Tuesday, September 1, 2015

Pregnancy and Diabetes FAQ

I thought I would write a little post including some frequently asked questions about my new life as a mom-to-be [with Type 1 Diabetes].

How are you feeling?!

This is definitely the most frequently asked question so far!! It's lovely to have so many people concerned about how I feel! I did experience about 6 weeks of nausea, but only once did I actually physically "get sick". While I didn't feel awesome during this time, I'm thankful my symptoms were fairly mild. The time I got sick was right after breakfast, which means I had already taken insulin for the carbohydrates I ate. This poses a slight problem when you throw up the carbohydrates you ate, with no way to "throw up" the insulin associated with them. I ended up drinking juice to avoid the low blood sugar, but it was a little nerve wracking. Like I said, thankful it was just this once!!

I'm now fully engaged in the second trimester, so most of my nausea has eased. I've found not letting myself get too hungry is the key to winning against the nausea monster!

Will your baby have Diabetes?

I have done a lot of research in this area, even years before kids were an "option". The truth is, I wouldn't wish Diabetes on my worst enemy, and I sure as heck wouldn't attempt a pregnancy if I knew the poor child was doomed to get the disease. The good news is, the research shows that our child is no more likely to get Type 1 Diabetes than a "normal" child. The statistics would be different if Chris had the disease, or if I was under 25 years old, but neither of those apply to our situation. Joslin reports the chance in our specific case is 1 in 100, equivalent to the general population.

How is a pregnancy with Type 1 Diabetes different from a "normal" pregnancy?

Ok, no one has really asked this, but I figure there are curious minds out there who may be afraid to ask. And, as a disclaimer, I'm not an expert on "normal" pregnancies (also, is there really such a thing?), so my comparisons are drawn simply from standard pregnancy knowledge bases or friends' experiences.

For starters, "pregnancy" for a Type 1 Diabetic really begins months before conception. To give everyone the best chance at health, blood sugars have to be maintained in tight control for a period of time (the recommendation is at least 6 months) before trying for a baby. Not only does this ensure mom is at peak health for baby, but it also ensures she hones her carb counting / insulin dosing skills prior to the real deal. During this time I set my CGM alerts to 80 mg/dl for "low" and 150 mg/dl for "high" (much tighter than the 70 - 180 mg/dl range my endo normally has me under).

Once the pregnancy was confirmed, my endo decreased my range even more to 80 - 130 mg/dl. This is extremely tight control, especially when you factor in the surges of hormones, pregnancy hunger, pregnancy nutrition, and exercise regimes. It really does take constant vigilance, tweaking and precise carb counting.

In the first trimester through some part of the second (it's a little different for everyone), Type 1 Diabetics experience more low blood sugars. Actually "normal" moms do too, but their body can counteract the effects almost seamlessly. This means lots of glucose tablets, and when those become too grotty (ugh, trust me they do), orange juice or yogurt or fruit or any other sort of fast acting carbs steps in to save the day. Once the placenta takes over and starts pumping out more hormones sometime in the second trimester through the end of pregnancy, blood sugars rise and the body builds up a nasty insulin resistance. This means later on I will require a LOT more insulin to cover the same amount of carbohydrates. However, once the baby is born, its likely my insulin requirements will be even less than before the pregnancy.

Other than all the fun of constant diabetes monitoring, I am seeing my Endocrinologist a lot more, on the order of once a month. As far as the OB goes, not too much different yet, except for a few extra tests, but later on it will be more frequent than a low risk pregnancy.

Have you had any cravings?

Not really, I mean I crave ice cream, but I also craved that before pregnancy, so....

Has Chris been helping with all the Diabetes-related-pregnancy fun?

I have to give Chris major props. He has come to and supported me through every.single.appointment since we found out I was pregnant. He has always helped me change my insulin pump sites, and he continues to help there. He is also getting accustomed to googling carb counts and just being more conscious about foods that may have an adverse affect on that 130 mg/dl goal.

What has been the hardest thing about pregnancy so far?

One word: guilt. Maybe this is how all mothers feel, but having a not-so-great blood sugar reading staring you in the face is just, so...quantitative. I feel like every bit of food I put in my mouth could potentially lead to a high blood sugar and in some way harm that sweet little collection of burgeoning life-cells in my belly. On the other hand, every second of exercise could lead to a dangerously low blood sugar and do just the same thing. It is such an incredible tight rope walk.

What has been the best thing about pregnancy so far?

Ohmygosh, all the things. Every moment Chris and I have spent sitting on the couch dreaming up funny answers to our child's inevitable questions, or thinking about what they will be when they grow up, or imaging family vacations to the new Star Wars Disneyland park, or anticipating them meeting our family has been the absolute best. Every mind-at-ease test result, every ultrasound with baby dancing, every successful carb count and insulin dosing....all of these have been the best. We really don't know anything about being parents, but we are excited to learn!!

Monday, August 24, 2015

Wednesday, August 12, 2015

RDT (Random Diabetes Thought)

I guess it's "whatever Wednesday". Oh boy.

I woke up this morning in a panicked sweat, around 2:30 am I was low and stumbled to the frig to swig some orange juice. After climbing back in bed, I saw my number turn the corner in the upward direction and decided it was ok to go back to sleep. Half an hour later I woke up in a complete panic, I had just dreamed about the most amazingly delicious Wendy's hamburger (I don't even really like Wendy's, or hamburgers) and freaked out because I "forgot to bolus for it". It literally took me a good 5 minutes after waking up to realize that I indeed had not sleep-drove to Wendy's, nor did I sleep-eat a juicy hamburger, nor-mostly did I miss a quite hefty carb count and bolus.

It was a Diabetic nightmare. Any one else have those or am I just absolutely off my rocker??!?!

Thursday, July 30, 2015

At the Top of the Mountain

I really like math and graphs and curves, a lot. I do.

And I've been thinking about my Diabetes control, a lot. [forever and always]

So, I decided there are two schools of thought on the issue: (1) maintain extremely tight control and (2) maintain "manageable" control. For the visual learners, it would look a little something like this:



In option 1, the blood sugars are maintained as close to "normal" as possible, likely decreasing complications from the disease. However, this tight control comes at a cost: your sanity. That ball is balancing ever so cautiously on the precipice of a giant mountain with steep sides. One wrong move, one carb counted incorrectly, one 5 minute exercise extension sends the ball over the edge with extreme effort required to bring it back to center (and probably feeling pretty crappy during that process).

Option 2, on the other hand, does not dance so "close to the edge" (pun intended). The slope is more gradual, and small mistakes are easier to recover from. No, control isn't the "tightest" (a different threshold for every Diabetic), but the pro to this management style is breathing room. There is built in breathing room for life's little curve balls and less stress associated with hitting the tight target thresholds.

So, which is better? Ugh....good question. For me, when life can handle it I am for option 1, but sometimes I need to relax a bit and settle into option 2. Choosing which to focus on - health or life - is the ultimate balancing act, and often changes on a daily (sometimes hourly) basis.

Of course, deep down we know that one affects the other - tight control can make life better with potentially less complications, and enjoying life can reduce stress hormones and help the diabetes animal behave.

Monday, July 20, 2015

Midnight Snackin'

Working the night shift is weird for many reasons, one being food!

And Type 1 Diabetes!

And food!

It's strange to shift one's sleep schedule AND one's eating schedule. And it has definitely been a game of guess and check (as in, guess what to eat, check blood sugar, lol). The first night I really don't feel very hungry. Sure I bring along a little snack, but it may or may not be consumed depending on how I'm feeling. The second night I eat my snack to wake up in the middle of my shift; at least my taste buds are awake, maybe they can fly the space station? By the third night, I'm pretty dang hungry around 4am. Lately I've been splitting a Luna Bar in half and noshing on the two halves around 4am and 6am (28 grams of carbs at once spikes the blood sugar a little too much, so splitting it up works perfectly), then I use some delicious red grapes to "fill in the gaps" when I just need a little crunch of something sweet. This is all fine and good during my shift, but what about afterwards?

Well, I usually have something around 20 grams of "slow" carbs when I get home (lately it's been a whole wheat English muffin), then hit the hay for my rest period. The first couple days I wake up around lunch time with some hunger pangs, but by the third day I'm sleeping like a baby through lunch.

I wake up around 4pm and have a small snack to hold me over for dinner (usually around 7pm), then get my snacks together and ready for the next night of shift work.

I would love to say Diabetes plays along with all these schedule shifts, but the truth is, it's a bit of a bear. Often I go low during the day when I'm sleeping, because my body is used to eating during the daytime, so I have to set temporary basal rates to account for missed meals. Then at night it is very dependent on the meal we have for dinner, how much we exercise and my stress level. I test a lot and watch Dexcom almost as much as the space station telemetry!

The truth is, I'm still figuring out the best ways to schedule shift, and each time I have to do it things turn out differently. I guess that's how Diabetes, and life in general, are.

Sunday, July 19, 2015

Sunday Funday

Ok, so the hours aren't great (11pm - 8am). 
And I have to don an eye mask just to sleep. [And Chris has to be extra quiet during the day].
And I watch lots of data, and plan a.lot.
And sometimes I start to see hidden messages and notes in the telemetry squiggles. 

But just when I start to feel real tired there comes an amazing sunrise; actually 5 sunrises and sunsets in just 9 hours. 



The beautiful local sunrise is just an added bonus!


#missioncontrol
#spacestationpilot
#dreamjob

Thursday, July 2, 2015

Wiener Dog, on the Blog

When my great grandma Rose died several years ago her stuff was split up for anyone who wanted something. I ended up with a simple set of daily sayings, sometimes prayers, sometimes phrases or quotes. They are printed on small pieces of paper and held together with two metal rings. The little sayings live in my kitchen drawer so I can reference them each morning with breakfast. Here is what the rolodex told me the other day:

"Don't pray for rain if you are going to complain about the mud."

I needed that little nudge so hard that day, and most days I can use the sayings it spews. 

The little things in life. 


Like trying to take a nap on the couch with a wiener dog hogging the space ;-)

Little things are sooooooo good.