It's Been A Long Time Since (You've) Seen (My) Face...

When I was thinking of a title for this post, I couldn't get this song out of my head:

I know it's been entirely too long since I've written, and all I can say in my defense is that I've been incredibly, incredibly busy and a lot of things have been going on in our lives.

First off, my husband got back around a month ago from working out of state and got to be home for three weeks, but then his brother's wife had their baby so he went back to run his crew while he took some time off. That was a little over two weeks ago, and even though I'm used to him being gone, it still isn't fun to see him go.

It usually isn't too bad once Baby Girl and I settle into our routine, but this time has been a little different. Instead of our usual staying at home during the day schedule, the first few days of last week I was a group leader at our church's VBS. I also had to fix a stopped up drain in the bathtub by myself, and have been washing curtains, miniblinds, and moving furniture and boxes (by myself) for the past two days in anticipation of our new windows that are being installed tomorrow. I was informed of this appointment on Saturday evening, and my husband isn't getting home until late, late tonight. All of that on top of trying to keep up with our little one, the house, and my work stuff hasn't been easy.

Besides the chaos, I've been in and out of doctors appointments trying to figure out what's going on with me lately. I've mentioned my anxiety issues before (which started with my Chiari flare-up around a year ago)...simply put, it's hard to tell when the physical feelings I'm experiencing are due to my diabetes (low blood sugar), the Chiari stuff, or anxiety. Some of the symptoms overlap, so it's basically a process of elimination. Add to that the fact that my husband has been gone for the better part of six months, and my anxiety quickly got out of hand. One ER visit, a Holter monitor test, and an echocardiogram later, the doctors haven't found any physical cause of my heart racing and palpitations. Everything has come back normal, so at this point we can safely attribute it all to anxiety...upwards of $2,500 in testing/visits later.

It's all been frustrating to say the least, and all I want is to feel better...normal. I've literally reached the point of being "sick and tired of being sick and tired." It seems like if it isn't one thing, it's another. My awesome doctor has been working diligently to balance my medications in order to gain control of my anxiety, so that's been a huge help. Since I was having actual panic attacks, I was taking a very small dose of Xanax whenever they would occur until the Celexa started to kick in. Since that failed to effectively manage my anxiety level, she upped the dose on my Celexa and prescribed me Buspar to replace the Xanax (not on an as-needed basis, of course, but as an additional means of eliminating the anxiety). With the addition of the Buspar, my anxiety has all but disappeared.  So basically, I'm taking a lot more medication than I'd like to be on, but I'm finally starting to feel human again.

Ideally, I would like to be medication-free, but obviously that isn't an option for someone that needs artificial insulin to survive. I'd at least like to get rid of my muscle relaxers for the Chiari and my anxiety medication, though. I discussed it all with my doctor keeping the future in mind, because I didn't want to be on something that would either be extremely hard to come off of or dangerous during pregnancy/breastfeeding later on. I'm by no means ready (physically or mentally) for another baby, but clearly I have to plan waaay in advance for those things!

Diabetes-wise, it's pretty much hit or miss it seems. I have some days or weeks that are really good, and some that I'd rather not think about. Highs frustrate me, but lows scare me. I've been very successful at avoiding the lows, but I still see more highs than I'd prefer to have. My next endo appointment is next month, so I'm interested to see how my A1c is. If I had to guess, I'd say it's probably going to be about the same as last time. I'm just hoping it's not worse. It's hard to explain to someone who doesn't have to monitor something that their body does naturally, but it's unbelievably frustrating to try so hard and want so badly to have normal numbers and not get them. I'm also pretty self-sufficient when it comes to my diabetes management, but I think if my numbers aren't where I like them this go-around I'm going to enlist some professional help to see what I'm doing wrong. I think sometimes I just get in a rut and either miss things I could be doing; or the opposite, I start doing too much and screw everything up.  I know a lot of it can probably be attributed to the stress I've been dealing with, but that doesn't make it any easier to accept. If anything, that lack of control just adds to the stress.

More than anything, it all makes me want a cure that much more. At our last JDRF board meeting, we were shown this video: http://www.youtube.com/watch?v=QNYI3ofxbJ8 (for some reason, I couldn't find it on Blogger to embed, so you'll have to follow the link to watch it). It's so amazing to think that in the semi-near future, people with T1D will have the ability to wear a machine (insulin and glucagon pump + continuous glucose monitor) that automatically regulates their blood sugar. Obviously it's not a full-blown cure, but it is a dramatic, exciting leap in diabetes technology. In addition, there is also current research that is focusing on encapsulating functioning islet cells for implantation to replace the body's own nonfunctioning cells, which would be very close to a literal cure in my way of thinking. Either way, my biggest hope is that I'll be able to utilize these technologies in the near future to achieve a better level of control over this disease.

With that said, I better go put our puppy up for the night and get ready for bed! My husband just made it into town, so I think I'll spend some time with him rather than my usual Facebook =)

Everything Works Out With Time

In my last post, I talked about my decision to try and make working from home work for all parties involved.  I'm SO glad to say that I've been doing exactly that for the past couple of weeks, and it's been great. Not only can Baby Girl play without me having to worry (as much!) about her getting into stuff; I feel like I can focus on work better because I'm not worried about everything that isn't getting done at home! And most importantly, my blood sugars have been much better since I made the change. The first week and a half or so, my average dropped about 10 points!

I still get dressed in the morning, because I figured out when I had my daughter that I just feel better if I don't stay in my PJs all day. It also makes it easier when I do need to go run an errand, or meet my mom for lunch! I feel like I've stayed on top of the housework better, because I can throw a load of laundry in the washer in between doing other things. I haven't spent much time just relaxing, or watching TV, or anything of that sort, but I'm less stressed just knowing I'm at home.

One of the most awesome changes this has all lead to is that I've started to get moving again! I had been working out consistently until about two weeks before Christmas, when my daughter got an ear infection and was running fevers of 105°+. After that, and with the usual holiday stuff, I just kind of stopped. Working out is a habit that is so incredibly hard to start and so, so easy to quit. I also have a bad habit of thinking in terms of "Well, I can't actually go for a run (because my blood sugar might go too low, or I'm not wearing the right clothes/shoes, or whatever, so I'm just not going to do anything." Big mistake, by the way. Something is always better than nothing, even if it's just a little something.

Going for a walk in the afternoon is great for both me and the baby (toddler? Oh my goodness!). It's nice to get some fresh air after being cooped up in the house, and Baby Girl enjoys that just as much, or maybe even more than me. She loves being out of the house and watching all of the cars and animals go by. Yesterday we walked by a pasture with some cattle grazing in it, and they got spooked by our stroller. She loved watching them run around! And whenever she sees a dog, she goes, "Ooof, ooof!" (Although every animal says "Ooof" according to her!)

I'm hoping that this will all be a step towards losing those last ten pounds and just being healthier in general. I know it can't hurt! It's funny, though, because I still feel like I'm on an extended vacation or something. Or like I'm "playing house", pretending to be a stay-at-home mom! I suppose I'm technically almost there, because I'm officially a work-at-home mom now =) Bottom line: I'm so, so glad things are starting to go my way and that maybe, just maybe, life will be a little easier and better as a result!

God's Timing

I thought I would try to blog more frequently this year, but once again it's been a month since my last post! I discussed last time how I fantasize at times about what life would be like for me now if I didn't have to deal with T1D, but I want to talk this time about something a lot of people bring up when I tell them I was diagnosed with something that used to be referred to as "juvenile diabetes" as an adult.

As many of you already know, I was diagnosed with T1D on August 24, 2010 (my seven-month wedding "anniversary"), at age 22. Some people think it's probably harder on me since I know what it was like to be T1D-free, and others think it's better because I got to have a normal childhood. To be honest, it's both. I sometimes think about how easy things were before, when I could eat something and not have to think about how it was going to affect my blood sugars. I always ate fairly healthy most of the time before, but it was still nice to have the option not to every now and then and not having to worry about it having a lasting impact on my body! I think that being healthy, or even being "normal", is something that we all take for granted until our lives change and make us think about things differently.

On the other hand, I'm so, so glad I was able to have a pretty average, healthy childhood. I didn't have to worry about my blood sugar being low during class (or recess!), or trying to hide an insulin pump under a prom dress. My pancreas did all of the thinking and worrying for me...until it quit. I think a lot about how I could have easily been diagnosed a year or two before, while I was still in college. I don't know if I could have graduated with a 4.0 had I been forced to deal with T1D on top of everything else. I biked across campus to get to my classes, so I would have had to factor in how that would affect my blood sugar on top of an already hectic eating schedule...one semester I had classes from 9:30 a.m. to 3:30 p.m., so I pretty much had to eat lunch at breakfast time if I didn't want to starve for the rest of the day. If I had T1D back then, I wouldn't have been able to do that.

When it comes down to it, I know God has a plan for my life and that I was diagnosed when I was for a reason. I'm incredibly thankful that He gave me the time to get my body back under (relative) control before we decided to have children instead of me having to figure out an entirely new life during pregnancy or while trying to take care of a baby. It's hard enough caring for a little one and dealing with diabetes at the same time even with the past couple of years' experience under my belt. Our now-toddler is pretty high-maintenance at times, but my diabetes is just as bad as a colicky infant...but sadly, it's one that never grows up!

Timing is everything in life, and with diabetes it's no different. Some think that being diagnosed as a young child (or baby) would be preferable to being diagnosed later in life because then "you wouldn't know any different," but try telling that to the parents of a 15-month-old whose life won't be the same until a cure is found. Diabetes is so much more manageable today than it was before insulin was discovered a little less than a century ago (when it was a virtual death sentence), or even before the advent of home blood-glucose meters in the last 40 years; however, it's still an absolutely life-changing event for the person who is forced to deal with it.

I don't think people without diabetes can truly understand how gut-wrenching it is to know you're going to have to depend on a medication for the rest of your life (at least until a cure is found!), something that is far from perfect. You can easily use too little or too much; dosing is not an exact science. And even if you do get the dosing exactly right based on what you're eating, a multitude of other things (that you can't always account for) can impact your blood sugar levels--stress, sleep (or lack thereof), exercise (or not exercising)...the list goes on.

Having tight blood sugar control also comes at a price--the lower your average, the higher your risk of lows. Low blood sugars are so frightening to me now that I have someone that depends so fully on me that I usually err on the side of caution these days and run a bit higher than I'd like just to avoid them. This is the catch-22 I'm facing now that we're trying to decide when to expand our family. Before I didn't really have to worry about the lows, so I would always choose them over a high. Now I just don't have that option, so getting back to the level of control I had before and during my pregnancy has been extremely difficult.

For that reason, we've decided that I'm going to have to make some changes to my routine before we think about another baby. The stress of coming to the office every day and taking care of Baby Girl while I'm working (and the fact that my husband is working out of the state until June) makes my blood sugars even harder to maintain, so I talked to my bosses(/parents) recently about working from home the majority of the time since my averages are always better when I'm there. I don't know when I'll make that transition, but I'm hoping it will make my life a little easier. At this point, any amount of "easier" is better in my book! I went back and forth over this decision, but at some point you just have to do what's best for you and your family. In this case my health is also hanging in the balance, so that adds an entirely different dimension to the game.

While I don't know when we'll seriously consider adding to our family, once again I know God has a plan for us and everything will happen in His time. I'm just going to have to trust that whatever needs to happen to get my life (and blood sugar) back under control will happen, and do what I can to make things better for my family!

Happy New Year! (2012 Summary; The APP & SDP)

It's a new year again, and what a big year 2012 was for us! I could go into more detail, but I think it can all be summed up in one simple sentence: We became parents! Everyone talks about how parenthood changes your life, but you truly don't understand it completely until you're a parent yourself...even when you're pregnant you can't fully comprehend what it's like to go night after night (after night, after night) without good (or even decent) sleep, or on the flip side, the amazing, indescribable joy that comes from the simplest things, like when your baby smiles or laughs.

It was also a year filled with new challenges in regards to my diabetes management routine. In the two and a half years since I was diagnosed, I don't think I've ever had such a hard time controlling my blood sugars-- aside from the first couple of weeks that I was pregnant. The biggest change for me has been a new-found fear of lows...even when I was pregnant, lows weren't really that big of a deal. If I were given the choice, I'd have picked a low over a high any day. Now that there's a little person whose safety is very literally completely dependent on my being able to take care of her, though, I have a very different view of things. I was extremely cautious about lows shortly after our baby was born, but it wasn't until my first experience with glucagon and what turned out to be a Chiari-related scare in Target that I became terrified of them.

My biggest fear is that I'll be giving my baby girl a bath or driving down the road with her and have a debilitating low. Either of those cases would be horrible, and they're not something I like to think about...but I have to. I have to because I have to think about them in order to prevent them. I don't get my sweet baby ready for her bath until I check my blood sugar, and I'm very careful while driving too. For the most part, I haven't had very many bad lows because I've been intentionally running slightly higher than I'm used to to avoid them.

As a result of that, though, I've had way more highs than I'm used to, and I hate it. I hate it because I'm a perfectionist to the core and want my numbers to be normal(ish). I told my husband we'd wait until our little one was at least a year old before thinking about another baby, but at this point I'm not comfortable enough with my ability to control my blood sugars like I did during my first pregnancy to take that step yet. I want to give our next baby the same chance at a good, healthy life as I did with our first, end of story. I don't know when I'll be ready, but I do know that it won't be until I get a better handle on things d-wise.

I've made a lot of changes to my insulin routine over the past few months in an effort to gain better control, but it's been hit or miss. What works one week (or day) may not the next, and any change in my routine causes a major overhaul to my insulin needs as well. I started exercising consistently a couple of months ago, but the week before Christmas our baby girl had an ear infection and I couldn't work out. Then there were the Christmas holidays, and since my husband was home (he's been working a few states away), I wanted to spend as much time possible as a family. Since then, I just haven't taken the time to exercise. I need to get started again because I KNOW I feel better when I'm consistently working out, but it's so hard to get back into the habit! I can also tell a big difference in my blood sugars then, although it makes preventing lows a little more complicated =)

Last year there were a lot of successes in the diabetes technology world too. The Artificial Pancreas Project is making good progress, and looks like a very promising treatment method for T1D. I know it's still going to be a while before it's available to the general public, but it's hard not to get excited about it! Here's what I posted on my Facebook page about the APP:

It's not a cure, but it will make our lives better and easier...a little more normal. Normalcy is something you take for granted until it's gone.

THIS is what we're all working for. As Jeffrey Brewer (JDRF President and CEO) says, "Less until none." Less needles, less complications, less highs and lows. Those are the things that T1D steals from us. You often hear about the time diabetes takes from your life, but most of the time it's discussed in terms of the years lost at the end. The reality of living with this disease means that you lose seconds, minutes, and hours; everyday moments (like sleep, when you're waiting for your blood sugar to stabilize before bed) and priceless ones that you can't get back. I don't even want to think about all the precious time I've missed with my daughter, being forced to tell her to "wait just a little bit" while I check my blood sugar, fix my basal rate, or change my pump site. It's so, so hard to put the needs of my diabetes before hers, but in the end I know it's what I have to do...the whole "put your oxygen mask on before assisting others" thing. Not doing it isn't an option, because I refuse to let diabetes steal anything else from my life or hers.

I think a lot about what my life would be like without T1D. Of course I know what it was like before (I was only diagnosed a little over two years ago), but I'm talking about now. Now that I have a daughter who needs me, and whom I love more than anything else in the world. It would be so awesome to not have to calculate carbs, or think about how everything else (sleep--or lack thereof, exercise, illness) will affect my blood sugar. It's a constant balancing act, and it always seems to tip to one side or the other. I would love to be able to have normal blood sugars again without thinking about it all. It's the "what if" that a lot of people with T1D don't like to fantasize about, because they don't want to get their hopes up that a cure will be found in their lifetime. I, however, have faith that even if a true cure is a long way off, new research developments will at least make our lives better. And as Chuck Eichten says in his book "The Book of Better: Life With Diabetes Can't Be Perfect. Make It Better", any amount of better is better. Perfection isn't attainable (although that's something I've yet to take to heart!), but better is. The Artificial Panreas Project isn't a cure, but it will mean a better life for those of us with T1D.

On a similar note, Congress recently renewed the SDP (Special Diabetes Project), which means that millions in essential funding will be available for diabetes research. According to the JDRF, "The SDP provides nearly 35 percent of the publicly-funded T1D research at the National Institute of Health (NIH)." This is HUGE. The JDRF works incredibly hard to obtain private funding, but private donors alone can't fund all the research that needs to be done, and the SDP covers some of that gap. Why is that so important? Because a cure could be waiting to be found in that gap. If the funding isn't there, the research doesn't get done. If the research isn't done, no progress can be made. If research progress is at a stand still, we don't get any closer to finding a cure. THAT is why it's so important.

Hopefully 2013 will bring some amazing new developments in diabetes treatment and technology, and better lives for all of us living with this disease!

Frustrations

It's been about a month since I last posted about changing all of my pump settings, and although things have gotten better, it hasn't been as noticeable (or quick) of a change as I'd like it to be. To be honest, I've been very frustrated with my lack of progress. Everyone who knows me or reads my posts is well aware of the fact that I'm a perfectionist to the core...so when my blood sugar #s are not where I'd like them to be, it irritates me.

The worst part about it all is that I know I can do better. Throughout my entire pregnancy, even though I had plenty of lows and highs, I was still able to keep my average in the normal range and my A1c stayed under 6.0%. Recently, however, I've had such a hard time getting my average back down to 130-135...it used to be closer to 115. I know a lot of it probably has to do with changing hormones (hello, postpartum period) and stress (ditto), but it's been hard for me not being able to control things as well as I used to.

I'm torn between being afraid of crashing and annoyed by highs, and for the past couple of months, the fear has won out. Now that I'm sure of what's behind my dizzy "low" feeling and that is slowly getting better, I've been slightly more comfortable with running lower again. It seems like such a long, frustrating road, but I'm hoping that my progress (however slow it may be) will continue and things will get better.

I re-worked my basal/bolus rates once again just like I did about a month ago, and again increased my TDD of insulin in hopes that it'll bring my average down a little more. As frustrated as I am by feeling so "out of control", I feel like that's all I can do so that maybe--just maybe--it will help. Either way, at least I'll be doing something, which always makes me feel better about the situation.

Through all of this, I've tried to remind myself that a few months of so-so control compared to a year and a half or two years of pretty great control isn't so bad...that in the grander scheme of things, it shouldn't make much of a difference. Nevertheless, as Type A as I am, it still feels comparable to one of those irritating little rocks in your shoe that you can't get to. Last week, I bought one of those at-home A1c tests that you mail off and can then get results either through the mail or online. I received an email this morning that my results were in, so I logged on and was admittedly more than a little disappointed to see it was at 6.9%. I know that the ADA recommends that someone with diabetes keep their A1c under 7.0%, but being the perfectionist that I am and knowing what I'm capable of, I like to keep mine in the normal person's normal range (4.0-6.0%). Even when I was first diagnosed, mine was never higher than 6.5%!

Now I know that 6.9% is still in the 6's, and it's still below 7.0%, and my endocrinologist will probably not care as much as I do about it. Usually, I'm much harder on myself than he is, but that doesn't mean I'm comfortable "slacking off." I want to be as healthy as possible for as long as possible...I love my baby girl too much to risk anything else!

Overhaulin'

On Friday, I wrote about doing a complete overhaul on my basal/bolus rates to get a better handle on my numbers. I wasn't sure what to expect, so I went into it with an open mind and some hope that things would finally be better...or at least not as bad as they had been! Well, I'm happy to report that although I've still had some wacky numbers (then again, who doesn't?!), everything is looking much better than before.

I was very skeptical of the one basal rate working effectively, but lo and behold, it seems to be working! My current rate is a little higher at night than the previous ones and quite a bit lower during the day than before, but it seems to be keeping me steady through the entire 24hrs. I'm thinking this single rate thing is going to stick around for a while!

Bolus-wise, I've been trying to trust the bolus wizard, so my postprandials are also much, much better. It's almost weird seeing numbers that are very close to the normal range, because they've been so far from that lately. I'm so glad to feel like I'm finally gaining control of the situation again...those of you who know me are well aware that I'm a perfectionist, so I like to keep my numbers in a tight range. It's always worked for me without too much trouble (except for at the very first of my pregnancy), but I've been so terrified of lows recently that I've ran quite a bit higher than normal just to avoid this...and avoid them I have, but that also means that my average is not where I want it to be.

I'm hoping that with the changes I've made and a little luck, I'll be able to bring everything back to where I want (/need?) them. I've also been working on the stress in my life and trying to improve things (myself included) so I can feel more like myself again. Sometimes I get so overwhelmed with everything that I forget to actually live. Motherhood is hard, and diabetes makes it infinitely harder, but we all do the best we can with what we're given...some of us are just given a little more to deal with than others =)

I knew theoretically how I was supposed to deal with my diabetes on top of parenthood, but reality is always quite a bit different (and a lot less rosy) than the books make it out to be! It seems like whenever my baby needs me most, my diabetes decides to make itself (well) known. Any other time it's perfectly content to lurk in the background, but whenever Baby Girl is throwing one of her Linda-Blair-esque fits or needs to be fed, my CGM is bleeping its lows or highs. I then have to stop what I'm doing and fix the problem, all while my poor baby screams. Her cry is my Kryptonite...it completely gets to me. I can't stand listening to her cry...needless to say, the "Cry It Out" approach is pretty much out of the question for us!

Bottom line, diabetes sucks. But until there's a cure (yay for the JDRF Walk tomorrow!), each of us has to deal with it the best we can...all of the ups, downs, and in-betweens. Some of us deal with everything better than others, and all of us have times when we lose our grip on things. The main thing is to refocus, reevaluate, and try your hardest to keep things in perspective =)

Back to Basics

First off, an update on my last post...I had my appointment with the neurosurgeon last Friday, and it went fine. He said that all of my symptoms were, in fact, due to my Chiari Malformation and that we had two options in regards to treatment. First, we could consider surgery (an option I wasn't a huge fan of due to the extensive recovery required), or we could simply wait and see if my symptoms got better. He was thinking that the vascular changes during the pregnancy and postpartum period may be causing more congestion in the craniocervical area and further compressing my cerebellum and spinal cord. In theory, then, once my body returns to "normal" at the end of the postpartum period (around a year after birth), my symptoms might be alleviated...fingers crossed!

Oh, and the T2 hyperintensity mentioned on my MRI report? He called it a UBO--Unidentified Bright Object! Thankfully, he said that I didn't have any symptoms of MS or any other neurological disorder, so he said for all intents and purposes we could consider it a fluke. He'll probably order another MRI in January to make sure that's the case, but I was satisfied with his explanation.

My next appointment with the NS to re-evaluate the situation is at the end of November. It seems like I've felt slightly better since the weather has cooled down a bit, but some days are still very difficult. Since I'm still breastfeeding, he couldn't give me anything for my dizziness or neck weakness, but he did say that massage might help. I haven't had a chance to call the one we have in town, but it's on my (never-ending) to-do list. He also said it was fine for me to start running again--I had stopped when all of this started because I was afraid of passing out. As long as I start slow and wait until it's a little cooler, the NS thought I would be fine.

Now that we've established that my symptoms are due to Chiari, maybe I can get a better handle on my blood sugar numbers again. I've been running higher than normal in order to (almost) eliminate the possibility of a low causing my sudden dizzy spells. Of course, with the way I've been feeling it's still hard to tell, so I've been testing A LOT more often...as in around 20 times/day instead of 10 or less. Not so budget-friendly, by the way--I've had to order a couple hundred extra test strips out of pocket in the past two months just to have a big enough supply. Thank goodness for Amazon!

My last official A1c was 5.5%, but I'm betting that my next one will be quite a bit higher. I'm hoping, though, that I can get things back on track and get my numbers back into the normal range where I like them.

To that effect, I decided to re-configure my basal/bolus rates for my pump. Of course, there are various methods and opinions on how to go about this, but I decided that it couldn't hurt to start back at the basics and work from there. It goes without saying (at least I think) that I'm not here to provide medical advice. As always, YMMV...what works for me may not work for you, and vice versa.

For the past week, I've used an average of 26 units/day, with 59% going to basal. It seems like it's best for me to have around 60% of my TDD as basal and the other 40% as bolus, but anywhere between the 50/50 and 60/40 range works fine. Given that my numbers are at least 20% higher than I'd like, I decided to increase my TDD to 31u/day (19% above what I'd been using). So:

31*0.60=18.6u total basal
18.6/24hrs=0.775u/hr basal rate

Since I'm still in the experimental mode for the time being, I decided to make that 0.75u/hr for simplicity's sake--which would mean 0.75u/hr*24hrs=18u total basal (58% of TDD)

I haven't had only one basal rate since I started using my pump, but I figure that you have to start somewhere! With the new rate, I can watch for patterns in my numbers and then adjust my rate accordingly.

Currently, I've been having a lot of correction boluses for highs...entirely too many for my liking. Since I've established that, I decided it wouldn't hurt to tweak my carb ratio too. Going on the 450/TDD=carbohydrate-to-insulin ratio (CIR) formula, that means my calculated ratio is 14.5grams/unit, rounded to 14. My pump was already set to a carb ratio of 15:1, but I've been dialing down the estimates a lot due to my recent fear of lows. Note to self: Stop. Trust the Bolus Wizard.

My nifty cartoon of how I envision the Bolus Wizard on the Medtronic Pump...

Next, Insulin Sensitivity Factor (or Correction Factor) is calculated by dividing anywhere from 1500 to 1800 by the TDD. The higher the top number, the more conservative the correction factor:

1800/31=58
1500/31=48

Since my previous ISF was set at 57, I decided to pick a number halfway between (53) until I know how it's all going to work. Hopefully I won't have to use it as often with my new settings!

Now I guess it's just a matter of testing, reviewing patterns, and adjusting everything accordingly. If everything goes well, I'm hoping that I can be back in the normal (or at least closer to normal) range before long!

Low Places

As with everything else in my very type-A life, I began thinking about what my life as a parent with diabetes would be like long before I was even pregnant.  True to my need-to-know-everything-about-anything-that-affects-me form, I read a book on the subject last year 
(When You're a Parent With Diabetes: A Real Life Guide to Staying Healthy While Raising a Family by Kathryn Gregorio Palmer).  It's a great book with tons of tips for managing your disease in the context of parenting, and I highly recommend it.  Of course, no matter how much reading you do, nothing ever really prepares you for reality quite like...well, reality.


I knew theoretically that there would be times when my diabetes got in the way of parenting to the point that I'd sometimes have to put taking care of my disease before taking care of my child (the whole "putting on your own oxygen mask before trying to save your children" thing); however, I never imagined how bad this would actually suck in practice.  Before when I had a low, even a bad one, it wasn't much cause for concern.  I'd treat it, wait a bit, and go on with my life.  Now, though, there's another little person who is completely dependent on me to think about.  When I have a low, I have to drop what I'm doing with her to treat it, which usually means leaving her there to cry on her own for what in reality is only a minute or two but in my world seems like an eternity.  Probably the suckiest time that this happens is when I've just sat down and have everything situated to feed her, only to have to leave our comfy home base (aka, the recliner) to find something with sugar as quickly as possible so she doesn't break into one of those gut-wrenching, inconsolably angry crying jags.  Ordinarily, getting up from a chair wouldn't be a big deal; however, when you're (severely) sleep deprived and are trying your best to satisfy a crying baby, it's an entirely different story.


I've also been letting my numbers run slightly higher than normal, especially at night, because now the fear of the low you don't wake up from has an entirely new dimension.  Our poor baby would undoubtedly go hungry until morning, because although the hubby helps me as much as he can when he's home, he just doesn't wake up at night.  The first two nights in the hospital, he woke at her every cry...now, sometimes I think it'd take a freight train to wake him up!  One of our first weeks at home, I remember having a pretty bad low during the night.  I turned the lamp above our bed on and went to get some glucose tablets, then came back to our bedroom to wait it out.  15 minutes later, my blood sugar still hadn't risen much, so I grabbed some orange juice from the fridge in the kitchen and crossed my fingers.  My blood sugar was back in the normal range after that, but I was hit with the realization that (a) my hubby (aka, the slumbering log in bed next to me) didn't even know I was up and (b) the baby wasn't going to be much help if I passed out.

Since then, I've made sure to keep a close eye on my numbers before bed, and set temporary basal rates if necessary to keep me hovering above 100.  Of course, this inevitably leads to slightly higher numbers first thing in the morning; however, at this point I'd much rather run a bit higher on average than to risk the danger of a horrible low at night...there's just too much at stake now!

When I was pregnant, I had to keep a super close eye on my diabetes because it very directly affected the baby growing inside me.  Thanks to the hormonal changes that come with pregnancy, it was very difficult to keep my numbers in a tight range.  I figured it would be a lot easier after the baby was born, and in a way it is...because my hormones have returned to normal, I no longer have to take massive amounts of insulin to cover my carbs at meals, and my patterns are a lot more predictable.  However, the fact that my baby is no longer directly affected by highs (but just as much by lows) makes me a lot more laid-back when it comes to my blood sugars than I was before.  Don't be mistaken; highs still frustrate me and I'm still concerned with keeping my average in a reasonable range; but at this point, I'm more concerned with the lows than the highs.  Once I get a better handle on the parenting thing, I know I'll return to my perfectionist style of diabetes management...for now, though, I'm okay with good enough.

Baby Love

Yesterday was the last official day of my maternity leave...and I honestly can't believe six weeks went by so fast.  I know everyone says that once you have a baby they grow up in the blink of an eye, but I've found out that (like many other things, a la the accompanying lack of sleep) you really can't understand this phenomenon until you have one of your own.


Six weeks ago, our lives changed.  Six weeks ago, we brought home a precious baby girl that still seemed like somewhat of a stranger to us (but whom we've since come to understand a little better, thankfully!).  In the time since, I've grown as a person.  I've learned what it truly means to be selfless as I've spent countless hours in a sleepless delirium trying to please a screaming baby, often to no avail.  I've come to understand a different kind of love, one in which the prospect of this tiny person being hurt, sick, or just unhappy brings a sinking feeling to my chest.  I've learned that good enough is, in fact, good enough when it comes to many things that I was a perfectionist about in the past.  Not only is it very difficult to get much accomplished when you're at the mercy of a newborn's crazy "schedule;" it's also incredibly easy to pass the hours and days entirely just holding her in my arms.


Then there's the sheer awesomeness of watching her grow and change before our very eyes...My husband was quickly amazed by the fact that such a tiny little girl could be so strong, and I love to take pictures of her (sometimes several a day) and look back to see how different she looks a short time later.  Around her one month "birthday," she started smiling...#ohmygoodness!  Her adorable toothless grins never cease to put a smile on my face, even if it is just while she's carrying on one of her "conversations" with the ceiling fan!  Last night, I had finally managed to calm her down after she'd been crying when she sighed dramatically.  I mimicked her, and got a huge smile in return!  It's true when they say that you'll do anything you can to get those priceless grins =)


She's also starting to interact more with the world around her.  There is a canopy on her Pack 'N Play that has giraffes hanging from it, and the other day while I was getting ready in the bathroom a short distance away, I could hear her cooing at them...and now they're within arm's reach!  I also finally ordered the Skip Hop activity gym I'd been wanting to get for her--it's a little pricey, but it's much cuter than any of the others I've seen.  The first time I laid her on it after it came in, I propped her up on her tummy on the miniature Boppy-style pillow it comes with so she could look at herself in the mirror, and I was amazed at how much head control she has!  It didn't take long for her to topple over the front of it, though, because her little legs never stop moving...if I lay her on my stomach, she quickly ends up by my face/shoulder as the result of her pushing off with them.  Of course, I knew when I was pregnant with her that she was going to be a little wiggle worm...she never stopped moving!  I didn't even bother doing the prescribed "kick counts" at the end because she moved so much...in that way, she's definitely her daddy's child!


To shift gears a little, I was reading a post on SixUntilMe the other day about Kerri checking her daughter's blood sugar and the fear that comes with being a parent with T1.  As Kerri says, it's a thought that creeps up on you, either during (or before) pregnancy or when a harmless symptom (such as a wetter-than-normal diaper or an extra-thirsty baby) pops up later on: the big "What if?".  As a PWD, we're very familiar with the subtle symptoms that accompany this disease, and sometimes we're a little over-vigilant when we see them in those around us.  The thing is, just like Kerri said in her post, there's no need to sit around fearing that our children will suffer the same fate we did in the autoimmune/genetic pool.


When I was pregnant with our little girl, the question of whether or not she would "get it" (T1) too came up fairly often.  I tried to use these instances as education opportunities as I informed people that my children would have about the same chance as anyone else of ending up with this disease.  Although their risk is somewhat elevated (4% versus 1%), there's still a very small chance that they'll have Type 1 as a result of my having it.  In fact, as stated on the JDRF website, "only 15 percent of people with type 1 diabetes have an affected first-degree relative - a sibling, parent, or offspring."  Therefore, that my sister and I both have it makes us an anomaly among anomalies...We're part of the 5-10% of people with diabetes who have Type 1, as well as the 15% of the aforementioned group!


Even though the chance of our children developing T1 is very slim, I'm still going to do everything in my power to decrease that possibility as much as possible.  Because of the (loose) link between the protein in cow's milk and T1, I chose to use soy formula when we were forced to start supplementing.  Of course, the original plan was to breastfeed exclusively for the first six months; however, we had to start supplementing with formula when she wasn't gaining weight like she was supposed to (which I still believe is possibly due to gastro esophageal reflux, because she will do fine for a minute or two, then arch her back away screaming...her two-month checkup is about two and a half weeks away, so I guess we'll find out then).  Because not much is known about the cause of T1 (and because it's an autoimmune disease, and therefore extremely complicated), it's so hard to know what to do to prevent it...I suppose all we can do is raise our kids with a healthy lifestyle and hope for the best!


What many people do not understand is the autoimmune aspect of T1.  Thanks in part to the media and popular (mis)conception of diabetes, they assume that age is the only difference between the types.  I'll be the first to admit that before I was diagnosed, I didn't understand the difference--and my younger sister was diagnosed years before me!  Since my diagnosis, it's become very clear that we need to put more effort into educating the general public about diabetes, but especially T1.  It would make life much easier for those of us living with it!  I've tried to use every opportunity I get to educate people in everyday conversations, and in November I wrote an article addressing many of the misconceptions about the disease for our local newspaper.  However, it seems like for every person who "gets it," there are 10 more who don't.  Sometimes it seems like a losing battle, but I refuse to give up.  Until there's a cure for Type 1, the next best thing is making living with it easier, and that's something I--and you--can be a part of.

An Eventful Delivery of a Precious Package

My last post was a little over a month ago, but I promise I have a very good reason this time...our sweet little girl is almost four weeks old!  Everything I last wrote about seems like it happened in a different lifetime, because there is now a very clear distinction between our lives before and after baby...and I honestly can't believe how quickly time is flying by now that she's here!  Speaking of which, I'll fill you in on the crazy journey that was her arrival...

As most of you know, we were scheduled for a c-section on January 25th.  The day before, we were supposed to go for my last ultrasound and OB visit to confirm that our little one was still breech and to go over any last-minute details and questions.  However, we never made it that far...it turns out that my mom's "feeling" that she would come before then was right!  Around 2:30AM on the 24th, my water broke.  After waking up my husband (whose first question was, "Are you sure?"...Yes, honey, I am positive that the huge gush I just experienced wasn't courtesy of my bladder!) and calling to talk to the doctor on call, we finished up packing the last few things so we could begin the hour-and-a-half drive to the hospital.  The OB I talked to told me there was no reason to rush; that once we got there, they'd just plan to call our doctor and we'd do the c-section around 7:00 that morning as long as everything looked good.

While we got our things together, however, I started having contractions...contractions that were three minutes apart.  I still didn't think much of it; after all, contractions were supposed to be irregular at the start of labor, right?  We got everything (and ourselves) loaded up in the car and took off.  Since we didn't think we were in much of a hurry, my hubby drove 75 the whole way, just five miles over the speed limit.  Meanwhile, I was trying to hold it together and deal with the pain by breathing deeply.  That worked for a while, but my contractions just got stronger and stronger and were definitely closer together...they were two minutes apart and a minute long the entire way.  By the time we were 30 miles away, I was having a hard time dealing with the pain; when we got into town, I was thinking that I would definitely need an epidural if I was going to go through that for a few more hours!

When we arrived at the hospital, we parked in front of the ER entrance and grabbed my file folder of paperwork out of the car.  Apparently, the triage nurse could clearly tell I was in active labor, because we were admitted instantly and taken up to the labor and delivery floor (fastest ER visit I've ever had!).  Once we got to a L&D room, the nurses started prepping me for surgery and asking me a million questions.  I was in A LOT of pain, and the nurse starting my IV had to keep reminding me to breathe deeply.  They were debating on whether or not to check me to see how much I was dilated, but decided since I'd be having a c-section there wasn't any need.  Right after that conclusion, however, I started to feel some pressure.  Once I told them that, one of the nurses did a cervical exam and announced that I was complete...as in, completely dilated, all 10cm!  (Oh, and she was still breech...which turned out to be a blessing in disguise, because if she'd been head down, she probably would have been born on the road somewhere between home and the hospital!)  At that point, things started moving a lot quicker (and they told me not to push), but I still had to sign more paperwork before they took us back to the operating room...I'm pretty sure my signature was unrecognizable as my own, but I was in so much shock at how quickly everything had progressed that I honestly didn't care!  I just couldn't believe that I'd progressed from 0-60 (relatively speaking, not literally of course!) in just a couple of hours, especially since first labors are supposed to be much longer, on average...Then again, nothing about me ever seems to fall on the "normal" side of things =)  Either way, it explained why I was in so much pain...which, I'll admit, did give me a certain sense of accomplishment since I wasn't sure if I'd be able to handle labor without medication!

Once we got back to the OR, they transferred me to the operating table and quickly shaved me and got everything prepped for the c-section.  Luckily, the anesthesiologist was waiting, so between (super painful) contractions, he did his thing.  (The spinal, by the way, was a breeze...I've had insulin pump sites that were more painful, although I'm sure it seemed a lot less so in comparison to my contractions!)  I was then able to lay down, and felt one more contraction before everything from the waist down went gloriously numb.  Meanwhile, my hubby was scrubbing in for the delivery.  He had planned to watch the c-section, but after everything had gone so quickly, he just wanted to be by my side through it all.  The nurses in the delivery room were joking that they'd have to teach him to deliver babies for our next children, since they always say subsequent labors go faster than the first--yikes!

Up to that point, I'd been wearing my pump and CGM and had been checking my blood sugar every so often so I'd know where I was.  Since I had been consistently around 110 throughout labor, I wasn't worried at all about my blood sugar during surgery; however, things in that respect unfortunately didn't exactly go as planned.  My doctor had given me the go-ahead to keep my pump on throughout the whole process and my CDE was going to be on site in case the anesthesiologist had any questions or problems with it, but since neither of them were there at 5:00 in the morning, I was left to hash out the details with them myself.  The anesthesiologist, though very, very nice and wonderful at his job, didn't like the idea of keeping my pump hooked up, so I had to take it off.  By the time I was in recovery, I think my blood sugar was around 140 (if I remember correctly).  Due to that fact, our sweet little girl's blood sugar was low upon her arrival into the world, something I never thought we'd have to deal with since my control had been so good through the entire pregnancy.

Other than that, however, we were incredibly blessed to have a perfectly healthy baby girl!  My husband got to watch them examine her while they stitched me up, and even got to have her little feet stamped on his disposable scrub shirt...he is so proud of that keepsake!  After they cleaned her up, I got to see and kiss her before they took her to the nursery and wheeled me to the recovery room.  They eventually brought her to me in there to breastfeed in an attempt to raise her blood sugar, but ended up having to give her some formula to do the trick.  For the first 24 hours, they checked her blood sugar each time I fed her and had orders to give her an ounce of formula if it was low again; luckily, however, we never had to do that.

The first two nights, my blood sugar was running so low that I set a zero basal rate and stayed around 100.  It's amazing how much easier my blood sugar has been to manage since delivery, other than the fact that I've had plenty of lows.  I've just tried to stay on top of changing my rates accordingly, and everything has gone relatively smoothly d-wise!

I have plenty more to tell about our new life, but I'll save that for later.  Right now, I'm going to enjoy holding our precious baby girl!

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:

 

Before

After

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 negativity...it'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.

Update Time!

I honestly can't believe it's been so long since I last posted!  Suffice it to say, it's been an incredibly busy one, especially because it's American Diabetes Month...It seems like I've had something diabetes-related to do since the beginning of November.  I'm not complaining, though--I am a very willing participant in all of the awareness activities I've done, and truly believe that all of our efforts are making a difference for the people who benefit from them!

I was contacted last month by Laura from Extreme Southern Couponing.  She has a 9 year old daughter who was diagnosed with type 1 diabetes two years ago, so she was putting together guest posts to feature on her blog throughout the month of November.  She had come across my blog and asked me to share my story with her readers.  Many of you already know most of the details of my diagnosis and journey thus far with T1, but if you're interested you can read it on her site here.

On November 15th, I had an OB appointment and ultrasound in Amarillo, so my mom, sister, and I met my aunt and cousin at Beef O'Brady's for their second "Dining for Diabetes" fundraiser.  They donated a portion of their ticket sales that night to the JDRF, so we got to eat some good food for an awesome cause!  I also got to meet the Branch Manager for the Panhandle JDRF in person, as well as some of the other board members.  They are all incredibly nice, welcoming people, and I can't wait to work with them.

The next day, the article I wrote for the local paper on diabetes awareness was published.  I was incredibly excited to see it happen, because it's something I've wanted to do for a while.  I decided to focus on the myths related to diabetes, because there are so many misconceptions surrounding the disease.  For those of us living with it, having to clear up these myths on a regular basis adds to an already challenging life, so my hope was that by reaching people in our community on a larger scale, things would be a little easier for people with diabetes--especially the kids and young adults who have to deal with it.  It turned out to be a long article, so I'll save it for another post!

I *think* that covers everything diabetes-month related thus far, but I could be missing something.  I was reading "Do Chocolate Lovers Have Sweeter Babies? The Surprising Science of Pregnancy" a few nights ago, and it said that a woman's brain shrinks by 4-6% during the nine months of pregnancy in order to build the baby's brain (at least according to one theory)...my husband says I'm definitely on the 6% end of the range!  Either way, my brain power has been somewhat diminished for the past several months...it's a strange feeling, being in a constant fog.  Then there are the days that I'm convinced I'm losing it, like the day I posted this on Facebook:

I've come to the conclusion that I'm losing my mind! I had to call Mom to ask her a question, but when I dialed her number on my cell phone, the office phone started ringing, so I had to hang up on her. I then picked up the office phone, and no one was there, so I tried Mom's number again. About that time, the office phone started ringing again, so I had to hang up to answer it...And once again, there was nobody there. This went on about five times and I was starting to get extremely frustrated before I realized that *I* was actually calling the office instead of Mom's cell phone number and hanging up on MYSELF. I think I need a break...♥

The diminished mental status and achy hips and back, though, I can deal with.  They're constant reminders that my body is on a higher level of functioning right now to make sure our baby gets everything it needs, and I'm completely okay with that.  When I had my ultrasound on the 15th, I was nervous once again--though not quite as nervous as I was before our first big one in September.  I suppose the worry that everything is developing as it should never quite goes away, but I'm glad that things were still on track with our little one!  She's in the 60th percentile even though I'm measuring smaller, and although she was breech, everything else was where it should be.  As it is in diabetes, "normal" is an amazing thing when it comes to your baby's development!  I'm just hoping she decides to head south sometime in the next 9-10 weeks...=)

My sister also had her baby a month ago after she developed preeclampsia and had to have a c-section at 34 weeks.  Her baby is still in the NICU-she had some breathing problems in the beginning and digestive issues after that, but she's stabilized and is doing better.  She just has to meet all of her milestones before they'll let her go home!  My relationship with my sister has been better since her baby was born, and I'm glad that we've been able to put most of the anguish of the past several months behind us.  The selfish part of me still finds it hard that everything is revolving around her and her baby at this point, but that's just because everyone is so focused on all of that that I sometimes forget we're having a baby soon.  I hear about it so often that I sometimes think of our little one by her baby's name, and that frustrates me!

It's also been hard having my parents gone so often, because it leaves me to take care of the office by myself--something that isn't out of the ordinary, but that can be incredibly stressful at times...and right now, I need to start slowing down rather than taking on more than my share.  We don't have much longer until she'll be here, and we still have so much to do!  I know it will all get finished, but it's still hard sitting at the office when I know there's so much I could be doing at home.  Hopefully I'll have enough time off in the end to get a few things done that I haven't been able to work on, like the quilt that I started over a year ago...The quilting part is not far from being finished, and then I have to bind it, but I never have a solid chunk of time to get it done.

Then I still need to get in touch with a pediatrician, work on my birth plan (/wish list), and about a million other things to prepare for the actual labor and delivery part of things...I try to not let it all stress me out, but sometimes the amount of things I have left to do hits me like a ton of bricks--or at least with the force with which our little girl kicks me sometimes!  Oh-speaking of her kicks, my hubby finally got to feel her kick for the first time about a week ago...I'd been able to feel it from the outside for about a month, but she never would cooperate when he was around!

Well, I think that pretty much covers what's happened over the past few weeks, so I guess I better get back to work!

The Tough Things in Life

Anyone who deals with diabetes on a daily basis knows it's not easy.  I never in a million years thought it would be something I'd have to deal with personally--it was something that happened to "other people."  Then, once I was diagnosed, I realized that even though it's overwhelming at times, it is manageable.  Some days are easier than others, of course, but even with all the carb counting, insulin-balancing, and trying not to let it take over your life, it's doable.  Some people tell me that they "don't know how [I] do it," or that they admire how "strong" I am...Little do they know that when you have a chronic illness, being strong is the only choice you have--otherwise, the disease wins.  I definitely went through a grieving process over the loss of my former "no diabetes" self, but eventually (with a lot of help/reality checks from my husband), I came to terms with the fact that this was just something I'd have to deal with (for the rest of my life).  Some days I don't want to do it, but I do--because I refuse to give in to diabetes.  It may be my stubbornness, but from day one, I've been determined to keep it in check as much as I can and/or kick its butt when I'm feeling up to it.

On the days I'm feeling especially triumphant, I'm able to see that there has even been some good that has come from my diagnosis.  For starters, I lost somewhere around 10-15 lbs as a result of my carb counting, and I took up running--which is something that would shock my junior high and high school coaches!  Most importantly (through lots of hard work, research, and help from my awesome CDE), I was able to rise to the challenge of the diabetes learning curve fairly quickly and take control of my blood sugars to bring my A1C down to the proper pre-pregnancy levels I was shooting for.  It wasn't easy (and still isn't), but I did it.  I would never say that I've conquered diabetes, though, because as soon as you think you have the hang of things, it throws you for a loop again...I just refuse to ever give it the opportunity to conquer me.

On the brighter side of things, diabetes has made me a stronger person.  I suppose you don't realize how strong you are until you're faced with one of your biggest fears, which for me has always been losing my health.  Even though I technically (and thankfully) haven't actually lost it, I do feel like I can no longer consider myself a "normal," healthy person, even if I'm otherwise healthier than a lot of my acquaintances.  When you are forced to face your fears, though, something happens: you (usually) realize that it isn't as bad as you imagined it to be.  Some days diabetes looms in the background, waiting to pounce if I let my guard down long enough; others, it's very much front and center, demanding my attention on a sometimes minute-to-minute basis.  Either way, it's a pain (sometimes literally), but doable.

One thing dealing with diabetes didn't prepare me for, though, is one of the other biggest challenges I've faced in my life.  I've written a few times about how my sister's pregnancy has affected me, and it's still an ongoing and very emotional battle.  It's something else that I never thought I'd have to go through, so finding myself in the middle of it all wasn't just a shock; it's truly been one of the hardest things I've ever had to deal with.  I think a lot of it has to do with the fact that it's a situation I have no control over, even though it affects me and the rest of my family in a huge way.  I resent the fact that she's the one who made her decisions, and yet we're all having to deal with the consequences.  From an outsider's view, many people may wonder why this would be such a difficult situation--after all, women (and younger girls) have unplanned pregnancies all the time.  That's the kicker, though...we all still wonder (and probably always will) if my sister's pregnancy wasn't planned, due to a lot of variables that were in place at the time.  In addition, the timing of it all made it even worse, because it happened right before I was supposed to get my A1C results back so that my husband and I could get the green light to start our family, something I'd been working towards for months, and that everyone knew about.  That, combined with the fact that I have to work full-time to keep my insurance in order to pay for my diabetes-related supplies and expenses and contribute to our bills while she has been jobless her entire pregnancy and has therefore been living off my parents, contributes to feelings of resentment toward her and everything related to the situation.

Even though people tell me all the time not to let her pregnancy interefere with ours, the reality is that it does.  Especially now that her due date is getting closer, my parents are stretched thin taking care of her preparations and appointments (which are very frequent since she's considered double-high-risk due to her own diabetes being so out of control when she got pregnant), and that takes a toll on everyone.  They're stressed out trying to get things done, and that impacts me directly since I work with them every day.  Furthermore, their being stressed makes me feel guilty for expecting anything related to my pregnancy from them since they're already so all-consumed with her.  My mom has been taking me to the majority of my appointments since my husband can't get off work to come with me, but even though my appointments are still three weeks apart, that means more time away for her (both of us see a doctor and will deliver two hours away from our small town since we're high-risk).  Also, my mom always told me she'd paint the nursery for me, but I don't think that's going to happen either.  My parents stopped by one night last week to see the paint color I'd picked out, and my dad told me they'd come help me "after they got done with [my sister's] stuff."  Even though my husband (very lovingly) told me he'd take care of it and I've had friends offer to help, it still hurts to know a lot of things like that wouldn't be an issue if I weren't pregnant at the same time as her.  It may sound horrible, but I honestly can't help but think about how different everything would be if things would have happened the way they were planned instead of the way they've turned out.  I know that all of this is somehow part of God's plan, but it's so hard to see how at the time.

The last couple of days have been particularly tough emotionally, and I sometimes wonder how I can handle all of this anymore.  I'm just so tired of having to deal with all the comments and no one knowing that I'm pregnant ("too"); or even if they do, only asking about her baby.  Even though I know that no one means bad by any of it, it still hurts...a lot.  I spend a lot of the time I'm in public trying to hold myself together, because I can only deal with so much before I can't stop the tears from coming any longer.  What's even harder than that, though, is dealing with my own family's tendancy to talk about my sister all the time.  My mom has been having a lot of fun buying baby stuff, which is great; however, she can't tell me about anything she's bought for our baby without telling me about my sister's gifts as well.  We literally can't have a conversation about my pregnancy specifically or anything baby/pregnancy-related without it somehow relating back to hers, and that wears on me--especially since I'm already more emotional than usual these days.  My mom knows exactly how I feel about everything, and even though I know she'd rather us all get along, it's just not going to happen anytime soon.  I wish that rather than trying to force the issue, she'd just let me enjoy what's left of our pregnancy without having to focus on my sister.  I already feel like I've had to share everything up to this point with her, and now that I'm finally able to enjoy things a little more since we've found out the sex of our baby (girl!), I just want to be able to that without being hindered by anything else...Is that really so much to ask?!

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.