Relaxing my Grip on Diabetes

For much of my diabetic life I would say that management of my disease has been intense.  I strived for perfect blood sugars 24/7.  I logged my blood sugars religiously into a fancy excel spreadsheet thinking that the more data and charts I had could help me to solve the diabetes puzzle.  I thought it could give me the answer to perfect blood sugar management.  I wanted to get my A1C under 6 and my multiple finger sticks between 80-120mg/dl.

I didn't get my A1C under 6 and the zig zags and curves of my BG charts just left me more frustrated.

Since I've had my baby I've stopped aiming for perfect, instead focusing on good enough.  In my past, striving for perfect led me into way too many lows.  With a baby now, I can't afford to be going low once or twice a day.  Its just not safe with a little gal to look after, especially when its just the two of us at home most days.  Taking care of myself during a low is hard enough sometimes.  I can't take the risk of looking after my girl with a low blood sugar.  This was drilled into me by my endo and I've taken his words to heart.

So I've loosened up.  My goal is to keep my BGs steady and minimize lows.  I still do all the correct diabetes management practices - weighing and measuring foods, counting carbs, testing 6-10 times a day, correcting highs, etc.  If my BG is 150mg/dl I don't sweat it.

But I don't use my fancy spreadsheets anymore.  And it feels good.  It feels like diabetes is just another thing I do.  Like brushing my teeth.  I check my BG, take an appropriate action (eat if its low, correct if its high) and move on.  I don't agonize over it.  I don't let it consume me.  It feels simpler now and I like that.

My last A1C was in December and it was 6.8.  If I can keep it in the 6's I'm doing all right.  Its not the 5's.  Its not perfect.  But I'm okay with being good enough right now.  

Things I've Learned Since Having a Baby

• I can check my BG while holding the baby - Not as easy as it sounds and definitely shouldn't be attempted until the little one can hold their head steady.
• Little hands like to grab pump tubing and once they get a hold its really hard to loosen that grip.
• Little feet get easily tangled up in pump tubing.
• Little feet don't care where your infusion site is - when they are being fussy they will continue to kick away until they are asleep.
• My pump is spit-up resistant - its gotten doused several times, in fact I think some dried spit-up is permanently stuck in the battery cover.
• Waiting to recover from a low feels like an eternity.  When a baby is crying it feels twice as long.
• Babies don't understand the phrase, "But I bolused. I HAVE to eat RIGHT now!"  The more you try to reason, the more they cry.

How She Got Here

I previously wrote about the sadness and disappointment I felt over having a natural, normal childbirth taken away from me because of my diabetes.  I wanted to let nature take its course, my baby would come when she was ready, when mother nature deemed it was time.

Instead I checked into the hospital the evening of 14 October to have my labor induced.

Gosh I look exhausted for NOT having
gone into labor!

The first thing the midwife did was hook me up to a CTG machine - it measures the baby's heart rate in response to changes in the uterus.  I had been going to the hospital twice a week beginning at 36 weeks to have this monitoring done so it was nothing new and every scan had been normal.  Before they administered any drugs to bring on labor they wanted to make sure the baby could handle the contractions of the uterus.  By measuring the baby's heart rate they get a sense of whether labor can proceed.

At this time I was not having any labor contractions just some braxton-hicks contractions - I could feel my uterus tightening but it wasn't painful.  I watched the graph plotted by the CTG machine   Each time I felt a tightening my baby's heart rate dropped.

I had done enough reading to know what this meant.  It meant that inducing labor could be too stressful for the baby. The midwife left the room to call my OB.  I didn't need her to explain anymore to me.  At that point I knew I would be having a C-section.

It all happened so fast.  My OB was on scene within 10 minutes then I was whisked to the operating room and was having a spinal block administered.  A sheet was draped across my chest and the surgery began.

So tiny in daddy's arms

It was weird - being aware and alert of what was happening but not feeling anything.  I could hear the doctors and nurses talking, I could feel tugging and pushing on my abdomen.  Then the sheet was lowered and the doctor lifted my daughter up so I could see her.  She was crying and the first thing I noticed was all the hair she had on her head!  (Just like how her momma was born!)

The midwife took her, weighed and measured her (7lbs 7oz and 18.5in), swaddled her up then held her up to my face so I could look at her.  And I sobbed!  I cried because I was so happy and so in love with her.  I kept saying, "She's so beautiful!" and "Oh my gosh she has so much hair!".

Then my girl was off to the nursery with my husband while I was put back together and stitched up.

A common occurrence with babies of diabetic mothers is that their blood sugar is low when they are born.  This is because  (no matter how hard we try) diabetes is a tough disease to manage and our blood sugars aren't perfect 24/7.  So our elevated blood glucose goes through the placenta causing the baby to produce extra insulin.  When the baby is born that high source of glucose is gone but their little pancreas is still producing extra insulin so they are at risk for hypoglycemia.

When they tested my little gal's blood sugar in the nursery the meter just read "low", meaning her BG was to low to register a numerical value!  They had to give her a feeding tube to pump her full of formula to raise her BG.  Poor little gal!  All this was happening while I was still in the operating room getting stitched up.

By the time I was ready and my girl's BG stabilized it was almost 2 hours before I was able to hold her.  I was so happy to finally get to hold her and have her close to me.  To see her and touch her and know that she was healthy.

In the end it didn't matter how my girl was born - natural, c-section, in a cave, in a taxi.  I was filled with so much love and happiness at the sight of her.  She is a part of this world now, healthy and thriving, and it doesn't matter how she got here.

Miss Me?

Me and my little gal one day after she was born

Wow!  My last post was way back in the middle of September.  Where have I been?  What have I been up to the past three months?

Well.

I had a baby.

And that pretty much sums up my life for the past three months.

On October 14th 2012 I welcomed my daughter into this world.  She is three months old now.  My life since then has been filled with caring for her - nurturing her, watching her grow and being in awe of this perfect little person.

There is also the diabetes.  That is always there.  But it has taken a backseat in my life.  And I'm ok with that.  After years of it being the forefront of my life and a source of angst and frustration I'm lightening up a bit.  It feels good to not have diabetes at the center of my life.  I have a daughter to look after now.

Pregnancy with Diabetes - My Reality Check

For 34 weeks I've been growing and nurturing a little baby inside me.  It still amazes me to see this little person on the ultrasound and feel her moving and kicking and rolling around.  Nature and biology have come together so perfectly to develop this little person - my body doing what its meant to do - sending signals, shifting hormones, and shuttling nutrients to this new part of me.  Its doing all of this on its own.

And its just happening.  Naturally.  And I feel like this is a normal pregnancy.

But its not.  Its a diabetic pregnancy.  And because of that little d-word the risks of the abnormal are multiplied.   And because of what can happen in a poorly managed diabetic pregnancy - intrauterine death, placental dysfunction, macrosomia, pre-ecclampsia, (insert your own adverse pregnancy outcome here) - nature won't be allowed to completely take its course.  I won't spend the last few weeks drumming my fingers, nesting, and waiting for the signs when labor begins to head to the hospital.  Instead my baby will be closely monitored and my labor will be induced earlier than my due date.

All of this is just in case.  Just in case weeks and months of normal tests and normal blood sugars and normal growth and completely normal pregnancy somehow might take a turn for the worse.  In the eyes of the medical community a diabetic pregnancy is a high risk pregnancy and interventions are the standard of care.

But I don't feel high risk.  My pregnancy has not been a poorly managed diabetic pregnancy - my blood sugars have been normal and in the words of my OB the pregnancy and baby's development has been completely average - with average being exactly what we want.  Everything has been normal.

It seems like my risk of adverse outcomes and complications should be lower at this point.  Yet my diabetic pregnancy will be treated like its been poorly controlled.  I feel sad and disappointed that in spite of maintaining as normal a pregnancy as posible I'm still considered high risk even though all indications point to a normal, complication-free pregnancy.  

I had a hard time accepting that my pregnancy would go down this path.  And I shed some tears over the natural birth experience that diabetes has taken away from me.  In my mind I felt that my baby should be born when she is ready, not at some pre-determined date (I didn't even really put much stock in my so-called due date).  Mother nature has been doing this for millions of years and I wanted to put my faith in her to know the right time for my baby to born.

At the same time I want the safest delivery for my baby.  I have complete faith and trust in my OB to do what is right for my baby and my diabetes.  My delivery will be in the hands of Western medicine.  Stories like this help reassure me that everything will be ok.

Pregnant and Diabetic

I'm coming down the home stretch with my pregnancy and with only a month and half to go I feel like I'm finally "really" pregnant - my belly is big and I can really feel the baby moving, I move slow, can't bend over, can't get comfortable in a chair or on the sofa, always going to the bathroom, can't find a comfortable sleeping position, the baby's butt or a foot or something is constantly jammed under my right ribs.

Oh and then there is the diabetes.

There is so much information out there about diabetic pregnancies resulting in larger babies, more complications, pre-eclampsia, malformations, and still births that it seems like a difficult pregnancy with a poor outcome is inevitable (you can just google it and see how depressing it is - here, here, here for a start).  Its scary, stressful, and daunting.

But so far things have thankfully progressed quite normally for me on both the diabetes and pregnancy fronts.  My A1C has remained steady at 6.0-6.2 for the entire pregnancy, my blood pressure has been completely normal and ultrasounds of the little bub in my belly show that her growth is right on track - not to big, not to small but right in the middle.

I have been closely monitored through this whole pregnancy by my OB and my endo.  I have probably had almost twice as many OB visits and ultrasounds at this point than a non-diabetic woman.  And I see my endo every two weeks to review my blood sugars and make adjustments to the settings on my insulin pump.  I've been very impressed with my endo - he has been great in keeping one step ahead of the late pregnancy insulin resistance, keeping my blood sugars from hitting the stratosphere while also not sending them too low.

But I think I deserve some credit here too for taking good care of myself.  

I keep very close track of my blood sugars and am very focused on the types of food I eat.  I avoid foods that I know will send my BG sky high and opt for lower-glycemic foods that I know will make my blood sugar easier to manage.  This means I eat alot of fresh veggies, some fruits, beef, chicken, fish and cheese.  I avoid breads, pastas, and pretty much all sweets (cookies, cakes, ice cream, etc).  I average about 30-40g of carbs per meal plus 25-30g of carbs in snacks.  It also means that I have pretty much ignored advice from diabetes health professionals who advocate that people with diabetes eat more carbs and more whole grains - this approach just doesn't make sense to me when I'm trying to avoid high blood sugars and when the foods I already eat (like veggies) have just as much or in some cases more nutrition than the whole grains they recommend.

I also cook alot.  I pretty much cook every meal we eat.  Its sometimes a pain and I sometimes don't feel like it but it allows me to measure my food so that I know how much carbs are in it so I can bolus as accurately as possible.  Eating out is always a carb guessing challenge and typically results in a high BG for me which I would prefer to avoid as much as possible at this point.

While things have gone very smoothly so far, it has taken a lot of dedication and focus on my part to manage my diabetes and eat nutritious foods so that I can grow a healthy baby.  I haven't given in to the whims of my cravings for chocolate or ice cream or pizza or banana pancakes.

That can come later when the baby is delivered.
 

Staying Active...sorta

I've been pretty good about staying activity and getting some exercise throughout my pregnancy.  My doctor says its good, things I read say its good and it just feels like its should be good.  In my mind it seems that maintaining some level of fitness is good for me to avoid muscle aches and pains as my belly gets bigger, strengthen core muscles to help support the big belly, and help my body to recover from birth easier.

Plus being active just simply makes me feel good.

Now in full disclosure I am by no means some super-fit, marathon-running type pregnant lady.  I'm more of the take a nice long walk, casual bike ride, lift some light weights kinda pregnant lady.  This is pretty much what I did before pregnancy and pretty much what I did until we moved to Australia.

Once we landed here my fitness routine went out the window.  My main focus became getting adjusted to our new life and taking care of myself emotionally.  Since arriving here my physical activity has been sporadic at best.  And now that my body has changed with an ever expanding belly and plummeting energy levels I've had to adjust my expectations for what I can do physically.

What were once hour long walks are now 30 minutes - that is about all my bladder can handle before needing a restroom.  I used to pride myself on being able to do real push-ups - straight back, chest to the floor.  Now I do push-ups from the knees.  I can barely bend over to tie my shoes which makes picking up a weight from the ground an extra challenge.  Walking up and down the stairs in my house leaves me winded.  An hour of house cleaning leaves me needing a nap.

While I may not be sticking to a so-called exercise routine, I'm doing what I can within my current capabilities.  I'm listening to my body.  I think that is a win.