Friday, December 23, 2011

Giving Up Control

I wrote last week about my OB appointment and my disappointment at the prospect of a birth experience that was nothing close to what I'd imagined thanks to the fact that I'm automatically high risk due to my diabetes.  Since then, with a lot of thinking and a new perspective (thanks, hubby!), I've come to realize that (a) I can't control everything, in life or labor; and (b) as important as the idea of the labor and delivery experience is to me, it really doesn't matter as much as having a healthy baby in the end.

Of course, all of this may be a non-issue if she doesn't head south pretty soon.  I had another ultrasound (which was a Biophysical Profile, or BPP) the day before yesterday, and while it did go super fast since she was moving, responding, and "breathing" like a pro, she was still breech.  Since I'm at 33 weeks right now, we have just a couple more weeks for her to turn (until week 36) before we'll have to think about an external cephalic version in which the doctor attempts to turn the baby manually.  If you're curious (like I was) about what this procedure looks like, here's a video to help you visualize it:

The problem is, it's not only supposed to be uncomfortable; it also only has a success rate of about 58%.  And, of course, there are several factors that make it less likely to work, of which I have at least a couple.  My OB said that because this is my first pregnancy (and, therefore, my ab muscles are still tight) and since my fluid level is on the lower side of normal, there is a greater likelihood that a version attempt wouldn't be successful.  For that reason (along with the already low success rate), I'm wondering if it's even worth it to try.  There are, of course, risks associated with the procedure as well, and although they're rare, they are pretty scary: placental abruption (which causes bleeding), uterine rupture (yikes), and premature labor due to rupture of the membranes.

At this point, I suppose it's just a waiting game.  If she turns on her own (Note to baby: Please do!), we won't have to worry about the alternatives.  If not, we'll have to go from there.  If anything, mentally dealing with these prospective outcomes has made me a lot more flexible in terms of my expectations of labor and delivery...There is definitely something to be said for giving up control and going with the flow!  Of course, I should realize all of this by now.  As anyone with diabetes knows, you can only control so much when it comes to your body; the rest is up in the air.  Even eating and doing the exact same thing on two different days will produce different blood sugar results, and sometimes you just can't predict how your body is going to respond to certain things.

Even so, there comes a point when you realize that there are some things you can control, and all you can do is your best when it comes to those things...and the rest?  Well, you just hope that it all leads to stable blood sugars.  If not, you correct it and go on.  That perfect balance is so hard to find, and impossible to have all the time.  It's probably one of the most frustrating things about this disease, and leaves you feeling like you're playing a huge guessing game (see also: S.W.A.G. Bolus).  Either way, you learn to live with it (and accept it)...eventually...most of the time.

So the moral of today's story is that, as with diabetes, there are just some things in pregnancy (and life) that you have no control over...and the best thing you can do to keep yourself sane is to accept it and go with the flow.  Otherwise, you'll end up like I do a lot of the time: pulling your metaphorical hair out over things that you have absolutely no influence over, and usually not realizing this until you're metaphorically bald.  Hopefully this time I can follow my own advice.  ;)

God grant me the serenity to accept the things I cannot change;
courage to change the things I can;
and wisdom to know the difference

Friday, December 16, 2011

OB Appointment//Limitations Due to Diabetes

I had my latest ultrasound and OB appointment yesterday, and while it wasn't super eventful, it was a little frustrating.  We found out that our little one is still breech, so she only has a couple more weeks to flip or we'll have to start discussing a C-section or an external cephalic version, neither of which are options I hoped to be considering.  For those of you who are familiar with my personality, you know that (a) I'm a slight perfectionist and (b) that I like to know as much as possible about everything that is happening to me (or might be in the future).  Because of this, I've not only read more than 20 books on pregnancy (and I'm not even exaggerating--just ask my husband, who gets exasperated by the stacks laying around the house!); I've also read another five or more books specifically on labor and childbirth--all so I can feel more prepared for what's to come.

The more I came to learn about everything, the more I realized that I wanted as natural a birth as possible with little or no interventions.  As long as the baby and I are doing well, I want to go into labor on my own and be allowed to progress naturally (i.e., no Pitocin, artificial rupture of membranes, etc.) with no stringent time limits.  I want to be able to be as active as possible during labor, with access to a birthing ball and bath/shower instead of an epidural.  Of course this means that I would forgo the usual EFM (External Fetal Monitoring) in favor of a nurse listening to the baby's heartbeat intermittently with a Doppler or fetoscope, because EFM requires you to be tethered to a machine.  Ideally, I would like to be allowed to eat and drink as needed, especially because I've had no issues with nausea during my pregnancy.  I will control my insulin pump as long as I am capable to do so.  When it comes time to push, I want to try pushing spontaneously (NOT on my back) without stringent time limits, and to risk a natural tear rather than having an episiotomy.  After delivery, I want to be able to hold the baby immediately, before any routine procedures are done.  I also want the cord to be cut only after it stops pulsating and to deliver the placenta spontaneously and without assistance.  Because I plan to breastfeed exclusively, I would ask that no sugar water, pacifiers, or formula are given unless deemed medically necessary.

I completely realize that this scenario is somewhat idealistic, and relies on everything going perfectly.  And of course, there is also that big elephant in the room that begs everyone's attention: the fact that my diabetes automatically labels me "high-risk," even if everything was to go perfectly.  Apparently, my diabetes makes medical professionals nervous, even though I've had an almost superwoman-like level of control and everything up to this point has progressed easily with no red flags...which brings me to the most frustrating part of my visit yesterday.  My OB has been fairly laid-back about everything thus far, but once we started discussing labor and delivery, it became clear that in his eyes, my having diabetes limits my options drastically.  Never mind that I've only dealt with this disease for a little over a year, or that my highest A1c to date (right after diagnosis) has been 6.5%...or that I've had absolutely NO complications to speak of--not even a hint of the possibility of a complication, or that I'm otherwise healthy.  Apparently, the fact that I (very purposefully) brought my A1c down to 5.7% (well within a normal person without diabetes' normal range) prior to conception and to 4.9% during the first half of my pregnancy doesn't matter when it comes to statistics.  Women with diabetes have a higher incidence of certain complications, and that's that.  That is what I have a problem with: I have a sneaking suspicion that when people refer to these statistics, they fail to differentiate among all of the factors and extremes of the disease.  All of us, type 1 and type 2, poor-controlled and well-controlled, those with complications and those with none, are lumped into one giant category of "women with diabetes."  Of course there will be a higher incidence of risk in such a group when these factors are not controlled for!

For that reason, I have a huge problem with being treated according to statistics instead of being evaluated as an individual.  I refuse to be placed in the same category as someone who has a very poor level of control, preexisting complications from the disease, and little interest in their health overall.  I also feel that the fact that my sister (who also has T1 diabetes and had blood pressure problems during her pregnancy) saw the same OB works against me.  Yes, we are sisters, and yes, we both have diabetes; however, we are very different in every way, least of all in regard to our individual disease.  Just because she happened to have a not-so-great outcome for her pregnancy (she delivered in late October by emergency C-section at 34 weeks due to the preeclampsia, but the baby is fine now) doesn't mean that I will.  I do not appreciate being told that "things can go downhill very fast for women with diabetes," because once again, there has been zero evidence to lead us to believe that this will be the case in my case.

I was super disheartened after my appointment yesterday, and still haven't decided what to do.  On one hand, I wonder if it's worth it to confront my OB about all of this, because you just can't change some people's minds.  On the other hand, I feel like I have the responsibility to at least try, not only for me but also for the women with diabetes that will come after me.  At this point, I'm just so tired.  It's not fair that I have to fight to be treated normally because of a disease I did not ask for, or that it would all be a non-issue if I didn't have diabetes.  I feel like I fight this fight on a daily basis in order to change the public's perception of the disease, so that I have to deal with this while trying to enjoy the last of my pregnancy seems especially cruel. Like many women with diabetes have commented, this is the one time I've truly felt limited by my disease.  If I had to have a C-section due to the fact that my baby is breech, fine--that's obviously beyond my control; but to be told that I can't have the birth experience that I so badly want solely due to my diabetes, even and especially if everything goes perfectly, is heartbreaking and extremely frustrating.  I want to be a part of changing the world's perception of this disease, but sometimes that mission can seem so futile and tiring.  Sometimes, and especially now, I just wish more than anything that I could have a normal, working pancreas.

Wednesday, December 7, 2011

Basal Rates, Artificial Pancreata, and D-Judgment

Oh, how quickly time seems to get away from me these days...I intend to write a blog post, then other things come up, and before you know it it's been another two weeks since I last posted!  I have to say, I really admire those in the DOC who are able to consistently update their blogs on a daily basis.  Between managing diabetes (which, of course, is another full-time job) and life in general, I have a hard time keeping up with mine at times.  Sometimes I wonder how I'm going to manage it all once the baby is here, but I know it'll work out...somehow!

At least life according to the D-monster has been better lately.  I was getting frustrated with my numbers and my apparent inability to control them despite all of my effort, so I finally (FINALLY!) took a step back to evaluate the situation.  Duh.  My basal rate patterns didn't make sense at all, and it took me a couple of months to figure that little piece of information out!  I suppose with everything going on, I was just increasing the rates themselves over time without looking at how my overall pattern was functioning (not well, by the way).  The day that I realized this, I decided to start from square one and recalculate everything based on the total daily dose of insulin I'd been using.  To do so, I had to pull out my trusty "Think Like a Pancreas" book by Gary Scheiner and review how to calculate all of the basal/bolus rates and ratios.  With a little math (which I always enjoy--seriously, because I'm a nerd), I had a basal/bolus pattern that was a little more sane looking:


It had been so long since I'd done such a complete overhaul that I was a little worried about highs and lows the next day, but everything worked out surprisingly well.  It's amazing what a little perspective can do...I was just metaphorically kicking myself for not doing it sooner!  My numbers have been much more even, and I haven't had near as many out-of-range results as I was having before.  Not that they were horrible before; it's just that I'm kind of a perfectionist and like for all of them to be as close to "normal" as possible--is that so much to ask?!

In other D-news, how about that Artificial Pancreas Project?!  I'm so excited that the FDA has started the process that will hopefully lead to approval in a timely fashion.  It's such a major step in the right direction for those of us living with T1, and although it's not a cure, it does represent a major advancement in treatment technology.  For more on what this means for us, please read this article:  Interpreting the FDA Guidance for the Artificial Pancreas

This morning I got a blog update from Jacquie Wojcik at Typical Type 1 in my email, and it was an awesome one.  You can read the full post here, but the general gist of the post was about how judgmental people without diabetes can be at times.  If you deal with this disease, no matter the type, you've no doubt encountered it at some point--if not more frequently.  Even when people don't make rude comments or say anything out loud, sometimes you can feel their judgment anyway.  It can make eating in public a psychologically difficult experience, because you know that if you split a dessert with your lunch buddy, there will probably be somebody who is thinking, "She has diabetes, she shouldn't be eating that!"  It's not that I mind talking about my disease or correcting misconceptions when people are genuinely interested; it's the ones that try to impress their diabetes "knowledge" and horror stories upon you that can be irritating at times.

I like to think I generally have a good, positive attitude and outlook on life, but even that can be challenged when dealing with this type of thing on a regular basis.  I've thought before about printing some of these diabetes etiquette cards for people who don't have diabetes to keep on hand for such situations, but I don't know how well received or effective that would be.  Instead, the action I've taken is one I'm super comfortable with: I wrote.  I mentioned it in my last post, but for American Diabetes Month I wrote an article for our local newspaper about the myths and misconceptions surrounding the disease so that maybe-just maybe-it will reach those that need to know these things.  Like I've said before, even though it's hard, I can deal with the's the kiddos who live with diabetes that I worry about.  Life with this disease is hard enough without having to defend yourself and your decisions all the time.  We already have to micromanage ourselves, so it's no fun when others try to do it for us as well.  Like one person in the comments said of Jacquie's post,  "It’s amazing how much more people care about/watch what I eat since I was diagnosed Type 1. They didn’t give a crap about what was on my plate before."  So very true.  The not-so-nice part of me sometimes wants to ask these people, "So just because you don't have diabetes, it's okay for you to eat that third piece of cake?!"  But I don't, because I could never actually say that to anyone, no matter how rude they've been to me.  In the end, I have to realize that there are some people who just don't get it.  I can try to change their perceptions, but sometimes their ideas are so long-held and concrete that there's not much anyone could do or say to fix the situation.  So instead, I just try to do the best I can and educate the ones who are willing to learn.