Our Vacation, The BIG Ultrasound, & My Latest A1C

It's been a couple of weeks since I last posted, and let me just say...they've been a busy (and eventful!) couple of weeks.  First, an update: I never received a call about our prenatal screening tests, so that's a big "yay!"...No news was good news, so that's definitely what we were hoping for.

We also had our big appointment with a maternal-fetal medical specialist last week that included a level 2 ultrasound to check for developmental/anatomical abnormalities.  Level 2 ultrasounds are fairly commonplace these days, even in women who aren't designated as high risk; however, my OB sent us for one specifically because I'm automatically labeled high risk thanks to my type 1 diabetes.  From my first appointment, my OB has been very supportive and encouraging, and was impressed with my A1C and tight level of control.  I appreciate the fact that he's treated me as normally as possible, because a lot of doctors have a standard procedure for treating "diabetic" women (as most of you already know, I hate that label!) that they don't deviate from, regardless of the patient's level of control.  The way I see it, if I'm able to keep my numbers relatively normal and generally within a normal person's range, there is no reason I should be automatically sentenced to C-section or induction at a certain cutoff point, provided everything continues to go as well as it has for the first half of my pregnancy.

I appreciate my OB's approach to my care thus far because he has been thorough and cautious, but optimistically so.  He has said from the beginning that if I'm able to keep my blood sugar levels as close to normal as possible, I should have an easy and uncomplicated pregnancy.  Of course, bad things can happen in pregnancy even for the healthiest of women, so he's also made recommendations (like the prenatal screening tests and level 2 ultrasound) to ensure that everything is developing as it should.  He did (predictably) go over the risks commonly found in pregnancies with preexisting diabetes, but thankfully didn't dwell on them.  Like anything else diabetes-related, pregnancy with diabetes is very YMMV (Your Mileage May Vary), and luckily my OB realizes that.  Some women have excellent control, but their prexisting complications from diabetes (like retinopathy) make it impossible for them to delivery naturally.  Other women have horrible control, but are able to (somewhat miraculously) have a normal pregnancy and delivery.  Therefore, I believe it's important to focus on the individual patient's unique situation in lieu of a textbook procedural code.  In that way, I feel very lucky to have found a doctor whose philosophy is closely in line with my own.

Due to some differences/problems between my OB's practice and the maternal-fetal medical specialists in the city where my doctor's office is located (about two hours from where we live!), we were sent to a different city three hours away to have our level 2.  Since we had a wedding in a nearby town the weekend before, we just decided to make a mini-vacay out of it and spent a few days in Carlsbad, NM, the week before our appointment.  We toured the Caverns and did A LOT of walking, but had a blast.  We stayed at the Trinity Hotel, an old bank that was renovated into a nine room hotel and restaurant.  The room we stayed in had a super comfy bed and the biggest bath tub I've ever seen:

The restaurant, which we ate at twice during our stay, was WONDERFUL.  The first night, we both had the lobster and cheese ravioli with vodka sauce, which was to die for, along with a piece of berry white cheesecake.  A couple of nights later, my husband had a ribeye and baked potato, and I had the Mastachana, penne pasta with massive grilled shrimp and a tomato-bacon sauce.  Per my husband's request, we also shared another piece of the same cheesecake we had before.  It was definitely some of the best food I've had in a long time!

The first day in the Caverns, we did the self-guided Natural Entrance tour, which begins at the Natural Entrance (duh) and ends in the Big Room.  I had never been to this or any cave, so it was a pretty cool experience.  It's like a completely different world down there...a world that remains a constant 56°F yearround.  Surprisingly, I wasn't cold, despite the fact that I was wearing a tank top and capri pants...I guess all the walking (mostly downhill, much to the irritation of my toes) kept me warmer than usual, because normally I'm freezing at 72°! 

Unfortunately, my blood sugar decided to not cooperate that day, leaving me stressed out at 308 post-lunch before we hit the trail.  I hadn't seen a number over 300 since I started insulin, and any number higher than 140 makes me nervous...Not to mention, I still struggle sometimes with the diabetes numbers game even though I have a generally healthy attitude about it most days (see #4 of this post).  It's hard enough for me to deal with an out-of-range number normally, but now that I'm pregnant that anxiety is sometimes through the roof.  After all, it's not just my life that depends on my numbers anymore.  Anyway, I corrected and hoped (and prayed) that the 1.25 miles of walking would bring me back to normal range.  About halfway down I tested again, and was at 209.  My hubby reminded me to not overdo it, but I'd rather be low than high any day, so I did another small correction.  By the time we finished our tour and made it back to the vehicle, I was at 46.  A Nature Valley Oats 'n Honey bar brought me back to normal range once again, and we were back in business.

The second day, we took a ranger-guided tour with 13 other people through the Left Hand Tunnel, which takes you through an unpaved and unlighted part of the cave not open to the general public (except on the guided tour) with only an old-fashioned lantern to light your way.  My husband wanted to take the more adventurous Lower Cave tour, but it was off-limits after I told them I was expecting...I'm pretty sure I would have been able to do it, but they didn't want to take any chances!  Anyway, the tour we took was pretty awesome since we were with such a small group and there was so much neat stuff to see (i.e., a mummified bat).  Towards the end of the trail back, we gathered in a circle and after telling what our favorite part of the tour was, blew out the candle in our lanterns.  The resulting blackout was an all-encompassing darkness that I'd never experienced before.  With absolutely no natural or artificial light in the cave, you literally couldn't even see your hand in front of your face.  Our ranger then re-lit our lanterns for the rest of the tour, and we ended up back by the restaurant area (750ft underground).  Since we'd seen the rest of the cave the day before, we decided in lieu of taking the elevator back up, we'd hike back out the natural entrance.

Mummified Bat (Lying Diagnally Across Above Rock)

Lanterns From Left Hand Tunnel Tour

The reason you "walk" down and "hike" up, we found out, is because the steep grade that leaves your toes aching on the way down is particularly murderous on the way up.  In the cold cavern air, my pregnancy lungs had to be given rest fairly frequently, and my buns/thighs/calves were all aching by the time we made it out.  The funniest part of the whole thing was when we encountered an older couple on their way down.  The woman asked her husband if they'd be hiking back up as well, and when I told her how difficult it was, she told me, "Well if you need any help, just holler and I'll come get you!"  Fortunately, we made it back to the surface (mostly) unscathed, and got back in the truck to return back to town--only to stop at the Living Desert Zoo and Gardens State Park, which gave us another 1.3 miles of trails to walk through that afternoon!  Although there weren't a ton of animals to see, it was a pretty neat place.  I was sad the cougar wasn't in residence (or possibly stalking us unseen) that day, but we did get to witness some prairie dogs freaking out when they noticed the wild hawks circling above them (hilarious!) and a mad rattlesnake (safely behind glass, of course) that looked like it was ready to strike at us.

We left the next day to head back to the city where we'd have our ultrasound and stopped to visit my husband's parents and some of his sisters on the way.  We rarely get to see them since they live so far away, so it was nice to be able to visit with them.  The next morning, I was so nervous that I didn't want to eat breakfast, but I knew I needed to eat something, so I forced down some eggs and cereal as quickly as I could so we could find the doctor's office in time for our appointment.  We made it with just a few minutes to spare, but I still couldn't calm down until they called us back for the ultrasound.  I don't think I've been that nervous in a long time, mainly because everything I'd done to keep myself and therefore our baby healthy up to that point was at stake...I can't begin to explain the tension and helplessness I felt.  I had been praying every night for the baby's and my health, but I still couldn't help but be a little nervous thanks to all the "what ifs" that creep into your mind if you let them.

It turns out all of my worries were for nothing, because our little one was perfectly normal and developing as expected!  After that was out of the way, I was on pins and needles wondering if our baby was a he or a she...I had been convinced throughout my whole pregnancy that I had to be carrying a boy, not due to any evidence but a feeling.  As it turns out, my intuition in this case was totally and completely wrong, because the ultrasound technician told us she was thinking we were having a girl, even though the cord was wrapped between the legs and she couldn't be completely sure.  She scanned a few more important areas then came back to double-check, and sure enough, it was definitely a girl!  I almost couldn't believe it at first, but I was definitely pleasantly surprised.  I always secretly wanted a girl, but wouldn't let myself dwell on it for fear that we wouldn't have one.  It's not that I would have been disappointed had we been having a boy; it's just that I'm so girly that I wanted a little girl to dress up and play Barbies (and John Deere tractors!) with.

I wrote a couple of months ago about how much the gender issue bothered me, not because we necessarily cared much one way or the other, but because of people's comments about our baby in relation to my sister's.  Since she is 10 weeks ahead of me and having a girl, we had to deal with everyone telling us that "maybe we'd have a boy" so that (a) my parents would have one of each for grandchildren or (b) because there'd be less competition between us.  It's hard to know what to say when people make those remarks, and even harder when they ask what you're hoping for.  For that reason, I never told anyone aside from my mom that I really wanted a girl...I didn't want to have to eat my words later.  My husband never said which he'd rather have, but I think he's thrilled at the thought of having a daughter.  He always tells me to be sure and take care of his little girl, and wanted to go buy her a little single-shot pink rifle as soon as we found out what we were having...Ours will be the third girl in our group, which currently contains five little boys to run from!  In the first stages of pregnancy, my hubby thought that baby monitors were ridculously expensive, but just the other day when we were at Target, he was scoping them out and commenting on how "cool" the video monitors were!  It's so nice to see him taking an interest in everything, and I know he'll be an amazing (and protective!) dad.

Last but certainly not least, I got my latest A1C results back yesterday.  Before conception, I was able to bring my number down from 6.5% to 5.7%, which fell safely within the person without diabetes's normal range of 4.0-6.0% that they like you to shoot for pre-pregnancy.  With all the higher numbers I'd been dealing with lately, I was afraid my number may have gone up slightly, but I was just hoping that it would still be lower than 6.0%.  When I got home yesterday and nearly ran to the mailbox, I ripped open the envelope with my test results and was shocked to see that my A1C was 4.9%!  I almost couldn't believe it, and had to read it a couple of times for it to sink in.  With all the challenges I've had to deal with and hard work I've put into managing this disease, it's so nice to see positive results.  In a way, it validates everything I've been doing and re-affirms my confidence in my ability to manage this difficult disease.  Most of all, it reassures me that I am doing everything I can to ensure my child's health and well being, which is the most important end result for me.

The Great Vaccine Debate

I decided yesterday that it was time for a change, so I revised the design of my blog and even got a new profile picture to match-and it actually looks kind of like me, so I thought that was pretty cool!  Every time I decide to embark on a blog makeover, I end up all tense with achy-shoulders from trying so hard to find the right html code to change in order to get the look I want, because the templates rarely work 100% for me.  Anyway, I somehow managed to get it decent-looking, so now I can finally relax!

I had another OB appointment on Tuesday, mainly to do the blood work for the quad screen prenatal testing that we decided to go ahead with.  Long before I was pregnant, I was undecided on the issue of finding out the risk level of having a child with a genetic defect or disorder (like Down's Syndrome or Trisomy 18), but since then I came to the conclusion that IF there was something wrong with our child, I would want to know before birth so I could be prepared for the challenges we'd have to face and get somewhat more mentally/emotionally adjusted to the fact, if that's possible.  A big needle stick (like I'm not used to that...), and 10 days later we should have our results.  They said no news is good news, so that's what I'm hoping for!

Prenatal testing, as I've discovered, is just one of the many difficult parenting decisions you have to make before your child is even born.  From breast/bottle feeding to the circumcision issue for little boys and even pacifier use (or not), there is plenty of controversy surrounding all of these choices.  People on both sides of every issue are passionate about their position, and few are willing to modify their ideas.  None of these debates, however, is quite so polarizing as the issue of vaccines.

Every time I come across an interesting article on vaccines, I post it to Facebook.  I am absolutely pro-vaccine, and passionately so...therefore, whenever I encounter these articles online, I opt to share it with my friends because I think everyone should have the best information possible to base parenting decisions on.  The first was an article about pediatricians who refer kids that aren't vaccinated to other physicians--as the article says, "no shots, no service."  The American Academy of Pediatrics stated that by instating policies like this, these pediatricians might be preventing unvaccinated children from receiving proper health care.  The bigger issue in my eyes, though, is that these children aren't being vaccinated in the first place-is that not considered "proper health care" too?  After all, babies can't decide whether or not they receive vaccines; it's the parent's choice.  And with so many rampant rumors and misinformation on vaccines, more and more parents are making the decision to not vaccinate their children or to delay their shots based on invalid information and anecdotal evidence from parents who claim that their children were injured by vaccines.  The thing that saddens me most is that these children aren't receiving the recommended health care because their parents either do not have access to accurate information, or simply choose to believe that the vaccine schedule is part of a big government/pharmaceutical conspiracy.  What they fail to realize, though, is that vaccines offer very little profit for the manufacturers (especially compared to other pharmaceutical drugs), and that the government has little to gain from children being vaccinated other than an assurance that the threat of disease outbreaks in the country is reduced.  I am not saying that politics do not influence medical issues and vice versa; I am just saying that given the current situation, I do not believe the vaccine conspiracy theory that anti-vaccine advocates are so quick to force.

In all honesty, I think that vaccines should be required by law in all children who aren't allergic to them or have compromised immunity for whatever reason.  The reason I believe this is very simple: the more children who aren't vaccinated, the greater the threat to herd immunity.  The second article I posted regarding vaccines on Facebook was a story about a little boy with leukemia who could not be sent to day care because his parents could not find one in which all of the children had been vaccinated.  The reason this was of such great importance was because this little boy, whose immune system was compromised due to chemotherapy, could not receive vaccines during his treatment--therefore, he (like many others, including young infants and other immunocompromised individuals) relies on herd immunity to protect him from the diseases that vaccines would ordinarily offer protection against.  The problem that scientists and doctors are seeing, though, is that in communities where so many parents are making the choice to not vaccinate their children, herd immunity is compromised so much that diseases that were once thought to be basically eliminated from the modern world are gaining a foothold once again.  As a result, children (both those who are too young or cannot receive vaccinations due to compromised immunity and those whose parents choose not to vaccinate them) are dying of preventable diseases.

Regardless of your views on vaccines, you only have to look at recent news stories to know that this is true.  Last year, the pertussis outbreaks in several states were devastating.  The numbers of children affected by the disease were disproportionately higher than previous years, and many investigators believe that it is at least partially due to the anti-vaccine movement.  It's pretty simple, really: the more unvaccinated children in a given population, the lower the percentage of vaccinated individuals; the lower the level of herd immunity, the greater the chance of disease outbreak.  What scares me the most about this is that the diseases that are emerging in epidemic proportions again are so threatening to babies who are too young to receive the vaccines that would protect them.  The first shot for pertussis, for example, isn't given until 2 months as part of the DTaP vaccine.  Before then, babies are vulnerable to the disease, which can kill an infant in a very short amount of time.

What I've encountered in posting these articles is that anti-vaccine proponents are quick to say, "Well if vaccines do such a great job of protecting your child, you shouldn't be worried about my unimmunized child making them sick."  No matter how often I get this reaction (and it happens surprisingly frequently), it still frustrates me to no end.  First of all, who are you to tell me that I shouldn't be worried about my child's health?  Of course I'm going to worry about my little one getting sick, and I absolutely worry about them being exposed to unvaccinated children for this very reason.  Secondly, if you know ANYTHING about vaccines, you know that they aren't all given on day one...so until they're given the vaccination for a particular disease (which may be months down the road), they're vulnerable to it--it really is that simple and obvious.  The more I've thought about it, the more I realize that this reaction is just part of anti-vaccine advocates' self-affirmation toolkit--the more that they can convince themselves that their children aren't going to be infected with and/or spread diseases, the more they believe they're making the right decision in not vaccinating them. 

I've also found that anti-vaccine supporters tend to surround themselves with people who think the same way they do.  My husband was raised Mennonite, and although he received all of his vaccines and believes the same way I do, there are a lot of people within that group who are part of the anti-vaccine movement due to all the popular horror stories and rumors of vaccine injury.  As Seth Mnookin points out in his book "The Panic Virus", being around other people who support your way of thinking seems to validate your decision: "[...]sustained encounters with a small group of like-minded people almost inevitably lead to the conclusion that everyone thinks the way you do." (pg. 141, Nook version)  Never mind that 90-95% of the population in almost any given area of the country vaccinate their children; being around other anti-vaccine advocates (who are part of the other 5-10%, mind you) confirms that you're making the "right" decision, even if it goes against what the majority of the general public does.  I'm not saying that the majority way is always the right way; it's simply that on this particular health issue, it's logical to assume that if virtually everyone else is vaccinating their children without ill effect, you can be reasonably confident that your child is not going to suffer any adverse reaction from being vaccinated as well.  In fact, the chance of contracting one of the vaccine-preventable diseases is about 20 times greater than being injured in any way from the vaccine.  To further break those numbers down, if the risk of being infected with disease X is 1 in 1,000, the risk of having any ill effects from the X vaccine would be 1 in 20,000.  Furthermore, the transmission rate of most of these diseases is anywhere from 80-100%, so that gives you a 0-20% chance of NOT contracting the disease if you're not vaccinated against it.  Given those odds, I don't see how anyone would willingly not vaccinate their children without a valid medical reason.

Anti-vaxers also like to make the argument that if their child is sick, they're not going to expose them to others.  However, this is a simple statement to refute as well.  Many of these vaccine-preventable diseases have incubation times that are such that you could go days or weeks without realizing your child has been infected before they start to have obvious symptoms.  Pertussis, for example, first appears as a normal cough/cold before turning into full-blown whooping cough.  What parent keeps their child home from school (or any public place) every time they have a simple cough or cold?  I'd wager that it's not many. 

I've had this debate several times on Facebook, and one person even asked me point blank what the chance was of their unimmunized child giving a vaccinated child one of these diseases.  Never mind that the point of the article at hand (the one about the boy with cancer) was the danger posed to children who couldn't be vaccinated (yet), or that the occasional immunized child who for whatever reason does not get full protection from the vaccine(s) they receive also relies on herd immunity; this is what I replied:

[...]Therefore, the disease transmission rates (percentage of susceptible individuals who will become infected by an infected individual, where the susceptible individual is a person with a compromised immune system or one who has yet to receive the vaccine due to being too young) vary based on the particular disease. For pertussis, the transmission rate is 80%+. For measles, it's nearly 100%. This means that when a non-immunized child becomes infected with one of these diseases, the chance that they will infect a susceptible child they come into contact with is 80-100%.

As mentioned previously, there have been many recent cases in which a non-vaccinated child contracts a disease and in turn causes an outbreak. Most notably, there were 21 cases of measles outbreaks in Minnesota in April this year, of which 85% or more were linked to one unvaccinated child. In Utah, another child may have exposed up to 1,000 different people in two different events to the disease. The pertussis outbreaks last year have been linked to the large percentage of children who were nonimmunized, infecting infants who were too young to receive the vaccine and for whom the disease is often fatal. So clearly, it's a very real issue, especially when it comes to the recent epidemics of vaccine-preventable diseases in the U.S.

I also linked to two more articles (here and here) about how recent disease outbreaks have been linked to the anti-vaccine movement and how it is fast becoming a social health issue.  Never mind that the original "study" linking vaccines to autism, conducted by Andrew Wakefield in 1998, has been found to be fraudulent (and, in fact, clearly should have never been published if you read chapters eight and nine of Seth Mnookin's "The Panic Virus") and completely baseless, emerging from his illogical connection between the measles part of the MMR vaccine and bowel disease (yes, bowel disease), leading ultimately to autism.  Even after hearing about the Wakefield study being invalidated, I never realized the full ridiculousness of his claims until reading Mnookin's book.  No matter how crazy and unfounded, however, it is easy to see how claims like Wakefield's can so quickly influence the public's perception and how difficult it can be to undo the damage once it is done.  The media loves a good public health scare, and articles confirming vaccine safety aren't as newsworthy or attention-provoking.  Therefore, once the public is sufficiently enraged over a perceived issue, the retraction or correction barely registers in the collective psyche.

More recently, a review of the current literature on vaccines was completed by the Institute of Medicine (a division of the National Academy of Sciences) and confirmed that vaccines are generally safe.  Before anti-vaccine advocates can shout bias or conspiracy, it is important to point out that this study is unique because it reviewed over 1,000 existing studies on vaccines.  So unless thousands of scientists are publishing falsified research in legitimate, peer-reviewed journals (unlike the some other "scientific" publications, which will admittedly publish any article, even those that appear to be questionable at the onset), it would be hard to refute these findings.  On a Facebook page for Pregnancy and Newborn Magazine, which posted a link to this article after I did, Organic Baby University commented on the link that "I would love in just one article or news piece from someone to provide the actual studies they used to determine no correlation. Never seen a link or attachment or anything to provide the public with the ability to read those studies that prove it. Just that they exist. As educators we would love to read the scientific studies!"  Another person and I both replied with the link to the bibliography from the study.  Perhaps after reviewing 1,000+ research articles, some anti-vaccine advocates will feel more comfortable with the conclusion that vaccines are, in fact, safe. However, there will always be those that dismiss any evidence in favor of vaccines as part of a conspiracy, even though this review was completed by an 18-member committee and included research by thousands of scientists!

That's the thing that has been the most striking about this debate for me--no matter what evidence you provide to anti-vaccine proponents, they would rather believe anecdotal "evidence" from people who have no medical background (not that I claim to have any medical training; I simply rely on facts from those who do to guide my decisions) over scientific fact.  Controlling for any potential biases, I just can't understand why anyone would believe that every single study confirming vaccine safety and neccessity is somehow "not real," or not to be trusted, or that peer-reviewed studies should not be used as a legitimate basis for decision-making.  Just last week, one of my closer friends (who does not vaccinate her child) deleted me as a friend on Facebook because she and her husband were offended by my posts on the subject.  She also took issue with the fact that my husband and I are choosing to not expose our baby (which will be born in February, the height of cold/flu/RSV season) to unvaccinated children until he/she can be immunized, because once again, she posed the question "If vaccines do what they say they do, why should you be concerned about our child?".  After I refuted this claim (again), I told her that my husband and I have every right to do what we feel is needed in order to protect our child.  I would rather take extra precautions to protect him/her and risk stepping on some toes rather than our little one getting sick when we could have prevented it.  I will choose protecting our baby over hurting someone's feelings any day, end of story.  I also told her that while I agreed that being a mom is a job that takes heart, I didn't see how my making educated decisions based on facts would make me any less of one.  I told her that if she chooses to believe other things over scientific fact, that's her decision-but it certainly isn't mine, and never will be. I simply could not make a decision about my child's health that goes against everything I know, simple as that.

I know that all of these people who choose not to vaccinate their children do so out of legitimate concern for their child's wellbeing and feel that they're doing what is best for their children, but it saddens me to know that they do so without accurate information to base their decisions on.  I believe that parenting decisions should be left to the parents until those choices affect my child's wellbeing-or theirs.  There is a reason why you can't get a religious or philisophical exemption for drunk driving or illegal drug use-it's an issue of public health and safety...The thing is, I don't know how many more children are going to have to die from preventable diseases until something is done about the issue.

It's Diaversary Time...

Today marks a very important day for me: it's been a year since I was diagnosed with diabetes.  In a way, I can't believe it's been a whole year; on the other hand, it seems like it's been forever already.  It blows my mind that there are people who have been living with this disease for 50 years or more, and I definitely, definitely hope that I'll be one of those people 50 years from now.

I saw something on Facebook the other day that a friend had posted that said:

It's hard to explain to someone who has no clue. It's a daily struggle being in pain or feeling sick on the inside while you look fine on the outside. Please put this as your status for at least 1 hour if you or someone you know has an invisible illness (COPD, Anxiety, Bipolar, Depression, Diabetes, Lupus, Fibromyalgia, Crohn's, MS, Arthritis, Cancer, Heart Disease, etc.) Never judge what you don't understand...

It's so true.  Those of us with diabetes have to deal with the (largely invisible) battle of highs and lows, and I have countless relatives & friends who live with other illnesses that few people can truly relate to.  Living with a chronic disease is tough-physically, mentally, and emotionally.  Even if it's not something that you have to deal with on a minute-by-minute or hourly basis (although that can certainly be the case with diabetes), it's always something that is in the back of your mind.  It adds an entirely new dimension to your life, and puts everything in a different perspective.  Once you are diagnosed with a lifelong disease, everything else pales in comparison.  Things that used to matter just don't anymore.  Relationships take on a new meaning, and you learn how to depend more fully on other people-and yourself.  "You never know how strong you are until being strong is the only choice you have."  Like I said in my six-month post, though, sometimes I don't want to be strong...I'd rather just be normal!

That's not to say that you can find that new found inner strength every day, though...there are plenty of days when the challenges of living with a chronic disease weigh so heavily on you that's it's just too hard-and sometimes impossible-to keep a positive attitude.  There are days when you just don't want to do it anymore, when you're sick of having the stare-downs with your plate trying to count carbs, dealing with insulin dosages, the highs and lows, and constantly checking your blood sugar, that you fantasize about what it would be like to have a working pancreas.  I've been through a lot of those days, and luckily I have a husband who is very supportive-but who also reminds me of reality when I need to hear it.  No matter how much I want to have a working pancreas, I don't...so I just have to deal with it.

It seems like a lot of what I've learned about diabetes revolves around "dealing with it."  How to deal with out-of-range numbers, diet modifications, basal/bolus rate changes on an insulin pump, taking care of your overall health...and with all that to think about, "dealing with it" can easily become overwhelming.  It is doable, though--something that those people who have lived through 50 years of slowly-improving diabetes technology are a true testament to.  One thing I've always been thankful for is that I was diagnosed at a time when there is so much technology available to make living with this disease a little easier.  I started out with just a blood glucose meter, then added oral medication, switched to the insulin pen, and now have a meter that communicates wirelessly with my insulin pump, which also doubles as a Continuous Glucose Monitor (CGM) when I wear the sensor with it.  That's not to say that today's technology is perfect, though--there are plenty of improvements that could be made in order to fine-tune what is available.  There are always news stories about the latest & greatest in diabetes technology, and rumors about what is to come.  I think the closed-loop pump/CGM system probably isn't far away from being a reality, but that's still a far cry from a working pancreas.

Another thing I've realized in the past year is just how misinformed people are about diabetes in general, and about type 1 especially.  I wrote a post in January about an exchange I had with a woman on another blog site about diabetes and it "going away", and it just showed me how little people know about the disease and yet are so willing to give "advice" and impress their "knowledge" upon you.  I even had a lady tell me once that weight loss surgery "cured" diabetes...Being of normal weight, I was thinking, Lady, if I had weight loss surgery I'd be nonexistent!  But some people just don't "get it," and some aren't even worth the trouble of trying to explain everything to.  I try to be patient and educate everyone I can, but some people just aren't worth the effort it takes because they are so set in their old-fashioned way of thinking.

Some people that definitely do "get it," though, are the members of the DOC-the Diabetes Online Community.  Without their stories, advice, and support-from-afar, I wouldn't have made it through this year as easily as I did.  Even though they may be miles away, knowing that there is someone out there who has gone through exactly what you're dealing with makes it a little easier to cope with.  One of the major things I worried about when I was diagnosed was my ability to have a healthy pregnancy and baby, and the DOC provided tons of answers and encouragement on the subject.  Thanks to them, I realized it was definitely possible to have a relatively normal pregnancy and happy, healthy baby in the end as long as you're willing to put in the effort it takes to effectively manage your disease before and during pregnancy.  It isn't easy, but it's doable-and so worth it.

Another thing I've learned from this disease is that sometimes, you just have to go with the flow.  There are going to be good days and not-so-great ones, and I finally learned that you just have to accept that.  Highs are part of the disease, so you just have to expect them, correct them, and move on.  It was incredibly hard for me in the beginning to see those numbers as information and not a "grade," but I've grown into a more balanced view of them over time.  It's still hard, though, especially when you know there's a tiny little human being inside you that is depending on your health to stay healthy...The highs are more emotionally tough than anything then. 

When you're diagnosed with a chronic disease of any kind, I really think you go through the typical stages of grief (Denial, Anger, Bargaining, Depression, and Acceptance) over the loss of your former, healthy self, though it's not to say that you don't drift back and forth between stages at any given point in time.  Depending on the day, you may want to deny that you have to give your disease any attention at all, or you may be mad at the universe because you're one of the unlucky ones who ended up with it.  You may tell yourself (or God) that you would trade XYZ to be able to go back to your normal, healthy self, and other days you're just down in the dumps just because dealing with everything becomes so difficult to handle.  Then, on the good days, usually when you have a handle on things and are feeling confident in yourself and your life, you accept your disease as a part of who you are, though never as a definition of yourself.

It's incredibly hard to not let a chronic illness take over your life.  Achieving a balance between managing and not is tough.  You have to have just enough control over it so that it doesn't control you, but not so much that it's all your life revolves around.  It's not an easy thing, especially when your disease places so many limitations on what you can and can't do.  I wrote not long ago about how diabetes disrupts my life, because as much as I try not to let it prevent me from doing anything, realistically, it sometimes does.  Anything that involves water is pretty much out of the question for the time being, because although I could switch back to shots for a day at the water park, I just don't want to risk the loss of control during a time when control is essential.  It puts a damper on our plans with friends, and even my vacation plans with my husband, because being on a (non-waterproof) insulin pump prevents me from doing a lot of things, and pregnancy limits me further.  It's just the way it has to be, but that doesn't mean it doesn't majorly suck.  I hate that my disease prevents my husband from being able to the things he wants to do, and I resent the fact that we're not able to participate in a lot of the things our friends plan because of it.  Even though being on the pump means giving up some of my freedom, though, I still wouldn't trade it for shots simply due to the level of control it gives me.

So, if there's one thing I've learned over the past year, it's this:  Life with diabetes, like any other chronic disease, isn't always easy...but it's manageable.  There are things that just plain suck, but as long as you're dealing with them in a way that allows you to control your disease without it controlling your life, that's a win in my eyes.  You're never going to have perfect numbers, and there are certain modifications that you have to make to your life in order to take care of your overall health, but once you have things (sort of) under control, your life becomes more normal(ish).  This disease might sometimes limit the things you can do or eat, but it never has to prevent you from accomplishing the things you want to do in life.  And in order to manage everything in the most effective way possible, you have to find a source of motivation to keep you going-especially on those days you want to quit.  Diabetes doesn't take a vacation, so you can't either...but as long as you have something to keep you motivated to stay healthy (mine is my future children), everything you do and all the effort you put in has a greater purpose.  That motivation is what makes all the pain and suffering worth it...it's what makes life worth living.

WARNING: Pregnancy Hormones in Full Swing!

I'm now 15 weeks and two days pregnant, and I can't believe how quickly time has flown by.  On the other hand, though, the next pregnancy milestones (the second trimester, then actually looking pregnant, and finding out the baby's gender, and so on) always seem so far away.  While I am now officially in the second trimester, I still don't look pregnant...Most days, it just looks like I've had one too many cheeseburgers!  It's hard to be patient, but I know I'll look like I'm smuggling a basketball under my shirt before too long.

In another time span, the past five months since my sister announced her unplanned pregnancy have been some of the most emotionally difficult of my life.  I've written a couple of times (here and here) about that whole situation, so many of you know how I feel about it and how it's impacted everyone in my family.  Even though I got past letting her ordeal affect me to an extent, it still weighs heavily on me some days.  There are still a lot of times that I question how all of this could possibly be part of God's plan, and how it could possibly turn out in a redeeming way.  I suppose we'll see exactly how it all works out in a few more months, but I'm still apprehensive about and frustrated by it all.  Here are some observations/questions/general musings related to the subject [WARNING: Pregnancy hormones in full swing!]:

• Why in the heck is it that my sister gets more attention due to her pregnancy than I do?  It may sound petty, but I truly don't understand how, when we've done everything the right way, some people-even and sometimes especially, relatives-ask her endless questions about her baby and don't even bring ours up in conversations...at all.  I just don't get it. 

Example: This past weekend, when we were at my cousin's wedding, my mom said that my step-grandma told her that her sister was making some booties for my sister's baby since she knew what she was having.  She proceeded to go on to say that she told her sister that "[her (my mom's)] other daughter (yeah, didn't even say my name!) was pregnant too," so that when we found out what we were having, she'd make us some as well.

These situations honestly infuriate me.  My grandpa congratulated us when I called him with the big news, but my step-grandma has never said a single word about it to me, and only ever talks about my sister's pregnancy to anyone.

Which brings me to my next point...

• I absolutely despise hearing that I'm pregnant too.  I want to say, "Excuse me people, but we've been planning our baby for a long time, and just because my sister is pregnant at the same time doesn't mean I'm happy about the situation!"  Seriously...It was hard enough to dealing with everything in the beginning and trying to decide if we wanted to go ahead with our plans for starting our family with her being pregnant without all of everyone's "helpful" comments afterward.  I had a lady tell me one day "how cool it was that [we] were pregnant at the same time", and I wanted to punch her in the face (figuratively, of course).  Newsflash, we made the conscious decision to start our family despite the whole ordeal, so if anything she should be the one who's pregnant too.

I know I've written about it before, but it's still a constant battle...

• In a previous post, I mentioned the gender issue, and it still hasn't let up.  The only way I've learned to get around it before people have a chance to force their opinions on us is to tell them upfront that a lot of people think we should have a boy since my sister is having a girl, but that we don't see why that should have any impact on us.  Putting it that way lets them know upfront that that isn't the way we feel, so most people get the hint and leave it alone.

Bottom line, we shouldn't have to feel that way...we should be able to enjoy having people guess what we're having-it should be fun!  But instead, it's hard not to get bitter about it given the situation...The same people who encourage us to not let my sister's pregnancy affect ours tend to be the very ones that force the comparison, so it's just a vicious cycle.  If they truly wanted us to enjoy our pregnancy, they wouldn't bring up my sister at all...But it seems like it's inevitable, so I always end up feeling hurt and defensive.

Next point:

• I also don't get why people ask about our pregnancies as if we're a single unit.  Even though I'm forced to sit at the same table with my sister while we're at lunch with my parents, that is in no way an indication that I'm okay with the situation.  I don't even want to see or talk to her after everything she's said and done to me, so I hate having to pretend like everything is hunky-dory in public.  We live in a small town and news (especially the scandalous sort) travels fast.  Due to my sister's need for attention, I'm pretty sure almost everyone in town knew she was pregnant by the next day after she told us, but plenty of people still aren't aware of our baby's existence since we don't advertise the fact.  This leads to endless awkward conversations to start, then once people are aware of the fact that we're both pregnant, they like to question us as if we were Siamese twins or something; i.e., "How are y'all doing?", "How are the babies doing?", or "How is [my sister's name]?  Oh, you're pregnant too?  Well, maybe you'll have a boy then!"  I'm always so frustrated by this that I usually just say "fine" and leave it at that, while my sister proceeds to go on and on about her pregnancy-related maladies, or how much the baby's moving, or how much she likes [insert food here].  Honestly, if you want a real answer, ask me a real question...Ask me.

I know it sounds like I'm being super pessimistic/pissed off, but I promise I have good days in addition to the not-so-great ones.  The one thing that gets me the most is that this isn't the way any of this should be for us.  I suppose it's a case of the "if only"s...If only my sister hadn't gotten pregnant, we would be able to enjoy our pregnancy and things would be the way they should be, doting grandparents-to-be, relatives, friends & all.  Instead, a huge chunk of that joy has been sucked from us by my sister's ordeal, and we're left with the crummy leftovers.  In no way do I regret our decision to continue with our family plans, but I still wish things were different, the way everyone assured us they would be even after everything happened.  I hate to break it to them, but they were wrong.  There are very few aspects of our pregnancy that haven't been affected in some way or another by my sister, and as a result, I have a hard time accepting our reality sometimes.  She seems determined to rip any hint of joy right out of my hands, and a lot of times, she does a very good job at it.  I try to hold onto hope that things will be different once each of our babies are born, but at this point I'm not counting on it.  I simply don't see things changing anytime soon, and it could potentially get much worse once the little ones are here.  I feel like she's invaded my life in every aspect...not only my pregnancy, but my relationship with my parents (eating lunch with my parents, doing anything with them, having them over at our house without her showing up), my job (because I work for my parents and she is there a lot), my town (since she moved back here last month), even my everyday enjoyment, because she's always there.  I know things would be a lot better if she would just get a job, but I don't foresee that happening in the near future either.  So for now, I guess I'm just stuck dealing with the mess that my life has become.

Disclaimer: No, I am not depressed (most days); I don't need professional help (although it would be nice to talk to someone who could tell me how to deal with all of this!); and I do very much appreciate my life and all the blessings in it...This is just an overall crappy situation, and sometimes it's very hard to put on a happy face and make the most of it.  I never claim to be perfect, and this is just one of those especially imperfect days.  I'm determined to have a healthy, happy pregnancy with a healthy, happy baby in the end.  I have a great husband to support me, and some awesome family and friends that are actually there for me and understand how this whole ordeal has affected us all. Most of all, I just want to be able to enjoy my pregnancy, because I know that it's a one-time thing for this baby.  I just haven't figured out how to achieve that yet...suggestions are always appreciated!

Resources for Diabetes & Pregnancy

Holy crapola, I just changed my pump site and it hurt like crazy!  I'm sure it had something to do with the fact that I was wingin' it, trying to insert the site without using a mirror at work...not a great idea unless you're amazingly coordinated, by the way!  What I thought was my upper hip actually ended up being closer to my lower back, where there isn't a whole lot of fat for that lovely needle to come to rest in.  Luckily, the sting is subsiding.  I've had plenty of sites that are completely painless, but every now and then I get one that hurts enough to make me cuss...like today!

Painful site change aside, I'm so glad it's Friday!  We have a wedding to go to tomorrow evening (yay, it's finally here!), but other than that I'm planning on using the rest of the weekend for some much-needed rest...and laundry, of course.  I started writing a post last Friday, and never got around to finishing it...that's how busy my week has been!  I had a doctor's appointment (OB) on Tuesday, and everything was fine.  Normal blood pressure, average weight gain (maybe 4-5 lbs total so far, at 14 weeks), and baby's heartbeat sounded great!  Next visit they'll draw blood for the multiple marker screening test that checks for Down's Syndrome, Trisomy 18, and Neural Tube Defects, among other things.  It's completely optional from my OB's standpoint, but according to the source I just read, it is recommended for women with diabetes who use insulin (among other high-risk pregnancies), although it doesn't explain specifically why.  I haven't discussed the test with my husband yet, but I would imagine that we'll go ahead and do it.  For me, knowledge is power and I would rather know early on about potential problems (or twins-omg!).

Speaking of knowledge, before I was pregnant there were very few (dependable) resources available regarding diabetes and pregnancy.  As soon as I was diagnosed last August, I made it my personal mission to find as much information as possible on the subject, because it was the thing that most concerned me at the time (especially being a woman of 22 at the time, diagnosed on our 7-month wedding "anniversary").  Unfortunately, I only found three books, one of which was (and still is) out of print.  Here's the rundown:

101 Tips for a Healthy Pregnancy with Diabetes by Patricia Bazel Geil , Laura Hieronymus , & Laura B. Hieronymous
This book, published by the ADA in 2003, is no longer available from retailers-but you can still find used copies on Amazon (or from other used-book sellers) like I did.  It is in a question-and-answer format and has some decent tips on the three different types of diabetes (1, 2, & Gestational) as they relate to various issues in pregnancy.  Each question and answer are marked with the specific types of diabetes they apply to.  It's pretty straightforward, but doesn't give much information beyond the bare basics that a lot of us probably already know from our medical professionals and personal research online (only from reputable sources, of course).  It would be a good place to start, though, if you're building your diabetes/pregnancy knowledge from the ground up.

Balancing Pregnancy with Pre-Existing Diabetes: Healthy Mom, Healthy Baby by Cheryl Alkon
For me, this was the Holy Grail of diabetes and pregnancy books.  It was current, published just four months before I was diagnosed, and full of information from women who had been through it all-and sometimes, that's the most valuable advice to have.  Cheryl's book was a Godsend because it shows that while pregnancy with preexisting diabetes is challenging, it is definitely doable.  It provides in-depth information starting at preconception, on through pregnancy, and then to life as a mom with diabetes.  The most amazing thing about this book is its friendly, conversational, between-girlfriends tone.  While other books on diabetes and pregnancy can be dry and sometimes dictatorial, Cheryl's guide provides accurate information and advice without being overbearing...in fact, it's just the opposite: encouraging-which is something that women with diabetes often don't encounter, especially when it comes to pregnancy.  We've all heard the horror stories, the discouragement from those around us (and even some medical professionals), so this book is a light at the end of the tunnel for those of us who don't live with our heads in the sand, and yet still believe that we can have a relatively normal pregnancy as a woman with diabetes as long as we take the proper precautions and manage our diabetes correctly.

When You're a Parent With Diabetes: A Real Life Guide to Staying Healthy While Raising a Family  by Kathryn Gregorio Palmer  
As I explained before, the idea of pregnancy with diabetes was something that weighed heavily on my mind when I was diagnosed.  Once I was reassured that it was possible for me to have a healthy pregnancy and baby (as long as I went about things the right way), I started to think about what life would be like as a parent with diabetes.  The idea of managing pregnancy with diabetes is overwhelming enough, but thinking about taking care of an infant while still trying to effectively take care of yourself and your disease is downright scary at times.  Enter this book, published in 2006.  Written by a mother with type 1 diabetes, this book covers everything from pregnancy through talking to your older kids about your disease.  Most importantly, it gives some wonderful tips on dealing with diabetes while you're trying to raise a family, right down to details like where to keep your juice/candy/other low treatments so your kids don't accidentally eat/drink them all, remembering to check your blood sugar in the chaos of daily family life, and explaining to your children what to do in an emergency.  This book, like Cheryl's, is credible because it's written by someone who has been there, and helpful because it's encouraging and informative. 

I decided to review the existing books on diabetes and pregnancy because the ADA just came out with its new, updated guide on the subject in June:
Diabetes and Pregnancy: A Guide to a Healthy Pregnancy for Women with Type 1, Type 2, or Gestational Diabetes by David A. Sacks
Upon finding out about its existence, I immediately downloaded this book to my Nook, excited to finally have some more information on diabetes and pregnancy.  What I found, though, is that it is elementary in its approach, offering nothing more than the information you get from your doctor or online from credible sources.  Maybe my expectations were too high, but I was disappointed when I found that all of this information was just a repeat of what I already knew on a most basic level.  It starts off with the whole "What is Diabetes?" discussion, the types of diabetes and their management, and goes on to explain the effects of diabetes on pregnancy, blah, blah, blah.  Maybe I'm being a little too critical, but I was looking for some new, useful information-not a review of what you can find in almost any current pregnancy or diabetes guide.  I suppose that, as with their tip book above, this book by the ADA would be good for someone newly diagnosed; however, if you're like me and have been reading as much as possible on the subject for a while, you'll probably find the content to be fairly useless in terms of application.  I haven't finished it yet, but I'm over half-way through it and haven't learned anything new.  Cheryl and Kathryn's books remain the most useful and comprehensive books on diabetes and pregancy/parenting available, at least in my eyes!

Other than books, there are some great blogs by women with diabetes who have been through the rollercoasters of pregnancy and parenting with diabetes.  I enjoy reading them because it helps to know that there are people who have been through the same challenges you're going through, and came out on the other side with a healthy baby.  My favorites are Kerri Morrone Sparling's, sixuntilme, and Cheryl Alkon's, Managing the Sweetness Within.

How Diabetes Disrupts My Life

I've always known that diabetes has a tendency to disrupt and/or rule my life on occasion, but the last several days have really made me realize just how much it impacts my routine, especially my ability to do things out of the ordinary.

Exhibit A: My Insulin Pump & CGM.

First of all, let me just say that I love my pump.  It's given me a slightly-closer-to-normal life than I feel I'd have if I were doing shots, which is great.  And by "doing shots," of course I mean MDI, or Multiple Daily Injections, not anything involving alcohol...just to clarify =)  I love that I don't have to leave the table at a restaurant to give myself an injection in the bathroom, because I was never comfortable doing it in public.  And by "doing it in public," I mean injecting insulin into my person.  (I swear I didn't think that this post would come out sounding quite so dirty!)

Anyway, aside from the convenience factor, being on the pump has also given me a level of control over my blood sugar that I don't think I'd be able to achieve with MDI, the primary reason being that I use the "square/dual wave bolus" options A LOT--Like virtually every meal.  And that's something that would be nearly impossible to do with injections.  (For those of you unfamiliar with pumps or Medtronic's in particular, the square wave bolus allows you to administer your mealtime (bolus) insulin over a period of time rather than all at once, which comes in handy when you're eating foods with a lot of fat and/or protein.  The dual wave bolus is similar, but divides your total bolus up into some given upfront and the rest over a specified time period...useful for meals that involve the aforementioned fat/protein as well as more simple carbohydrates.)

For those two reasons alone, my pump is priceless to me.  But that's not to say that I don't resent it (along with this disease) from time to time.  The past few weeks, I haven't worn my CGM (Continuous Glucose Monitor) sensor as often as I probably should.  If it's due to the crazy marks it leaves on my inner thighs (the site of choice since I've been pregnant) or the constant beeping, I've simply had the urge to be free from it here recently, at least for a while.  So when my last sensor went kaput a few weeks ago, I just didn't put a new one in and enjoyed the temporary freedom from it for a while.  My diabetes management didn't suffer much at all-I only had a couple of highs that probably could have been caught with the CGM, and both were after eating some amazing homemade birthday cake my mom made me, so they weren't that surprising.

Sunday night, though, I decided I better get back on the CGM bandwagon and make sure I wasn't missing any consistent lows or highs.  I put a new sensor in, and was back in (beeping) business by Monday.  For whatever reason, though, the numbers I was getting weren't jiving with my meter at all.  That afternoon I hit 209 two hours postprandial (following another slice of the aforementioned bday cake), while my CGM was showing I was holding steady in the 120s-big difference!  I was frustrated, but I corrected it & moved on.  Then later that evening, I was on my Gazelle after supper and got the obnoxious HIGH PREDICTED alert.  For some reason, that alarm sends me up the wall-whether from what it means or the annoying all-caps reminder, it just makes me want to scream.  My screen was showing double up-arrows, so I set my pump to deliver a little more insulin and finished my 30 minutes exercising.  By two hours postprandial, I ended up at 54 and was dropping fast-LOW PREDICTED.  Thanks for that.

I know, I know...you shouldn't bolus from the CGM results.  But it's just so dang hard not to do when the thing is SCREAMING AT YOU IN ALL CAPS(!!!).  So, after I was setting comfortably at 101 post-low treatment, I set the low alert silence to last through the night so I wouldn't be waking up every five minutes due to the incorrect "low" numbers it was showing then.  Yesterday, more of the same, so I finally shut the thing off and restarted my sensor thinking that maybe some good calibrations would do the trick.  Today it's been better, but it's still not spot-on.

The thing about all of this CGM alarm craziness is that it wears on my already-thin patience and sanity.  I didn't realize how much I didn't miss the constant BEEPING until my peaceful couple of weeks came to an end with the new sensor.  Don't misunderstand me-the CGM is an AMAZING invention that has helped me fine-tune my diabetes management and pump therapy in a way that would be impossible without it.  BUT, as with everything else diabetes-related, it doesn't come without its drawbacks, and sometimes the cons can seem to outweigh the pros even though they definitely don't in reality.

Another of the ways that diabetes has taken over my life recently is due to the logistics of travel with a pump.  My hubby and I haven't been on a decent vacation since our honeymoon a year and a half ago, so we've been grasping for chances to get away, if only for a weekend.  The thing is, these attempts are complicated by the very real limitations of being on an insulin pump.  We can't accept last-minute invitations to the water park with our friends, and now that I'm pregnant, even a well-planned water-related vacation is out of the question due to my reluctance to switch to shots for the weekend...the reason being that the last time I was on shots was in January, and I don't want to completely throw off my diabetes management routine (and overall awesome blood sugar #s) for a weekend at the lake, no matter how great it would be to spend time with the hubby's family.  We don't get to see them very often, but I also don't want to risk damage to our little one, no matter how remote the risk of a few higher-than-normal #s.  In this case, the long-term definitely outweighs the short-term, so I had my husband tell his sister that although we want to join them, it just isn't possible right now.  I could be a good sport and go anyway, but I know that it would mean being landlocked in the extreme heat by myself, so I'd rather just stay at home.  I also explained to him that although I may make it look easy and effortless (ha!), dealing with this disease is an everyday challenge even under the best of circumstances, and can be downright maddening when I don't have the standard level of control I'm used to...I'll be the first to admit that I'm a bit of a control freak when it comes to all things diabetes-related, especially now that there is another little life that is directly dependant on my decisions.

Although my hubby understands the dilemmas I face thanks to my diabetes, I know that deep-down, on some level, he has to resent this disease as much as I do.  After all, it isn't just my life that is limited by diabetes, his is too-and if it sucks for me, I know it has to suck for him.  The past several weeks, though, have been especially impacted due to the simple fact that I'm pregnant in addition to having diabetes, which adds a whole new level of limitations.  Even if the water itself didn't limit me from 90% of the activities at the lake, being pregnant prevents me from doing the other 10%.  Please understand that I'm not complaining about being pregnant; I'm just explaining (as I had to do with my husband the other night) that it does realistically limit some of the activities I can do.

We talked about going to Carlsbad, NM, with some of our friends, which I was all for...Even I can walk through the caverns and the zoo they have there!  But just today at lunch, some of my hubby's friends were talking about the vacation they just got back from in Colorado that involved white water rafting and such...his eyes lit up, but all I could think was "Not so fast, buddy...you know that's out of the question on SO many levels!"  Hopefully one of these days we'll agree on a mini-vacay that involves activities we can both participate in and enjoy, but until then I have a feeling I'm going to be resenting my diabetes for all the limitations it puts on my life-and my husband's.

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!