase... and I got back on track before too long.

And then, there was when I got way sick of spending so much time doing test after test! I stopped properly washing my hands or cleaning my finger before hand and resorted to just licking it and wiping it off (maybe marginally better than just sticking your dirty finger). But at least that kept me testing, and now that habit is gone as better control and my Dexcom have helped reduce the "extra" tests and as I've learned better shortcuts (like dunking the finger in a glass of water instead of licking it, or rubbing soap and water between just one finger and my thumb if I want to take less time and mess than a full hand washing).

So while breaking them is advisable, don't always knock the bad habits, especially when you see them in others. Maybe it's an alternative to a much worse habit... like not injecting or testing at all!

You've Got to Move It, Move It!

2010-09-12T14:12:00.006-05:00

Over all, I'm not a big exerciser. I did, however, manage to get into a good exercising habit for a while before I was diagnosed... which stopped when I caught a cold that turned into a cough (which was typical for me, but I hope it won't be now that I'm healthier), and the rest I took for healing time broke my good habit. Then I found out I was diabetic, and was told not to exercise, then to only do light exercise on a regular basis instead of the twice-a-week-average that had been my good habit... and I was both out of the habit and scared of lows.

But now that I know I generally feel a low pretty quickly and have my trusty Dexcom, I don't think I have any more excuses when it comes to going low. And that every-other-day-light-exercise-only rule is probably the ideal plan, but you know, I'm not the ideal person.... Despite my GP declaring I'm the ideal patient. Getting my butt moving, even if it's only one or two times a week and whatever exercise appeals to me at the time, may just be the best I can do at this point. In the grand scheme of things, despite the fact that sporadic exercise habits can make for sporadic insulin needs, some exercise is better than no exercise.

I hereby give myself permission to be a less-than-ideal exerciser. And if I get into the groove and become a more regular exerciser, hey, all the better! But I need to start where I need to start.

Bonus: I've discovered an awesome little park near where I work, which will be perfect for brown-bag lunch and a short hike. I'm so glad I found this place, because I learned long ago that staying at work during lunch, even if I'm not working, does not give me the proper mental break I need to stay sane... and a nice, quiet walk through a shady wooded area is very good for my sanity... while also helping me get a little extra exercise.

Because I Like Having Pretty Feet

2010-09-10T18:19:00.003-05:00

Maybe I'm just spoiled by being such a newbie with no complications at all, but I sometimes read the dos-and-don'ts of diabetic self-care and I'm like, WTF? I'm not made of glass!

Like this "Treat Your Feet Right" quiz on dlife. Sorry to spoil some of the answers for you, but never go barefoot on the beach?! (Are you really knocking sand for being "ground up rock?") Don't get pedicures?! Oh, and cut toenails about once a week?! (My toenails would be itty bitty nubs if I tried that!)

Yeah, OK, I get that you could step on something sharp in the sand. And I'm sure there are a few rogue pedicurists out there who turn the water too hot (check it first!) or are careless enough to cut you with their germy nail clippers, but I wouldn't think of a pedicure at a clean and reputable salon as dangerous.

What it comes down to, I think, is calculating your risks and deciding how much precaution to take. For example, having phenomenal circulation, all of the feeling in my feet, and pretty decent control of my blood sugars, I don't think a cut toe will put me at great risk of anything serious (as long as I care for it or get it taken care of, whichever is called for). So, on the rare occasion that I go to the beach, I'm going to walk barefoot in the sand. And I'm going to get a cute pedicure once in a while, because I can never keep up with all that dead skin myself. (But, at the recommendation of my CDE, I won't let them use one of those scary callus razors anymore.)

Now, if my condition changes in the future and I become more prone to infections or lose some feeling in my feet, that risk level becomes a little too high. I might wear sandals on my beach stroll and just dig my toes in the pre-checked sand at the foot of my towel... but I'll probably still get an occasional pedicure!

I think this is exactly the kind of stuff that makes a new diagnosis so hard to deal with. You're faced with a complicated treatment program, a complicated diet, and lots of complications living life (basic exercise shouldn't be potentially dangerous, damn it!). And then you're thrown alllllll this nit-picky stuff that could possibly be more of a risk for a new diabetic, and it starts looking like diabetes is taking over every single nook and cranny of your life.

Don't get me wrong, this information is important. I should be reminded that injuries to my feet are now more serious than before, and that barefoot walks on the beach and pedicures carry some risk of injury... but being told I simply shouldn't do those reasonably safe activities anymore flat out doesn't cut it for me. I'll do my best to manage this disease well, I'll take every precaution against wounds becoming infected, but dang it Diabetes-Care-Powers-that-Be, I'm pretty dang healthy and normal so, you leave my pedicures and tropical vacations alone!

My feet are freeeeeeee!!!!!

How Much Disclosure?

2010-09-09T17:40:00.003-05:00

I've started a new job... my first job change since diagnosis (aka, D-day). While I'm neither advertising or hiding my diabetes, I've had a couple struggles about how much to volunteer.

First of all, lunch time is more social. Today, a group went to a Chinese buffet. There are certainly some Chinese dishes that could be reasonably compatible with carb counting and a diabetic-friendly diet... but that doesn't really describe most food on a Chinese buffet. Plus, even if I found a couple acceptable items, OMG YUMMY CARBS ALL OVER THE BUFFET! Yeah, I love carby, fatty Chinese food. It would be very hard to resist the bad and hard-to-count stuff. So I did not join the lunch outing. I wasn't brokenhearted about it myself, but I do want to make a good, friendly impression with my coworkers.

Then one of the Big Bosses was handing out chocolate chip cookies from a bakery with no nutrition label. I could have looked up the "average" carbs for most chocolate chip cookies, but my blood sugar was already on the higher side... I didn't want to take the risk of miscounting and going even higher (or bolusing for both the high BG and the miscounted cookie, possibly making me go low). No thank you... but really, I appreciate it!

A few coworkers know I'm diabetic, and so does one of the Big Bosses, but I'm not in favor of labeling or limiting myself in their eyes. I don't care if everyone knows, but I don't always want to explain why I'm turning down a cookie today, but don't stop offering them to me because I really can eat them! Or that I'm not being snobby about your choice of lunch cuisine, I just find it very tough to eat Chinese food right now, but really, I can eat any kind of food! I'm just making a decision that is best for me today.

They're also putting together an emergency info list with everyone's important medical info and emergency contacts. This included any medical conditions that could be relevant. The "keeper" of this document is someone I'll work with pretty closely, so I went ahead and showed her that I keep a glucagon kit in my purse, in case I'm ever unconscious and someone around is comfortable enough to use it on me (and if not, then 911 is the answer)... but also followed that up with a disclaimer that, oh, I've never needed it, probably never will, because I don't want her thinking I'm going to keel over dead on them! I debated whether to tell her about the kit at all, but decided in the end that it's best for her to know in case there's a situation where 911 isn't an option.

Just feeling this stuff out... What's the balance? I want to be seen as independent and normal, but I also want to be safe and understood.

Nothing about this disease is easy.

A Meme!

2010-09-08T21:53:00.002-05:00

I've never been one to pass up a meme, and this one's just for us people with diabetes (PWDs)!

What type of diabetes do you have: Type 1

When were you diagnosed: May 3rd, 2010

What's your current blood sugar: Dexcom says 158 (about an hour and a half after my late-night dinner)

What kind of meter do you use: One Touch Ping. (And sometimes a Freestyle Freedom Lite, simply because I still have strips for it.)

How many times a day do you test your blood sugar: 8 on a steady day.

What's a "high" number for you: I'm unhappy with 160 +.

What's do you consider "low": 70 or under, obviously, but 80s and 90s could be "too low" for certain times of day (in relation to meals).

What's your favorite low blood sugar reaction treater: If I have my choice of any treatment, I go for a toddle-size box of 100% juice. I also keep starburst around for when I want something a little more junky, but not so tempting that I'll eat them when not low.

Describe your dream endo: I don't think I've known enough of them to say. Mine is pretty cool. I suppose my dream doctor in general would have more time to spend with me than doctors ever do.

What's your biggest diabetes achievement: So far, on this very short journey, I'd say simply coming to terms with my disease. I'm aware that there will be times when diabetes really gets in the way, but I'm feeling pretty happy despite all of this.

What's your biggest diabetes-related fear: Shortly after I was diagnosed, I would have said "dying in my sleep from low blood sugar." Now? Becoming a burden later in life because of complications... or dementia that me unable to manage my own disease.

Who's on your support team: My husband and my mom lead the team, and all of my close friends are key players.

Do you think there will be a cure in your lifetime: I don't think a cure is around the corner, but perhaps "in my lifetime" is a possibility. More likely, I think we'll have a really awesome treatment within the next ten years... something that takes significantly less maintenance than current options. Maybe an artificial pancreas that can really, truly act "real time" on its own.

What is a "cure" to you: Either transplanting a pancreas/islet cells without the need for anti-rejection drugs and stopping the immune system from killing off the new cells, or an artificial pancreas that is inside the body and somehow "makes" insulin (yeah right).

The most annoying thing people say to you about your diabetes is: I've only had one person tell me what I "can't eat" anymore, but I do have a lot of people ask, "Can you eat that now?" It's normally just out of curiosity, but I hate having to explain that I can eat anything I want... but that some choices aren't as good as others so I should limit them.

What is the most common misconception about diabetes: There are tons. None have really shown up as one I run across often, though.

If you could say one thing to your pancreas, what would it be: It's not your fault. It's not our fault. And all in all... things could be worse.

In Which I Say BACK To Dexcom, "???"

2010-09-06T14:59:00.006-05:00

I've had my (non-trial) Dexcom since Thursday evening. The first sensor was crap, apparently. The trial one from the previous week had gone so well (after the first night, which was crazy), but this one seemed to give me numbers not even remotely related to the ones my meter showed me (Dexom 44, meter 126?! Dexcom 250, meter 160?! ), and it gave me ??? errors a couple times, plus a long and inexplicable out-of-range error... so after another insanely inaccurate reading followed immediately by ???, I finally ripped it off and started a new one Sunday afternoon.

I also wasn't especially pleased with the new sensor the first day and started wondering if it could be the transmitter or receiver... until that evening, when everything started going smoothly. And now, it's damn near perfect, staying well within the acceptable variations (20 points off on the low side, 20% off on the high side). Even over the first night (which gave me trouble on the trial sensor), it didn't throw me any usual numbers, and my fasting numbers matched pretty closely.

Ahhh, CGM bliss. I'm hoping Dexcom will replace that crazy sensor (I tried contacting them, but you know, it's Labor Day weekend). In any case, I'm once again so glad to have this tool. It's just too useful... when it works.

What to Eat?

2010-09-03T13:29:00.005-05:00

Since diagnosis, I've struggled with what I should eat in my overall diet. I don't believe anything is 100% banished from my kitchen, but I have struggled with whether or not I should limit carbs in general.

I already eat far fewer carbs than before I was diagnosed, but that's largely because:
a) I was so freaking hungry all the time!
and
b) You can't mindlessly snack on carbs as a diabetic. You have to be deliberate enough to measure and bolus. So no box of crackers next to me, thanks. I'll count out my portion and put them on a napkin.

And I'd probably have gained way more weight if I'd kept eating the way I used to... now that my body can use and store carbs.

Which brings me to one reason why I think a lower carb diet is a good one to consider...

Fewer carbs helps maintain (or lose) weight. Aside from a potential reduction in calories, and the theory that our bodies' metabolisms work "properly" when we consume fewer carbs, fewer carbs also means less insulin. I am skeptical of this next point, but I've read over and over that "insulin causes weight gain." I'm not so sure about that... It seems more likely, to me, that insulin allows us to gain weight from what we eat. After all, you take more insulin because you're either eating more carbs, or because your carbs aren't being properly absorbed with smaller doses. But still, it's a theory that worries me.

And the other significant reason for considering a lower-carb diet...

Smaller mistakes. If you're eating something high-carb, that calls for more insulin. So if you get the portion size wrong for something carb-dense, your dosage error could also be pretty significant. Take that piece of cake I had yesterday: I was guessing at the carbs, based on how many carbs are in other frosted cakes I've had before, and gave myself three units of insulin for the piece I ate... but I guessed wrong, my BG (blood glucose) dropped quick, and I struggled for the entire afternoon to keep my numbers up (which meant consuming a lot of unwanted calories, tying back to my first reason!!!). Let's compare that to if I'd eaten, say, a sugar free cup of yogurt. If the nutrition label was torn and I couldn't look up the brand, I'd remember that my usual sugar-free yogurt cups are about 7 carbs and (assuming this cup is the same size) given myself anywhere between .65 or .8 units of insulin (depending on my insulin-to-carb ratio for that time of day). My guess might be off, but I doubt it would be by more than .2 of a unit. As long as my BG was at a pretty safe number in the first place, an error of that size isn't going to hurt things much. Unlike the cake, for which I probably gave myself one whole extra unit (if not more).

I love carbs, and I believe everyone should be able to enjoy cake once in a while... but I know from experience that I can eat a generally lower-carb diet and feel satisfied. But that was a few years ago... If I can just get back into that mode!

Cake Will Make You Go... Low?

2010-09-02T19:56:00.004-05:00

Today was my last day at work (I start a new job Tuesday!), and some coworkers were sweet enough to bring me a yummy red velvet cake. I admit I gave in to the "obligation" to eat a piece right then and there, but whatever, I can just bolus for it, right? No biggie.

Except I apparently suck at judging the carbs in cake. Like, really really suck. A lot.

I should have known sooner that my blood glucose was dropping, as I felt an odd anxiety creep in. But I knew by the time I was actually low (caught it at 68), and I downed a juice box... then ate my lower-carb lunch with no insulin... then drank a carrot-apple juice box... Then later, a couple random bites of cake again... then more cake yet again, with almonds for some staying-power. All without insulin. I'd get up to a reasonable number, then go right back down!

And it's not like I gave myself some amazingly huge bolus for that cake. I most certainly ate more than enough carbs afterword to account for that insulin. But they say that once you go low, you're more likely to go low again over the next few hours. Weird. Why can't it be simple? Take this much insulin, consume this many carbs, and all is fine. But no, it can't be that simple. And my last day rather sucked because of it.

Maybe this cake was made of anti-carbs. Like anti-matter. Only... not as deadly and destructive.

OW!

2010-08-31T23:20:00.004-05:00

Nap? Check.
Snuggles with the cat? Check.
Lingering too long in the shower listening to Radiohead? Check.
Most painful freaking moment since starting insulin treatment, followed by blood? Fraking CHECK.

Screw you, Diabetic Powers That Be, for throwing a major kink in my nice, relaxing evening in.

To hell with it, I'm having ice cream... After I bolus. I'm such a rebel.

Dexcom, Weddings, and Alcohol

2010-08-29T13:48:00.009-05:00

I absolutely love this thing.

It's a Dexcom reciever. Part of a Continuous Glucose Monitoring System. The sensor and transmitter are pretty small, and currently attached to my abdomen. Every 5 minutes, the Dexcom gives me my glucose levels.

These are not yet accurate enough to totally replace traditional glucose meters. Before you ever give yourself insulin based on your current BG, you have to stick your finger. But the number on the screen isn't what's so awesome about this device. What's so awesome is that you can see where your blood glucose is going!

Three examples of when I loved this thing this week:

Wednesday: I was driving to an appointment when Dexcom buzzed to tell me my BG was dropping fast. I knew (and it showed) that my numbers weren't high enough to stand such a quick drop for long, so I chowed down on some glucose tabs. 5 minutes later, I could feel that my BG was getting low... but very shortly after that, the glucose tabs kicked in and I felt better, and Dexcom showed my BG starting to slowly rise to safer levels.

Friday: At my birthday party, I decided to have some wine. I rarely do this for fear of what it'd do to my blood glucose levels, but I had Dexcom to tell me about any sudden drops... which I did not have. Dexcom gave me a view of my BG trends all evening, and I kept it where it would wake me if I went low during the night. I didn't have to stress.

Saturday (last night): I went to my cousin's wedding with an already elevated blood glucose due to eating fast food for lunch. At the reception, I gave myself insulin and made myself wait until Dexcom showed my BG starting to lower before beginning to eat my dinner (thus avoiding an even worse spike). This meant that, when it came time for cake, I didn't feel horrible about eating sugar. Again, I took my insulin a few minutes before eating the cake and saw that my numbers were starting to come down slightly before I ever put the first bite in my mouth. In fact, after that cake, I finally saw my numbers begin to return to a healthy range. Then, about three and a half hours after the cake, Dexcom buzzed me and showed a sharp drop in BG. What?! I tested to confirm and yes, I'd had a sharp drop. Aided by Dexcom (and the occasional finger stick to confirm whenever I was shocked to not see a rise in BG), I started consuming carbs. A small cookie... nothing. Another cookie... nothing. A 10-carb box of apple-carrot juice... A slight drop?! Glucose tabs... a slight rise, so wait and see.... no change? Finger-stick shows a BG of 88, which is too low for bedtime with such a downward trend and the knowledge that I'd had alcohol two nights in a row! I ate a 16-carb South Beach bar and sleepily watched Dexcom's numbers rise to almost 100 (with a slightly-upward trend arrow) before nestling it next to me and going to sleep. Dexcom shows I reached the 190 range in the night (which, I've discovered, means I was probably closer to 170 or 180), but the glucose meter showed me a 112 (Dexcom showed 130) when I got up late in the morning. I'd rather not go that high, but I think two evenings of alcohol threw my system through a loop, and it was necessary.

I've found the Dexcom numbers off by 20 points pretty often, but it's been an invaluable tool already. This was just a "trial" week, required by my insurance before they'll actually cover Dexcom, and I'm now more convinced than ever that I want one. It's helped me learn more about the timing of my insulin (I'm now trying to take it 15 minutes before I eat, when I can, to avoid spikes) and has helped me live a slightly more normal life (normal for me!) without worrying that I'd have a middle-of-the-night emergency. (I also learned that something last night didn't work for me. Was it two nights of wine in a row? Or did I guess horribly wrong about the carb content of cake? Or did even that small amount of dancing bring my BG down? I'll now have a much more watchful eye on all of those elements until I figure out what the problem was.)

Dexcom, you rock.

The Other Side of 30

2010-08-28T11:54:00.003-05:00

So today is my 31st birthday, and last night was a celebratory game night with close friends (which wound up feeling more like a party than I expected, which was cool!). I opted against the rather large parties we tend to have partly because I still occasionally feel frustrated when faced with some food and drink situations, but also partly just because I wanted a smaller get-together.

Food and drink awesomeness:

I made low carb peanut butter balls, which took a little modifying (1 oz of chocolate was not enough!) and recalculating but turned out great and made 35 small balls at 1.3 carbs each (mmmm!).
Two desserts arrived with me in mind! Jenn brought cupcakes (with sugar-free penutbutter cups in them, FTW!) and told me upfront how many carbs were in them, and Jess (quite a famous chef in our group!) brought a low carb plumb tart with an almond crust. Yum!
I had three glasses of red wine and, while I let myself run slightly on the higher side for the evening, I wasn't afraid of dropping too low since I have a trial Dexcom unit this week (what great timing!).
No one brought anything super hard to "count," and I didn't feel pressured to eat out of courtesy.

Rock!

Other awesomeness:

GAMES! We played Ultimate Werewolf and Quelf, both of which make for goofiness and fun!
Friends! I felt really loved.
Fun and thoughtful gifts! One of the things Jenn and Bonnie gave me was a set of Russian nesting dolls that double as measuring cups!!! As Bonnie is also type 1, they probably knew how handy it is for me to have plenty of measuring cups around (and these are so cute!!!). Liz and Matt also gave me some cool vintage fabric with the thought that I could use it for making purses or meter cases to carry all my stuff, and Melissa and Jade gave me a copy of Quelf!
A really awesome husband! It was Chad that arranged all of this, and it turned out to be perfect. He's so sweet. :)

It was an awesome birthday celebration. I have to admit that, a couple months ago, I worried my birthday would be depressing. But surrounding myself with just my closest friends and not facing down a giant, sugary cake (and happening to have a Dexcom to help make drinking safer!) worked out beautifully. I felt normal, and yet not pressured to be normal.

Chad has commented a couple times that, after this diagnosis and some other less than pleasant issues this past year, we should be glad to say goodbye to 30. I think I agree with that, but I also think I've come out the other side of 30 in better shape than I went in. I suspect I went into it with this disease already in development, and now I've finished it with it under pretty good control and... overall happiness.

This was not the most pleasant year for me, but I think I'm better off for having gone through it.

T1 vs. T2

2010-08-16T21:38:00.003-05:00

I've noticed something, ever since I was diagnosed as a type 1 diabetic: We T1s tend to be defensive.

We don't want to be confused with type 2 diabetics, we don't want people to think we could get better "just by eating right and exercising," we don't want people to think we take insulin because we don't take care of ourselves. All understandable. I remember, in particular, seeing a mother on a message board say something like, "some people think my child got diabetes because I gave him too much candy." The very thought makes me so angry for her!

But let me flip this around... When I first knew I was probably diabetic but was still assuming (before further tests) that I was type 2, I was kind of embarrassed. Even though I lead a healthier lifestyle than what usually triggers T2, I felt I had done this to myself. I'm a little overweight (actually more than a little, according to height/weight charts), I lovvvve carbs, and I don't exercise as regularly as I should... and I suddenly felt like these were sins for which I was being punished. Then once I knew I was T1, I didn't want people to confuse it with T2.

So, here's that flip (finally): What does all of this T1 defensiveness say about people with T2? It says, "They do it to themselves. They could prevent it. They are being punished for their gluttony and sloth."

And that's not true.

"Hold on!" you cry. "All the experts say it's caused by poor diet, lifestyle, and obesity!" But actually, those are some of the triggers (sort of like T1 is "triggered" by an illness that throws the immune system into overdrive). T2 is hereditary, and far more common than T1. There are even athletes who develop and live with type 2 diabetes, and I'm not about to tell them they did it to themselves. (I have no doubt they could totally pound me!)

And what if someone's poor choices moved them further down the path toward T2 diabetes? Are we going to judge them for it, when their habits may not be any different from those of someone more fortunate in their genetics?

Yes, poor diet and lifestyle can trigger or worsen T2 (those things can also worsen T1). Yes, some T2s can (and some do!) control their diabetes through exercise and diet (this also helps T1s manage diabetes). Yes, some T2s are non-compliant and allow their condition to get worse and worse (there are also T1s who do this). But that doesn't change the fact that they have a disease, and one very closely tied to our own.

We are on the same team. The diseases, triggers, and treatments may not be identical, but we're all facing many of the same challenges and dangers.

When I encounter someone who makes assumptions about me based on T2 information (which is, understandably, much more commonly distributed than info about T1), I will strive to educate them without pointing fingers at people with type 2 diabetes. It will be, "Actually, I have to use insulin no matter what because being type 1 means my immune system killed all of my insulin-making cells." It will not be, "It has nothing to do with how I eat! That's type 2!"

Because I'm not going to talk smack about my teammates.

Smoothing Out the Seams

2010-08-09T20:00:00.006-05:00

I think I’m beginning to incorporate diabetes treatment into my life more smoothly. Even with the pump being so new, and even with other new things (CGM) on the way, it’s all starting to blend in. All of the actions are inspiring less, “Let me stop my life for 5 minutes to test my blood sugar and take an injection,” and more, “I hope I don’t look too inattentive while I test my blood sugar and listen to this person talk at the same time.”

The most invasive daily activity at this point is counting carbs, even though the pump takes care of some of that for me. Even if the database were easier to browse, some foods are just always a mystery unless you make them yourself. There could be sugar in your sweet corn, flour in your omelet, or (on the flip side) far more fiber in that dinner roll than is typical. And what is the tuna-to-pasta ratio in that tuna casserole??? It helps, when dining out someplace without a nutritional guide, to stick to simple foods. I’ve been eating a lot of poultry and seafood with rice and veggies or salad lately... The meat has little to no carbs (as long as it's not battered, and depending on sauces and glazes!), I can pile rice or veggies into a mound and judge which of my measuring cups it would likely fill, and side-salads with creamy dressings (ranch or Caesar), a few croutons, and no fruit have pretty reliably acted like about 10 or 15 carbs (depending on size). I’ll probably branch out into more combination foods as I get a better feel for carb content, but simple and familiar foods make life a little easier when there are no hard numbers to rely on.

Making food at home is easy. Meals for just myself are usually packaged and frozen (I love Kashi meals for lunch!) or routine enough that I know exactly how many carbs are in the final product as I always make it (my usual PB&J sandwiches are 34 carbs). If it’s a more complex meal for my husband and I, I usually try to cook exactly enough for both of us. I jot down carbs on a scrap of paper as I choose ingredients, total it up, then divide by two to determine the carbs in my half of the meal. (Or, more likely, I take a look at the carbs for one serving of a frozen “meal for two” I’ve just sauteed!) I test my blood sugar while the food is in the last couple of minutes of cooking, then punch the carbs into my meter-remote for my bolus calculation as soon as we sit down to eat. I’m already eating the first bite before the pump has finished its bolus. (So much faster than taking a shot!)

So it’s all falling into a rhythm. I’ve had to make some adjustments to my routine to more seamlessly incorporate treatment (eating simple foods at restaurants without nutrition guides, taking a few extra minutes every third day to put insulin in my pump and insert an infusion site so I don’t have to take a shot 5+ times a day, buying a more organized purse to easily carry and find my gear, buying some 1-cup tupperware bowls so I know exactly how much cereal I’m eating without breaking out the measuring cup...), but the treatment itself is also becoming easier to adjust (the pump means less time and mess before meals, I can use my glucose monitoring kit more quickly and without taking every little thing out of the case now that I’m used to it, and I don’t have to do as much math to give myself insulin anymore).

I still have these surreal moments when I realize, “I’m diabetic. I have a chronic disease. I have to take medicine multiple times a day to stay healthy and alive.” This strikes me especially hard when I wrestle with the tube of my pump while changing clothes, but then the pump disappears quite effectively under the front of my bra, and I only occasionally talk to it for the rest of the day through what looks pretty much like a fat little PDA... and it talks back to me from beneath my shirt through the quietest whisper of a *click* when it gives me a basal dose of insulin, and through a rhythmic vibration that translates into, “Bolus insulin for 41 carbs coming right up!!!” And I can hear the quiet twist-and-deliver as I enjoy the first bite of my meal... and then I think about other things.

Every now and then, I’m amazed by the things I do automatically. The seams are smoothing out...

Pumping It Up!

2010-08-08T11:34:00.005-05:00

OK, so here's the pump update!

I started on Wednesday. The frustrating thing is that the CDE, who I had never met before, kind of started from scratch on a lot. Like, though I knew I needed lower basal rate in the afternoons and evenings, she still set the same rate all day. Maybe that's standard for starting on a pump, but I kept wishing my usual CDE were there instead.

But, over two hours (which could have been more like one hour, if she weren't such a chatter!), she got me started and set up. I was nervous about inserting the needle/cannula for the infusion set, but discovered that it hurt less than some of my insulin shots do! It was a little awkward, but generally easier and less invasive than I thought it would be. My mom, who went with me and is a nurse, was concerned that the cannula was too shallow and started making suggestions about angling it differently next time... But the CDE assured her that it was in exactly right, and my later numbers showed that the insulin was indeed getting into my system properly. Pretty cool.

This really is kind of like starting from scratch, though. The CDE seems pretty happy with where my numbers have started (some people's blood sugar does crazy stuff when switching treatment methods!), but we're still having to adjust for evening and afternoon lows. A total pain. But it's interesting to watch my insulin needs go down so much on the pump! She commented that they start a new pumper on a slightly lower basal rate than they'd had because most people weren't getting every little last drop in their system when doing shots. And I believe that, because I usually saw a remaining drop (maybe two) come out of my pen needles even after the recommended count-to-ten.

Wearing it has been no problem. It's a little surreal to be hooked up to a medical device, but it's small and cute. So far, I've worn it:

Clipped under the middle of my bra (I'm glad I'm endowed, now!).
Under my waistband.
In my pocket.
Clipped inside the front of my nightgown (around the house and in bed).
Clipped to the side of my underwear (in bed).

(Under my waistband.)

Pretty simple. I dig it!

What Diabetes Has Changed

2010-08-07T10:19:00.007-05:00

I suppose I should be doing a post about my first three days on the pump, but that will have to come next. (But I'll say, it's going pretty well!) This list is what's been bumping around my brain this morning...

What Diabetes Has Changed:

Let's get the biggies out of the way and move on to the more "fun" ones... It's brought my mortality to my attention. Health was never a concern beyond needing to eat less and exercise more, but now it will be a very prominent part of my daily life.
I used to be terrified of needles. I'm still nervous about intravenous needles, but too a lesser extent... and I never thought I'd be OK with sticking my stomach or thigh with a needle multiple times a day... Or, as the case is now, sticking a needle into my stomach and leaving behind a cannula. If you'd told me that four months ago, it would have freaked me the hell out.
My nutrition label review used to go: calories, ingredients, types of fat, amount of sugar. Now, it's: carbs, fiber, sugar alcohols, ingredients (for types of grains & sugars), amount of fat, types of fat, calories.
I carry a much bigger purse, and it's about to get bigger again!
When I got distracted by the internet, it was usually over something crafty or geeky. Now, it's usually over something diabetes related.
I used to think an insulin pump was a sign of very hard-to-control diabetes. Now I know it's a sign of better diabetes control for that person's lifestyle. (And I think they're pretty cool!)
I have better knowledge of how the glycemic index works. I knew that lower-GI foods were better because they caused fewer sugar spikes and drops, but now I'm even developing a feel for how quickly different foods raise my blood sugar.
I eat less, but weigh more... both thanks the the ability to use and store carbs again. *sigh*
I want to exercise more than I ever wanted before, but I almost never do now. I seem to trend low for a lot of various reasons, which makes me less inclined to go do something that will make me go even lower. (This will be less of an issue once they "approve" me using temporary basals on my pump, and once I have the Dexcom CGMS.)
Other than stress symptoms and occasionally feeling low, I feel better. It wasn't one of those night-and-day things where I took my first shot of insulin and felt like a new person, but there's definitely a difference.

Dexcom on Its Way!

2010-07-30T22:18:00.005-05:00

So not only am I getting an insulin pump, but I found out today that I've been approved for the Dexcom continuous glucose monitor (CGM)!

I was skeptical my insurance would approve it, because it's still so common for people to get turned down, but I'm betting the pregnancy planning is what won them over... though Mom pointed out that my situation is an unusual one, even if it's not uncommon, so they may have been prone to approving it for someone with a brand new case of Type 1 at the age of 30. She also thinks insurance companies are catching on to the fact that good treatment now is usually less expensive than complications down the road.

Caremark and BCBC of Oklahoma, your recent moves to benefit my health and treatment plan are starting to shake my whole insurance-companies-are-evil stance!

While the pump is very exciting, I'm even more excited about some of the benefits of the Dexcom. First of all, it'll warn me about lows and highs, sometimes even before I think to test for them. And I find that, while I feel most lows before they get bad, I haven't really tuned into the symptoms of highs yet. I don't pee like crazy, my thirst isn't unusual enough to tip me off, and I don't feel that "off," which I attribute to having recently spent so much time with even higher BGs as an undiagnosed diabetic. Highs just feel like more of the same to me. But now, Dexcom will buzz me when things are climbing too fast.

And, in tandem with the temporary basal options the pump gives me, I think this technology will let me exercise and be otherwise physically active without worrying as much about lows anymore. If I take a sudden nose dive, Dexcom will most likely tell me.

Badass.

Robo-Pancreas!!!

2010-07-29T23:20:00.007-05:00

Look what I have...

That's right, I have an insulin pump!!!

It's an Animas Ping... A pink Animas Ping! I used to hate pink, but I now really appreciate it when it's an unexpected color... like in the case of a medical device.

I'm not using it until Wednesday, when I'll meet with my CDE and get the official "training." I've been playing with the functions, with a cartridge and tube full of water. Tonight, per my CDE's recommendation, I'll tape the tubing to my stomach (pump attached) so I can figure out how I'll want to sleep with it.

Aside from how awesome it is that I'll soon have more precise blood sugar control and will just have to push buttons instead of giving injections in public (not that it's embarrassing, just a hassle), I'm totally drawn in by the fun that comes along with a pump! It's a medical device, yes, but it's a gadget. It's advanced, cute, and it makes fun noises! Oh, oh... AND IT DOES MATH FOR ME!!! Sold!!!

I keep reading about T1 girls struggling to "hide" their pumps, and I'm sure I'll get tired of the questions and start tucking it away into my bra, but I currently have no anxiety over the prospect of it being visible on my everyday outfits. It's cute, and I imagine a lot of people will assume it's an MP3 player of some sort. For those who ask, my current plan is just to tell them and to answer any other questions.

I should also comment that my insurance has all worked out remarkably well! Blue Cross Blue Shield approved this earlier than their policy normally allows, and Caremark agreed to cover vials of Novolog for me right away even though I very recently refilled my prescription for the Novolog pens (technically, this was like trying to "refill" my Novolog prescription too early). I still think the system needs reform, but I have to say that I'm pleasantly surprised by how relatively few roadblocks I've hit.

And, in general, I have to say things are pretty good right now!

A Very Important Cog in a Much More Important Machine

2010-07-17T11:30:00.007-05:00

"At some point, you have to stop and say, 'Lord, why?'" said my doctor. "But thank God we found this early. God really did protect you! Most people end up in the ICU for a week!"

There are so many things about these statements that do not ring true and clear for me.

I will absolutely never tell people what's right when it comes to religion, spirituality, and a divine being... except, perhaps, that I do not believe any higher power would approve of hurting others except in self-defense or the defense of those who cannot protect themselves. Beyond that, I only know what feels right and what doesn't... and I don't feel that any one organized religion has it entirely "right."

This makes me a grade A agnostic, and there have been times when I considered myself an atheist. So, I'm no authority on God.

But I don't think I would ever stop and say to God, in whatever form I believe in Him/Her/It, "Why would you let me develop diabetes?" If there's one thing I do believe about divinity, and I do believe there is some kind of divinity, it is that we are all very important cogs in a much more important machine that is the universe. Everything happens because that's the way the universe, and the divinity that made or is a part of this universe, works. That doesn't mean there was a conscious divine plan for me to get diabetes, just that it is one of the tiny little processes that make up this amazingly complex and ever changing universe.

And do not believe that I am so uniquely special that a personal god would protect me with an early diagnosis. Not when there are small and innocent children who develop the same disease and don't know it until their parents have rushed their limp little bodies to the emergency room, racing against time and death. This does not mean I consider myself insignificant to a personal god, but rather that I am no more special to Him than those children.

I do not consider myself cynical in this lack of belief in a personal god who makes things happen in my life or protects me. It doesn't even mean I believe there is no god, or that God must be impersonal if He exists. I believe, rather, that any such god would be an eloquent designer who created the universe (and everything that happens in it) exactly as it must be, and who would see all good people as equally deserving of whatever benevolent intervention He might offer.

But developing a chronic disease that puts me in a much higher risk category for other life-threatening conditions has certainly gotten me thinking about belief. I believe that there is divinity in the universe, though I've leaned away from picturing that divinity as a being... But my sudden sense of mortality made me ask: Is there something there for me after I die? And if I were to pray for help, is there someone to listen? And would that someone actually be willing to consider answering my prayers?

I still haven't learned those answers, or even developed much of an opinion on them... but I am no longer content to not ask them. Perhaps this is one good thing diabetes has given me.

Who is This?

2010-07-02T17:24:00.005-05:00

I find it difficult to relate to other people with diabetes. Wait, that's not right... I can relate to the people, but I find it hard to relate to their diabetes.

I read blogs where people talk about their lives with diabetes, and I'm overwhelmed by their... overwhelmed state. It's like it's ingrained itself into every minutia of their lives. As so many of them say, diabetes doesn't define them... but it sure does seem to shape their lives. Sometimes their entries scare me. Blood sugars of 500 because your pump malfunctioned?! Such horrible lows that you weren't with-it enough to trust the person trying to give you juice?! I read these and boggle. That's not me! They must be "brittle!" But... What if it is me? What if it's just a matter of statistics, and these things are bound to happen a few times in the lifetime of a diabetic? What if it's not happening now only because I'm having a little "honeymoon," and it'll start once my pancreas has utterly crapped out?

On the other side of things: when I talk to a friend who has had diabetes since she was 7, I'm in awe of how normal her life has always seemed to me... because I don't feel very normal right now. And though she and I have the same disease, we are in such different places at this point. She's such an awesome resource and I'm so lucky to know her, but sometimes I get frustrated about not even knowing the right questions to ask.

And I even have trouble relating to my own diabetes. A little over two months ago, I was just Elizabeth. Who am I now? I know I'm still me, but I'd be fooling myself if I thought a chronic disease didn't change me at all. It's like now I'm Elizabeth*, with the asterisk pointing to a footnote explaining all about diabetes and how it affects me.

But the thing is, I think I can get used to the asterisk... as long as it stays an asterisk. I would never have invited this into my life, but I'm starting to understand that diabetes is now a part of Who I Am. It's not Me, but it's one of the many, many things that make up Me. It's going to shape my life, but I have some control over how.

I don't really know this Elizabeth* yet, and that's disconcerting, but I'm starting to think she's an OK girl.

A Need to Return to Normalcy

2010-07-01T12:46:00.001-05:00

Long time no post, but I've been a wee bit busy. I'm sitting in a new house full of cardboard boxes.

Also, I went through a dark patch there. I was very, very down about life, including diabetes. Not that I'm totally over that, but I feel a little more in control again. And I want to get back to blogging, but I feel bogged down by everything I want to say when I do... So, I'll just type.

Moving plus my period did a number on my blood sugars. I had a lows four days in a row, including a 40!!! So today begins a slightly new routine with the Lantus ("basal" or long-acting insulin): A smaller shot every 12 hours, instead of a larger one every 24 hours. My educator thinks it'll help prevent my evening numbers from going so low.

The honest truth is that this has been trickier than I thought. I wasn't going to have crazy lows like all those other diabetes bloggers! I wasn't going to have mystery blood sugar numbers that logically shouldn't have occurred! But alas, I am no VIP to diabetes.

I think one of the most important things I can do for myself right now is take control of my life. I may not have perfect control of my diabetes yet (it'll improve, though it will probably never be "perfect"), but maybe I can take control of other areas. For various reasons, I've felt like a passenger in the process of finding, moving into, and buying this new house. I need to make it mine. My job is not where I want to be. I need to make the best of it for the moment while taking steps toward where I do want to be.

Some other areas aren't as easy. Diabetes has its claws in my diet and, to some extent, my physical activity. This is necessary, at least in these early stages when we're still "figuring it out." But I have to say that the psychological effect that has on me is very negative. The first month, no problem, I was surviving. Now, I need to start living. I need to reclaim these areas to the extent that I can. I'm eating more fruit again, for example, which I avoided at the beginning simply because I wanted labels and things I could measure. But now I'm branching out and letting myself use my best judgment on portions/carbs. Exercise? Well, moving certainly was exercise. Unpacking is too, as far as my blood sugar numbers are concerned. After all this is winds down, I'm going to go do the exercise I always enjoyed most, damn it!!! If I have to do shorter or lighter sessions, so be it, but I'm tired of being scared to walk-run on the treadmill or go to my favorite yoga class. I'll be extra cautious, but I need to return to a little normalcy.

Phew! There's my lunchtime post. Back to work!

Party Pooper

2010-06-18T17:34:00.001-05:00

I have to admit that this learning phase is starting to bug me.

First of all, I'm a little impatient, and a lot independent, so I want to be in control of managing my own diabetes now.

Second, I'm sick of my records dictating some if my actions. I could eat that giant cookie (and take insulin with it) at 4 in the afternoon, but then my before-dinner numbers would be useless to my diabetes educators when they review my records to decide on any changes to my insulin treatment. I could drink at a friend's birthday club-hop tonight, but that'll throw my numbers out of wack for at least a day and, again, make them useless to my educators.

I'm not a drunk and I don't "need to drink to have a good time," and other such cliches... But I do drink, and it is a part of my social life. I've only briefly mentioned my social anxiety, but it's affects my life a great deal. I'm no recluse and I don't start hyperventilating the second someone talks to me, but socialization (except with certain people I'm very comfortable with) often brings about more stress than enjoyment for me. So when I'm in any sort of "party" environment, the relaxation and uninhibition (is that a word!?) that comes along with a couple drinks helps a lot.

Plus... it's fun.

Things can't be all doom and gloom!

2010-06-16T18:11:00.001-05:00

I have in my hands a wonderful, wonderful thing.

Lab results... Showing my cholesterol significantly improved!

You can't imagine the relief this brings... And the motivation to start taking an active roll in improving my cholesterol! When my results were so terrible and my GP doctor was telling me that she's never known a diabetic who could get their cholesterol to the levels where they really needed to be on their own, I felt helpless. Fine, nothing I can do will fix this. Just give me more medicine, and then more medicine (hormonal birth control) because of that medicine, and then I'll take more insulin because of that medicine!!! Just whip up a medical cocktail in my bloodstream and kill every delusion I have about control over my body and fate...

But not now! Bringing down my blood sugar alone brought me to an "OK" level, according to my endo: 170 (down from 238) overall. My lab results say that below 100 is desirable for diabetics. I don't know a whole lot about cholesterol, but it doesn't seem unreasonable that I might be able to achieve that through improved diet and exercise. My GP also said that she wants my HDL ("good" cholesterol) up to at least 70, and it's already improved from 36 to 60. Again, by replacing bad fats with good fats and getting my self-pitying butt off the couch? I think I might be able to get to 70!!!

Maybe I'll need cholesterol meds some day, but I don't think today is that day. Now that my numbers are "OK," I don't feel like my heart is a ticking time bomb anymore. I just feel like someone who needs to eat better and exercise... which was true before any of this ever came to light.

My current plan:

Exercise at least 2 times a week, preferably 3... Even if it's just a walk around the block, DO IT!
Do a better job of avoiding trans fats and excess saturated fat. (Please ignore the Burger King chicken sandwich wrapper on the coffee table! That... that was for my cat! I swear!)
Lose 10 pounds. Not only does weight loss improve cholesterol, but 10 pounds would put me back into the range where I just feel better!

Now, I'm going to go get dressed for yoga class!!!

Raw, Open, Beating, and Vulnerable

2010-06-12T23:17:00.001-05:00

One of the hardest things for me since my diagnosis is the knowledge that it affects more people than just me, and the way it affects me affects others. The truth is that I've always had problems with depression, and now is no exception. I'm actually doing a lot worse than I usually let on.

Not wrist-cutting-bad, but going-to-the-bathroom-just-to-cry-bad. I have dysthymia, which is basically chronic (long-term) "mild" depression. People with dysthymia are mostly functional (unlike people generally are when they have full-blown "major" depression), and it's common for them to go without treatment since they think of that mild depression as "normal." I have sought out treatment, whenever it got to its worst. I take Wellbutrin and I visited with a counselor briefly last summer. But, because depression is "normal" for me, I've made a habit of pretty much never reaching out. My husband, bless him, is very willing to listen and support me. So is my mother. I've had numerous friends express a desire to be there for me. But if I were to talk about the way I feel every single day? Lay that out--raw, open, beating, and vulnerable--on the table? Hell, *I* wouldn't want someone to show me that on such a regular basis. So... I never do. The two people I'm closest to see some of that when I'm really and truly in need... but they're also the two people I care about most, so I'm always afraid of hurting them in the process. So, I often hold back when maybe I don't need to. Hell, during the composition of this entire post, I'm fighting the urge to delete it because I worry about what people will think of me, or that someone close to me might feel bad to discover how I'm feeling.

This, I've found, is one of the things a professional counselor/psychologist/psychiatrist is good for. There is no fear with a counselor; that counselor isn't there to like me, and he can't do his job unless I'm honest with him. His opinion of me isn't going to lessen because I always talk about my negative emotions, I'll never scare him off with neediness, and he will never be adversely affected by knowing how badly off I am... At least, no more than the common emotional toll that drives many mental health professionals to also have their own shrink.

So, I am looking forward very much to going back to the same counselor I saw last summer, a week from Monday. I was hoping for an earlier appointment, but I have no free leave left and had to opt for an evening time slot... of which he does not have many. I'll soon get to talk to someone who isn't emotionally invested in me or my health, other than wanting to help me get better. He was also great at putting things in perspective for me, and making me face important issues I'd normally like to ignore (like my social anxiety, and the too-high expectations I have for myself). I'll be going to talk about coping with my new chronic illness, but god knows I have numerous other problems I need to deal with right now...

Pity Party!

2010-06-12T13:56:00.002-05:00

Well, this week sucked.

It was positively wonky on the blood sugar front. I've had to snack between most of my meals to keep from going too low. Tuesday was the worst and probably a little influenced by that glass of wine from Monday, but the major culprit for the entire week (and my Diabetes Educator agrees on this) is most likely hormones.

I stopped using the NuvaRing after only a week because it had turned me into a sobbing, pathetic ball of hormonal self-pity. I'm so glad to be rid of it, but stopping so soon also meant starting my period very early. Your period can lower your blood sugar, and apparently this one did a WHAMMY on mine.

Though I've successfully avoided actual lows by checking my blood sugar regularly and snacking whenever it's on a clear nose-dive, the chaos made this week awfully hard. There was little else I could think about and I felt fuzzy-brained (from the fast drops and rises?), which made me somewhat useless at work, and I'm just exhausted. My boss even sent me an email in which she told me to "go back to the drawing board" and re-prioritize some projects, and she concluded by telling me, "I want you to come back on Monday refreshed, organized, and determined." I had all kinds of emotions about this:

Guilt, because I know she has valid concerns about my recent performance.
Frustration, for the same reason.
Anger... because she has been very casual, even cheery, about my diabetes. My mental response when first reading her closing request: "Does she not get that it's possible I won't be able to be refreshed exactly when she demands it?"

People with diabetes live normal lives and work just as effectively at their jobs, but the fact is that there are times when diabetes takes center stage even if you do everything right. I intend to get to the point where I am living a normal life and putting forth normal (exceptional!) effort toward my job again, but I've only been treating diabetes for just over a month, and I'd say I was barely in control of my blood sugar this week. I'd told her twice that week, including earlier that day, that I was fighting low blood sugars for the first time. Her response? She squinted inquisitively with a "Hm!" and moved on. After that email, I'm starting to think she doesn't understand that treating diabetes isn't as simple and effortless as some people make it look, and that low blood sugars (or rapidly dropping blood sugars, which was my issue this week since I fended off the sub-70s) affect your body and brain.

But then, reintroduce guilt: She's right in that I'm not delivering like I should. And also introduce a sense of being trapped... because maybe I just need to take a couple FMLA days off from work to rest, but I can't because of projects at work and because I can't afford it with the new medical bills, the purchase of a house right around the corner, and having finally paid our taxes (yeah, I know, way late).

So, what am I trying in order to make myself more "rested" for her? Asking to have someone else host our Friday night D&D games for a little while. Skipping my cousin's wedding shower tonight. Staying at home while my husband and nephew watch the US soccer game at the local Irish pub. Not going on my Sunday visit to my parents' place. Working at home tomorrow (Sunday), because I could not focus enough to finish an article that needs to be finished by Monday morning. So restful... I miss the days when I worked jobs that were pretty immediate, meaning I couldn't take work home, like working reference at the public library.

And, honestly, my stress is sky-high. When I started treatment, I was stressed enough to be dizzy and headachy (which had me checking my blood sugar repeatedly!). I'm back to that right now. I don't really have anything that I do on a regular basis for stress releaf. Exercise might normally be my answer, but I can't do that with already-plummeting blood sugars. Sadly, I dislike a lot of the things other people do. Bubble baths are boring, massages are uncomfortable (one masseuse made me cry!), beauty treatments like pedicures make me feel awkward, and my mind has been racing too much for meditation. Escaping into my third read of Watership Down has been my one resource. So... maybe I'll go try and read that while I take a hot bath, so it'll be a little less boring.

Because I'll Never Completely Abandon My Vices...

2010-06-07T22:18:00.001-05:00

Had my first alcohol since diagnosis, tonight: One decent-sized glass of Pinot noir. I'm keeping a very close eye on my blood sugars with my sexy little red (cheap cheap CHEAP) back-up meter. So far, a consistent drop that seems a little faster than I'd otherwise expect. But since I started with a slightly high number, it's in more-than-safe levels. I'll test again for my bedtime snack/shot... then once more before sleep, just to be safe. I just hope that one glass doesn't make things plummet overnight!

Most alcohol causes blood sugar to drop (though it might cause an initial spike), despite the sugars in it. My initial reaction to reading this was that, hmmmm, Intensive Alcohol Management might be slightly more fun than Intensive Insulin Management. But... I don't think I'll be bringing that up to my diabetes educator anytime soon!

Better Pace than Expected

2010-06-04T17:34:00.001-05:00

While talking to my diabetes educator on the phone yesterday, she said she felt my insulin ratios and doses don't need any changes yet. I was disappointed, and told her I was eager to really get things down... and she pointed out that the last couple of days had been great. And it's true. And after thinking about it for a while, I realized a few things:

My recent numbers aren't that far from what she said will be my eventual goal range. I occasionally rise above it, but not by that much.
I'll learn to adjust my own ratios and doses for specific situations.
I want "normal blood sugar," but I don't have a normal body. I don't have a working pancreas, which would normally create both insulin when my blood sugar starts to rise, and glucagon when my blood sugar gets too low. Until things are a little more predictable and I've recognized a few more lows, staying on the higher side of normal is probably safest.
I hadn't been exercising, and exercise tends to lower blood sugar!

So I went for a brisk, 20 minute walk yesterday evening. Afterward, my blood sugar read as about 25 points lower than I started... and this morning, my fasting (morning) blood sugar was 20 or 30 points lower than it normally is. If I have the same results for another day or two, I'll check with my educator to make sure the new trend is safe. (One of my my fears is having a low blood sugar in the middle of the night!)

In other news:

I'm meeting with an Animas pump rep tomorrow morning. At Panera bread... I'd better check their nutritional info!

My left arm is randomly sore, like I strained or twisted it. I know I tend to try and carry too much with that arm, in order to free my right hand for things like unlocking the door, but everything seems like a symptom of doom and gloom diseases these days!

Numbers and a trip to the endocrinologist

2010-06-02T12:51:00.000-05:00

My blood sugar numbers have gotten pretty good, and I really hope my Diabetes Educator lowers my target numbers. They're currently 130 (before meal) and 180 (after meal), but the general range I'll be shooting for eventually will be between 70 and 140... or 70 and 120 when I get pregnant. Most of my numbers are generally between 100 and 150 right now, which isn't too far off from that long-term goal range!

I went to the endocrinologist yesterday, which I'll talk more about later. But she told me three things that make me very happy:

I should go ahead and start the paperwork necessary to get an insulin pump. I may not be able to get it until I've met some time requirements set by my insurance (6 months), but starting now means less waiting when I get to that point.
She doesn't see any reason why I shouldn't be healthy enough to start trying to get pregnancy again by the end of the year, maybe even by fall. (Also, planning a pregnancy makes getting a pump approved much more likely!)
She thinks we should see how much my improving blood sugar lowers my cholesterol before starting cholesterol medication. She seems to think there's a chance I won't have to take any at all until I'm older. *This is quite different from my GP's statement that she's never even known a diabetic who had their cholesterol sufficiently under control without medication. If my cholesterol improves enough that my endo doesn't think I need meds, I may take the middle road: Wait until I'm done having babies, then take the meds if my GP still thinks it's warranted.)

So far, I'm leaning toward an Animas Ping insulin pump. (Medtronic's Paradigm is a close 2nd choice.) I'm already looking forward to the greater precision of a pump!

Where the hell am I, and how did I get here from there?!

2010-05-30T11:31:00.003-05:00

I didn't really know how to expect my treatment to affect my life when I first found out. Actually, I still don't fully know. But one thing stood out to me immediately: We had to stop trying for a baby.

We'd been trying for a while, though I wasn't to the point of obsessing, charting my cycle, and calling my husband to meet me at home during lunch because my temperature just jumped half a degree. But still, we're ready to start a family.

And now I'm on birth control.

You can have a healthy pregnancy and a healthy baby as a diabetic, but you have to get your blood sugar under control to make it happen. Plus, I have one other factor to consider: Like many diabetics, I also have very high cholesterol.

Actually, high cholesterol doesn't affect pregnancy much. But when my doctor said I'd have to start cholesterol medication but that she understood if I was too overwhelmed to start right away, I decided that the more overwhelming prospect was to not do everything possible to get my health under control... Get my cholesterol down, please!

But I also told her that I want to have a baby as soon as I'm healthy enough to do so, and she explained that I absolutely must not become pregnant on cholesterol meds. She clearly felt that hormonal was the best stand-alone method, and in fact insisted that condoms alone were "not good enough," considering the risks. So we discussed options and I left with a pack of Crestor samples, a prescription for NuvaRing, and a promise that she had no worries about me stopping both once my blood sugars are normal and stable enough for pregnancy. Oh, but not until I got the scary "worst-case side effects of cholesterol meds" warning about cramping muscles. Even though I know the serious side effects are rare, it still scared the crap out of me.

And reading the NuvaRing information before starting it today, all those warning sections were scaring me all over again. Diabetics with certain complications (none of which I have, most likely) were listed under "who shouldn't use this product," and Diabetes in general was under the list of conditions that indicate a need to discuss NuvaRing with your doctor (which I already did, of course). Scary, scary, scary.

And here's hoping that this hormonal birth control doesn't throw a wrench in the gears of my improving blood sugar (it can raise it), and that it doesn't make me crazy depressed (the pill did). But I was the one who mentioned NuvaRing as a specific option, because I've been told before that it has the lowest dose of any of the current hormonal birth controls. I'm hoping that will mean fewer side effects, as a previous doctor suggested to me.

So there you have it. I originally went to the doctor about cracks at the corners of my mouth, and now I'm on insulin and birth control and will soon be starting statins... all of which are a little scary for me. This is a topic to be fleshed out in another post, but I'll just say: All of this has me praying for the first time in years.

Food

2010-05-29T10:21:00.002-05:00

I have a conflicted relationship with food now. Wait, that's not right... I've always had a conflicted relationship with food.

I love food and I hate food. I've been in good places with it, and I've been in bad. I remember one night in college, back when I was unhealthily heavy and seemingly unable to change it, I was standing over my food drawer in my dorm room, eating Doritos and crying because I couldn't stop. And then, by about a year after college, I was down to a normal weight and was eating mostly organic food that I loved... Largely because I was a happier person and didn't have much of a need to eat emotionally. I'd have my vegetarian lunches of a cheese and broccoli slaw sandwich on whole wheat (honestly so good!), light miso soup, and seriously tasty organic chips. I was satisfied, eating in moderation, and avoiding most sweets because I just didn't crave them.

So to show you those two polar opposite pictures gives you a little background. For the past couple of years, I've been more like the average person. I ate a little too much and there was more junk food to be had when I was under periods of stress, but it was about what you'd expect from an average American working girl. I gained enough that I wanted to get back to better habits and lose weight again, but most of those better habits never formed permanently.

But for the past year or so, I was more or less eating whatever I wanted without gaining weight. Nothing insanely unhealthy, but I ate all the time because I was hungry all the time, and I either held steady or lost a little weight. At one point, after a couple days of eating way too much junk and sugar, I got on the scale and thought, "Wow, I didn't gain! I guess since most of what I eat is on the healthier side, I do OK with eating as much as I do and having the occasional sweet treat."

How bizarre, to think that I was maintaining what seemed like a "healthy" weight only because my body was anything but healthy... because it wasn't working properly... because my cells couldn't get the fuel they needed.

I didn't fix my eating habits the moment I discovered I was diabetic, but I did as soon as I started my extremely conservative insulin regimen a few days later. At first, since I knew I was really only taking insulin for my existing blood sugar and not what I was about to put in my mouth, I began eating meals of no more than 30 carbs each. Once I started calculating my insulin to account for my food a few days after that, the dietitian assured me that I could eat more carbs as long as I didn't go crazy. 45 to 60 carbs per meal is the realistic range.

But I still keep most of my meals around 30 carbs. Sometimes 40, rarely up to 60. I know there will be times when I eat more than that (damn it all to hell if I can't have a little piece of real cake on my own birthday!), but that's fine with me for now.

It's a combination of things. First of all, I'm satisfied with that 30 to 40 range. I mean... my hunger stops! I may be consuming far fewer carbs than I used to, but my body is able to use so much more! So my physical cues to "eat more fuel" aren't there.

Second, I currently don't like giving myself the larger amounts of insulin that go along with higher carb meals. This is all still new to me, and I feel nervous every time I take a larger dose of insulin than I have before.

Third, I'm realizing that a lower carb diet will not only mean possible weight control now that my body is working normally, but also savings on medicine... The fewer carbs I eat, the less insulin I need! I'm not going to make decisions for my body based on financial issues, but it's something that's crossed my mind. And is it somehow better to need/take less insulin, anyway? I think the true answer is "stay healthy and take the insulin to support that health," but haven't fully adopted that attitude. To be healthy on less medication is better than to be healthy on more medication, in my mind.

And I can't leave out the the fact that I worry I'll blow up like a balloon now that my body can use and store the fuel I give it. I got the green light to do start doing some light exercise (should have started already, definitely will this coming week), but all of this has made me want to become a freaking athlete. Diabetes puts you at risk of so much, including cardiovascular disease, that I want to reduce as many other risks as I possibly can. That means losing and then maintaining my weight and getting fit in general... especially my heart. I'm a 30 year old woman who is still menstruating, and that gives me a good window to get my heart up to speed before I become more at risk for heart attacks at menopause. I'm going to take advantage of that window, damn it! (This will have to be an entire post unto itself. There are many layers of fear and frustration surrounding exercise, fitness, and risk for cardiovascular disease.)

Another thing I've considered, regarding food, is starting the Nutrisystem Diet again. The prepackaged, perfectly portioned entrees would make it easy to know exactly how many carbs I'm putting in my body, and they have a low-glycemic version called "Nutrisystem D" that's designed to help Type 2 Diabetics gain control over their disease through food. A low-glycemic diet could not control Type 1 Diabetes, but it would support the medical treatment. I'm struggling with this decision though, because it's fairly expensive once you start adding in the grocery items. And the last time I did Nutrisystem, I grew tired of the dinners and lunches fast. (But man, do they have awesome breakfasts and snacks!) That, and I actually suspect I may end up consuming slightly more carbs than I currently do. Many of the meals would be 40 carbs once the salad and veggies are added. Not bad, but maybe not what I want.

But I think it could be a really great choice for someone who's eating a few more carbs than I currently do. Hell, it still may be a great choice for me, anyway. (And, FYI, the first time I did Nutrisystem was awesome. I loved the food while it was new to me, I was only tempted to do some very minor and rare "cheating," and I think I lost about 20 pounds!)

Things I Hear

2010-05-23T12:16:00.002-05:00

Things I hear from people, having been recently diagnosed with Type 1 Diabetes:

Did you have any symptoms?!?!

This is probably out of sheer surprise. I'm at an odd age for either type of diabetes, and I wasn't clearly ill. I have to admit that, at first, this question bothered me because I felt like maybe I should have gone to get tested far before I did. Yes, as a matter of fact, I did have some symptoms... but I sure as hell never thought I had full-blown diabetes! I remember one day thinking, "Why am I so thirsty lately?" I also started getting up to pee in the middle of the night, whereas I hadn't needed to before. And every once in a while, I lost a couple pounds when I expected to gain from all the sweets I'd been eating, but I attributed that to eating an otherwise decent diet. Plus, I was hungry all the time and didn't have a lot of energy, which was especially frustrating to me. But when you hear stories of diabetes symptoms, you hear that people drink gallons of water, pee every 30 minutes, lose 10 pounds in a week, and are flat out sick right before diagnosis. After the fact, when I shared the above symptoms with my doctor, she was still surprised at the lack of obvious symptoms. My dentist was also surprised by how well-hydrated my mouth was. Go figure.

You're doing so well!

I hear this one a lot, from all sorts of people. It means a lot from the people I know well. For a while, I felt slightly uncomfortable hearing it from people I'm not as close to... Maybe because I felt they could have no idea how I was doing. Did they really think I was "doing so well" simply because I showed up to work and managed to stare at the computer and not cry in front of people? They weren't there for the time that I a cried over having to do 9 injections a day (before they got closer to my correct ratios), or miscalculated how much insulin I needed and made my blood sugar go borderline-low, or threw a genuine tantrum because I dropped my lunch all over our carpet after I'd already given myself my bolus insulin. But hearing it from the people closest to me really matters. I feel good that my mom is proud of me, and that my husband is impressed with the way I've adapted... especially since they've both let me cry and rant during my moments of frustration and self-pity. It also means a lot from the members of my health care team, because I thrive on any sort of teacher-student dynamic and appreciate feedback that tells me I'm doing a good job.

This is a real, life-changing event.

People seemed quick to point this out at the beginning, often following it up with some sort of reassurance like, "But you can do it," or, "But you'll adjust in no time." This statement has created the most conflict in me, because I just don't know what my opinion is on it yet. Some days, I don't think it changes life that much. I have a friend who is type 1, but I never would have known if it hadn't come up in a conversation. Her lifestyle is very similar to what mine has always been. Another type 1 I knew more casually had the pump, and that was the only sign of her diabetes. But then, some days, I'm daunted by the idea of counting carbs and possibly battling the insurance companies for the rest of my life (come on Obama, get that health care reform moving!). Some days, I'm terrified by the thought that my pancreas will soon be totally kaput, and then I'd die without my medication. Some days, I read about other people's struggles to keep within their target range and worry that it will be that hard and time-consuming for me, too. Yes, things are going to be different, but I just don't know what to think about how utterly life-changing this will be, yet.

I'm diabetic, and I can tell you you'll be fine. Let me know if you need to talk.

I'm lucky to be receiving so much support from all of my friends and family, but I'm especially comforted by support and encouragement from people who are diabetic or who have a spouse/child/parent/sibling who is diabetic. It's primarily that they're experienced in this, and yet they think I'll be OK. It's so good to hear that. Now that I know what a low blood sugar feels like and that I'm able to identify it before it gets really bad, my greatest fear is the major complications. Hearing from diabetics without major complications eases the worst of my fears. I really, truly, honestly intend to give myself the best possible treatment, and these people make me believe that it will be worth it.

Not Going Broke in an Emergency

2010-05-22T12:31:00.000-05:00

Here's a tip for anyone who gets a diagnosis that requires maintenance medication that doesn't have a clear and consistent dosage: Make sure your doctor has either written the prescription to reflect that fact, or that (s)he is totally confident they've prescribed enough for that 30 days.

My doctor initially wrote all of my prescriptions as 30 day supplies, but I ran out of blood glucose test strips long before 30 days... and my insurance refused to refill it even when she revised the prescription.

Buying test trips out-of-pocket is expensive. My copay for 100 strips was less than $30, but out-of-pocket for 50 of them was about $70... ON SALE!!! (Freestyle Lite strips. You can find them for less than that if you do some googling, but they're still a little pricy.)

Well, even that 50 I picked up while waiting to see if the insurance company would decide to cover my refill after the revision wasn't going to last once they gave us a final "no." I wasn't about to shell out another $70 if I could find another option.

And, gosh, OK, fine, I found that other option at a store we all love to hate: Walmart.

I picked up a Relion Micro (a Walmart brand) glucose meter for $12 and a 50 pack of the corresponding strips for $20. That's less than half of what I would have paid for a 50 pack of the Freestyle strips, and now I have a back-up meter if I ever lose or break my nice one.

Though the Relion Micro is a little more cheap looking than my Freestyle Freedom Lite, I'd done my research and found good reviews and posts about it, and found that the Relion Ultima (different model by the same company) was declared a "top pick" by Consumer Reports. And while I say it looks a little cheap, I should also point out that the Micro is little and cute, and it comes with interchangeable colored faceplates!

Mine included a bold red option, so now I have a sexy little red glucose meter!

I bitch about Walmart sometimes, but it's times like this when I realize the value (haha) it must hold for people who who live patcheck to paycheck. I could have gotten by with buying another pack for my pricy brand name strips, but some people could not. And if you don't have insurance, this meter might be one of the best financial choices a diabetic could make.

I should point out that I also had the same prescription issue with the needles that go on my insulin pens. Though I hadn't run out, I counted and knew I didn't quite have enough to make it until my refill. Cue tons of research on whether or not reuse is safe... And as it turns out, most people in forums said they reuse their needles once or twice and the ADA has recommendations on how to safely reuse needles:

Reusing syringes may help you cut costs, avoid buying large supplies of syringes, and reduce waste. However, talk with your doctor or nurse before you begin reusing. They can help you decide whether it would be a safe choice for you. If you are ill, have open wounds on your hands, or have poor resistance to infection, you should not risk insulin syringe reuse. Syringe makers will not guarantee the sterility of syringes that are reused.
Here are some tips to keep in mind when reusing syringes:

Keep the needle clean by keeping it capped when you're not using it.
Never let the needle touch anything but clean skin and the top of the insulin bottle.
Never let anyone use a syringe you've already used, and don't use anyone else's syringe.
Cleaning it with alcohol removes the coating that helps the needle slide into the skin easily

So I reused a few of my pen needles, and I was just very careful while removing the cap and putting it back on, making sure the needle touched nothing but my prepped skin. I store the used & capped needle in an empty glucose strip case, which is a very convenient size, and I make sure that I only reuse a needle for the same insulin as the first use. I've been taking a look at the needle before reusing for any obvious issues, and I know there's no blockage since you have to push a little insulin out before you even set your dose. I can't tell a difference in pain/comfort with that one reuse, though lots of people on forums said that more than two uses starts to hurt a little. Those needles are so fine, they start to get dull just from passing through skin!

Also, on a related note, did you know that you don't need a prescription to buy regular insulin in the United States, except in Alaska? It's just kept behind the pharmacy counter. And apparently, it's not insanely expensive (someone on a forum said they got a vial for $22 at Walmart). So if you were ever in a real bind but can scrape up a little cash, there's a way you might be able to get by. (You should absolutely still talk to your doctor about how to use regular insulin before buying it, unless it's the kind you already use!) Here's a chart that lays out the legality of buying insulin and syringes, by state.

I Choose to Fight

2010-05-19T19:21:00.000-05:00

Three weeks ago, I thought I was a pretty normal, healthy person. I didn't have a lot of energy, but I was starting to exercise and was determined to create habits that would let me live a long, healthy life. I wasn't afraid.

Now, have a chronic disease with some serious potential complications... including heart disease.

I feel... changed. Diabetes is very manageable (thank god!), but its very real dangers has made me... mortal. And I am afraid.

I visited my doctor yesterday, for the first time since I got this diagnosis. She told me, "You're really doing great, you're doing everything you need to do. I see a lot of people run and hide from something like this."

But the truth is, I'm just much more afraid of the complications than I am of the treatment and day-to-day concerns. I was faced with a fight or flight scenario, and I chose to fight.

I'm scared, but I think it's a healthy fear. That fear is making me follow my Diabetic Educator's every direction, eat a healthier diet, and look forward to the green light to exercise.

The fact is that diabetes is faster than you. If you run, it will catch up with you, and it will take you down from behind. But face it head-on, and you have the advantage. You can see and respond to its every move, and you can stay on your feet.

I'm scared, but that's why I choose to fight.

"You have to live, and you WILL live."

2010-05-16T13:00:00.000-05:00

I've been monitoring and using insulin for over a week now, and really calculating my insulin needs for about half a week. I'm not going to lie; I've had my frustrations. But I can say that it's doable, the shots don't hurt, I've had enough flexibility since getting clarification on scheduling, and can already tell it's getting easier.

Every now and then, it strikes me as so strange that, unless they perfect something like an artificial pancreas, I'll never again be able to just eat without adding up carbs in my head and somehow delivering insulin (whether through injections or through a pump). The dietitian said it'd get easier; I'll know about how many carbs are in a piece of cake in the work break room by simply judging the size of it. I hope that's true, but I also know there will always be variables.

Another great frustration is that my husband and I had been trying for a baby, and now we have to wait until my blood sugar and A1C reach certain numbers and stay stable. I'm reasonably confident I can tightly manage my blood sugar once everything settles down and we have my insulin at the right doses, but it sounds like the A1C could take a very long time to get down to normal numbers no matter what I do. And I may not be at the end of my childbearing years yet, but I am 30 and don't feel that I have oodles of time left. My husband and I want two kids, and neither of us are spring chickens. We're both open to adoption, but that can also take a great deal of time.

Everyone keeps reminding me that diabetes isn't a death sentence, but it sometimes seems like a life sentence. I know it'll get better. A friend of mine who has had type 1 since she was 8 recently said to me about not having a doom and gloom attitude like some people do, "You have to live, and you will live."

Tough Day

2010-05-14T18:18:00.000-05:00

I got really frustrated today because of all of the "correction" doses of insulin I've been having to do between meals, and because I thought my meal schedule was too inflexible due to them... Then everything in the world was suddenly so overwhelming, and I just let myself cry. But after faxing my blood sugar records into my Educator and Dietitian (and after expressing my frustration), they changed my carb-to-insulin ratio and set me straight about my meal/insulin schedule. I can eat any dang time I want and take the right amount of insulin to cover it. It's only the insulin I take based on my existing blood sugar that I can't take too close together.

*big sigh* I feel so much better now, but everything caught up to me for a little while, there.

Seriously, if you are a newly diagnosed diabetic, go to a diabetes educator. And try to find one who'll do more than just teach you in a class then tell you numbers without explanation. Yvonne, my educator, has been so totally awesome. She clearly cares, explains the "why" for everything, and gave me her cell phone and email so I can always get in touch with her.

On another front, my mom has been talking to the Diabetes Educator at the hospital where she works. She went ahead and asked about insulin pumps (a topic my Educator has briefly mentioned as a future likelihood), and she thinks I'll be able to get one in a reasonably short amount of time. They just have to get me started and make sure I know what I'm doing first. The pens/needles honestly aren't so bad, but I'm already looking forward to the reduced hassle of a pump!

See You Later

2010-05-12T23:08:00.000-05:00

I went to my "Intensive Insulin Therapy" training today. I learned how to give myself appropriate amounts of insulin for meals and for corrections. They also started increasing my long-acting insulin dose, and told me it'll probably be increased a few more times. I'll talk about this more later, but I'm afraid I need to keep my computer session short.

There's been a lot I've wanted to write about, but being on the computer for too long hurts my eyes... which may be partly related to my insulin therapy! Weird!

Having high blood sugar for an extended period of time makes your lenses bloat, and starting medication for diabetes brings your blood sugar and that bloating down. This can cause temporary vision changes. Sometimes that means blurry vision, but it is rumored to have occasionally improved vision!

How bizarre is that?

Personally, I'm far-sighted and sometimes get eye strain after reading or sitting too closely to a computer screen for a very, very long time. Right now, that eye strain is happening more easily than usual. I've been having to lower the resolution on my computers to use them comfortably. I even picked up a bookmark style magnifying glass in case it starts becoming tough to focus at work. Man, it makes me feel old!

What's next? Seriously! The past week and a half as been one of the most life changing times of my life.