Monday, August 1, 2011

Diabetes & Pregnancy

My last few blog posts have concentrated more on the emotional side of pregnancy and other issues I've been dealing with, so I thought I'd come back to my roots for this one.  No matter what challenges I face related to pregnancy, whether emotional or physical, one thing is constant, looming in the background of my life: my diabetes. 

If you've regularly read my blog since I started it in November of last year, you know that one of my main motivations in getting my diabetes under control since my diagnosis in August 2010 has always been our future children.  I worked my butt off (literally) for months in order to get my blood sugar numbers and A1C down in the normal range so we'd get the green light to start our family, which happened in May when my lab results came back and my A1C was 5.7%-well within the "under 6.0%" parameter set by my CDE.

After my appointment in May, we decided that I'd quit taking my birth control and see what happened...which, a few weeks later, turned out to be the beginning of a nine (ten?) month journey that will end in early February with the birth of our first child.  I didn't expect for it to happen so quickly, and in fact was a bit unnerved by the fact that it seemed too easy...after all, nothing in my life for the past year has been what you'd call easy.  I finally came to terms with the fact that if it was part of God's will for us to have this very baby, everything would work out-so I was able to calm down a bit and see the short journey to conception as the wonderful blessing it was.

Even though I'd prepared for months for the challenges of pregnancy with diabetes, the reality of it hit me the first week I knew I was pregnant when my blood sugars were crazy and hard to control.  I knew theoretically what would happen once the hormones of pregnancy flooded my body, but I guess it didn't quite sink in just how much of an impact they would have on my numbers until it happened.  I was freaking out for a few days (on the inside, since no one knew our big news yet), but after a few emails and chats with my CDE, we got things back in line again.  For a few weeks after that, my insulin needs greatly increased-I'm talking 45-50 units/day instead of my usual 25-30-but that leveled out again as well.  I'm now 13 weeks pregnant, and my average total daily insulin is in the 30-35 range most of the time.  My blood sugars have greatly improved since those early couple of weeks, with my average now steadily under 100.  According to my meter, my 30-day average is 95, and my 7-and 14-day averages are at 92.

Even though my average is pretty awesome (according to my OB, if all of his patients with diabetes had my numbers, his job would be super easy), I still have more highs than I'd like to.  Before my last appointment, I calculated my high numbers (above 140) to be 11% of the total number of tests.  In fact, my lows were much more significant, around 25%.  However, that knowledge doesn't exactly make dealing with the individual high numbers any easier.  In those first few weeks, I freaked out (again, on the inside, so as not to alarm those around me) whenever I saw a higher-than-normal number.  This freak-out would last slightly longer than it should have, with thoughts of the damage my body was doing to my baby.  In the past several weeks, though, I've become a lot more laid back about dealing with the inevitable highs.  I have diabetes, first of all, so high blood sugars are a huge part of the disease.  Second of all, I test an average of 10 times a day and wear a CGM (Continuous Glucose Monitor) to keep track of where I'm at throughout the day...which means that if my BG is high, I have a pretty good idea how long it's been that way.  This is important because it's easier not to freak out when you know that it's coming down on its own anyway, or if it was only two hours ago that you were in the normal range.  Now, I just correct it and move on, which is sometimes in and of itself a challenge, however-the constant balancing act of trying to give just enough insulin is what gives me the most grief when it comes to managing my diabetes.  Too little=too high, then a correction; too much=too low, and treating it.  If someone discovers the secret to the perfect insulin dosage, please let me know!

I suppose that all of the worrying about highs and lows and the impact they have on your baby is actually good training for parenting.  After all, ask any parent when they quit worrying about their child's health and safety, and I'm sure you'd hear the same answer over and over again: never.  For those of us with diabetes, I think the worrying just tends to start earlier out of the necessity of managing our disease in an effort to have as healthy a pregnancy as possible.  Fortunately, I've been lucky to have an easy pregnancy thus far, and my OB is so confident in my diabetes self-management that he's only been seeing me every month, as opposed to my sister, whom he's been seeing every two weeks since the beginning because her numbers were so out of control at that point.  I've learned a lot about myself and about my diabetes since I've been pregnant, most of which revolves around the fact that you can never predict what life is going to throw at you next.  I try not to get too confident in the hold I have on my diabetes, because I know that it could change tomorrow thanks to the craziness of the pregnant body.  I've learned to be more flexible and adapt my routine/regimen to my body's needs, which is an important skill during pregnancy anyway.

This coming Sunday marks the beginning of my second trimester, and I'm looking forward to it...mostly due to the promise of more energy!  I underestimated the seriousness of first trimester fatigue, and it kicked my butt.  Now that I'm finally regaining some of the energy I lost (though I'm still no where near my normal level), I've been able to get more things done after I get off work and have even begun exercising again, albeit slowly.  I ran 11 miles in the week before I knew I was pregnant, but now a 30 minute trek on the Gazelle is about all I can muster.  I talked to my OB about running again, and he said it was fine as long as I was comfortable with it-read: once my belly gets bigger, I'll probably have to switch back to the Gazelle.  However, I've been too scared to start running again, mainly due to the awful Texas heat that lasts through the night these days.  I used to run as soon as I got home from work, then moved my time to after supper as it started getting warmer, but now I'm not sure that I'd be able to handle the heat even at that time.  My plan, as soon as I get brave enough, is to start back with some walking interspersed with light jogging like I did when I started running...only this time, it will be to (hopefully) get my groove back!

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