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July 26, 2011

CWD: Pregnancy and Diabetes.

When Jeff Hitchcock approached me last year and asked if I would feel comfortable leading the Pregnancy and Diabetes session at Friends for Life, I was honored.  But also a little confused.  What on earth was I going to tell the session attendees?  I couldn't spout off medical information.  I am not a licensed medical professional.

"I'm just a person with diabetes who had a baby.  And my pregnancy was a bit of a tangled one, too!"  I remember emailing to Jeff, wondering if they'd be better off with a doctor at the helm of that discussion.

He replied within minutes, telling me that was exactly why they wanted me to lead the session.  And I grinned, but felt nervous.

Before the little bird joined our family, I did a lot of research about pregnancy with diabetes.  Hard facts, statistics, and professional recommendations were available by the fistful.  The problem was finding anecdotal information about managing pregnancy and diabetes at the same time.  Before Chris and I left for Spain that year, knowing we were ready to try for a baby, I felt prepared.  But when we came home and found out I was pregnant, I wanted nothing more than to find a room full of other pregnant women who had diabetes, so I could immerse myself in their support and say, "I have NO CLUE what I'm doing!! HELP!!"

Thing is, most pregnancy discussions don't take that kind of personal turn.  I've attended a few other pregnancy sessions in the past (as a participant, not a discussion leader), and I remember leaving with panic in my stomach and a lack of eyelids because I was so bugged out about the information that was presented.  Pregnancy isn't easy, even if you take diabetes out of the equation, so being pelted with gobs of information on "what to expect" can be completely overwhelming.  For me, it made me scared to try, and unsure if I could actually do it successfully.  One session I attended in the past had the speakers throwing out fact after fact about how arduous and chaotic pregnancy is, and then turned to the side, rolled their eyes, and said, "But it's so worth it."

Really?  Is it?  SHOW ME!  Make this accessible!  Help me feel less afraid! 

Looking forward and feeling happy is a good thing.  See?
An example of looking forward, feeling happy, and rockin' yet another hair bow.

During the pregnancy session at the Friends for Life conference earlier this month, we only had a few people participating in the discussion.  I think there were about twelve of us, all women, and we sat in a circle and introduced ourselves.  There were many of my peers in attendance (women with diabetes of child-bearing age), and there were also some moms of little girls with diabetes who wanted to talk about their daughter's future.  I was determined to make the discussion something that made people feel inspired and hopeful.

We talked about pre-pregnancy planning, and the importance of getting your A1C down to a stable level predetermined by you and your medical team.  "Planning ahead is like the most important thing I could ever recommend.  Not that you can plan ahead, every time, but if you're able to, it's crucial."  We talked about "big babies" (not all babies of women with diabetes are "big", and not all "big babies" are the result of uncontrolled diabetes) and the impact of breastfeeding on diabetes management.  (And I found out that I wasn't the only person who liked the idea of hiding fruit roll ups in the couch cushions.) 

Of course, THAT movie came up:  Ye Olde Steele Magnolia(e)s.  Or, as I called it, "Metal Flowers," because it seems like everyone who mentions that movie feels depressed.  I personally love that movie; I just don't care for the taste it leaves in my mouth about diabetes and pregnancy.  "Love it or hate it, it's one of the few mainstream media representations of what a diabetic pregnancy looks like.  Which is why I'm glad we're all here, sharing our stories, because we have the power to change that perception."    

I hope the discussion went well, included moments where people felt safe to ask what they were really thinking about, and that the answers made them feel empowered.  It wasn't a medical session.  It wasn't about a doctor telling patients how to best manage their pregnancies.  It was just a few women, sharing the common bond of type 1, sharing their real stories and drawing strength from one another.

That, to me, is the power of this community.

August 11, 2010

I Couldn't Wait.

I found out I was pregnant and I couldn't wait to know
If 'it's a boy' or 'it's a girl' I would spend nine months to grow.
I couldn't wait for her to show us that she was our little she.
I couldn't wait to see her dancing on the ultrasound TV.

I couldn't wait to touch her tiny hands or kiss her little nose.
I couldn't wait to count her fingers and to tickle little toes.
I couldn't wait for weeks to pass and my body to look round.
I couldn't wait to hear her heartbeat.  (I still love to hear that sound.)

I couldn't wait for docs to tell me it was time to meet our girl.
I couldn't wait for her to cry and let us know she's in the world.
I couldn't wait to dress her up in little socks and little dresses.
I couldn't wait to sing her songs and make her laugh and stroke her tresses.

I found out I was pregnant and I couldn't wait to meet
The little girl I worked so hard to build, from ears to arms to feet.
I couldn't wait to see her smile, to hear "Mama," to watch her crawl,
To go on trips, to see the world, to watch her grow, to Do It All.

But then this morning, as I fed her, I noticed that her little legs
Were stretching out in small pajamas that no longer were "too big."
And I noticed she was eating more than she had done before,
And that clothes all marked "newborn" were packed in boxes on the floor.

I found out I was pregnant and I couldn't wait to see
The daughter I was meant to have and hold her close to me.

And weeks, they pass in minutes, and she grows so very fast
That I can't wait to hold her close and hold these moments while they last.

August 05, 2010

BSparl and Her Mommy in Diabetes Forecast.

We both love purple.   Can you tell?Babies, babies, everywhere!  In particular, there are babies in this month's issue of Diabetes Forecast, with a focus on pre-existing diabetes and pregnancy.  I'm very proud that BSparl and I had the opportunity to share our story with the Forecast readers, and that the photographer who visited our home wasn't too bothered by the cat hair.

(One quick note after reading through the "Guide to Pregnancy" article in the magazine:  Diabetes is tough. We know that.  Diabetes and pregnancy is tough, amplified.  But don't let the long article about "what could happen" sway you if you are planning to pursue a pregnancy and you have diabetes.  The information in that article is important, accurate, but can admittedly be overwhelming.  Not all diabetic pregnancies encounter the same kinds of complications that mine did - everyone's experiences vary.  Just know that information overload comes with any pregnancy, and diabetic ones are no exception.  We may get some added bonus worries, but the end result of our pregnancies can be just the same as the pregnancies of non-diabetic women:  a healthy baby.  Take all of the information you read online in stride, including the stuff I've posted here.  It's a lot of hard work, but like they say, it's so, so worth it.)

And with that, I'm off to give the BSparl a snuggle.

June 22, 2010

Pregnant With Pre-Existing Diabetes?

For anyone who has been reading my blog since my engagement three years ago, you know that motherhood has been on my radar for a long time.  Longer than marriage.  That quest for a decent A1C, that desire for a "normal" pregnancy, and that hope for a happy and healthy baby.

Buy this book!Part of the reason I wanted to write about my pregnancy here on SUM is because there wasn't a lot of information out there about pre-existing diabetes and pregnancy.  There was a LOT of information on gestational diabetes (obviously), and type 2 diabetes got some good press, but type 1 was sort of swept under the rug.  Thankfully, there were a few diabetes bloggers who had chronicled their journeys, and I wanted to add my voice to that hopeful chorus.   

But also thankfully, Cheryl Alkon had taken the topic to her publisher, and she penned the first book on managing pre-existing diabetes and pregnancy.  And I'm very honored to have been both featured in her book (as a women preparing for pregnancy) and to have her contributing here on SUM:

Doom and gloom. That was the message I got several years ago when I first thought about trying to have a baby while also dealing with my type 1 diabetes. Whether at the doctor's office, going online, or reading the very few books about the subject, trying to get and be pregnant while managing blood sugars, taking insulin, closely counting carbs (and avoiding a lot of low-carb proteins that were good for blood sugars, but bad for babies-to-be) all sounded like a nearly impossible task. One fraught with higher risks of birth defects, overweight babies, worsened diabetes complications, and more.

But I also saw type 1 friends who had healthy babies and sensed what could be possible. This spurred me to research, craft a book proposal, and eventually devote myself to publishing an insider's guide to pregnancy with type 1 or type 2 diabetes. I'm thrilled to say that, five years later, "Balancing Pregnancy With Pre-Existing Diabetes: Healthy Mom, Healthy Baby" was published by Demos Health this spring, and has been enthusiastically welcomed by others who, like me, craved the inside story about how to have a healthy pregnancy and baby while managing diabetes.

I had the pleasure of receiving an advance copy of Cheryl's book just before my baby was born, and even though I was in my third trimester and just weeks away from delivering my daughter, it was so reassuring to read about all the things that could go right.  A diabetic pregnancy is a high-risk one, and the challenges can lead to some tough emotional roller coasters and some scary medical experiences (see also:  stuck in the hospital for a month) - but these pregnancies can also lead to a healthy, happy baby.  (See also:  BSparl)  Touching on everything from pre-conception to managing the months of the pregnancy to post-delivery recovery and how to wrangle in diabetes control once again, this book was exactly what I needed to read while pregnant with my daughter.  I only wish it had gone to press before I had conceived!

If you are a woman with diabetes and you're thinking about becoming pregnant, this book is a good resource for you.  If you are the partner of a WWD (woman with diabetes) and you want the full story on how pregnancy and diabetes can mix, this book is a good resource for you, too.  And if you are the parent of a woman with diabetes and you want to know that your child can have the same chances of a healthy pregnancy as any other woman, this book is a good resource for you as well.  

Cheryl will actually be speaking in Boston in the coming weeks (the first event being THIS WEDNESDAY - sign up!), so if you'd like to hear more from Cheryl in person (and meet my endocrinologist, who consulted on the book with Cheryl), you can attend a discussion this Wednesday.  For more details on upcoming events, check out Cheryl's post on her blog.

Thank you, Cheryl, for giving new moms and moms-to-be with diabetes a sense of peace.  And congratulations on your BIG ANNOUNCEMENT on your blog today!

June 12, 2010

Six Week Follow Up.

Yes, I have used this image before.  Yes, I am lazy.  :)For the last year of my life, it's been a monthly visit to the endocrinologist, and then once I was pregnant, the dam broke loose and I basically had a cot set up at the Beth Israel/Joslin pregnancy clinic.  Oh yeah, and then I spent a month at the hospital while waiting for BSparl. 

I have doctor burnout, big time.

So I'm done with doctor's appointments for at least a few weeks.  Mentally, at least.  (Because there is another one scheduled for August - WTF?)  But last week, I had my last appointment, for a while.  I was up at BIDMC for my "six week follow up" appointment (which took place seven weeks after the birth), and I met first with my endocrinologist. 

"How are you feeling?"

"Tired.  That's normal for a new mom, right?"

"Exhausted is more normal," she said, as she opened up my file on the computer.  We ran through my vitals, going over the medications I'm taking, the ones I'm not bothering with anymore, and how my blood sugars have been reacting to new mommyhood.  

"I've had some really good days, but the bad days are like epically bad.  Like 300's and 400's kind of bad," I said, looking at the floor.

"We want to prevent those highs, and the lows that either cause them or follow them, but you aren't the first postpartum patient I've seen who is hitting these kinds of numbers.  It's normal.  You'll even out," she said.

My basal rates seemed to be okay, but we did some tweaking to my afternoon/evening insulin:carb ratios (going from 1:12 to 1:15, which is math beyond my capacity).  Overall, I've had some nasty numbers, but my endocrinologist reassured me that my A1C wouldn't be too awful, because I wasn't letting any of those numbers ride.  (And when she called me on Monday to let me know what my lab work results were, my A1C was sitting comfortably at 7.0%.  Some people might call that too high, but I'm calling it a wicked victory for me.)

After I met with my endo, I was off for my exam with the OB/GYN.  Not to be terribly TMI, but I can't stand the pelvic exams.  They are unholy and cruel and a very strange way to spend an afternoon.  (Not only that, but I can't figure out why I'm not allowed to greet the doctor while I'm dressed.  No, they send her in only after I'm clad in the awkward paper johnny, with my regular clothes balled up on the chair near the examining table.  And it was the first time I had met with that specific OB.  "Nice to meet you, too!  This is my floppy body.") 

Thankfully, I appear to be healing well, both inside and out.  My c-section incision doesn't hurt anymore, and even though my lower abdominal muscles are currently useless and squishy, I am recovering like a "normal person."  (Read:  Not a diabetic who has seen 400's three times in the last eight weeks.  Nasty.)  There is still a little bit of light bleeding (not from the scar, silly), but my doctors told me the bleeding can last as long as nine weeks.  (Yay.)  The scar is shorter, and a light pink color as it attempts to heal.  I can't see the staple holes anymore, and when I spy the scar in the mirror, I don't want to jump out the window due to grossed-out'ed-ness.  That's progress!

So I'm cleared for "normal life," which includes being able to pick up the carseat while the baby is in it, which means I am no longer tied to my house.  THANK GOD, because I swear I was hearing the cats talk about me - in ENGLISH - which means my mind was starting to leak out.  Onward!  To normal life!

(Normal life - ha!  That's redefined with each messy diaper and baby smile.)

May 27, 2010

Guest Blog: I Dream of Sleep.

Windy is has been a Type 1 diabetic for 22 years and is the wife of Justin and mother of five year old Gabe  and two year old Zoe.  Every once in a blue moon, when she’s not chasing them around, Windy blogs at The Diabetic Domestic Diva, and today she's guest posting here on Six Until Me.  (About sleep.  Sleep?  What's that?) 

Thanks, Windy!    

*   *   *

Windy and her beautiful  familyI dream of more than four hours of consecutive sleep. 

I remember in college when I would sleep till noon on days I didn’t have morning classes.  I remember those sunny Florida days when I’d drive over to the beach and lay on the warm sand to my little heart’s desire.  Or those romantic weekend newlywed getaways we’d spontaneously galavant off to and lay in each other’s arms till the 11 am check out time.    

But then we had kids.    Glorious kids!!  

I wear many hats in this life... wife, daughter, sister, friend, piano teacher, chef, housekeeper, ... the list goes on and on. One of my favorites, is now "Mommy." As the mother of a 5 year old boy and 2 year old girl, I hear it often, "Mommy, Mommy, Mommy!" They always need something. Milk, snacks, diaper changes, a play mate, kiss for their boo boo, and often a referee!  I LOVE being a Mom, and I am blessed that I get to spend a lot of time with my kids, despite the fact that sometimes it's exhausting, and I just want to get a friggin' nap!

Last night something incredible happened.

They both slept all night.

No one had a bad dream.
No one wet the bed.
No one needed a 3 am sippee cup.

We spent the whole day at the beach and just wore them out silly with the swimming, sandcastle building, and burying each other in the sand.

But alas... I was still awoken.

Ah, diabetes.

The third red-headed step child I never wanted. Like a pre-schooler whose been locked in their car seat a little too long and is relentless with a high-pitched whiny voice, "Feed me. Change your infusion set. Charge your Dexcom. BEEEEEEEEEEP!!! Test! Pick up your prescription. Schedule your check up. Ketones? Drink water! BEEEEEEEEP!!"   

Get the picture?

People with diabetes are warriors.  
Members of the Diabetes OC are well aware of this.   
But diabetic moms and dads with young children?
They are Super Warrior Samurai Ninjas.  (You’d agree, Ninjabetic?)   

Kerri, congratulations on entering the amazing world of parenthood!   May your red-headed step child behave so you can enjoy your beautiful BSparl in all her glory!  :0) 

May 26, 2010

Oxygen Mask.

Gotta wear mine before I can help BSparl.In the airplane safety manuals, they instruct you to, in the case of an emergency, put your oxygen mask on first, before assisting others with theirs.  Makes sense.  Can't help someone if you are in need of help, yourself.

Chris and I reference the "oxygen mask" all the time, mostly when I'm low.  During the course of the pregnancy, I had some wicked lows that kept me from attending conference calls, making it to dinner meetings, and even just meeting a friend out for coffee.  "I'm going to be late, but I need a few minutes.  Oxygen mask, you know?"  And Chris would nod, knowing that I was waiting until my blood sugar was stable before I headed out. 

But as I wrote about yesterday, I'm in the middle of The Suck.  Can't wrap my head around what I need to do in order to take care of myself, because I'm too overwhelmed with what my daughter needs.  The baby learning curve is pretty steep, and both Chris and I being schooled on just a few hours of sleep.  My baby is well-cared for, but my diabetes management has seen better days.

... so I guess my baby isn't as well-cared for as she could be.  Because I'm trying to put her oxygen mask on while fumbling with my own.  

Yesterday's post had some good ideas in the comments section, and I'm going to try and implement them going forward.  Like the testing suggestion.  I'm already testing my blood sugar before I feed the baby, so now I need to find other benchmarks in my day to assign testing to.  I'm working off a mental "even numbers" schedule today, making sure that I test at all the even hours.  I'm awake around 6:15 am every morning, so that means I get a 6 am fasting, and then a test every two hours. 

Some other things I simply need to make part of the routine.  So it becomes natural(ish).  Like the Dexcom.  That tool is extremely useful to me ... when I look at it.  For the last 11 days, I had a sensor in and the Dexcom was working great, but I wasn't looking at it.  The receiver would sit on the dining room table while I worked on my laptop and I'd barely pay it any mind.  Then, one night when it was pinging because I was high, I turned off the high alarm so that it wouldn't wake up BSparl.  Being the dingbat that I am, I left the high alarm off.  For four days. WTF?  What's the point of wearing the device when I'm not using it when I need it most?  Today, a new sensor goes on and I'm determined to reset the alarms and to actually use the data.  (Otherwise, what's the point?)

And then there's what Chris and I call "life stuff." Like remembering to call in my reorder for insulin to my mail order pharmacy.  And then remembering to pick it up from the mail drop.  Or remembering to throw a bottle of glucose tabs in my purse or the baby bag, or grabbing a back-up insulin pen, or making sure I have enough test strips in my meter case to get through the day.  Maintenance.  Life stuff. 

But I can't do all this stuff at once.  Baby steps, right?  Today, I'll start with testing more frequently and rearming myself with the Dexcom.  I threw a bottle of glucose tabs both into my purse and the baby bag this morning, and I called in my insulin reorder a few minutes ago.  New bottle of test strips is floating around in my purse.  Small changes that will hopefully make a big difference in how things roll out, diabetes-wise.  Because the better care I'm taking of myself, the better care I'm taking of the little BSparl baby.

Oxygen mask, you know?

May 25, 2010

The Suck.

Bright?  Not me these days.While motherhood is going well and I'm completely in love with my daughter, I'm reminded, daily, that diabetes doesn't care if I've slept or if I have carefully counted carbs or if I've just changed my infusion set.  Diabetes doesn't give a shit about my schedule.

It's The Suck.

Like last week, when at 4:30 am, my "alarm" went off - also known as BSparl starting to fuss and wail from her bassinet in our bedroom.  Not a problem.  I woke up, tested my blood sugar, and saw that I was 176 mg/dl.  That number (albeit spiky) works just fine for feedings, so BSparl and I spent some quality time hanging out, having an early snack, and debating where exactly the sun hides behind the trees before it starts to poke out.

We both went back to bed around 5:45 and slept until the next alarm went off - the Dexcom BEEEEEEEP!ing wildly at me at 8 am.

"Do not wake up the baby, you."  I grumbled while fumbling for the receiver on the bedside table.  "LOW.  Under 55 mg/dl" was the warning it was flashing up at me.  While BEEEEEEEPing.

"Shhhhhh!!"  I unzipped my meter case and deftly stuck a strip into the top of the machine.  I wasn't sweaty, my brain was functioning fine (aside from shushing inanimate objects), and I felt physical capable.  Maybe the Dexcom was just being finicky and throwing lower numbers?

"36 mg/dl"

Well shoot.  Not a whisper of a symptom, either.  I got up from the bed and wandered out to the kitchen, where Chris was making his protein shake.

"Can you keep an ear on the baby?  I'm 36 and just want to grab some juice," I said, opening the fridge door.

"Of course."  Pause.  "What?  You're 36??"

"Yeah.  No symptoms, dude.  Not even one."  I chugged a few sips of grape juice and put the bottle back in the fridge.  "I feel fine.  The Dexcom woke me up."

A blood sugar of 36 mg/dl without a single symptom, other than a wailing Dexcom and a bit of a groggy feeling.  But, in true diabetes form, once my blood sugar started to rise, I felt the symptoms acutely. 

"I feel pretty bad right now."  Shunk.  "Fifty-six.  Why do I feel worse at 56 than I did at 36?"

There's no rhyme or reason to diabetes.  The symptoms of lows and highs change with the seasons, it seems.  And they come without warning, these numbers.  Sometimes it's a hormonal or emotional surge that sends numbers pinging.  Other times, it's a little, teeny technical glitch that sends thing spinning.

Like two nights ago, when I bolused for a snack and felt a damp spot on the side of my shirt.

"What the ..." and I probed with my fingers and felt that telltale wetness around the gauze of my infusion set.  I tugged up the side of my shirt and gave the spot a sniff - yup, that bandaid smell.  Frigging infusion set was leaking some how.  No symptoms, though.  I wasn't thirsty, I wasn't lethargic, and I was actually just about to head off to the gym.  I felt pretty okay.  Problem was, I hadn't tested in about four hours, nor had I peeked at the Dexcom.  So basically, I didn't have a clue what was going on in my body. 

I tested my blood sugar and a 423 mg/dl grinned back at me.   

(Have I mentioned Yosemite Sam yet in this post?  Suffice to say, I rocketed through a list of curse words that would have caused Yosemite Sam to give me a frick-a-frakin' high five.)

New site, quick injection with an orange capped syringe from the fridge, a ketone test (negative), and an hour and a half later, I was down to 195 mg/dl.   But I was pissed.  Because during the course of my pregnancy, I maintained an A1C between 6.0% and 6.5% and I busted my butt to keep myself controlled.  But now, with my body reacting to adjusting levels of hormones and a serious lack of concentration due to a truncated sleep schedule (read:  no sleep 'til Brooklyn, with Brooklyn being college, I think), I'm all over the map. 

I'm frustrated with my control, or lack thereof.  Trying to figure out my post-pregnancy insulin needs and taking care of my little girl have become a full-time endeavor, and I'm not getting it completely done on either front.  I have to buckle down.  These epic lows and highs are not fun, and are wrecking havoc on my healing body. 

Next week, I'm back at Joslin to see my endo.  Diabetes needs to take center stage until I can get things under better control.  It's my priority.  I need to get back to logging, to testing every hour and a half or so during the day, to actually cooking meals instead of just snacking when time allows, to changing my infusion set when it's due, not when it's convenient. 

... after diaper changes, of course.  And breastfeeding.  And BSparl laundry.  And pediatrician appointments.  And 3 am feedings.  And that occasional moment when I lock the bathroom door and look at myself in the mirror with determination and say, "Get it together, Mommy."  

May 19, 2010

Breastfeeding and Diabetes (AKA: Oh dear, another TMI post.)

Opinions run rampant on everything health-related. 

In the diabetes community, there are varying opinions on insulin pumps vs. multiple daily injections.  Humalog vs. Apidra.  Lantus vs. Levemir.  Medtronic vs. Animas.  Coke vs. Pepsi.  (That last one isn't a joke - Diet Coke or Diet Pepsi?  I know I go against the grain with my preference, but I'm a Diet Pepsi gal, myself.)  And there isn't a "right" or "wrong" when it comes to these management decisions.  Just different ways of managing diabetes within a lifestyle.  We share our opinions and personal health choices with one another, and there isn't a lot of judging going on - or at least not within the safety of our diabetes blogosphere.

Now that I'm a mom, I'm encountering the same sort of opinions on how I'm raising my child.  Opinions, advice, you name it.  And I'm all for advice, mostly because I am not an expert on anything and am always open to other people's input.  But some stuff I'm a little less snuggly about. Hell, there was commentary run on my "decision" to have a c-section (and again, I'll reiterate:  it wasn't a choice.  It was a medical recommendation based on the location of my diabetic retinopathy.  See also:  gardening).  And lately, I'm getting a lot of feedback on breastfeeding.

For me, I decided to give breastfeeding a go for my daughter.  There are pros and cons to this decision, though.  (What, you thought this was going to be straight up rainbows and unicorns?)  -->

PROS:

  • Breastfeeding my daughter helps provide her with antibodies that protect her from the chaos of germies and viruses around her.
  • Feeding her is truly a bonding experience, where it's just she and I and we're snuggled close.
  • My medical team at Joslin recommended that if I could breastfeed and if it worked for my lifestyle, it would be to the benefit of my daughter.
  • Honestly?  Breastfeeding is cheap.  We don't have to buy formula, and our biggest expense has been the breast pump that I staggered into Babies R Us for the day I was discharged from Beth Israel.
  • It's convenient in that if the baby needs to eat, there is very little preparation required.
  • Magical moment:  BSparl's poop?  Literally?  Doesn't stink.  Something about breastfeeding keeps the poops from smelling weird.
  • I'm currently able to produce enough milk to feed the baby and stash sterile bags of milk in the fridge for those moments when Chris needs/wants to feed the baby, or for when we're on the road.  I can't lie - being able to create a stash of food for the baby fuels my OCD.
  • Breastfeeding is a wicked calorie burner.  I'm not back to my pre-pregnancy weight by any stretch, but feeding the baby and making milk are caloric furnace activities.  It's tough because I don't have a previous pregnancy to compare things to, but I feel that my uterus has shrunk faster and weight has come off a bit easier due to breastfeeding. 
  • Diabetes connection - Apparently, there's research that shows breast feeding a child can help ward off a type 1 diabetes diagnosis.  But I'm not sure how I feel about that, seeing as how I was the only breastfed child in my family, yet I'm the only diabetic.  Go figure.
  • Another diabetes connection - The actual feeding process doesn't seem to make me low, but when my supply is refilling?  That makes my numbers plummet.  This is a good thing when I want to eat a sandwich after feeding BSparl because I can just skip the bolus.
  • Thankfully, BSparl is happy to feed from the bottle and the breast, which I've heard is not often the case, but I'm grateful she'll do it that way.  I've had many moments when my blood sugar has been too low to breast feed the baby, and it's good that she'll happily take a bottle from Chris.  I've also fed her a bottle, myself, without issue.  BSparl doesn't have any nipple confusion (thank God), and she goes from breast to bottle without issue.
  • I like knowing that I'm providing BSparl with the most natural food source possible.  Also, feeding her makes me pay more rapt attention to my blood sugars, because even though my medical team told me that I can feed BSparl at any blood sugar, I prefer to be as stable as possible so BSparl gets normally-sweetened milk.

CONS:

  • When the milk comes in at first, it feels like your boobs are filled with rocks.  Rocks that want to GET OUT RIGHT THE HELL NOW.  It's not comfy.  My milk didn't come in until the fourth day, which is a little later than your average non-diabetic mommy, but right on schedule for a mom with type 1.
  • Using the breast pump is awkward and sometimes uncomfortable, and not something I could ever do in public without feeling like a complete weirdo.
  • On that same theme, I'm not comfortable enough yet to feed BSparl in public, so I am currently restricted to feeding her in our home or in the home of a friend of family member where I can duck into a private bedroom for a spell. 
  • If I'm unable to feed BSparl and unable to pump, the discomfort can be intense.
  • Sometimes, at very inopportune moments (like while I'm asleep), there's "leaking."  Preventing this can require the use of breast pads, which don't look cool.
  • The whole "her poop doesn't stink" thing also comes with the reality that her bowel movements are sometimes ELECTRIC YELLOW (but they do not glow in the dark, unfortunately - I checked). 
  • The nickname "Bessie" used to be a "con" because I was trying to get comfortable with breast feeding and the whole "Oh hey, these things are supposed to be used to feed a baby?" But now I don't mind.  And I just say "Moo."
  • I worked with the team at Beth Israel to get BSparl to latch on properly, but sometimes that initial latching at the beginning of a feeding is pretty painful.
  • The dietary restrictions feel like an extension of pregnancy, in some ways.  As in, no drinking (unless I know it's going to be hours until I feed the baby).  And nothing exceptionally spicy or garlicky, because that could make the kiddo colicky.  And that's not on my To Do list.
  • That Pro about being able to skip boluses?  If I forget to eat after feeding her or pumping, the lows can be extremely stubborn.  Stubborn as in "Wow, I just ate that whole box of Tollhouse crackers."  Or "Wow, I go low so quickly that I need to keep Fruit Roll-Ups stashed in the cushions of the couch."

I have no idea how long I'll decide to breast feed my child, but I know that it's been four weeks already and I'm not planning on stopping anytime terribly soon.  I can't say that I'm planning to keep it up for a year, or even six months, but I'm taking it week by week and letting life dictate my decision.  For now, with my work-from-home schedule and the fact that BSparl is still so little, I'm sticking with breastfeeding because it works for us.

These are my opinions based on my personal experiences, not a pile of facts.  I know I keep throwing out these disclaimers, but I'm very sensitive in regards to people who think they know it all or think there's only one way to do something.  This is the way I'm moving forward, but it's not the rule for every new mom.  Or every diabetic.  Or every cat owner. 

(Okay, it could be good advice for cat owners.   Because my crew of felines have had some opinions of their own re: BSparl.  More on that in a later post, because the pictures are just too damn funny.)

May 17, 2010

C-Section Recovery.

More details on the c-sectionI've been putting off writing about the recovery from the c-section because, quite frankly, I'm not fully recovered just yet. But I've received a lot of emails asking about the specifics, so here they are - just be warned, there's a lot of boring details and TMI going on in these posts.  :) 

After BSparl was born and we were back, as a family, in the recovery room, I spent a few hours vomiting myself silly.  But once the nausea had worked itself out of my system, I was feeling pretty decent.  Not much pain, but then again, I was in bed, with a catheter in place (so no need to jump up and use the bathroom), and on morphine.  I was also holding my baby.  (She's an excellent pain killer.  So cute!)

It wasn't until the next day - Friday - that I started to feel the effects of the actual surgery.  Once the morphine had worn off, I became acutely aware of the incision.  There was a big gauze patch over the incision itself, keeping me from catching a good look at the staples and all the ick in that region.  What I did know was that the pain was a little less than I expected ...

"Hi Kerri!  Would you like your pain meds?" the nurse asked, the morning after BSparl's birth.

"Oh, I think I'm okay.  I'd like to see how far I can get without them."

... until the morphine wore off.

"Hi Kerri.  How are you feeling?" the nurse asked, later that morning.

"Pain meds.  I'll take 'em NOW.  Anytime.  Now would be awesome, though.  I love you?"

After the morphine was out of my system, my medical team had me on a combination of Percocet and mega-strength ibuprofen.  The ibuprofen was fine with me, but I was very uncomfortable taking the Percocet.  I'd never taken a pain killer of that nature before, and it made my brain feel like it was total mush.  I resolved to come off the Percocets as soon as possible, and only ended up staying on them for about four days.  But because the pain was so intense at times, and because I had no clue what the "right thing" was for me, I followed the doctor's orders.

Note re: Dexcom:  Two days after the surgery, I asked to move from Percocet (which is an oxycodone/Tylenol blend) to straight oxycodone, because the Tylenol mucked with my Dexcom readings.  Once I was off the Tylenol, I plunked a new Dexcom sensor on to help me keep track of the chaotic blood sugar readings.

Once the catheter was taken out (embarrassing moment, having the very kind, patient nurse pull the tube out of me and then help me scurry into the bathroom like a wounded crab), I was at the mercy of my bladder again.  Which meant that I was getting in and out of bed finally, working my abdominal muscles for the first time since the surgery. 

It was not a snuggly experience.  I moved sloooooooowly to help minimize the pain, but it was still very uncomfortable. For the first few hours, I was like a 95 year old woman, half bent over and favoring my abdomen and saying things like "Oh, my medication is wearing off!" and "Those nurses are so sweet - we should call their mothers and thank them for raising such nice girls."  Using the bathroom was very awkward because that motion of sitting to pee was a strain on my stomach, and also because the bleeding post-surgery was exceptionally heavy (you pass clots, which I was not prepared for but is common), making for a lot of activity in a region of my body that had been pretty quiet for a few weeks.

Thankfully, I had plenty of help.  The nurses were constantly coming in and out of the room, checking on me, on the baby, and spying on my incision to spot-check recovery.  Chris stayed in the hospital with me for the four days I recovered, so he was able to help me get in and out of bed and also was able to serve as BSparl's primary caregiver.  (He did most of BSparl's diaper changes in those first 24 hours - thank goodness.  Because if she was waiting for me to leap up out of bed to change her poopy diapers, she would have been waiting a while.  I was a sloth, only with five toes.)  I was able to start breast feeding BSparl, though I only had colostrum to offer at that time.  My milk didn't come in for a few days.  (More on the diabetes/breast feeding fun in another post.)

So pain in the incision area was expected, and I was also expecting to feel sore in my back where the epidural went in and where all the other pokes and proddings took place.  I had also expected the nausea and the blood sugar bounces.  But what I didn't expect was the gas pain.

Oh holy hell, that was painful.  

I hadn't thought about it before, but when they opened me up for the c-section, my internal bits and pieces were exposed to the air.  And some of that air got in.  It's like a Ziploc bag - you need to push the air of of the bag before you zip it shut, or else air gets trapped in there.  For a person's body, you can't help but end up with air trapped after an abdominal surgery like a c-section.  Which meant that my body had these pockets of air in it that needed to work themselves out.

"Oh, it's just gas," people say (often while holding their tea cups with their pinky in the air).

Oh, it's just freaking awful.  The air trapped in there was one of the worst parts of my recovery.  When my OB came in to examine the incision, she grazed my stomach skin with her pinky finger as she went to remove the bandage and I jumped an absolute mile.

"WHOA!  I'm sorry.  Whoa, that hurts a freakin' ton right now.  I'm not sure why ..."  I panted, unaccustomed to that kind of insistent discomfort.

"It's that gas pain.  All the air trapped in there.  It will work itself out over the next 24 hours or so, but it can be really painful.  Would you like something to help break those air pockets up?"

"YES.  Please.  That would be awesome.  And it's okay if you don't want to touch me until the pain has sort of gone away, right?"  (At that point, I didn't have the guts to tell someone not to examine me.  I just sort of hoped they wouldn't if I asked in a really passive way.)

"We can wait a few hours.  I'll have the nurse bring you something to help with the pain."

The nurse showed up with what tasted like a stale wedding shower favor mint, and after chewing on it, I felt some relief in the abdominal region.  About 24 hours after the c-section, I was starting to feel a lot better re: the gas pains.  I worked to get out of bed and get moving as much as possible, because everyone who had left comments here on SUM regarding their own c-sections said "GET UP ASAP!" to help speed up recovery.

It's now a month later, and I'm feeling a lot more like I'm in once piece again.  The staples were left in for a full week, but once they were removed, I felt much better.  (I didn't anticipate that the staples were ACTUAL staples.  Like from Office Max.  I thought they'd look more medicinal or surgical.  Nope - they looked like someone had grabbed a black Bostich and worked me over.)  The scar is about eight inches long and looks very narrow and well-healed, and should shrink up even more as my uterus goes back to its previous size.  I'm able to walk without much issue, and in two more weeks, I'll have my surgical follow-up, where I'll hopefully be cleared for exercise, lifting, sexual activity - LIFE

Tiny daisies for my tiny baby

So - to recap:  The c-section did freak me out.  The recovery was harder than I thought it would be, but that's probably because I'm a wuss and I don't like pain.  And the actual incision was way more FrankenKerri than I thought it would be, but every day it becomes less obvious and uncomfortable.  I wish that I had the opportunity to deliver my child vaginally, but the damn retinopathy was a factor, so the c-section is how we had to move forward.  I wouldn't chose surgery, if I had a choice.  (Note to anyone who wants to tell me that I made a horrible decision to have a c-section:  My medical team and I, together, decided that a c-section would help ensure a safe delivery of my daughter, in addition to preserving my vision.  If you still have a strong opinion on the method of my daughter's arrival, I suggest you start gardening.  It will bring you to a zen-like place where I bet you'll appreciate the fact that my health is intact and my daughter is safe, instead of getting all judgy on me.  Just a thought.)

Overall, as the scar fades, so do the memories of the discomfort.  And every day, I have the blessing of this baby girl in my life.  Doesn't matter how she got here - point is, she's here.  She's safe.  And she's my buddy. 

May 10, 2010

A Day in the Life of a New Mom with Diabetes.

For D-Blog Week, Karen challenged the diabetes blogging community with a week's worth of blog prompts. Today is "A Day on the Life," and I've decided to focus on my new life with BSparl.  (Because if I tried to pretend that motherhood isn't affecting my diabetes, I'd be lying my face off.)

DING!!!  Game on.

A day in the life of a mom with diabetes5 am:  Alarms?  We don't need no stinkin' alarms.  Because now we have little baby girl who wakes us up at all hours of the night. 

When BSparl starts to fuss from her bassinet, either Chris or I leans up to check on her to make sure she's okay.  Since Chris usually does the 1 am feeding with a bottle, I try and do the 5 am feeding.  Since I'm breastfeeding, what I need to do first is check my blood sugar.  Anything less than 120 mg/dl and I'm snacking while she's eating.  I start this feeding at 98 mg/dl.

5:15 am:  BSparl is done with one side.  I switch her to the other side to finish eating, and I brush the foil wrapper that the fruit snacks came in to the floor.  

5:45 am:  BSparl is fed, burped, changed, and tucked back in.  I test my blood sugar again - now I'm 74 mg/dl and the Dexcom is showing a bit of a drop.  I wander out to the kitchen for peanut butter and a piece of toast.  (Not froast.) 

7 am:  Up again, only this time because the Dexcom is blaring at me.  49 mg/dl.  WTF?  Breastfeeding has very unpredictable effects on my blood sugars.  Some mornings, it doesn't make me low at all.  And then other mornings, it makes me plummet.

7:30 am:  BSparl and Chris are asleep in the bedroom, so I settle in on the couch with my laptop and a cup of tea.  My goal?  Answer some emails, write a blog post, finish some stuff that always seems to be due and I'm chasing the deadlines of, and use the breast pump to stash some milk for BSparl.  My insulin pump tubing sometimes gets tangled up in the breast pump tubing.  Which makes me think I'm wearing too many freaking pumps.

9 am:  Husband and daughter emerge, both sporting the same furrowed brow of the morning.  BSparl needs to be fed again, so I test my blood sugar to see where I'm at.  145 mg/dl - thank goodness.  Enough with the lows.  Bring on the BSparl!

11 am:  All of a sudden, it's almost noon, and I haven't eaten anything since 7 am.  I also haven't answered a single email.  Or finished the article I needed to finish.  My mornings are usually spent testing my blood sugar, feeding BSparl, changing her diapers (which have baby Sesame Street characters on them, which makes me laugh.  Because what do you call "Baby Big Bird?"  Little Bird?), and doing laundry.  I test my blood sugar - 118 mg/dl - and thank God that it's not pinging all over the damn place today.  Because some days it does. 

High Noon:  Still haven't eaten.  I force myself to stop and devour a Greek yogurt.  Blood sugars are holding steady.  But my pump site is aching a little - when was the last time I changed out the site?

Noon-thirty:  BSparl and I investigate the site.  Well, she hangs out in her bouncy chair on the bathroom floor while I take a look at the infusion set.  Looks fine - edges are peeling a bit - but it's only been four days.  Even though the reservoir isn't anywhere near empty, I opt to change the site because it's achy.  And because if I don't do it now, while I'm thinking about it, it will be another full day before I remember.  With all of my focus on BSparl and adjusting to life as her mommy, sometimes diabetes takes a wicked back seat.

1 pm:  New infusion set is in, baby girl is getting a bottle of breast milk because my own breasts need a break sometimes, and I still haven't answered one single email.  Is this why people take maternity leave?  I need some coffee.

2:15 pm:  Thirsty as all hell.  Test again - oh, that's nice.  233 mg/dl.  Frigging pump site change ... did I forget to take a little 0.3u bolus before pulling the site?  That seems to be the only way for me to avoid post-site change highs.  But of course, I had forgotten to do that.  And now I'm basking in the warm warming glow of a high blood sugar.  FanTAStic.  Still haven't eaten lunch, and now lunch is on a further delay due to the high.  I bolus down the high.

2:45 pm:  Dexcom shows that I'm dropping.  Meter confirms the same - 177 mg/dl.  Thing is, with the baby now out of me, I'm trying to figure out what my body's insulin needs are.  And that's tricky, because with breast feeding, I am never able to do an accurate basal test.  I have an appointment with Joslin in two weeks (for my 6 week follow up after surgery/birth), so I'm trying to log blood sugars to give my endo something to go on.

2:46 pm:  CRAP!  I haven't logged any blood sugars in three days!  With BSparl in my arms, I open up my laptop and try to find the spreadsheet.  I locate it, and then try to scroll through my meter memory and type the blood sugars into the spreadsheet using one hand.  BSparl decides this isn't a good time for her, and she makes a sound not unlike a can of shaving cream being deployed.  (She is a delicate, fragile, pooping flower, this child of mine.)  Diaper change time!

3:30 pm:  Lunch.  Finally.  Blood sugar is 109 mg/dl.  Lunch is a turkey and cheese sandwich, even though I'd much rather go low-carb these days to help lose the pregnancy weight.  But without carbs, I'm low all the time after feeding BSparl, so carbs it is. 

4 pm:  Time to head out to the grocery store and then to the post office.  BSparl hangs at the house with her dad while he works, and I test once more before getting into my car.  167 mg/dl.  How is the post-prandial that high?  I counted those stupid carbs.  My insuiln:carb ratio, I thought, was settled back into 1:12.  I need to test that ratio again, but no time today.  Must run errands.

4:04 pm:  As much as I love my daughter, I felt guilty blasting the Beastie Boys while she was inside of me.  Without her in the car, I can crank up the volume of the music again.  So i do.  As I head to the grocery store.  Damn, my life is a thrill a minute.

5 pm:  Walking out of the store, I realize that my Blackberry has been pinging for three hours and I haven't looked at it yet.  Checking the emails, I see that 75 emails have come in since 7 am.  And I STILL haven't answered a single one.  Whoops.

6:30 pm:  It's time for BSparl's dinner.  And then we read a book together - I like Dr. Seuss, but sometimes we read other books because I can only make my mouth navigate words like "Th'need" so many times before I start to either giggle or accidentally spit on my daughter while reading.  

7:45 pm:  Chris heads down to the gym and I prepare to go when he gets back.  (No, I'm not really "exercising."  Can't for another two weeks, due to the c-section.  But I can go for walks on the treadmill, so that's what I do.)  I test my blood sugar (139 mg/dl) and get all my crap together for the gym:  Dexcom receiver, meter, cell phone, reaction treaters, and that ever-elusive pair of workout pants that actually FIT. 

9 pm:  Back from the gym, blood sugars are steady for once, and BSparl is napping.  FINALLY, I answer some emails and finish up that article.  Oh crap - dinner!  I find something in the kitchen that doesn't require much assembly.

11 pm:  I realize that, since 5 pm, I've either fed BSparl or pumped six times.  How is that even possible?  Sure does account for the unpredictable blood sugars, though.  My body is in a constant state of "feed," making trends nothing short of chaotic.  And I have to be honest - I'm not sure I have the mental bandwidth to wrangle in diabetes and motherhood with any kind of precision these days.  Working off of very little sleep, and trying to understand the new swell of hormone changes in my body, is frustrating as hell.  Diabetes fine-tuning isn't my top priority these days.  I just want to coast as safely as I can at the moment.  (Note to people who may want to lecture me about my own health: Back off for a few weeks before you run cryptic commentary.)

Midnight:  What am I thinking, still awake??  BSparl will be up in two hours for her 2 am snack.  I'd better restock the bedside table with low blood sugar snacks and call it a day.  

Midnight-thirty:  Whoops, forgot to test.  94 mg/dl.  Dexcom confirms it's a steady number.  Off to bed!

Game Over ... until 5 am.  :)

May 07, 2010

BSparl's Birthday: Part Three.

Babies rule.My last entry, about the birth of my daughter, was simply about her.  About how she joined our family and how much we loved her even before we heard her cry.  I didn't want to focus on all the diabetes crap because it paled in comparison to becoming her mom.

But.

Diabetes was definitely in the mix of things.  Of course, right?  So here's the gist on how diabetes played into BSparl's birthday.

After she arrived and I was sewn back up, I don't remember a whole lot.  I know I ended up in a recovery room in the labor and delivery department of Beth Israel, but how I got there is a mystery to me.  As I was preparing to write this post, I had my head in my hands.  Chris came over.

"What's the matter?"

"Dude.  I clearly remember going into the operating room, and I remember all the moments about her birth, but I have no idea how I got into the recovery room.  Did she come with us?  Did they ever take her away from us?  I think I was in a fog after the delivery."

So Chris filled me in on what my brain missed.  Apparently, we all stayed in the operating room together.  The nurses took BSparl at first to clean her off, but after that, she was with her mom and dad until we all left the OR.  Chris told me that I was moved from the surgical table to a hospital bed, and BSparl was in a glass-walled bassinet on wheels.  When the surgical team was finished putting me back together, I was wheeled down the hallway to the recovery room, and my baby followed.  

I was completely in a fog, but Chris told me that the baby was removed from the recovery room for about 15 minutes so they could take her to the nursery and test her blood sugar.  I remember when they returned - the nurse said that BSparl's blood sugar was 20 mg/dl.  They seemed somewhat casual about that number (I guess a baby's blood sugar is most often close to 60 mg/dl, so 20 mg/dl wasn't enough to send them scrambling.)  However, I wasn't able to wrap my head around that concept.  I knew what 20 mg/dl felt like, and my heart broke.  I know it's common for the babies of type 1 diabetics to have low blood sugar issues after birth, but still ...

"We can give her a bottle, or you guys can give her a bottle.  Either way, she needs to have something."

The anesthesia was hitting me hard, and waves of nausea were taking over rational thought.  I knew my blood sugar was fine (I'd been testing every 30 minutes or so since 6 am, and it was now about 10 am), but if my baby was having trouble, I wanted someone to feed her immediately.

I blinked.  Or maybe dozed off due to the drugs.  But when I came to, I saw Chris, sitting in a chair by my recovery bed, holding our daughter and giving her a bottle.  "She's fine now.  She'll be just fine," he said to me, not looking up but instead keeping his eyes locked on his child.

"Have they been testing her blood sugar?"  I could see these little bandaids on her heels, proof positive of the blood sugar checks.

"They're going to check her again in a few minutes.  Don't worry," Chris said.

They did - she was monitored steadily for the first 12 hours of her life.  And after that initial post-birth low, her numbers held in the 68 mg/dl - 75 mg/dl for the rest of her hospital stay.

On my end of the diabetes stuff, the situation got a little tricky once I was back in my hospital room.  After about an hour and a half in the recovery room (during which time Chris called all of our friends and family members to spread the good news about BSparl's safe arrival, and I opted not to talk to anyone for a bit because I kept throwing up into the handy bedpan - yum), Team Sparling was escorted back to the hospital room I'd been captive in for weeks.  I was still hooked up to the insulin drip, the glucagon drip, and was being monitored by my own glucose meter at my discretion.  

Problem was, my numbers started to bottom out.  And I wasn't able to keep anything down, due to my body's reaction to the anesthesia.  Some c-section ladies get "the shakes" after the spinal, but I didn't have that issue.  I had "the pukes."  I threw up - like a champ - about seven times in the hours following BSparl's birth, which the doctors said was normal but my blood sugars weren't digging it.  I was stuck, for about three hours, at a blood sugar of 50 mg/dl.  I tried to keep down some grape glucose tabs but they made their way back out, so we buzzed the nurses and asked for the dextrose drip to be turned up.

"Okay, we work off a sliding scale for this sort of thing, so we'll increase you to 20u of dextrose over the course of the next hour."

Even though I was still in the post-surgery fog, this wasn't a good plan to me.

"But I'm dropping.  A lot.  Like right now.  Can't we truncate the time frame on that dextrose?  Maybe get the 20u administered in the next 15 minutes?  Instead of over the course of an hour?"

Nope.  The sliding scale (bah) didn't call for that kind of action.  The best they could do was to turn off the insulin drip for a little bit to help counteract the plummeting blood sugar.  This scene played out for about three hours, with me calling for the nurses and asking for upped dextrose, watching my meter continuously throw out results under 60 mg/dl, and any attempts at glucose tabs or gel immediately evacuated by my body.  BSparl was being cuddled by my husband and then my mother (my mom came up to the hospital for the surgery - I may have been having my daughter, but hers was having surgery, so she was nervous), so baby girl was safe.  But I was stuck in the lows for hours.  And by the time I was starting to come up, the insulin drip had been "off" for three hours, I had been dosed with a pile of dextrose over the course of those three hours, and my blood sugar was rising fast.  (Why, oh why, couldn't they just quick dose me when I was low, instead of the sliding scale crap?)

It wasn't until about 7 pm that night that I was able to keep down some food.  And it wasn't until about 12 pm that they let me remove the insulin drip and reconnect the Ping pump.  My pump, once cranked beyond recognition in efforts to accommodate my third trimester insulin needs, was dialed down to a flat basal rate of 0.3u per hour and programmed with an insulin:carb ratio of 1:20.  They err on the side of caution with lows, post-birth, because of the nausea, etc.  And my body responded in kind, with blood sugars over 260 mg/dl for the next 48 hours.

"Oh, fabulous.  I'm 300 mg/dl now.  This is a far cry from the control I had just yesterday, right?"  I asked my husband.

He was holding BSparl in our now-quiet hospital room, looking at all the hair on her head and her tiny features.  I didn't want to wake her up.  I just wanted to watch him hold her, seeing the bond between the two of them grow as I watched.

"She's still okay, right?  Her blood sugars are okay?  She's okay over there?"

BSparl whimpered and stretched a little bit, her little hands reaching.  Her dad smiled.

"She's perfect."

April 30, 2010

BSparl's Birthday: Part Two.

The door opened and Chris was escorted in by one of the nurses.  He was wearing a bright blue jumpsuit over his clothes, and a face mask to prevent germs from entering the operating room.  My hands, which had been held by one of the nurses (because I asked her to hold my hand because I was scared, I'll admit it), fluttered animatedly and reached for Chris.  

"She's on her way," I said to him as he took his seat up by my shoulder.  He and I were both above the sterile field, listening to the sounds of the procedure as the anesthesiologist gave us the play-by-play as she peeked over the curtain towards my belly.

"Your daughter is almost here.  Just a few more minutes now," she reported.  I could hear her smiling underneath her mask, despite the fact that I couldn't see her face. 

My body was completely numb, but I could still feel the pressure of what was taking place down there.  It was like having dental work done, where you can't feel the pain but you feel the pressure.  I felt them shifting things about inside of me, but it wasn't uncomfortable.  

My obstetrician's voice rang out from below the sheet.  "Ready, Mom and Dad?  She's just about here!"

Chris held my hand, and I felt this enormous shifting inside of me.  And then the sweetest sound I have ever heard broke through the din of the operating room.  The sound reached into my heart and my mind and wrapped around the most vulnerable parts of me and closed tightly, making me feel safe and terrified and excited and … ready.  All at once.  

It was the sound of my baby's first cry.  The child I had been hoping to have for as long as I can remember.

My daughter.

Chris said I burst into tears instantly upon hearing her cry.  I don't really remember all of the details - everything became somewhat of a blur at this point, as the anesthesia worked in combination with the euphoria I was feeling.  A nurse came and asked Chris if he wanted to help wash the baby off.  He took pictures of her while she was being cleaned and weighed and swaddled.  The nurses working on me kept asking if I was okay, and finally let me take off my oxygen mask.  The surgical team worked to put me back together down there. 

So much was going on, but the only soundtrack I could focus on was the sound of my daughter, crying with all her might and proving that her lungs were strong and healthy.  

Suddenly, this little creature was brought to me, wrapped tightly in a white and pink striped blanket, a yellow hat on her head.  She was pouting with her full, little lips, her chin quivering just a little bit as my husband put her in my arms.  

My child.

"Oh, my baby.  It's you.  I'm your mommy.  I love you."  I remember murmuring the same sentences to her, over and over again, marveling at the fact that this tiny baby was just tucked inside of my body, and now she was breathing the same air as me, nestled between her mother and father for the first time in all of our lives.

Even though it took about 40 minutes for the surgical team to close me up and finish the surgery, I was completely absorbed by my child.  Her long eyelashes and her tiny nose.  I thought about how hard I had worked in efforts to make my baby healthy and strong.  How hard I would continue to work to ensure that she and I, and her daddy, would have a long, healthy life together.  Diabetes wasn't part of these moments.  My heart didn't have room for anything that hurt.  I couldn't focus on anything but this incredible moment.

I looked at Chris, who was staring at his baby with wide, tear-filled eyes. 

"This is our baby, Chris.  She's ours.  We did it."

He kissed my forehead, then kissed his daughter's forehead.  

"We did." 

BSparl's Birthday: Part One.

(I've tried to write her birth story with more precision, but I'm a bit of a rambler, so this is a two part post.  Had to be.  I couldn't edit myself down enough.)

The evening before my c-section, I was a complete wreck.  I'd never had any kind of surgery before (except when I was four years old - I had accidentally stepped on a sewing needle and half of it broke off in my heel, so I was put under to have it removed.  Ew.).  I'd never even had an I.V.  You'd think that, after living with type 1 diabetes for over 23 years, that I'd have had my share of hospitalizations and needly bits, but I was relatively green when it came to anything other than insulin and pump sites.  

So I was freaking about the surgery.  In addition to feeling really nervous about becoming a mom.  

But technical stuff first:  Thanks to a wicked allergic reaction that I had to the heparin injections (oh itchy rash that cropped up everywhere that I had injected the heparin - scratchy town!), I was taken off the blood thinner the Monday before surgery.  As a result, I was safely able to plan on the spinal block only, instead of being put under fully.  I was hooked up to an I.V. line for fluids at about 10 pm on Wednesday evening, which also served as an emergency glucose drip if I happened to go low overnight.  (Likely risk, since I was unable to eat or drink anything after midnight.  I was in Gremlin mode.)  

I went to bed on Wednesday night connected to the I.V. pole, with a blood sugar of 109 mg/dl and my baby kicking away inside of me.

And at 5:30 am on Thursday morning, I woke up to take my last shower as a mom-to-be.  The surgical team at Beth Israel requested that I shower using a special antiseptic soap to prepare my skin for the procedure, and after my shower, the nurses came in to connect the insulin drip and disconnect my insulin pump and Dexcom sensor.  (The Dexcom was on my right thigh, and since everything from the breastbone down was part of my "sterile surgical environment," I was asked to remove the 15 day old sensor in efforts to keep things pristine.)  

At about 6:30 am, Chris and I went up to the labor and delivery floor of BIDMC.  I was told to dress in the stylish hospital gowns and lose all of my undergarments (though I petitioned for - and won rights to wear - my socks, damnit).  The nurses wheeled me into the triage room, where Chris and I waited for my OB/GYN.  While we waited, the nurses carefully monitored my blood sugars with my personal meter, and I watched as my nerves caused the numbers to rise.  Actually, my climbing blood sugars delayed the surgery a little bit, because my medical team wanted me between 80 - 110 mg/dl for the surgery, and I was cresting up towards 160 mg/dl.  But once I was holding steady, my OB (Dr. A) came in and said we were ready to administer the spinal block.

I went into the operating room alone, because Chris wasn't allowed to be present for the epidural (in efforts to keep the environment sterile.  Not that he's dirty or anything, but still …).  The epidural was one of the things I was most nervous about.  A needle going into my spine that would cause me to lose all feeling below the waist?  The thought made my stomach lurch.  

My wonderful OB knew I was bordering on a panic attack.  She stood in front of me and held my shoulders steady as the anesthesiologist prepared my back for the spinal block.  

"I'm really nervous," I said.  My legs were shaking uncontrollably.  There were about 12 people in the room, and I had only met five minutes earlier, and I was feeling exposed, in just about every way.  The room was almost completely silent as the medical team prepared to operate.  On me. 

"Can someone say something?  I'm starting to freak the hell out here.  How about some jokes?"  I couldn't stand the silence.  I needed someone to fill the air with nonsense, and I couldn't provide that noise myself.

The doctor leading the surgery piped up in his British accent.  "I've got one.  What has more spots than a leopard?"

"What?"  I wanted to focus on the punchline, not the needle easing into my back.  "More spots than a leopard?  I don't know … a thirteen year old boy?"

The surgeon laughed.  "That's not too bad.  But it's not the answer.  What has more spots than a leopard?"  He paused for dramatic effect.  "Two leopards."

The needle went in.  I felt the numbing solution spreading through my legs, making them feel warm and slippery and fading.  

"That's what you fill this awkward silence with?  That's almost horrible," I said through staggered breaths, still completely afraid of the surgery to come.  The surgeon laughed at me again.  "It's true, though.  Two leopards definitely have more spots than the one."

The epidural was starting to take effect, and the team helped me lay on my back and relax my legs.  Unfortunately for everyone, the c-section required me to be naked from the sternum down, so basically everyone in the room had a bird's eye view of parts of me I personally hadn't seen in several weeks.  A catheter was set up, a drape was established to block my view of my belly and to keep the lower half of my body sterile, and I was ready for surgery.  Ready for my baby to arrive.

"Where's Chris? Will he be here soon?"

"He's coming in now.  And your daughter will be out in just a few minutes.  Are you ready?"

(To be continued in Part Two.  :) )

April 26, 2010

My Baby Girl.

With a lot of stories, it's best to start at the beginning.  But I'm still recovering from surgery and adjusting to a sleep regimen that … well, doesn't include much sleep.  So I figured I'd start at the end and work my way backwards.  

We've gone from "It's on!" to "She's here!"  

Mommy and baby
My daughter and me.  I've been waiting a long time to write that phrase.

Our little baby BSparl was born, healthy and strong and at 6 lbs 15 oz, on April 15th at 9:09 am.  "She's coming!  She's almost here," the doctors all started speaking in unison, and seconds later, the sound of my baby girl crying pierced the operating room. 

And at that moment, Chris and I became her parents, and our whole world changed with her first breath. 

Baby girl snuggling with her daddy
BSparl and her daddy

We were a family before our baby girl arrived, but now our hearts are swollen with love for this new little creature.  (And she's very tolerant of her goofy parents as we negotiate this incredible learning curve.  She didn't even mind when I couldn't figure out how to snap up her first baby outfit without making it into adorable, yet useless, clothing origami.  Why on Earth are there so many blasted snappy things?)

I'm slowly making my way through emails and cards, but I want you guys to know that Chris and I (and BSparl!) really appreciate all of your emails, cards, gifts, prayers, well-wishes, and support.  Thanks to the wonderful people who offered to guest post, I'll be hosting the words of others on and off for a few more weeks, but I'll be popping in with updates and the full birth story.  There's so much to tell. 

In the meantime, THANK YOU so much for everything.  Our baby is healthy and that is in part to the support I've received from you all  You guys mean a lot to us, as a family, and I can't thank you enough.

She has thoughts.  Many of 'em.  Mostly about poop, I think.
She thinks deep thoughts.  Mostly about poop, I believe, but deep nonetheless.

More later, but for now, much love!

April 15, 2010

Dear Baby Girl.

Dear Baby,
I love my baby girl.
I've been thinking about your face.  Your hands.  Your little feet and the chubby cheeks I've seen countless times on the ultrasound monitor.  I've been thinking about the round swell of your baby belly, and the teeny nails on your little hands.  Your petite ears.  The little rosebud of a mouth.  

Growing up, I didn't have fantasies about the wedding with the white dress and the table seating charts and the guest list.  I just knew I would end up with a man who loved me and treated me both like a best friend and a partner for life.  And I found that man.  Your daddy is one of the kindest, most special people I've ever known, and you and I are lucky girls to have him in our life.  He's taken such good care of me for the last few years, and he'll continue to take care of both of us as our family grows.

But while I didn't dream about my wedding, I've always dreamt about you.  For as long as I can remember, I've wanted you in my life.  It's different than the dreams I had of being a writer and a race car driver and the owner of a breakfast restaurant with a cat that hangs out in the kitchen.  My dreams of you were always a little cloudy, veiled in the insecurity of what a pregnancy with diabetes would be like.  Doctors told me for years that women with diabetes, particularly those diagnosed when they were really young, like me, would have a tougher time getting pregnant and seeing the pregnancy through.  I pretended not to hear them, but their words settled in my head and I was always hopeful, but never sure, that you would become part of my life.

And then your daddy and I prepared for you, working so hard to control diabetes so that it would be as minuscule a factor in your creation as possible.  We got married.  We celebrated a year as husband and wife.  And then we took the leap to make you ours.  We traveled overseas without you, but returned home with you as our secret.

Time has gone by quickly, little girl, and over the last eight months, we've watched my belly grow as you've grown, too.  Ultrasounds and blood tests and fetal monitors confirmed that you were inside of me, strong and healthy and preparing for your debut.  The first few months of pregnancy were comfortable, the last few a bit tougher, but all the while we continued to work hard and pray and wait for you.

And now we're here, baby.  Today is your birthday.  You are my greatest achievement, my proudest moment, and my whole heart.

Your daddy and I couldn't be luckier than we are today. We can't wait to meet you.

All my love,

Mommy

April 14, 2010

Almost There.

II AM A BUSY BEE, DAMNIT!'m a tangled web of emotions today.  

I'm nervous about tomorrow.  The surgery itself scares me.  I've never had surgery before, and the last time I was hospitalized was when I was diagnosed with diabetes, so this experience has really broadened my perspective on what some people have to go through with their health conditions.  I'm afraid of the epidural, of the actual incision, and of how the recovery will feel.  Despite other people's experiences and the "quick and easy" adjectives that seem to come up when people talk about c-sections, I'm still unnerved.  But I'm sure you guys figured I'd be tweaking out, because I tweak out about everything.  ;)

I'm a little overwhelmed.  This is only the second time I've ever been in the hospital in my entire life ... the first was 23 years ago when I was diagnosed with diabetes.  So spending almost three weeks here has been physically draining (all muscle definition I once had is now completely gone - I'm like spaghetti girl) and emotionally insane (no sleep at all, too much focus on "what's coming down the pike," and barely any social interaction with anyone other than nurses who want my blood pressure readings).  I'm pretty sure that on Monday, I'll run screaming from this  place. 

I'm homesick.   I haven't slept in my own bed for weeks.  I haven't showered in the comfort of my own bathroom.  I miss the comfy couch, the sunshine coming in through the giant windows, the closet where my shoes are strewn all over the place.  I miss those stupid cats.  And I miss my husband and being alone with him.  Even when he's here at the hospital overnight, we can't be close to one another because when nurses come in the room and we're sitting together, we feel like high school kids who were caught with the door closed after being told "DO NOT shut the door."  I really can't wait to be home.

I'm absolutely shocked at how quickly this has all happened.  I feel like it was literally last month that I was talking about lowering my A1C and thinking about taking the leap of faith to make a baby.  Spain seems like a very long time ago. All those Joslin appointments when I wasn't pregnant, and then the dozens that followed after we found out that we were expecting ... seems like a very long time ago.  But it's almost over - and tomorrow is her birthday.  

I'm thankful, too.  So thankful for all the support and well-wishes from you guys.  The comments, emails, packages that have arrived at the house ... everyone has just been so overwhelmingly supportive and kind.  Chris and I really appreciate all of the love you guys have been sending our way, and we are excited to share our daughter with you all.  Posting here will be light, from me at least, over the next few weeks, but there are some really generous people who have offered to guest post while I'm learning to change diapers, and once I'm recovered a bit from the surgery, I'll post an update and hopefully a picture of the BSparl.  Time online will be very hard to come by in these first few days of parenthood, especially since I'll still be at the hospital for a few more days, but as soon as I can update you all, I will

I'm worried.  What kind of a parent will I be?  I'm completely goofy and ridiculous ... will she think I'm too bizarre to be friends with?  Will she listen when I tell her "no?"  Will she think I'm mean when I let her cry it out?  Will she and I be able to handle breastfeeding?  Will she like me?  Will I have the patience to be a good parent?  How on earth do people do this and seem to be so centered and confident?  

I'm excited, too.  Despite all these fears and worries about the actual surgery and what kind of a parent I will be, I can't wait. I can't wait to finally see her face, and hold her little hands, and give her a big hug.  She's done such a good job in there, and now she joins my husband as the other hero in my life.  

Tomorrow morning will hold one of the most life-changing moments for me, and while my body is literally shaking with anticipation and nerves and excitement, I am so excited to meet my little girl.

Baby, you're almost here!!!  

April 13, 2010

Diabetes During the C-Section: Here's the Plan.

Preparing for the diabetes part of BSparl's birthI've received a lot of emails about the how diabetes will be handled during the actual "birth" of Ms. Bsparl, and while I won't have all the details until it's all over with, I do have a few answers for now.  I talked with my OB (who will be performing the c-section) and my team at Joslin about some of the details.  This might be a detailed, kind of boring post, but I wanted to make sure I'm answering all the questions possible! 

Here's what I know so far:

On Wednesday night, an IV will be "installed" in preparation for the insulin drip.  I'll still have my insulin pump on, though.  As of midnight on Wednesday, I won't be able to eat anything from that point until post-surgery, so the IV will be at the ready in case I go low during the course of the night.  In the event of a low blood sugar, my team will do one of the following:  suspend my insulin pump, administer glucose through the IV, or potentially allow me to drink apple juice, depending on the circumstances. 

The c-section will be first thing in the morning (8 am), so the night before will be spent checking my blood sugar with the glucose meter every 30 - 45 minutes to ensure the tightest, steadiest control possible.  In my circumstances, I plan to keep the Dexcom connected throughout the night, too, to help with that goal.

The morning of the c-section, I'll get up wicked (pissah) early (5:30 am, I think) and I'll rip out my insulin pump and remove the Dexcom sensor.  The nurses will hook me up to the insulin drip and my blood sugar will be monitored - wait, strike that.  Stalked.  :)  I'll be hooked up with the drip, etc by 6:30 am and up to the delivery room.

We'll move into the operating room and my blood sugar will be monitored stalked by the Joslin team while the OB/GYN team prepares to deliver my baby girl.  Chris will be in the waiting room while they administer a spinal epidural (Do not Google this, because it will make you cringe.  I made the mistake once of Googling it.  Never again.  It made me want to give birth orally.) and then they will ensure that my lower half is numb and ready for surgery.  Chris will scrub in and be brought in to the room, where he'll be situated up near my head and the surgery will begin.  My team said that Chris is welcomed to hold my meter and test my blood sugar at our discretion, and the Joslin team will be doing the same using their meter or mine, depending on our preference.  But if I feel nervous about going low, etc, I am able to keep tabs on my own numbers. 

During the course of the surgery, I'll have a regular IV in for fluids, etc, and then the insulin drip will be combined with a glucose drip, the contents of which can be adjusted based on my blood sugar needs.  So if I start to spike, they can increase the insulin titration.  If I start to drop, the glucose can be turned up.  All of this is handled by the Joslin team, so my OB team can concentrate on BSparl's escape.

According to my doctors, the whole c-section will take about an hour, from start to finish.  Bsparl should be in Chris's arms by 8:30, and I should have all my pieces back together again by 9:00 am.  I'll be brought to the recovery room and Chris and BSparl will join me soon thereafter, barring any issues.  The insulin/glucose drip will remain in until I'm able to eat something, at which time the pump will be reconnected (by me), and after an approximate 30 minute overlap, the insulin drip will be removed. 

The Joslin crew told me that my postpartum insulin settings on the pump will be a whisper of what they were during the pregnancy, and about a third of what they were pre-pregnancy.  At this stage, they're assuming that I'll jump down to a midnight to midnight basal rate of 0.3u, an insulin-to-carb ratio of 1:20, and a sensitivity factor of 1:80.  (My pre-pregnancy basals were more around the 0.4 - 0.6u range, an I:C of 1:10, and a sensitivity factor of 1:55.)   And once I'm breastfeeding, all bets are off as to how that activity could affect my blood sugars.  Only time will tell. 

So that's the low-down on how the diabetes, at least, will be handled during delivery.  I don't want to think too much about the surgery itself, because it freaks me out.  But handing over all of my diabetes control also has me a little tweaked.  After over 20 years of doing it myself, it's hard to grasp the concept of "let someone else handle it entirely."  But I know I'm in capable hands with Joslin, and I know that my focus needs to be on the baby. 

She's worth every hurdle that we, as a family, have overcome to make it to this point.

Because at some time during the whole ordeal, her little teeny cry will cut through all the noise, and in that moment, I'll become a mom. 

April 08, 2010

Across the Universe.

Or at least across the street. 

My window here at the hospital faces a research building across the way.  This building is covered in shiny, reflective glass and looking into the reflection is my only way of telling what the weather is outside, because apparently their building is taller than mine and gets a slice of sunshine there at the top.

I asked one of the nurses if that was another hospital, wondering if there were other patients trapped in there, being all impatient.  

"No, that's a research building.  They're there at all hours of the day and night in their white lab coats," she said.

Sure enough, when I peeked out my window, I could see the research people scurrying around like lab rats (rimshot) and chatting with one another.

So, after careful consideration (and also after covering my fingertips in marker), I made a few signs:

Someone in that building HAS to be as bored as I am.

And stuck them to my window, in hopes that one of the researchers would maybe write back.

Anybody out there??

(And, of course, a makeshift cartoon version of Siah made it onto the sign.  Because I miss that fuzzy little piglet - don't tell her, though, because I don't want her getting all arrogant.)

This cat ends up EVERYWHERE.

So far, no response.  I may need to update the signs later today or tomorrow with a new message - any suggestions?  Because my brain is FRIED OUT at the very thought that, a week from today, I'll be holding my daughter in my arms.

(And, for the record, Across the Universe is a quality song.  No denying it.  The Beatles are on the top of my playlist as I wait for BSparl.)

April 07, 2010

Day Twelve in Captivity.

I've been in for twelve days, and we have eight to go before BSparl arrives.  And I can't do any rainbows and unicorns crap about this experience.  The first week or so that I was here, I was a miserable mess, very depressed and experiencing some huge emotional swings.  In short, I was completely wussed out.  I felt very alone, despite the fact that I was visited every two hours by nurses and doctors.  I felt alone, despite the many phone calls from family members and friends.  And I felt alone, even when Chris was sleeping in the cot next to my hospital bed. 

Granted, I'm pretty sure I'd be crying my face off even if I was comfortable at home, just being at this level of hormonal upheaval in my 35th week of pregnancy.  (Case in point was the other night, when I saw the Folger's commercial on the television - the one where the daughter came in late the night before?  And she's talking to her dad at the breakfast table?  And she shows him her brand new engagement ring?  Oh, I lost it.  All sobbing like I knew this girl and was going to be her maid of honor.  /digression)

There's something so isolating about being stuck in the hospital. 

I could really use one of these cards these days.
One of these would be great right about now.

This room, this little box of a room that I've been hanging out in for twelve days, started to feel like a jail cell.  The ceiling has 35 tiles.  The floor is hardwood, and I was on the verge of counting those slats, too.  I would go from the bed to the bathroom to the window back to the bed and then to the bathroom again, only to end up back on the bed.  Occasionally I would venture out into the hallway and grab some ice water, but I was trying to stay off my feet as much as possible because since being admitted, my swelling has reduced considerably.  (Considerably as in I've lost eight pounds in the last twelve days, and it's all water weight.  My hands and feet look more human every day.)  

Physically, yes my swelling is improving but the blood pressure is creeping up oh-so-slightly.  Every time the nurses come in (and sometimes they come in without knocking, which confirms that I have zero privacy while here, which goes against every fiber of my privacy-desiring being ... yes I understand the irony of a blogger who craves privacy.  /digression no. 2), they check my blood pressure and it's gone from my at home readings of 120/70 to 136/78 to 144/82 ... and last night it got as high as 155/90. 

"Whoa."  I said, trying not to freak out.  

"Not to worry.  We'll page the resident on call, and we'll keep checking your vitals every two hours or so.  Nothing will slip by us.  Promise," the nurse said.  I felt confident that they would stay on top of this.  And eventually, my blood pressure came back down to the 140/80 range.  Still high, but not nearly high enough to induce a quick delivery.

Despite the progression of my preeclampsia, in the last day or so, I've turned an emotional corner.  Maybe it was marking the halfway point of "being stuck here" and "BABY!!"  Once I was on my 10th day in captivity, I realized I was halfway there.  And that made it easier, seeing the light at the end of this lonely tunnel and knowing my baby was at the other end of this.

"Maybe it's because you're used to being here now," Chris said last night, as I told him I felt a little better about being trapped here.  "You wake up, you know what to expect, and you know when this whole thing is ending."

"Wow, that's sad.  I'm used to expecting a loooong, boring day of pokes, prodding, and fetal monitoring?"  I laughed.  "That's like the saddest thing ever."

"We're almost there.  She's going to be here so soon, and then we can all go home and ..."

"Freak out."  

We both grinned.

April 02, 2010

Day Seven in Captivity.

Little on the down side today, thanks to having just marked one week "in" and with still two to go.  What the hell is there to write about, from the mind-numbing confines of my hospital bed?

At the moment, BSparl and I are hooked up to the fetal monitoring system, and I can hear her heartbeat pumping along like a rhythmic Clydesdale and can see the movements of her little 5lb, 5oz body being tracked on the graph.  It looks almost seismic, like a BSparl earthquake.  


They haven't checked the protein levels in my urine in a day or two, but things appear to be holding steady.  Blood pressure is climbing ever-so-slightly, but monitored constantly, and there's room for titration in my Labetalol medication (read:  they can give me more of that crap).  Still rockin' the heparin injections twice a day (hate) and still not sleeping through the night thanks to the monitoring.  (Which I understand the necessity of, but it's not making for "relaxing bed rest."  Bed rest is a misnomer.  This is more like jail where the wardens grin and mean well.)

One of the hurdles I'm having a little trouble with is the diabetes management aspect of things.  The Joslin team comes by once a day to review blood sugars and make suggestions, and they are the experts in all-things diabetes.  However, I am the expert in all things specific to MY diabetes, so I've been working hard to achieve a tolerable blend there.

For example, one of the (very nice, very knowledgeable, mind you) endocrinologists had some commentary about a post-prandial blood sugar of 137 mg/dl that I had two days ago.  In my mind, 137 mg/dl an hour after eating is downright badass, and I'm very happy with it, especially considering that the pre-meal number was 84 mg/dl.  Good control, in my eyes.  

"Well, this is a little high.  We'd like to get this post down."

I don't mean to be rude.  I try to be a good patient, a "patient" patient, and to find that careful blend I had mentioned, the one of my non-medical knowledge and their medical knowledge of diabetes.  But it was 8 in the morning.  And it was the third time I had been woken up by a doctor who wanted to review my goods.  And I didn't agree that 137 mg/dl post-prandial was too high.

"Really?  Too high?  I don't see it that way.  I think that's a number to aim for, especially seeing as how I leveled out to 98 mg/dl at the two hour mark.  That's a respectable peak, don't you think?  Otherwise, I'd be treating a low at the two hour mark."

"Yes, but it should be lower than that."

And I sort of lost my cool.  

"Okay, well how about we all call the FDA and get them to tighten up their requirements for 'what's accurate' to something a little more precise than 20%, and then we can start griping about a 137.  Because for all we know, that 137 mg/dl could actually have been a 110 mg/dl, and then I'm right in the acceptable range, right?"

(I am Kerri's terrible, bedrest-fueled, pregnant rage.)

They agreed that 137 was okay.  And that revisiting my post-prandials after another day of review would be a good idea.  And then the fleet of them shuffled out the door.  I felt bad about blowing off steam, but really - I'm in no way a "perfect diabetic," but these days, I'm running really tight and carefully with my numbers.  Let's remember that the reason I'm having post-prandial peaks is because - oh yeah - I have diabetes?

It's challenging, that feeling of having people take my diabetes management control away from me.  Not that I have all the answers or have it all figured out, but I've been living with this a long time and my own instincts and experience should be as strongly considered as the vast medical knowledge of my new, trusted caregivers here.  I'm no diabetes expert, but I'm pretty well-versed when it comes to "Kerri."  ;)

Eventually, I'll find a way to balance my issues with control while "in captivity," but until then, I may need to vent here a bit.  Because I'm pretty sure they're not reading me. 

... Whoops.

March 31, 2010

Fake Factor V, Heparin, and the Puffy Pregnant Girl.

I have fake Factor V Leiden.

Okay, not exactly "fake," but this blood disorder can come in two forms:  heterozygous and homozygous.  I have Factor V Leiden heterozygous, which means I have one mutated allele and am a higher risk for deep vein thrombosis than your average blogger, but not as high as my homozygous counterparts. 

I didn't know this disorder was part of my genetic makeup until about a year and a half ago, after a family member was diagnosed and prompted the rest of us to get screened.  And at that time, I didn't have to make many changes, other than switching my birth control pill and popping a baby aspirin before I got on a plane.

But playing host to my little lady friend now, Ms. BSparl, raises risk factors for clotting across the board.  Which means that I need to regard Factor V as a viable enemy, instead of "just that thing." Between bed rest (aka "lazy lump of Kerri), pregnancy (aka "growing awesome baby"), and Factor V (aka "blargh"), I'm at an increased risk of throwing a clot, so precautionary measures are being taken.

Namely:  compression boots and Heparin shots.

The boots don't bug me.  I know some people on Twitter were a little split on their opinions, but I am holding on to about 10lbs of fluid below the knees, so these boots (which blow up and relax in a way that compresses my legs and keeps the circulation at an optimal level) are helping to alleviate some of the swelling.  I wore them for a few hours and after taking them off, I saw my ankles again.  ANKLES!  Hadn't seen those suckers in about two weeks, so that was a treat.  Ankles and I had tea and crumpets and celebrated their re-emergence. 

What bugs me are the Heparin shots.  For several reasons. 

First off, I'm not on complete bed rest.  I'm on modified bed rest, so that means I'm able to use the bathroom, shower, and wander to the kitchenette for ice water and tea.  So the idea of taking an anti-coagulant because of my doctor's requests that I lay low just makes me feel plain lazy.  Lazy and I?  We don't get along, not even in theory.  I'd much rather do a little exercising every day instead of taking these injections, but I do understand that the priority is keeping my blood pressure down, watching the swelling, and - oh yeah - resting.

Secondly, the concept of Heparin freaks me out because if my situation progresses quickly and my daughter needs to be delivered without much notice, this whole mess goes from "scheduled c-section" to "actual surgery," where I'll need to be put under and wouldn't be awake for the birth of the most important person I'll ever know.  In that situation, Chris wouldn't be able to be in the delivery room and I wouldn't see BSparl until I came around from the anesthesia.  That does NOT sound like a fun plan to me.  Granted, Heparin takes 4 - 6 hours to get out of my system, so this kind of emergency situation is unlikely (especially considering how often they monitor me here), but still, I'm uneasy at the thought.

And thirdly, the shots suck.  Royally.  Even though I've asked to use an insulin syringe and administer the injections myself, the pain is sharp, and the bruising is intense.  It looks like someone stuck violet petals all over the backs of my arms and on my thighs, but that's making it sound too pretty.  Actually, it looks more like the nurses come in here at night, grab me violently by the arms, and shake me around until I yell "Uncle!"  (Or, more likely, "Nurse!)  Here, have a look:

Stupid bruises from the heparin injections.

Ghastly.  And other than the look of it, it's hard to find real estate to inject the Heparin into, seeing as how my lower back is claimed by the pump and my legs have dibs called by the Dexcom.

I'm having blood drawn today to check the levels of anti-coagulant in my body, which will help my medical team see if this is the right course of treatment for me to actually be on.  I think this just gets chalked up to "another hurdle during a high risk pregnancy," and while I'm bitching about it now, the payoff (read:  cuddling with my kiddo) far outweighs any arm bruises or discomfort.

March 30, 2010

Tracking Pre-Eclampsia.

Almost there!By virtue of the name itself - "bed rest" -  you'd think I'd be sleeping a ton and feel all squishy and relaxed here at the hospital.  Like a spa, only with crappy food.

Oh hell no.  Because of the nature of pre-eclampsia, and having a high risk pregnancy to begin with, I'm under constant supervision.  This is a good thing, because the doctors and nurses here absolutely know how to handle any circumstance that crops up, but it's a tough thing sometimes because the "rest" part of this is hard to achieve when the door is opening and people need vitals all day long.

My day begins around 5:45 am, when the resident on call pops in and checks up on my basal rates, blood sugars, and overall puffiness.  Her questions are usually the same - "Any bleeding?  Spots in your vision?  Pain in your upper right side?"  I'm happy that I can answer "No," to these questions.  And then she leaves. 

My nurse comes in at about 7:00 am to review blood sugars, liquid intake, urine output, takes my blood pressure and temperature, and gets the heartbeat on the baby (which is a great way to wake up in the morning, to the sound of my daughter's galloping heartbeat).  She leaves, I test my blood sugar, and try to go back to sleep.

But at 8 am, the Joslin team comes in and does a review of my blood sugars, basal rates, and everything else diabetes-related.  (Basically, I review the same information about three times before 8:30 in the morning.)  We review and/or make adjustments as needed, and their crew leaves in a flurry of labcoats.

(At this point, I order breakfast from the kitchen and hope it doesn't arrive while I'm in the shower, because nothing is more awkward than "Room service!" trilling in from the door while I'm making attempts to wash my hair with these enormously swollen hands.)

10 am brings the nurse back to my room with a dose of Heparin (fun shit) and my Labetalol pill.  I've asked to administer the Heparin myself, because there's something about the way that the nurses give the injection that makes my skin bruise ferociously.  (Pictures to come soon of those messy bruises.)  So instead of using the normal "horse needles," they're letting me use insulin needles and give the shots myself, which helps a lot in managing the bruising and pain.

After the medications, they hook me and BSparl up to a fetal monitor, which keeps track of her heart beat, her movements, and any contractions in my uterus.  She's been dubbed "busiest baby on the floor" because she's a very active little biscuit, and even though I'm attached to the monitor for 40 minutes, it's comforting to hear the sound of her heartbeat filling the room.

And then it's like lunch time(ish), and I make futile attempts to catch up on emails, check in with work stuff, and read some blogs.  My hands are beyond swollen, so computer work is very limited and after about 30 minutes of typing, the pain is pretty intense.  (And from what I've been told, after I deliver the baby, I'll swell up even more for another day or two before it starts to subside.  This kid better love the hell out of my Cookie Monster mitts and Fred Flintstone feet.  ;) )

The afternoon seems to vary, but always includes input/output tracking for my liquids, at least a few hours laying on my left side to alleviate the stress on my kidneys, and my watching of an episode of Law & Order: SVU. (Best.  Show.  EVER.)  And a vitals check from the nurse staff.  (Yesterday had a bonus visit to the radiology department, where I had an ultrasound and saw my daughter's chubby cheeks.  I love her.)

Evening includes dinner.  And usually a few phone calls.  And another round on the fetal monitor.  Sometimes I make attempts at the computer again, but it all depends on what my hands are agreeing to follow through on.

10 pm has the nurses visiting again with my prenatal vitamins (Note:  They let me keep bottles of insulin in my room but they confiscate my prenatal vitamins?  Not sure if they think I'm hooked on DHA or something.) and the second dose of Labetalol.  Vitals are taken again.

Midnight brings the second dose of Heparin, and another check of the baby's heartbeat and my blood pressure.  After the nurses leave, I try and collapse into bed and fall asleep.

Until 3:30 am, when the nurses return for another heartbeat check, blood pressure check, and blood sugar check.  Check, check, check ... 

Bored yet? Well-rested, are ya?  This is the day in-day out routine for the next two weeks, and I'm snoooooring at the very thought (yet unable to really sleep because I have nurses visiting every few hours).  But BSparl and I are being watched so carefully and so closely that if any issues crop up, they won't take anyone by surprise.  That helps keep she and I safest, I think.

But for now, it's boooooooring.  Thank goodness for my parents, who have come by with flowers, entertaining pictures colored by my nephew, and magazines.  Thank goodness for my mother-in-law, who calls daily to check in and reminds me that this is only temporary.  Thank goodness for my best friends, who call often and keep me in the loop on what the hell is going on in the "real world."  Thank goodness for the Internet, which is letting me connect with you guys and Facebook crap and all the other nerdy connection points that I'm relying on when I'm the only person in my hospital room.

And thank goodness for Chris, who is shuffling back and forth between our house and the hospital, working hard to prepare the nursery (we didn't have much notice on this visit, so things are a little bit in disarray for Ms. BSparl), maintain our home, and oh yeah, work?  When he comes here and sleeps over, just having him in the room makes everything easier.  (I'm just waiting for one of the nurses to accidentally try and get his blood pressure.)

... it doesn't hurt that as soon as BSparl hears his voice, she gets all bugged out and wants to dance.  She loves her daddy.  I think she likes me okay, too.  I'm hopeful that the next two weeks go by as smoothly as possible, keeping her safe and happy in there, and eventually bringing her out to us. 

So we can hold her and dance with her on the outside.

March 29, 2010

Diabetes and Pregnancy: The Bed Rest Chronicles.

Hanging here for a few weeks.All day Wednesday, I had the pleasure of collecting my urine in a "hat" for 24 hours and then sending it off to my doctors for protein analysis.  Since I was ordered to remain on modified bed rest until further notice, Chris ran the collection up to the hospital for analysis at noon.



Where they lost it.  Twice.  And the test wasn't actually performed on the sample until almost 10 pm that night.  



Which lead to the mad scramble on Friday morning after my OB called, saying that the protein content of my 24 collection was too high for comfort, and they wanted to admit me to the hospital until the baby was born.



I'm not the most calm, relaxed person.  (WHAT DO YOU MEAN, YOU PICKED UP ON THAT?)  I get nervous about things, I have a hard time adjusting to change, and I have a lot of trouble letting people make the full decisions regarding my health care.  So being told I needed to pack a bag for a time frame ranging from 1 - 3 weeks, and that upon my return home, I'd have my daughter with me ON THE OUTSIDE, I melted down just a little, teeny bit.



But it's not about me, or what I need.  This is about my kiddo, and keeping her safe and sound.  So the bags were packed (where I put in jeans and "real shirts" but then realized I'll be on bed rest, so replaced those items quickly with sweatpants, sports bras, and t-shirts) and Chris and I headed off to the hospital.



"See you in a little bit, Siah.  But when I come home, you won't be the queen bee anymore.  Ms. BSparl will outrank you by an awful lot."



Siah looked at me, slightly crossed-eyed, and then ran off to chase a speck of dust that scampered by.



When we arrived, the doctors checked my blood pressure (was a little elevated - 140/84, but no one was freaking out) and labs were drawn to assess the levels of creatinine in my blood.  The medical team checked on BSparl, too, with a full ultrasound and non-stress test to assess if and how the pre-eclampsia was affecting her.  Thankfully, she's having her own personal dance party in there and seems to be just fine, despite all of my symptoms.

So we're in for the long haul now, which just got a bit shorter.  I'm currently 34 weeks, 4 days along in this pregnancy, and the hospital goal is to make it to the 36 week mark.  If anything becomes unstable between now and then, BSparl will arrive on an earlier flight.  :)  But I'm being watched carefully, and so is she, so nothing will be sneaking up on us while we're under the careful eye of the team here. 

My blood pressure is being checked every few hours, my liquid intake/urine output is being tracked to keep tabs on my kidney function, and we have ultrasounds and blood work scheduled every two days.  I'm on heparin shots three times a day, thanks to this bed rest/Factor V heterozygous combination (more on that later).  And the nurses are keeping my blood sugar logbooks for me, which means this is the most thorough logbooking I've ever done in my entire life.  (Also, my numbers haven't been over 120 mg/dl in three days, which means I've scared my diabetes into complete compliance.  Testing every hour probably helps a bit, too.  Panicking slightly doesn't appear to hurt, either.)

I'll be a little scarce at times online, thanks to the swelling in my hands that keeps me from being able to work comfortably, and due to the barrage of docs and nurses that are checking in throughout the day and night.  (I have upwards of 10 doctor or nurse visits throughout the course of the day - makes for a very BSparl-focused 24 hours.) 

Chris and I are so thankful for the support and well wishes we've received from you guys - it makes a world of difference, and I know BSparl is benefiting from these good vibes.  (And I am too - thank you!!)

March 25, 2010

Showered.

Over the weekend, my family (special thanks to my mom, who worked so hard!!) threw Chris and I a baby shower - a beautiful baby shower.  Our families and friends came together to celebrate this baby-on-the-way, and I don't really have proper words to describe how nice it felt to welcome this baby into our family.

Thankfully, I do have a few pictures.  :)

Me and my college roommates
My college roommates and I (and the BSparl baby bump, front and center.)

Opening gifts
Everything we received was soooo tiny and complete cute overload.  My face basically looked bewildered in every photo during the gift opening.

BSparl is single.
These bibs all had mantras, but this one - "Single" - made me laugh out loud.  It also made me fast-forward mentally to when my little girl might not be single, and then my brain shut off.

Baby shower favors.
Our baby shower favors were these delicious chocolate treats in the shapes of baby bottles and pacifiers.  Fortunately, they are delicious and lovely.  (Unfortunately, we ended up with several favors at our house, and I'm trying like hell to resist eating them.)

And now we have a house full of baby gifts from our very generous friends and family, and hopefully a few more weeks to go before we actually are tucking a baby in at night.  Thanks for all the well wishes, you guys.  It means a lot to us!!

March 24, 2010

Signs of Pre-Eclampsia in a Diabetic Pregnancy.

Dear Baby,

I know you can hear me in there.  You are about 5 lbs of baby girl and when I sing to you while we're driving, you move around from side to side.  (I hope you aren't trying to escape the sound of my tuneless voice.  In my mind, and in my car, alone, with the windows rolled up, I'm fooled into thinking I sound pretty decent.)

So make sure you're listening now, because I need you and I to work together pretty closely for the next few weeks.

Yesterday, at the doctor's office, we were there for a routine visit but my damned blood pressure was a little spikey, coming in at 140/90.  Much higher than what we see at home, which is closer to 125/73.   (White coat syndrome, anyone?)

Our OB reacted immediately.  She sent the nurse for my urine cultures and confirmed that protein was spilling into my urine.  They took three more blood pressure readings, all which came back in the 130-140ish range.  And then they did a quick measurement of you and your heartbeat.

"I know you have an ATU appointment today, but I want to send you over to labor and delivery for monitoring.  Basically, I think you're showing signs of pre-eclampsia.  I do not want to take any chances."

"Okay, what does that mean in terms of what happens next?"  The words "labor and delivery" and in my vocabulary, but I wasn't planning on using them until ... oh, say the end of April.

"I want them to hook you and baby up to monitors and keep an eye on both of you for a few hours.  If your blood pressure continues to climb, or if the baby shows any sign of distress, we may need to have her come today."

Baby, you feel enormous sometimes, all rolling around in there.  I can feel your legs up about four inches past my belly button, and I can feel the swell of your pretty head closer to my pelvis.  You take up a lot of room in this belly now, and when I'm trying to get up from the couch at times and need to roll a little on my side to launch myself upwards, I laugh because it's just ridiculous how big my pregnant belly has become.

But when the doctor said that you may need to come early - 33 1/2 weeks along kind of early - depending on the stress on both of our bodies?  I couldn't help but picture just how small you are.   We have five weeks left.  I want you to stay put as long as possible.

"Today?  That's like instant panic.  Today?  So should I call Chris?"

"Yes.  Once we have you over at labor and delivery, and they monitor you, we'll be able to determine if you can go home today and tackle bed rest for a few weeks, or if we should keep you overnight and monitor you both, or if you should be admitted for a few days, or, and this hopefully is NOT the case - that she's coming today via c-section instead of in a few weeks."  

Lots of information to digest.  I called your dad from the foyer as I waited for the elevator and gave him the details.  "Basically, she is probably not coming today.  But she might be.  And I'm freaking out a little bit.  I think it's okay for you to wait to come up, just until I know what their plan is.  They're not going to make any fast decisions - more ruling stuff out and ... honestly?  I have no idea what's going on."

Little girl, I was confused.  But after spending a few hours having blood drawn, blood pressures taken, and non-stress tests performed, things were looking a bit better.  They did an ultrasound of you and you look strong and healthy (and round in the head, you cute little mess).  They also scanned the placenta for any signs of detachment or calcification, and took measurements of the fluid level in your uterine apartment.  Everything was looking good, except for the protein spill and the elevated blood pressure.

The doctors came to evaluate me.  Us.  And their main concern was the protein.

"We'd like you to do a 24 urine collection and stay overnight."

"Stay overnight for monitoring purposes?  Are there concerns for me or the baby?  Or are you just really eager for my pee?" It had been a few hours, I was hungry, and my hands were sore from texting Chris and keeping him updated on our situation.

"At this point, just the ... um, we just want your pee."  (Baby, I love making doctors repeat back the odd things I've blurted out.  Those awkward moments from them almost make the initial awkward moments from me worth it.  Wait until we're at the pediatrician.  I'm sure I'll embarrass you endlessly.) 

"So can I do the collection at home instead of being admitted?  And bring it back after 24 hours?  Or is that risky in ANY way?  I don't want to tell you guys what to do, I just don't want to hang out in the hospital purely for urinating purposes."  (And also, I didn't have any back up pump supplies or clean clothes or anything to even read, so the idea of being trapped in the hospital for 24 hours, purely to offer up constant urine samples, made my head spin.)

"No, home is fine.  So long as you can bring the samples back after 24 hours.  And we'll need you on modified bed rest until further notice, because if pre-eclampsia progresses, we don't want any problems.  You'll need to keep an eye on your blood pressure, and any headaches that might crop up, and if you have any pain in your upper right quadrant, you need to call your doctor immediately."  

"Got it."

After discussing a few more items, they worked through my discharge paperwork and handed me two, enormous orange jugs for "collecting."  "Here - you pee in this hat and then pour it into thYou pee in a HAT?e jug."

"Excuse me?  Into a hat??" 

"Not an actual hat - this plastic thing.  It's called a hat."  The nurse tried to control the grin tugging at the corners of her mouth.  They must have thought I was completely unscrewed.

"Ah, okay.  I can do that."  

And off we went, toddling back to the parking garage and heading home to your dad.  Baby girl, we're almost there.  If you can hang tight and stay strong for a few more weeks, that would be the best for both of us.  It seems like we're not sure how soon you're coming these days, so it's up to you and I to try and hold out as long as we can, in good health.  Everyone at the hospital is keeping a very close eye on us, and we're under the best care possible, so it's up to you and me for a little bit.  We need to stay calm.  And hydrated.   And keep tabs on blood pressure.  And stay calm.  Did I mention calm?  Calm would be good.

I love you so, so much.  And when they tell me that "she looks beautiful" and "healthy" and "strong," I feel so proud of what you and I have done, and how far we have come.  Daddy and I will take the best care we can of you, and we're almost ready to have you as part of our family.   Almost.  You just need to stay put and keep growing for a few more weeks, so when you arrive, you are as strong as you can be. 

Be good.  (And if you see my pancreas, give it a kick, would you?  Maybe you can jump start that lazy thing.)

Love,
Mommy

March 16, 2010

Emergency Room Visits.

On Saturday night, I was stuck.  Completely stuck at 260 mg/dl and not budging, despite stacking boluses and not even thinking about carbs.  (Because if I even thought about carbs, my blood sugar would magically rise.  It's an unproven fact.)  And I was very, very frustrated. From about 9 pm - 1 am, I battled with boluses, wondering why they weren't working.  Like a moron (Morrone?), I didn't just pull out the infusion set, but instead tried every other trick in the book.

Until I realized it just wasn't working.

So I pulled the set at about 2 in the morning, restarted a new site, and tried to get some sleep.  But by this time, a roaring headache had set in.  I'm not sure if it was caused by the high, the frustration, or dumb luck, but my dome was throbbing all night long.

I woke up with the headache. I don't get headaches often at all, so having one was a big deal.  And "headache" was one of the main symptoms my doctors at Joslin told me to keep an eye out for, as far as signs of preeclampsia go.  Fantastic. 

So, being the genius that I am, I decided to sleep in on Sunday, stay very hydrated, and then go to a hockey game in Providence with my sister-in-law and her husband STEVE.  (Hocky game when trying to ward off a headache?  WTF was I thinking?)  The game was great, I had a chance to hang out with my always-entertaining and adorable niece M, but being surrounded by a bunch of happy, screaming kids and adults cheering on the P-Bruins made for an epic crescendo of said headache.

Chris and I ducked out a little bit early, and on the way back to our place, I called the doctor on-call at Joslin to give them the run-down.

"I have had this headache for about 12 hours.  But it came on after a bad night with a stubborn high blood sugar, so it's hard for me to say what's caused what."

The medical team recommended that I go home, take my blood pressure, drink water, take Tylenol, and have a cup of coffee to help make a dent in this headache.  They said they would call me back in an hour and a half to check on my progress.

ER bracelet, in fashionable blue.

"Seriously, I'm not concerned.  Dude, go to the movies with your friends.  I'll call you if, for some reason, they decide they want me to go to the emergency room or something.  But I seriously doubt they'll want me to," I said to Chris.  He took some convincing, but I felt okay - just a headache.  I had the very same discussion with NBF over the phone as I waited for Joslin to call back.  "No, they are just going to tell me to go to bed or something.  No worries, my friend."

Ha, ha.  And ha.  Joslin called back, I confirmed that the headache wasn't gone yet, and the doctor recommended that I head to the emergency room so that the baby could be monitored and I could have labwork run.  "Preeclampsia can come on quickly, and we aren't taking any chances," they said.

"Chris - just kidding.  Joslin wants me to to go to the ER."  I texted him.

"I'm leaving right now."  He responded.

So we spent four hours in the emergency room on Sunday night, checking on our little biscuit of a BSparl.  They drew labwork on me to screen for preeclampsia (no indicators, thankfully), checked my urine (no protein, - also a good sign), monitored my blood pressure (which was fine), and hooked my abdomen up to a few sensors to keep track of baby girl. 

"Every time she moves, press this button so we can track how active she is in there.  When you press the button, a green line will show up on the graph up there, see?"  The nurse pointed at the computer screen, where the baby's heartbeat was being graphed.

"No problem."  (BSparl must have loved all the attention, and maybe she liked listening to the episode of House that was on in the hospital room, because she filled that graph with green lines for 45 minutes as a result of her dancing.  Busy little baby bee.)

After a few hours, the ER doctors talked with my team at Joslin and everyone determined that I was okay to go home.  The baby wasn't at risk, I seemed to be okay, and the only issue was this lingering, nagging headache.  They prescribed extra strength Tylenol (bye bye, Dexcom for a few days) and this other medication that is intended to treat nausea in pregnancy but has been used to manage headaches, as well.  Hydration, sleep, relaxing, and medication were my recommended course of treatment.

What's the point of this post?  I have no idea.  I'm just rambling these days.  :)  It seems like everything is a pushed panic button when it comes to high-risk pregnancies (any pregnancy, I'd guess, but I only know my own so intimately), but I do have a kick-ass team when it comes to managing potential emergencies on a Sunday evening.  The headache still hangs on, but the medication is making it manageable, and I'm hoping it's totally gone by the time I head to Rhode Island for my baby shower on Sunday.

Counting down the weeks until BSparl arrives and makes her little mark in this world.  She comes with a how-to manual, right?  ... Where's that headache medication ... ?

March 15, 2010

Home Stretch: Diabetes, Pre-Eclampsia, and a Cute, Round Head.

The loooong home stretch.Part One:

The people at Joslin are eventually going to lock the doors when they see me coming.  Because last Friday, at my latest round of BSparl appointments, I burst into tears a few dozen times. 

I am not a crier.  I'm very emotional, but can usually keep my emotions well-contained until I'm back in the safety of my friends or family, and then I let loose.  But with just over six weeks until the baby arrives, I'm the definition of a basketcase.

Arriving at Joslin, I was on time.  For once.  And sporting hands clad in wrist braces and ankles sheathed in compression stockings.  Again, hot momma.  ;)  This puffiness was my top concern that I wanted to talk with my obstetrician about, so it was good that I was at least exhibiting the signs, so she could see Le Puff first hand.

During the first appointment, Dr. T lubed up my belly and we took a peek at Ms. BSparl.  

"Wow, she's got a good head on her!"  

"Yeah, the Morrone kids, all of 'em, were born with these tremendously round, sunshine heads.  We're like little moons orbiting around.  My niece and nephew were absolutely adorable, and they had the same beautiful, round heads."

"Well your daughter appears to have that head.  She's perfectly round!"  Dr. T took some measurements and determined that BSparl was about 4 lbs, 11 oz at this stage.  "She's on track to be about 8 lbs, 5 oz, it seems.  She's in the 58th percentile, and I'm very happy with that."

"Is she a little bigger because of my diabetes?"  (This question prompted the first set of tears - damn, I'm an emotional mess these days.)

"No.  If that was the case, her abdomen would be out of proportion, and her body is in perfect proportion.  She's just a little tiny bit bigger than average, but her size is not diabetes-related.  Your blood sugar control has been great.  How big was your husband when he was born?"

"He was 8 lbs, 8 oz.  And I was 7 lbs, 8 oz, I think."

"Right.  So your daughter is on track to land between the two of you.  It's completely normal."

And finally, finally, I saw my daughter's face on the ultrasound machine.  In previous checkups, BSparl had been spine up, face in, so her face was obscured by the placenta and I never had a good look at her.  A few other times, she had her hands up in front of her face, only letting us see a little bit of her.  But this time, she was pretty visible, and I could see her chubby cheeks, her button nose, and her father's lips. 

She has a face I can't wait to smooch.

After the ultrasound, Dr. T and I talked about her main concern:  my weight gain.  In the last month, I've put on 10 lbs, without reason.  My pants and shirts still fit the same, I haven't been eating more or less, and my numbers have been creepily stable, but the scale tipped out at 10 lbs heavier this visit.

"What the HELL is that about?"  I asked, ashamed that up until the beginning of March, I'd only gained 27 lbs with this pregnancy, but now I was already pushing the 35 lb mark ... with six weeks to go.

"Your feet.  Your legs.  And your hands.  I'm very concerned about this weight jump, not because of the weight itself, but because it's obviously water weight.  And I don't want any issues with pre-eclampsia cropping up."

(Enter the second set of tears from me.)   "I've been checking my blood pressure at home, and haven't seen any spikes.  But I'm puffy as all get out, and it's very, very uncomfortable.  No headaches, no trouble urinating, but puffy?  Yeah."

"I think we should run some blood work today to see if you have the blood indicators of pre-eclampsia.  It's not just the blood pressure and the headaches that are indicative of this issue.  By running the blood panel, we can see if your body is already gearing up to develop this problem, and we'll be prepared either way."

"Okay."  Blotting tears.  Such a mess.  "So we'll do that and an A1C and go from there?"

"That's the plan."

After a few other appointments, I headed home and focused on the weekend.  Dr. T called me on the ride home and said that my blood work came back perfectly, without a single blood panel indicator of pre-eclampsia and my urine also didn't show any protein spilling.  I felt reasonably at ease and comfortable with the fact that Le Puff was simply due to Le Pregnancy, and nothing more.

But there were some aggravating moments at Joslin, which deserve a whole separate post.  And the weekend?  Had plans on tap other than "relaxing." All is well, but it was a long and tangled experience.  More on that tomorrow.

March 10, 2010

Eight Months ... But Two to Go?

Ah, the cruel truth to pregnancy.  I'm currently 32 weeks pregnant, which means I'm eight months along.  "Oh great, Kerri!  That means you only have one month to go!"

WRONG!

Those perpetuating the rumor that pregnancy is only nine months long, I beg you to stop.  Because when we, the pregnant messes, crest up to the eight month mark, only to realize that there are eight weeks left to go?  We cry.  Sometimes we just bust out crying.  Because pregnancy is 40 weeks long, and when you divide 40 (weeks in total) by 4 (weeks in a month) ... well, even I can do that math.  It equals 10.  Ten months. 

So I'm eight months along, but I've got seven weeks left to go.

BSparl at 32 weeks
(Yes, this shirt is the same one that my best friend wore to her baby shower.
Nothing says "I love you" more than sharing maternity clothes.)

Expansion is rapid these days, and my pregnant body has gone from "comfortable" to "OMG, TEN MONTHS LONG?"  On the regular ol' pregnancy front, I'm experiencing some wicked swelling in my hands and feet, but thankfully my blood pressure is still holding steady.  Also thankfully, it's been warming up for the last few days, so sporting flip flops doesn't look too dorky.

Sleeping is an issue, though.  I'm having a miserable time getting a good night's sleep, because this swelling in my hands is waking me up with shooting pains in the middle of the night.  Actually, every hour or so I'm waking up with pain, despite the fact that I'm wearing wrist braces to bed.  I may have to bite the bullet and take some Tylenol, even though it will render my Dexcom pointless. (Tylenol makes the Dexcom throw inaccurate results, and I can't take Advil while pregnant, so it's about choosing pain or accurate CGM results.)  I'm trying to relax and remember that it's only a few more weeks of this.

On the diabetes front (and I'm afraid to say this out loud), I seem to have hit some kind of stride.  The 300's are gone.  The 240's are gone.  I'm seeing a few spikey 200's, but they are sometimes explainable (like after I was 50 mg/dl and I over treated a low) and some I just need to forgive myself for.  Overall, my numbers are steadier and I'm seeing more flat lines on the Dex than I saw a few weeks ago.  I'm so, so hopeful that the next seven weeks roll out in the same fashion.  My total daily insulin dosage is up to between 68 - 75 units of Humalog a day (far cry from the 24 - 28u I was taking pre-BSparl), and I'm wondering if this will remain the case until the delivery.  I'm holding my breath, praying that things just hold freaking steady for a little longer.

This week, I'll see my OB/GYN and the rest of my prenatal team, and I have a lot of questions to ask.  Like what happens if I go into labor before my scheduled delivery date?  What exactly is supposed to be that "bag that stays packed just in case?"  What can I do to alleviate this swelling, in efforts to stay comfortable for the next seven weeks?  How about those four days we'll be spending in the hospital - will I be able to wear my pump once the c-section is over?  Can I put the Dexcom back on at that point, too?  Does the baby sleep in the room with us or does she have to go to a different part of the hospital while I recover?  Will I be on painkillers after the surgery?  Does someone show me how to breastfeed or is that something I'm supposed to take a class for beforehand? 

Are they really going to trust me with a BABY??

(The question mark has become the most-used key on my laptop these days.)    

March 05, 2010

Puffy Pregnancy Hands.

I loved Venkmen the best. Nothing says "hot momma" like a pair of puffy pregnancy hands. 

BSparl and I almost at the 32 week mark, and I'm rocking what I've heard is a very common, but very uncomfortable symptom of pregnancy - swelling.  Water retention.  Puffiness.  Or, as I call it when I'm frustrated but more like Pepe Le Pew-frustrated when he can't get his mitts on that black cat: "Le Puff."  

The first half of my pregnancy was very comfortable.  No morning sickness and no real discomfort, just the growing potbelly and lots of blood sugar lows.  Second trimester was good enough (just got bigger and bigger) but now, deep into the third trimester, I'm starting to really feel the burn.  This puffy hands thing isn't just a mild complaint.  "Le Puff" is serious stuff! 

It's a combination of puffiness and pregnancy-induced carpal tunnel syndrome, with my hands aching and often seized with that 'pins and needles' feeling.  Wearing a wrist brace while I work helps a little, but not enough, and I find myself taking more and more long breaks to ease the pain in my hands from typing.  I wear the brace to bed, too, in efforts to keep my hands in a "neutral position" throughout the night. (Neutral, instead of like flipping Chris off at 2 am?  Would that be an "offensive position?")  And today, I'm off to get a second brace for my left hand, which will make me officially robotic while I sleep, with the two braces, the pump, the Dexcom, and this massive belly.

Like I said ... total hot momma.  :p

So one of the treatments for this miserable symptom - oddly enough, is more water.  It seems counter-intuitive to down a bottle of water when I'm feeling at the peak of Le Puff, but staying hydrated is the best way for me to keep the puff at bay.  And I'm also being monitored closely for pre-eclampsia, seeing as how I have a few of those risk factors in play (first pregnancy, diabetes, pre-existing hypertension ... good times again!). My blood pressure, and the other signs of pre-eclampsia, are being closely watched for, so hopefully no worries.

My next round of doctor appointments (and the beginning of the bi-weekly visit routine) is late next week, so I'm doing what I can to stay off my feet these days and prop them up while working.  Exercise is a little bit of a trouble spot, too, because shoving Le Puff feet into non-Le Puff sneakers is proving tricky on some days, but I've been trying to supplement with in-house yoga and stretching exercises (while barefoot).  And I'm resting a lot, which makes me feel like a lazy bum, but people keep telling me to get these naps in BEFORE the little biscuit arrives, so I'm taking their advice.

In the meantime, I'll Stay Puft.

March 01, 2010

Interviewing Pediatricians.

What the hell are we doing?With only a few weeks left to go before the baby arrives, Chris and I are starting to think past "just the pregnancy."  The focus is shifting slightly from "How do we manage this pregnancy" to "Okay - she's here.  … now what??"

A few months ago, we started to make some changes for the baby's sake.  We opened a savings account for our daughter.  We spent that one crazy day at Babies R Us registering for things BSparl might need when she arrives on the scene.  We spoke with our insurance company and talked about the process of adding BSparl to our plan.  And now - we're starting the pediatrician process.

As in, who is going to answer the questions about our baby's health?  Who will work with us to help keep BSparl safe?  Admittedly, I wasn't always the healthiest kid, my issues having nothing to do with diabetes.  Like there was that time I ended up with a splinter in my eye from a neighborhood "sword fight" using tree branches.  Or the time I was watching a movie when I was about 3 years old and stuck bread in my ear, just to see if it fit.  (It happened to fit quite nicely, thanks.)  Or … um, the time I was also watching a movie and decided to see if I could fit a raisin up my nose.  (The raisin also fit.  And it had to be extracted by a doctor at the emergency room.  And apparently I liked to put food in all the available spots in my head.)

Knowing what kind of bizarre things happened to me as a kid, I am already braced for when BSparl toddles over to me and tells me she fit four Cheerios up her nose.  So, like I said, Chris and I are starting to think about our pediatrician options.

I'm not looking for specific recommendations for doctors, but more the questions that you ask your child's doctor.  Do you interview a pediatrician like you'd interview a babysitter?  My OB/GYN suggested that Chris and I actually go meet a potential pediatrician and ask them a few questions, see how we feel about having this person as part of our child's life.  You know, get a feel for what it will be like to engage with this person.  So what kinds of questions should I be asking a potential pediatrician?  The ones that jump to mind don't seem right to me:

"Do you like children?"  (I'd hope so.)
"What made you want to be a pediatrician?"
"We have some chronic illnesses in our family.  What's your familiarity with diabetes, etc?"
"Do you like cats?"  (Not relevant.)
"Do you take our insurance?"
"How long will we need to call in advance of making an appointment?"
"How many fingers am I holding up?"  (Three.)

While I'm not worrying about whether or not my child will end up with type 1 diabetes, I do realize that there is a slightly increased risk.  And I want to have a doctor who is able to work with Chris and I through our decisions to pursue TrialNet, and other research studies, as we keep close tabs on BSparl's health.  So it's time to start putting together our questions and subjecting some poor soul to our curiosities.  

Any suggestions on how to find a pediatrician?  And do you know how many fingers I'm holding up?

February 24, 2010

The Good, The Bad, and the Eh.

The good, the bad, and the egg.  I mean, the eh.We'll start with The Bad:

  • Getting my sorry arse to Boston proper yesterday should have been a quick ride.  My first appointment was at 8 am, I was leaving my house with an hour and 15 minutes to spare (I had hopes of grabbing breakfast before my appointment and getting a little work done on the trusty laptop) but traffic on the way into the city dashed all hopes of getting there on time.  It took me two hours and fifteen minutes to make a 35 minute drive.  Needless to say, I was livid by the time I had arrived at Joslin.
  • And while I'm driving, I'm watching my blood sugar climb.  Crap on several levels, because as I edged closer to 170 mg/dl, I started to wonder if my insulin to carb ratio needed to be changed, I fretted about the effects on the baby, and I also realized that two hours in the car at an elevated blood sugar equaled "OMG I have to pee like you read about."
  • Also, felt a dampness in my armpit and became disgusted with myself, realizing I was sweating through my shirt?  Gross, Kerri.  That's just gross.
  • Arrived at my appointment 30 minutes late, they squeezed me in, and after I gave a urine sample, they told me that I was spilling ketones for the first time in my pregnancy.  FanTAStic.

Which leads me into The Eh:

  • Turns out that my blood sugar was climbing because my infusion set wasn't connected to my body.  The pump was on my hip, the site in my arm, but the two weren't joined at the set, leaving every bolus and every basal unit pooling into my armpit.  Thus explaining the stain on my shirt (and the fact that what I thought was sweat was, instead, vital insulin units).  Two hours without insulin explained the high, the headache, and the ketones.  And also made me feel extremely dumb.
  • My eye dilation was deemed "inconclusive" by the retinologist.  She said that my right eye was perfectly fine, but the left did still have two spots close to the macula.  Again, less an issue with the spots themselves and more with their precarious location.  "But I feel comfortable with you attempting a vaginal delivery.  But if you have a long labor, or a difficult labor, you'll need to have a c-section."  My initial response was "Oh, but I'd really like a healthy baby and healthy eyes for myself, so would a section be a better chance at having both?  Or do you just want me to push, possibly harm my left eye, and then possibly still have the c-section?  Does not compute."

But thankfully, there's still The Good:

  • BSparl remains at a steady, healthy weight, and her heartbeat was lovely enough to make my own skip a beat.
  • My doctor called me at nine o'clock last night to tell me that she reviewed my eye exam with the other high risk OB/GYN and they feel confident in recommending a c-section.  Their main concern is the Factor V Leiden issue, which could cause a clotting concern with the delivery wound, but I've already had my medical team advise me that I'd be on Heparin for a few weeks after delivery.  They just want the baby out safely, and for my eyes to remain intact.  I'm on board for that, as I'd like to be able to clearly see this creature we've created. 
  • And now I know how she's arriving, and I can start Googling that and freaking out.  No, I know not to Google and not to completely melt down.  But honestly, the whole "giving birth" thing, no matter the method, has made me nervous for years.  And it's strange to know that in eight weeks, I'll be doing it.

Which brings me to the best part of The Good:  Only 64 days until I can hold her in my arms and tell her I love her.   It's on. 

February 22, 2010

Orange You Glad?

That old knock-knock joke about the oranges and bananas?  My brother and sister and I would bust that one out at one another all the time:

"Knock, knock!"
"Who's there?"
"Banana."
"Banana who?"
"Knock, knock!"
"Who's there?"
"Banana."
"Banana who?"
"Knock, knock!"

(This is where you either ended up with the giggles or started to get annoyed.)

"Who's there?"
"Orange."
"Orange who?"
"Orange you glad I didn't say banana?"

Of course you're glad I didn't say "banana."  Because that joke sucks a little bit.

This is all a big build up for a photo I had taken of my new favorite food:  oranges.  Odd thing is, I usually don't like oranges - something about the smell of the rind and the sticky hands and the fact that there is no really clean way to eat one of these pesky things - ugh.  Was never my snack of choice.  Reminded me of soccer game halftimes, when I'd have to shovel in a few slices of these, or wouldn't be able to have any, depending on my blood sugar at the time. 

Of course, thanks to the magic of pregnancy (which has also given me a taste for seafood and taken away my preference for winter mint gum), oranges are what I'm craving most this week.  Back in the beginning of my pregnancy, I was jonesing for citrus all the time, drinking pulpy orange juice right from the carton.   Second trimester gave me a break from this indulgence, but it's back in full force.  (Sidenote:  And shoving the rind down the garbage disposal and churning it up in there actually makes the disposal smell good, which I thought was an impossible feat.  Double-win for citrus!)

Tomorrow I have a few doctor's appointments at Joslin, including a follow-up eye dilation.  I'm hoping that my eyes are clean this round, because I do not want diabetes issues dictating the arrival method of the baby.  But I'm definitely on board with just "getting her here safely."  Whatever it takes!

(And if you can serve up a goofier knock-knock joke than the old school oranges and bananas one, I'm all ears!)

February 19, 2010

It's All Rainbows and Unicorns.

I love BSparl.  I love her little feet and her pouty lips and that feeling I get when she rolls around inside of me.  I love knowing that my daughter is just a few weeks away from becoming a part of our Sparling family, and I know that every moment of this pregnancy is completely worth every iota of effort and worry.

That being said ...Rainbow not included.

I'm starting to lose my mind a little bit.

I've blogged about the details of the doctor's appointments, and the ultrasound scans, and the way that diabetes has impacted my pregnancy, and vice versa.  But by the end of my posts, I feel better having purged the feelings and worry.  And I want to reassure women who have type 1 diabetes that a pregnancy is possible, and enjoyable, and like they all say - so, so worth it.

But, like I said, I'm starting to crack a bit.  On Tuesday, I'll be at 30 weeks, seven and a half months pregnant with just under nine weeks left to go.  And these last few weeks have been ... well, not exactly rainbows and unicorns.

  • Like last week, when a string of 200's had me bump my basal so high, on the heels of amped up nerves, that I overdid it and ended up with two 50 mg/dl's in the middle of the night.
  • Or on Monday, when a carefully measured breakfast and a carefully calculated bolus, delivered 45 minutes before the meal, sent my blood sugars rocketing up to 248 mg/dl and held there for two hours.  
  • Or the other day, when i realized that pregnancy is actually ten months long, not nine.  Damn lunar months, and why the hell didn't someone give me a head's up about that?
  • Or that yesterday, Joslin gave me the run down on the rest of my appointments that are scheduled.  There are 20 of them.  I don't understand how people manage a high risk pregnancy and keep their jobs. 
  • Or that next week, I'm having the eye dilation that will determine BSparl's method of arrival, and I'm really nervous about it.  I'm nervous about vaginal birth or c-section.  Doesn't matter.  Just "giving birth" has my stomach twisty.
  • Or the fact that I'm craving carbs (nasty carbs, like cheeseburgers and chicken nuggets and pastries) and am having a very hard time not caving to these cravings.  I can't have anything even close to a sleeve of Ritz crackers in the house or they will disappear within a day's time.  I'm ravenous for these rotten carbs, and I've crocheted three scarves in efforts to curb the cravings.
  • Or that every time my numbers are out of range, I want to hold her little hands and tell her I'm sorry.
  • Or yesterday, when a perfect Dexcom flatline overnight was shaken by a cheese stick and a cup of decaf tea, leaving me with a blood sugar of 350 mg/dl and on the cusp of a panic attack.  What does this do to my baby?  Is she okay when I'm spending an hour over 300 mg/dl, without much food at all in my system?  Does she hurt when I am chugging water and stressing out but trying to control my emotions because I want her little womb to be serene and calm, not the spin cycle of diabetes chaos that I am so good at tossing her into lately?

Diabetics have healthy babies all the time.  I know this.  I've read this, others have proven this, and I hope to write those words myself in a few weeks.  But honestly, the mental part of pregnancy is more than I was prepared to deal with.  The guilt of every blood sugar and every miscalculation makes my heart ache, and I have found myself praying more in the last seven months than I ever have the thirty years before. 

I want to paint that "rainbows and unicorns" picture for you guys.  I want to make pregnancy seem like it's the most beautiful thing on the planet and even a person with type 1 diabetes can see the nine (ten?!) months through safely.  But as my delivery date draws closer, I'm not sure.  And I'm scared.  And I feel stupid because I have zero control over my emotions these days, leaving plenty of tears in my wake. (I've become a mega-wuss.)

Ugh, downer of a post.  I really can't wait to have the baby, but I know that part of why I want her out is because I believe she'll be safer once she's in the world and outside of me.  I know that Chris and I can take care of her, as parents, and keep her as safe as any other couple who loves their child.  It's the whole "now" process that has me in knots, wondering if I'm taking good care of her now.  I want the absolute best for my daughter, and I feel so guilty because I know that my body creates a challenge in some ways.

Just a few more weeks.  Every test, every infusion set change, every moment of blood work, every doctor's appointment, every time I pay the co-pay or the parking garage fee, every refilled prescription, every new CGM sensor, every curbed craving ... everything.  Everything is worth it if I can get to the end of this and have her out, safely. 

And then she and I will get matching mommy and daughter tattoos - hers a rainbow, and mine a unicorn.

(Note to people who may think I've completely lost my mind:  Kidding about the tattoos.  But I might buy her a t-shirt.)

February 16, 2010

Update on BSparl: Third Trimester Goodies.

We've made it this far:  the seventh month of BSparl's little cookie-baking gestational period.  Seven months and one week, actually.  Third trimester. 

(Holy.  Crap.  She's almost here!!)

Last Friday, Chris and I were at Joslin for the first of many, many third trimester appointments.  Turns out that from here on in, the visits to the doctor become as regular as Siah waking me up by putting her nose in my ear. (Read:  all the time)  Here's the long run-down on what's what with the BSparl (and for those bored by the pregnancy posts - bear with me.  Only about nine more weeks to go!):

Baby Girl Sparling, clocking in at 29 weeks

OB/GYN:  She did a quick scan of the baby to take some measurements, and I was very, very happy to hear that BSparl is right on track with her weight.  One of my concerns, and rightfully so, is having a very big baby, but BSparl clocked in at 2 lbs, 11 oz and falls into the 51st percentile for weight, so she's not exhibiting signs of "big diabetic baby" yet.  

"She's long, measuring in a week ahead.  That's a nice surprise!" Dr. T said, laughing as I scooted my 5'3 3/4" self further up the examining table.  

"She'll be tall.  And lanky.  And slender," I said, hoping BSparl will have her father's metabolism instead of my sluggish fight-for-fit.

We discussed, briefly, the day of BSparl's birth.  Apparently, I'll be disconnected from my insulin pump at the last moment and put on an insulin drip, because that's the route that Joslin takes with its mothers-to-be.  "If you have a scheduled c-section, we'll pull the pump right before we do the epidural.  And if you have natural birth, we'll do the drip before you're in active labor."

"So you guys will be monitoring my diabetes throughout the whole mess?  Will I be able to test and treat myself, as needed?"  I asked.  This was a concern of mine, and Chris's, because we are so used to being able to test my blood sugar whenever I feel "off," and the idea of having to rely on others to keep tabs just didn't sit right in my mind.

"Oh, no worries about that.  You can test, with your meter, as often as you want.  We just want you using the same meter throughout, you know?  That way, things are consistent.  We can use your meter through the whole process, if you'd like.  Totally up to you."

"And there will be a glucose drip, too?  In case of lows?"

"Yes.  That's a good question.  Lots of times, keeping moms higher is part of the trouble.  Active labor is like being at the gym!"

"And a c-section isn't a guaranteed go yet, right?"

"Not yet.  I want to see the results of your eye dilation this month, and if that spot near your left macula has been reduced, we can discuss natural birth.  But if it's still there, I'd like to really keep the c-section options open.  I want your baby out, and I want your eyes safe, all together.  But you don't have any protein in your urine, and your baby's size is completely normal, so the only thing that may dictate a c-section are those eyes."

News to me.  So there's still a chance I can deliver BSparl naturally.  (Don't get me wrong - "naturally" means "with drugs," as far as I'm concerned.  I'm tough, but not nearly that tough!)  I have an eye exam scheduled for the end of February, so that will determine how the baby makes her entrance. 

Endocrinologist:  Dr. B and I ran through my basals (her response to my increased rates throughout the day, "Whoa!  I knew this was going to happen, but I'm glad you made the adjustments.  But whoa - some of these spiked a lot!") and made some adjustments to my insulin-to-carb ratios.  Overall, my numbers are creeping up a little higher all over the place, but this is on-par with how a diabetic pregnancy progresses.  Damn insulin resistance!  I'm up to about 60 units of Humalog a day, which blows my old insulin prescription out of the water.  I actually had to have Dr. B write me a new script so that I would have enough insulin to get me through the end of April. 

(And for those who asked about the 185u insulin cartridge in the Animas Ping, it's the same size, essentially, as the one in my Minimed 522.  Before pregnancy, using about 25u total of insulin per day, that size worked awesome for me.  Now?  I'm refilling the cartridge mid-way through the second day and just switching out the set on the third day.  I'm anticipating that my insulin needs will drop dramatically once baby girl is out and that anti-insulin hormone producing placenta is out, too.)

Basically, this was the nerdiest endo appointment I've had yet.  After giving her the quick rundown on our trip to Sundance (the crew at Joslin is very excited for Chris, which makes me grin), we crunched numbers like two little accountants, minus the cool visors and the green lamp.  But by the end of the appointment, we'd done a little more tweaking, and when I see her again in two weeks, I'll hopefully have steadied out a bit.  They drew an A1C and a CBC, and I'm holding my breath to see if the A1C holds steady or goes up a bit.  (I am expecting an increase because of the overall increase of my numbers, but we'll see.)

Phew!  Long day (long post), but only two appointments.  And starting in March, I'll be there once a week to monitor BSparl and her little world in there.  And then, I'll be there twice a week to keep tabs.  I will eventually rent a room at the Joslin Clinic and live there, until my daughter is born.  Good thing I have a flexible work schedule at the moment.  Otherwise, I have no idea how I'd manage this routine.  

The best part of the day, of course, was just after Dr. T put the ultrasound wand on my belly, and the baby swirled into view.  BSparl head-down, feet up, and very active.  And even though she was shy, once again, in showing us her face, I did see her eyes and her cheek and the crest of her little mouth. 

And I love her.  Every teeny inch of her.

February 12, 2010

Diabetic Mommy.

I opened this gift that arrived in the mail, and almost burst into tears because I hope, hope, hope this is the case for my daughter.

Thank you, Lindsay!  For making me feel like I'm going to be a good "diabetic mommy."
(This photo is also part of today's Diabetes 365)

I was thinking about how much planning and effort has gone into this pregnancy, from a diabetes perspective - never mind the regular gearing up that parents-in-training go through.  Chris and I have worked very hard, as a team, to manage my diabetes in efforts to get pregnant, and now that BSparl is in there baking cookies (or whatever it is she does all day), diabetes focus has turned up even higher in our household.

I'm blowing through test strips like a champ, wearing the Dexcom to help me keep track of the constantly-changing numbers, using an insulin pump, trying hard to eat healthy (even though I'm currently weighing the pros and cons of a red velvet cheesecake - recipe link courtesy of my friend Elizabeth Arnold), and making feeble attempts to get a workout in here and there.  Managing diabetes has become, seriously, a full-time job as my pregnancy rockets into the third trimester.

But I wonder what she'll think when she arrives.  And how much things will change.  Will she understand when I need to eat before she does, sometimes?  Will she feel upset if I need a few minutes to get myself together before I'm able to play with her?  Will she think I'm cramping her diaper bag style if I shove my meter in there, alongside her wipes and her binky?  Will she wonder what's wrong with my priorities when I refuse to share my juice box with her on our future playground dates?

Will she understand that even though that t-shirt will only fit her for a few weeks and she may not even remember it, but will she know that her diabetic mommy loves her, and has loved her since the moment she knew she carried her?

(And will she forgive her for all the third-person dialog?  Maybe not.)

I'm heading to Joslin again today, for the first of my four seven-months-pregnant appointments.  Chris and I will see our baby girl through the magic of ultrasounds, and then I'll meet with my endocrinologist to discuss how my body is soaking up insulin like a sponge.  Just a few more months until she's here, in our house, in our arms.

Baby girl, I hope you know how loved you are.

(This is part of a gift from my friend Lindsay, who I've never actually met in person, but I feel like I know, though emails and Facebook and blogging.  Thank you again, Lindsay, for such a thoughtful gift!  BSparl says thanks, too, only I can't really hear here because she's muffled by my enormous uterus.  And potentially the sound of the oven *ding* as her cookies bake.  Who knows?)

February 03, 2010

We Can Work It Out.

The Dexcom seems fit enough.  I need to get my yellow legs in gear.(Great song.)

Now that we're back from our trip, it's time to reintroduce myself to the "swing of things."  While we were away, Chris and I were up late, eating fancy food at fancy restaurants (including desserts and carb-fantastic sweet potato french fries and gelato ... things we wouldn't normally eat but we devoured in spades - and in our mouths - all week long during the festival holy run on sentence), going to bed at 3:30 in the morning, battling the frigging hills, and waking up the next day only to do it again.  For nine days running.

It was exhausting. 

But now we are home.  And in the comfort of my own schedule, I can wake up early, eat a breakfast that doesn't include sausage (not the cat), get enough sleep at night, put my feet up as necessary, and get some exercise in.

Oh, the exercise part.  How you plague me.

I used to be awesome at getting to the gym.  Not to toot my own horn - more to toot Chris's, actually - but his dedication to the gym helped me keep my proverbial (and literal) butt in gear.  It was just part of our routine, and it was easy.  And the benefits were tremendous:  good health, pants that fit, and that feeling of "ooh, I'm sort of strongish."

But now?  As the baby belly grows and my sense of balance leaves the building for the next 75 days?  Exercise is hard.  Wicked hard.

Since we've been home, I've been back at the gym with Chris, only the workouts I'm doing now feel completely lazy-ass, compared to the ones I was doing before.  No weights (thank you, retinopathy), no jumping rope (thank you, bouncy belly), and no increased heart rate over 130.  

So I walk.  For like 40 minutes on the treadmill, without an incline and at a speed of only 3.0 miles per hour.  On paper (screen?) that looks wussy, but in reality, it's kicking my behind.  I'm not sure if it's the weight I've put on in the front or the fact that my lungs are squished in there, or maybe just because my whole body is completely different now than it was seven months ago, but just walking on the treadmill is a challenge these days.

I'm going to see how long I can keep exercising.  I've heard that many pregnant women make it to the day before they give birth, and I've also heard that the more active I can remain, the better my recovery will be after having the little baby.  Activity helps keep BSparl healthier, too, which is even more incentive to keep plodding.

Weird thing is, my blood sugars don't drop during exercise anymore.  In fact, they seem to go up a little bit.  Before becoming pregnant, I would disconnect my pump and exercise without insulin, but now I need to leave it attached.  And I sometimes need to bolus during the workout, depending on how the Dexcom is trending.  It's very odd, what my hormones are doing to my blood sugars these days.  I also had to increase part of my wee hours of the morning basal today, after two mornings in a row of waking up at 150 mg/dl.

"Kerri, you're rambling.  You realize that, right?  You're just rambling on about exercise and blood sugars and do you actually have a point with this post?"

Why thank you, Internal Motivational Speaker.  I appreciate you bothering me.  Yes, I'm rambling, but I'm just trying to get all these thoughts out before I lose them.  Which seems to be the case lately.

"Why don't you just tell them that the real reason you're fixated on exercise this week is because when you came home from Sundance, each cat had gained 5 pounds?  Now you have a trio of porkchops racing around the apartment?  Why don't you admit that Siah can't even fit under the couch anymore because she's too darn fat?"

Sigh.  I need to get back into the exercise groove. 

And apparently so do my cats.

February 02, 2010

BSparl: She Likes to Make Me Work.

Park City is an old mining town nestled among the Wasatch Range of the Rocky Mountains, and aside from buzzing with Sundance excitement and brimming with film-goers and celebrities, let me just say that the damn place is not flat.  Not even close to flat.  (See also:  built amongst the mountains)  The majority of the "stuff to do" is on Main Street, and I'm pretty sure that street is a 60 degree angle.

BSparl and her mommy (me), in all their frontal weight gain glory, were not amused.

Something about walking up and down (and usually up and down a few more times) that street had me more winded than if I'd tried to run a mile on the treadmill at a 6.0 incline.  I know that the air is thinner in that part of the country, being so freaking high above sea level, and I also know that having a little baby girl growing inside of me is compromising the room for my lungs to expand.  But I had not anticipated how hard it was going to be just to WALK around in Park City.  We'd take the bus from our condo down by the Yarrow Hotel and get dropped off at the city transit center, and then the huffing and puffing would begin.

We have HOW many more steps to go??

"I'm ... sorry ... for ... not ... keeping up."  I'd pant with each step as I tried to keep up with Chris.

"It's okay, baby.  We'll go slow.  We're not in any rush."

"Awe ... some.  Hang on while I lean against this lightpole for a minute ... and let my lungs ... do stuff."

(Thing was, we were late for two different dinner appointments because I couldn't catch my breath about 15 minutes into the walk.  I've never felt more awkward, or more yeti-like, than I did trying to plod up Main Street.)

Overall, little BSparl was a well-behaved fetus, doing her job of kicking and sleeping and rolling around in there.  I'm officially sporting a major baby belly, complete with visible baby movements even through my shirts.  And thankfully, my basals didn't need any adjusting while we were away.  I don't know if it was the time change or all the walking around or maybe it was just the grace of the diabetes gods, cutting me some freaking slack for the week, but my numbers ran relatively stable while we were away.  (Save for that f'ing 300 that came up as a result of overtreating two 48 mg/dl's in a row, pissing me off royally and causing me to have to skip dinner one night.)  I changed my infusion sets every three days like clockwork - mainly because I'm now using about 50u of insulin a day and that's the shelflife of one pump cartridge and also because sets left in too long are starting to get infected faster than usual - and I tested about 18 times a day.  In addition to Dexcom'ing. 

I may have left a trail of test strips on that there Main Street.

BSparl is proud of her daddy.  When I was trying to coax her into kicking at times, all it would take is a quick "Hi baby!" from Chris to get her scooting around in there.  And during the five screenings of Buried, she danced in celebration for her father's success.  I believe I may be building a "daddy's little girl" in there, and I think they're respectively smitten with one another. 

A sculpture on Main Street in Park City, Utah

Traveling at almost seven months pregnant was definitely a challenge, and I'm not sure I would have done it, were it not such a big freaking deal to go to Sundance.  Heparin before the plane ride was one thing (that shit stings going in, FYI), and not being able to lift my suitcase wasn't exactly heartbreaking, but moving around was a little awkward.  And having to pee every 30 minutes was also cumbersome.  (I know where EVERY bathroom is in Park City.  Thank you, BSparl, for making my bladder your pillow all week long.) 

But I wouldn't have missed this for the world.

January 26, 2010

BSparl: How on Earth Did THAT A1C Happen?

I've had a lot of trouble controlling my late second trimester blood sugars, as I've written about all over the place in the last few weeks.  But it's true!  While the first trimester was crammed with low blood sugars, this second bit has been plagued with 200's ... and some of them fasting.  (I hate the idea of waking up high.  Makes me feel like the day gets off to a miserable start.)

Baby girl Sparling, 25 weeks along

I have been working very, very hard to keep track of these numbers and doing what I can to keep any highs from hanging out more than an hour.  But still, there were highs.  And not as many lows.  

So how on Earth did my A1C go down again this month?  I'm confused!  

Last week, I called Joslin to get the results of my most recent bloodwork, and when the receptionist answered, I was braced for the worst.

"Hey, this is Kerri Sparling.  I was calling to see if my A1C result was back yet."

"Let me check," the receptionist B said.  

I couldn't keep my mouth shut because I was just certain that it had gone up.  "I'm pretty sure it's going to suck a little bit."

B laughed at me.  "What?  Well let's just see then."  I heard her clicking on things and shuffling papers.  "Okay, Kerri.  Well it hasn't gone up.  You're at 6.0%."

"What?  I don't mean to sound like a jerk, but are you seriously looking at my chart?  I've had some really rotten blood sugars this past month.  But it's lower now?  How the heck did that happen?"

"I don't know.  Maybe you're getting those highs down faster than you think."

"I'm shocked.  But I'll take it.  Whatever's best for the baby girl, right?"

We hung up the phone, but I didn't feel particularly proud.  Believe me, I'm not complaining at all about an A1C of 6.0%.  Not even close to complaining.  But I know that I've been doubting the accuracy of the A1C for a while now (wrote about it a few months ago, when I was up in the 7's and distressed about those results) and now, after getting the lowest result in my entire history with diabetes, I'm not sure how I got there.  A few weeks ago, I understood why my A1C was lower because my overall blood sugars were lower.  I wasn't over 180 mg/dl for weeks on end.  Now?  I've seen a pile of highs, yet my A1C is at the tail end of six.  I'm happy with the number itself, but not sure it's completely accurate.

It's weird, what being pregnant has done to my mentality.  Before BSparl was thrashing away in there, I wanted an A1C of 6.0% so badly that I was willing to do anything for it.  Now?  I'm sitting pretty with an A1C of 6.0% and wishing that it was definitively the result of steadier numbers.  I want what's best for this kid, and I'm hoping that this number is indicative of a safe little environment for my daughter to flourish.

Because God only knows how I'll manage to screw her up once she's on the outside.  ;)

January 25, 2010

What's Sexier Than Compression Stockings?

Thanks to the happy combination of Factor V Leiden and being pregnant, I'm rocking a higher chance than average for a blood clot while traveling.  Back in October, when I was just a few months along, a lot of my travel was on the Acela, cruising back and forth between Boston and Philly, in addition to some flights.  So I needed to take these clotting risks into account.

"You're telling me I should pick up some compression stockings, then?"  I asked my obstetrician, after we had discussed my upcoming travel plans.

Compression stockings are cool ... right?  :p

"Yes ma'am.  And wear them.  Not just for traveling, but as often as you can."

"Will do.  So I'll be potbellied and wearing compression stockings.  Hot!"

My feeble attempts at joking aside, these stockings are important.  Even though I'm working hard to get to the gym several times a week, I'm more definitively working hard on making money, so there's a bit too much time spent at the computer these days.  Heeding the advice of my doctors, I'm careful to keep my legs elevated as much as possible, and I'm sure to pop up and walk around every hour or so, in addition to staying hydrated.  (Note:  Staying hydrated makes getting up every hour easier, especially when BSparl is gnawing on my bladder.)  

And I'm also sporting these socks, purchased for $4.99 at my local CVS.  (Another note:  CVS takes too much of my money on a regular basis, from their clever selection of lip glosses - love me some Bonnie Bell - to their strategic arrangement of Hallmark greeting cards to their convenient pharmacy that's open 24 hours.  I have an intense love/hate relationship with CVS, as evidenced by their constant contact with my debit card.)  The socks aren't uncomfortable, they appear to be working well (no varicose veins yet), and they are black, so thankfully they go with my go-to flats of choice these days.  I'm safe, BSparl is safe, and CVS is safe because they will continue to get my money.

So what's sexier than compression stockings?

Nothing.

Because without these blasted old lady leg warmers, I'd be risking a blood clot and varicose veins, thank you very much.

January 19, 2010

Registering for Stuff We Don't Yet Understand.

Snoopy's Breast Pump/Sno-Cone Machine?We prepared like it was war.

"Okay, so we have a print out of what we need the most, right?"

"Right."

"And we'll just go in and like jump right in?  Just grab that gun and beep stuff?"

"We're all over this."

And with that, Team Sparling stormed "Babies R Us" and tried to make sense of the chaos.

(Sidenote:  My best friend's water actually broke at Babies R Us.  Just goes to show you how much cute overload goes in that store.  Basically makes people give birth on the spot.  /sidenote)

We started with the big items, like car seats and pack-and-plays and a stroller, because those were items we knew that babies used.  (And we knew what these things were - double win.)  This very nice, old woman, Evelyn, helped set us up with our registry and gave us a "handy checklist" of items we'd want to add to the list.  And then she gave us the beeper gun thing, which we used to scan items and add them electronically to the list.  

"This thing.  I love.  Like from when we did the wedding registry," I said, trying to find some kind of familiarity with the words on the car seat boxes (like "key fit" and "bubble level indicators" and "OMG you're having a baby and you're going to put it in your CAR?"). 

"Yeah, but with that stuff, we knew what it was.  I don't know what half this stuff is."  Chris had the scanner gun in his hand and was brandishing it like an actual rifle.  

"Me, neither," I admitted.  

Aisle after aisle of intensely cute items that looked like bomb parts to me.  What is a boppy, and why do I need one?  How exactly is that little sock going to stay on her teeny foot?  How many bottles are we supposed to have?  Or burp cloths?  (Burp cloths threw me for a loop, because the burps I am most familiar with do not require wiping up afterwards.) Or little no-scratch mittens to protect her little face? 

After about an hour, we both needed a snack.  (My blood sugars were holding on the low side, thanks to walking around the store endlessly, and I think Chris's were too.  We snacked on protein bars and nuts, leaving a trail of crumbs as we meandered aimlessly.)

After two hours, we were losing our minds a little bit.  And then we ventured into the section with all the bottles.

"What.  On.  Earth.  Is.  That?"  I pointed to the machine that looked like a hybrid of Snoopy's Sno-Cone Machine and two megaphones.

"That's the breast pump.  Right?  That's the pump?"

"I do believe it is.  And we're going to have one.  In our house.  Another pump.  I love pumps.  Don't you?"  At this point, my mind cracked right open and started to pour out in a panic on the floor.  I went, in a hurry, over to where the shelves of baby powder were and started beeping the bottles.

"I know what to do with baby powder.  This is safe.  Let's get some of this."

Chris and I are bright people.  We both went to college, we are reasonably educated, and we can string a sentence or two together without sounding like we need a break.  But something about this baby has us completely tongue-tied.   After doing our best registering, we went to a nearby restaurant to grab lunch.

And we sat there for about fifteen minutes, not talking.  Just sort of glazed over. 

"She's going to live in our house.  We get to keep her.  Like, forever."  I said outloud.

He nodded and grinned.  "She's our friend.  Permanently."

We both stirred our drinks with the straws.  

"Holy crap, this is really happening."  BSparl gave me a quick kick in the bladder to make her presence known, and I rubbed my hand along the side of my belly.

"We love you, kiddo.  A lot.  Just forgive us in advance for having no clue what we're doing, okay?"

*kick*

January 17, 2010

BSparl Fights Back.

Last Friday, Chris and I were back up at the hospital for another round of doctor's appointments to spy on Ms. BSparl.  (This might be another long post, because I'm trying to include everything we're doing for this pregnancy, just in case someone else is looking for this info.  So thanks for bearing with me!)

Fetal Echocardiogram No. 2:  We started with a follow-up echocardiogram appointment at Children's Hospital in Boston, because last time we tried to see the structures of our little girl's heart, she was hiding out too low in her little uterine apartment to be properly found. This time, a full month later, she's over a pound and a half, and the size of an eggplant.  So hiding is a little harder.

The babies of type 1 diabetics aren't prone to every kind of complication, but are instead screened for everything under the sun, just to make sure.  The ultrasound technicians were looking for problems with BSparl's heart - ranging from a floppy valve to flow problems between the atria and ventricles, checking out the umbilical cord blood flow, too.  

"She not much of a cooperator, is she?"  the technician asked, pressing the ultrasound wand firmly against the left side of my uterus. 

"I guess not.  Bit of a shy one." 

(I love this kid already!! /sidenote)

"Well she can run, but she can't hide.  We're going to get these pictures today, whether she likes it or not."

The technician visually isolated BSparl's beating heart, looking at every chamber and pulse to make sure she was in one piece.  But as the technician worked to get the ultrasound images she needed, she was pressing pretty damn hard against me ... and against BSparl.

"Almost done.  Just one more image to capture.  You doing okay, Kerri?"

"No problem.  But I think our friend here is ... ooof!  Um, she's not very happy with you."

And when I looked down, I could see the baby kicking and fussing on my right side as the technician pressed the wand against my left.  Big kicks, clearly visible to Chris, who was sitting in a chair on my left.  BSparl was pissed - she didn't enjoy being bothered while she was trying to sleep during the day, apparently.

'Fiesty one, eh?"

I felt a little proud.

"Yes, she is."

(I guess if you poke at my kid, she fights back.  I like that.) 

The fetal echocardiogram came back without any red flags, so thankfully her little heart seems to be okay in there. 

Some orange flowers.  Not diabetes-related, but I thought they'd break up this long, boring post a bit.

OB/GYN: 
After that appointment, we had a quick visit with my OB/GYN who took some measurements of BSparl to see how big she's getting in there.

"Looks like she's about one pound, 12 oz.  She's right on track, so nothing to worry about with her size at this point."

I was relieved.  "I'm glad you're saying that, because I've had some really tough blood sugars these past 2 1/2 weeks.  I was afraid she was beefing up in there."

"No, she's in the 61st percentile, and we aren't going to worry about anything until she's in the 75th.  We're going to watch you to make sure she doesn't get too, too big in there, but at this point, she's doing just fine.  And so are you."

She printed some ultrasound photos for us (which will go into the baby scrapbook I've started but definitely need to catch up on) and then I met with my endocrinologist about my blood sugars.

Endocrinologist:  I am very, very thankful that I have a comfortable relationship with my endocrinologist, because the emotional toll of diabetes has really affected my ability enjoy being pregnant.  I've had some highs that wouldn't go away, and plenty of unexplained blood sugars that have made me feel so frustrated over the last few weeks.  I'm pretty sure my A1C will be up again this month (hopefully still under 6.5%) but I needed help fixing some of it.  And I also needed to be told that what's happening to me is normal.

"I'm high.  Like, crazy high, sometimes first thing in the morning.  And other times, I can't make my post-prandials come down under 160 mg/dl for at least two hours, no matter what I do.  Is this normal?  Is it normal for me to be experiencing such wild insulin increases at this point?  And is it normal for me to be sort of losing my mind at this part in the pregnancy, too?"

She assured me that this is the point in pregnancy when the placenta does, in fact, produce anti-insulin hormones, causing my numbers to elevates and my need for more insulin.  

"Anti-insulin hormones?  That's cruel.  Cruel irony."

She smiled as she worked to adjust my basal rates (now up to almost 20 full units of Humalog per day, in addition to bumping my insulin to carb ratio down to 1:8).  

"You're doing fine.  And you've been adjusting your own basals and going after these highs, so that's the right thing to do.  We just don't want you chasing.  I want to help prevent them in the first place."

I could have hugged her.

"Me, too.  I want to make sure she's safe in there.  I don't want to hurt her in any way, and the recent highs have me freaking out a lot."

"Don't freak out.  Just keep doing what you're doing.  Follow those numbers, stay as controlled as you can, and fax me any blood sugars that have you concerned.  I can review the changes you're making, or I can make changes for you from here.  Either way, we'll get her out just fine."

Building this baby is tough work, and these days, I feel like a full-time diabetic.  This baby, and by default, diabetes management, is my top priority and I am focused on keeping her as safe as I can.  But as my body changes and my insulin needs become less and less predictable, it's getting tougher to stay in good control.  And in solid spirits.

We're almost at the end of the second trimester.  Third trimester starts on February 8th, and after that, it's a fast track towards her arrival.  This is happening really fast.  We actually started registering for baby stuff this past weekend - holy crap.  Emotionally, I'm overwhelmed and excited and scared and trying to figure out how to just slow things down for even a day.

(More on that tomorrow, once I wrap my head around the whole concept.  For now, I need to go make some pancakes.)

January 14, 2010

Evicting the Hippo.

Yesterday's Diabetes 365 photo was this:

Blue hippo - BSparl is NOT a fan.

This little, blue, ceramic hippo came with a circus playset I received decades ago.  I can't even remember how long I've had it, but since college, this one creature has been living in the drawer in every bathroom of every apartment I've ever lived in.  It just refuses to be lost or misplaced, though its face is chipped and it's not the same vibrant blue it once was. 

Over the last few days, BSparl has been moving actively and visibly, poking her little legs and arms into my abdomen and dancing around in there.  Being the mature adult that I am, I wanted to see if she would respond to things being placed on my belly.  If Chris puts his hand on me, she reacts immediately.  (She loves her daddy best, I think.)  I rested a glass of ice water on my stomach for just a second the other day and she went after it like Siah after a pump cap.  And yesterday, a warm mug of tea made her jut her legs out aggressively.  (Someone on Twitter said this baby has beverage editorial going on.  I'm not shocked - she's my kid, so she's bound to have some strong opinions on stuff.)

Knowing BSparl is going a little stir-crazy in there, I wanted to give her a challenge.  So I placed the blue hippo on my belly and encourage her to go after it.  The first time (of course, not on video - blast!), she waited a few minutes quietly, then launched the damn thing right off my belly onto the bed.  Hippo got some serious air on that one, and I couldn't stop laughing.  So I set her up again, this time with the Flip at the ready.  Her attack isn't as solid as the first time, but you can see her moving in there.

Chris came home from a meeting and I was laying on the bed, shirt scooted up and belly swollen, with a blue hippo on my stomach and the video camera in my hand.  He put his computer bag on the floor.

"Um ... hey, Kerri."

(I can just imagine that split second, just as he's putting his key in the door, not quite knowing what to expect as he walks in.)

The last couple of days have been a diabetes and pregnancy nightmare, with very unpredictable numbers and an ever-increasing insulin resistance, but I'm very encouraged by your messages and am inspired every time BSparl moves to keep things under the best possible control.  And she's growing.  And moving. 

Diabetes be damned, pregnancy is amazing.

January 11, 2010

Moody, Pregnant Mess.

(This is one of those posts I'll write, and then promptly wish I hadn't written, but then revisit in a few weeks and be thankful that I let these emotions out.  But for now, I want to hide in bed and stay there all day, even though I can't sleep because my guilt is keeping me awake.)

Pregnant Kerri worries about EVERYTHING.  Except these flowers.  They seem self-sufficient enough.

I am not sure what's causing what, but my emotions feel like they're in a tailspin today.  Over Friday and Saturday, I had blood sugars that seemed like they came straight from the store - shiny, flat, and steady, with the Dexcom showing me a straight line for over 24 hours (aside from one very small spike after pineapple and cottage cheese on Saturday morning) and with the meter confirming this anomaly every hour or so.  And BSparl was poking and kicking around in there, letting me know that she was alive and okay and having a good time floating in her safe, amniotic sea. 

And then, for absolutely no reason, I had two rotten lows in a three hour span.  Rotten as in sweaty, dizzy, Dexcom wailing at me, orange juice spilled on the kitchen floor due to downing it too quickly from the carton kind of lows.  Lows that left me needing a nap and feeling physically compromised. 

And I worried about her - this little friend I'm building.  

Of course, these lows were followed by highs.  Tricky highs - ones that made my mouth dry and my head hurt and my blood sugar average leap up by at least 20 points all on their own.  Highs that made me test, bolus, and then go into the bathroom and cry because I felt so guilty about what I was doing to myself and to this little kid.  (Granted, the crying part may have happened because of the hormone influx, but I can't tell what's causing what these days.)

I have these books that I bought after finding out about BSparl - volumes with titles like "What to Expect When You're Expecting" and "I'm Pregnant!" - and for weeks, I pored through them and read all about how the baby was growing from a little cluster of cells into a creature with arms and legs and a beating heart.  But these books all come with what I call the "scary chapters," about complications and all the crap that can go wrong during pregnancy.  I skimmed these chapters at the outset, felt completely overwhelmed and terrified, and decided to not read them anymore.  Then we had the scare with the bleeding back in September (where I was about 7 weeks along and there were no problems detected, but my heart remained in my throat for ... actually, not sure if it's come down at all yet), and I decided that I wanted to stick my head in the sand and pretend that nothing bad is even possible.  Every pregnant woman has a healthy, happy pregnancy, and that's it.  There are no other options.

I know that diabetics have healthy babies all the time.  And that in the grand scheme of things, it's not about each individual blood sugar, but the general gist of how my blood sugars are running.  But I've only read about other people's pregnancies.  I've never been pregnant before, and all of these feelings, both physically and emotionally, are so new to me.  Even though there are so many examples of families before me who have taken this journey and come out safely and happy on the other side, I've never done it before.  I don't know what I'm doing.  I'm scared a lot of the time because I don't want to hurt her.

This morning, after going to bed at a blood sugar of 119 mg/dl, I woke up around 5:45 am at 293 mg/dl.  I bolused, tested for ketones (none), drank a bottle of water to hydrate my sandpaper throat, and then climbed back into bed. 

(Mind you, this high was on the same basals that have had me waking up under 100 mg/dl for three days running.)  

And couldn't sleep.

My mind keeps freaking out, going back to the scary chapters.  And no amount of rationalization (it's just a few hours high, it's just one blood sugar, it's just one bad day, everyone has those bad days, the baby is okay, you're okay) could make my mind quiet. I just feel like a failure, frustrated to tears because no matter how much technology we have access to as modern-day diabetics, we still have diabetes.  And this obscene disease looks so quiet from the outside, but it rages on inside of me every day, even when I'm working so hard to pretend to be cured for my daughter.  

It's going to be better.  Now that I've finished this post, my number is back down to 131 mg/dl and falling slowly, and within the next 20 minutes or so, I'll be back in range.  And I'm hoping that I can stay on top of things today and keep her safe. 

Six months pregnant tomorrow.

I've never wanted anything more than this, in my entire life.  I might sound overly dramatic or obsessive or frantic, but I can't lie.  This baby girl is so important to me, and she may be the only child we have.  She's what I've been thinking about for years, and she just rolled inside of me right now, as if to say, "It's cool, mommy.  Stop freaking out.  Let's have pancakes!"  

I should make her some pancakes. 

(I feel better now.  Thank you for listening, you guys.)

January 08, 2010

BSparl: She's a Mobile Biscuit.

We're just over 23 1/2 weeks with Ms. BSparl, and she's an active little biscuit in there.  I know I mentioned it in my vlog earlier this week, but this baby is scooting around all over the place inside of me.  Last night, for the first time, Chris and I could actually SEE her kicking from the outside.  Feeling her kick is one thing, but seeing it?  Completely amazing.  When she shuttles and rolls from one side of my uterus to the other, I can see her moving.  My belly swells more on one side, and then I can feel and see the 'bulge' move over to the other side.  (I'm trying to get a video of her doing this, but usually when it happens, I'm too taken by surprised to grab the Flip!)

Baby Girl Sparling, 23 weeks along

On the diabetes front, my insulin resistance is climbing.  Daily.  Like a cat in a tree, howling from the top branch and refusing to come down.  (I need the fire department - stat!)  My basals, once at a conservative 12.4u today per day, are at an even 20u per day and I'm sure they'll need to be upped again sometime next week.  I feel like I'm chasing my tail right now with these blood sugars, but so long as I can continue to effectively stalk them, I'm confident that I'm not boiling BSparl.  This morning, after three days of waking up at 140, 155, and 203 (gah), respectively, my fasting number was 79 mg/dl and the Dexcom reflected a steady overnight, too. I'll take that, and hope it happens again tomorrow. 

But if it doesn't?  CRANK it up again!

A big hurdle I'm encountering is the exercise bit.  Honestly, I haven't had a good workout since before we went to Spain (and returned with Ms. BSparl).  In the first trimester, I was usually too exhausted to get to the gym (went three times a week instead of the five I was getting in before), and then we moved out of our apartment in Connecticut, so that whole transition sucked out my desire to work out almost entirely. 

Now, well into the second trimester, I'm trying to get to the gym but it's just so boring.  My exercise options feel so limited, and I'm not used to the whole "get on the treadmill, walk steadily for 35 minutes, END" routine.  No ab workouts, or I could smoosh BSparl.  No jumping rope, or all these new sticky-outtie parts of my body might leap off of me and my pelvic floor could be weaked.  (Kidding on the body parts leaping off but true on the pelvic floor concerns. I also can't imagine jumping rope being almost 6 months pregnant, nevermind the fact that the kid won't like it.)  And no strenuous weight lifting, thanks to compromised diabetic eyes. Those little five pound weights I have are borderline questionable, considering my retinopathy progression.  Booooooo.

So the treadmill it is, for long and awkward ambling.  (For now.)  And even though it's a whole lot of boring (I've watched that "build a six foot gingerbread house in 8 hours" challenge on the food network like seven times now), it is getting harder and harder to keep moving.  With BSparl expanding every week, my organs are getting a little smushed in there.  An expanding uterus puts pressure on my bladder, my diaphragm, and every other organ I have in there, leaving me short of breath a lot of the time and generally feeling like I'm going to tip over a little bit.  I guess these walking workouts are still exercise, even though they aren't even close to what I was doing before BSparl's creation.  

Every week is different, but I'm definitely not complaining.  Pretty damn grateful, actually.  I'm so happy to look in the mirror and see that my waistline has all but disappeared and has been replaced by this bump o' BSparl.  She's in there, she's doing well, and in just about four months, she'll be here.  

January 05, 2010

BSparl and the Buried Poster.

It's been aaaaaaages since I recorded a new vlog post, and much of my delay was the fault of my old PC (and its magical, melting hard drive).  That and I lost the tripod for the Flip, so it's taken me a while to figure out how to wrangle in iMovie and all the Mac crap. 

Here's my first Mac vlog, touching upon that moment every mother-to-be experiences as her baby is growing in the womb ... when she realizes that the ultrasound pictures sort of look like her husband's film poster.

(Sundance in less than two weeks - I can't wait!!)

January 04, 2010

Oh, High!

I hope BSparl is going okay in there.Back at the Diabetes 2.0 conference in Florida in November, I was talking to Manny Hernandez about how evenly  my numbers were running due to the pregnancy.

"Dude, it's like a cure.  It's creeping me right out, but I am NOT complaining.  Whatever keeps this baby safest!"

Oh how I wish that was still the case.

The lows chased me all around the house for about five months, helping my A1C drop like a rock and keeping highs out of the rotation for approximately twenty weeks.  A blood sugar of 150 mg/dl felt HIGH (which was a far cry from the 250's I was sadly bonding with this time last year) and my low symptoms weren't kicking in at all (see also:  the 29 mg/dl without a whisper of a hint). 

Tomorrow I'll be in the 23rd week of my pregnancy, and the highs are back.  With a freaking vengeance. 

It started innocently enough - with some spiky numbers in the middle of the night.  Nothing chaotic, but 120's where there were 80's the day before, and they continued to climb a bit every day.  For about four days straight, I was waking up at 4:30 in the morning between 120 - 140 mg/dl, correcting back down to 100 mg/dl, and then the creeping would start again around 10 am.  It was like my body wanted to incubate BSparl at a steady blood sugar of ... 180?  NO WAY. 

After a quick chat with my endocrinologist (who told me, in no uncertain terms:  "Pregnancy is completely different.  Two days is a pattern now.  You know what you're doing - adjust your basals as often as needed."), I starting hiking up my basal rates.  Before I got pregnant, my total daily dosage was around 24u per day, thanks to a low basal rate and a lower-carbohydrate diet.  Now?  Five months and 3 weeks into my pregnancy and 17 lbs heavier?  My TDD is 45u and climbing. 

I am wearing my Dexcom and testing very regularly, but it seems like full-out stalking is necessary for the next four months.  I'm also changing my insulin pump infusion set every three days, like clockwork, to keep absorption issues from adding to the pile of variables.  What's becoming challenging is avoiding basal stacking.  As in, if I'm 140 mg/dl and I bolus it down, I need to be patient and let the insulin do its work.  I can't freak out and take another bolus 35 minutes later just because I'm nervous.  Bolus stacking (and rage bolusing, too) are totally counterproductive when they result in a nasty low blood sugar that leaves me spinning.

So what's the moral of this story?  ... honestly, I have no idea.  All I know is that blood sugar management during pregnancy just went from literal cakewalk (as in, I'd take a step and would require cake to take another step) to a struggle that has me acting like an emotional wreck.  My last A1C came in a little higher than the one the month before (went from 6.1% back up to 6.3%), and I know this is because the lows are tapering.  But I don't want to crest back up towards 7% because I'm unable to wrangle in these stupid highs.  

There's a lot of guilt when it comes to diabetes.  I knew that before.  But what I didn't realize before becoming pregnant is how much I worry about this little baby while she's growing inside of me.  Every time I test and see a number above 130 mg/dl, I feel so sad and frustrated.  My hands immediately go to my belly and I want to feel her kicking, because that at least soothes my heart, knowing she's still okay in there.

Actually, she's rolling around in there as I type this.  My blood sugar is 96 mg/dl and holding, I hope.  I have every confidence that I can do this and that she and I will be okay, but these last few days have been really emotionally tough, and I've found myself praying more now than I ever have before.

(Thank goodness for cute baby girl clip art.)

December 22, 2009

Feeling Maternal.

Between these slowly rotating into the laundry cycle as we get ready for the baby:

Baby clothes in the laundry basket - makes my brain melt.

and the fact that my baby bump has popped overnight:

Kerri, Five Months Pregnant

I'm feeling pretty pregnant these days.

That is all.  :)

(Light posts this week, what with the holidays and the fact that I'm headed to my mom's to make gingerbread cookies all day today.  Photos to come ... and probably a few boluses, too.)

December 21, 2009

Living at the Joslin Clinic.

Last Friday, Chris and I (and BSparl) were at Joslin all day long.  ALL DAY.  But that's what's required with type 1 diabetes and pregnancy, so I wanted to recap these appointment for posterity, and for anyone else who is curious about what it takes to manage this whole party.  It's a long post, but with five different appointments to cover, I want to make sure I don't miss a beat.

Grab some coffee.  I'll wait.  :)

I love this baby.

Eye Dilation:  At 8:30 Friday morning, I had my eyes dilated to check on my non-proliferative retinopathy.  A few years ago, my eye doctor found a few small spots in my eyes, and referred me to a retinologist.  Since that time, I've been carefully stalked by different eye doctors, but without any real change or issue with my eyes.  Being pregnant, though, can throw eye complications into overdrive, so I'm now being monitored by the Joslin Clinic's Beetham Eye Institute.

First they did a regular eye exam to see if I was experiencing any pregnancy-related vision changes, and I've definitely lost a little.  "You've gone from 20/15 to 20/20."  Okay, so better-than-perfect vision to just perfect vision?  If that's it, I can handle that.

But then then did the dilation, and even though my retinopathy remains non-proliferative, some of the spots have changed.  The ones that were there have healed, but there was a new one in my left eye that was a little too close to my macula for my retinologist's comfort.  "I want to keep close watch on this one, because it could progress quickly due to your pregnancy.  Let's slate a follow up dilation for February, which will help us determine how your OB wants to move forward."

That was that.  I slide my sunglasses on, Chris and I went to an early lunch (he read the menu to me because I was so dilated I couldn't read a damn thing), and moved on to the next appointment.  No time to get upset about the eyes when there were still three more appointments. 

(Note:  But in writing this, it surprises me a little to write the word "retinopathy" without a pit in my stomach.  Funny how we just move on, despite fear.  Despite everything.)

Fetal Echocardiogram:  Our next stop was the Boston Children's Hospital, where I visited the high risk prenatal clinic for a fetal echocardiogram.  Basically, it was a special ultrasound to check on BSparl's heart, as a high risk pregnancy also comes with a laundry list of "maybes."   Our Level 2 Ultrasound (I think that's supposed to be capitalized) came back with no signs of any issue, but we had to make attempts to rule anything out. 

Thing is, BSparl wasn't cooperating.  (Imagine my shock.  She is my daughter, after all!)

"She's really low in your pelvis.  Maybe you can walk up and down the hallway and see if you can get her to move up a bit?"  The doctor asked, after spending almost twenty minutes trying to get a good look at BSparl's heart.

"Sure thing."  So I paced the hallway and danced around a little bit in hopes of getting her to scoot up a smidge.

"Great - now she's even lower.  She's breech, and facing away from us, and just about as low in your uterus as she can get at this stage."

"Should I do a handstand?"

They said no.  ;)

After a lot of time spent searching for a clear view of her heart, we eventually decided to make another attempt at a later date, once the baby is a bit bigger and less shy.  Because she was hiding snuggly in my pelvis, waving her little hands at us as if to say, "Hey!  Catch me if you can!"

Obstetrician:  After searching for her little heart, we headed back up to the pregnancy clinic for a regularly schedule OB/GYN appointment.  Discussions revolved around our flight to Sundance (a hearty congrats from the team for Chris, and then we talked about how heparin worked for me when traveling to Florida), measured my belly (clocking in at the anticipated 20 weeks), and discussed BSparl's estimated April birth plan.

"With this morning's eye exam, that might dictate what we decide to do, as a team.  If your retinopathy is still close to the macula at the end of your pregnancy, a C-section will be what we want to move forward with, so that your eyes can stay as safe as possible.  But we don't have to make that decision now.  We can decide closer to the date."

My OB gave me a rueful grin.

"It's that whole 'the tighter your control, more your eyes rebel' thing."

"Cruel irony, isn't it," I said, my hands across my belly.  BSparl gave a defiant kick.

I was a little bit upset at this point - I want to have the option to give birth naturally and the idea of diabetes taking that option from me made me feel frustrated - so my OB leaned in and whispered conspiratorially, "You are having a girl, right?  We should go make sure."

And we had a quick ultrasound (second one that day), to not focus on the intricate measures of my baby's heartbeat, but on her round little head and her kicking legs and her hands with their five fingers each.  Photos were printed, Chris and I laughed, and I felt like parents-to-be again, not just a lab rat going through all the motions. 

Endocrinologist:  After visiting the OB, we visited with my endocrinologist, who - in her infinite patience - printed out my logbooks from my meter because I had left my logs at home.  (I'm losing my mind - have I mentioned that already?)  We reviewed some numbers, did some basal tweaking due to an increasing fasting blood sugar that once was under 100 mg/dl but has been increasing up to 130 mg/dl steadily.  We made some changes to my afternoon insulin:carb ratio as well to help bring down my afternoon post-prandials. 

"Overall, you look good.  These numbers look great, and the ones that are creeping up, we'll get them back down.  We're on to the point in your pregnancy when things might change every other week or so, so don't get too comfortable with any of these rates and ratios yet.  We're just getting started!"

(I love my endocrinologist.  She makes this seem like it's totally doable.)

Labwork:  One last stop, to be jammed in the arm.  They grabbed a few vials of blood to run standard second trimester testing, including my A1C again, and a test to check for neurotubal defects in the fetus.

And then we left.  Finally.  After eight hours of intense appointments.  

That night, I was exhausted and decided to hang in.  And while I was watching a movie on the couch, I felt a few thudding kicks from my baby.  

"I feel you, baby girl.  I know you're in there."

I would do these appointments every single day if it meant she would be safe.  Type 1 diabetes and pregnancy is exactly as much work as they promised it would be, but when I think about this little girl and how excited I am to hold her and to be her mom, I realize I would do anything for her. 

Anything.

December 15, 2009

BSparl: 20 Weeks.

Dear Baby,

Daddy and I are at the halfway point in our journey to meeting you, and I'll admit - I'm a little surprised at how quickly this is happening.  I feel like I was just in Spain, hoping you were there with us, and then just at Joslin, wondering if they were going to tell us you were indeed hidden inside of me.

Baby, we know you are a little girl, and that every week, different parts of you progress in their development.  Daddy and I read through those books we bought and marvel at what's actually happening inside, when my outside just looks bulgy.  "She can hear us now!"  "She'll start kicking any day."  "Will we catch her sucking her thumb in the next ultrasound?" "Does she realize I don't know the lyrics to ANY songs, not even Christmas ones?"

Baby Girl Sparling, 20 weeks

And I've felt pretty healthy, Baby.  I am about 13 lbs heavier and wearing maternity clothes now (you'll see them when you're born - the crazy pants with the elastic waist bands that everyone was jealous of at Thanksgiving?), but a lot of the "pregnancy woes" aren't part of our lives yet.  Like heartburn.  And stretch marks (yet).  Just some back pain and I feel pretty tired a lot of the time.  Heating pads and naps work wonders these days. 

But Baby, I get very nervous about things that other people don't know about.  The stuff that isn't mentioned on the "What to Expect" websites.  We visit the doctor every two weeks, and I'm being followed very closely by my medical team, but sometimes my mind gets panicked about how capable my body is of taking the best care of you.  I can't lie - I know that diabetic women have healthy babies all the time, but Baby, when my blood sugars ring in at 200 mg/dl after a meal, no matter how carefully I've counted carbs and bolused insulin, I'm terrified that I'm hurting you.  Or this morning, when I woke up at 135 mg/dl at 7 am, I felt a pit in my stomach because I know that it's best for me to be under 100 mg/dl first thing.   I wonder, when the infusion set really stung yesterday morning upon inserting it, do you feel that pain?  Is it normal to worry about every little thing when it comes to your well-being?

Of course it is, moms and dads who have done this before will tell me.  It's completely normal for me to want the very best for you and to hope and pray for your good health and safety.  And it's also completely normal for me to worry about every little thing.  But what I worry most about are the things I am scared to talk about.  The things like blood sugars and hypertension and diabetes-related complications for you and I alike, that other people in my life think I have figured out but I just don't know how to do it right every day.  And the idea of doing it "wrong" makes my breath catch in my throat.  My numbers seem "good enough" and my A1C is lower than it's ever been, but those 200's that are creeping back in at at times terrify me.  So does the 31 mg/dl in the middle of the night.  And so does every single thing that threatens to affect you in any way.  Will I keep you safe enough? 

Diabetes is the shifting sand I'm trying to build my life on, and I can handle my being affected, but I don't want it to touch you.  Not even for a moment.

I love you endlessly, Baby.  I'm so grateful to even be this far, and I appreciate every moment I have with you, and will have with you in the future.  Don't worry, Baby.  I'm not spending every minute of our pregnancy in a panic.  It's just sometimes I feel so scared that I'm not able to provide to you everything that you deserve.  I'm very protective of you already, and I want to be a good mom to you.  When I feel you kicking around inside of me, I know you are exactly what I've always wanted.  You are a new life that your father and I created together, and I hope that I can give to you even an ounce of the joy you've already given to me in the last five months. 

I can't wait to meet you, and hold you, and know that you're okay.

Love,
Your Mommy

December 14, 2009

Pineapple Express.

I could eat this by the POUND.

Hi there.  I'm addicted to pineapple.

This week, I'll be five months pregnant, and it seems like the vitamin C cravings I had early on in my pregnancy are back with a vengeance.  Orange juice (yes, with pulp), kiwi fruit, apples, raisins (even though they're low in it, I still want them), and pineapple.  To the point where Chris and I bought a pineapple at the grocery store last week and I ate half of it in two days time.  What's good is that, for whatever reason, my blood sugars aren't rebelling against this fruit overload.  (Different from cute overload, where hamsters play the trumpet.)  Before the BSparl invasion, I had things like oatmeal timed out with precision, so that I could eat something with 30 grams of carbs in it without a spike, but just one apple could cause my numbers to go berserk.  Now?  Oatmeal is hard to predict, but I can nosh on a whole bowl of fruit salad, estimate the carbs, and coast in the low 100's for NO REASON. 

Pregnancy and type 1 diabetes is a very peculiar combination.  /digression

But then I Googled "pineapple and pregnancy" and received a pile of search results that made me feel like I was going to have the baby that night.  One site said that "Bromelain [found in pineapple] can soften the cervix and bring on labor."  Another said that it could cause uterine contractions. 

So, of course, I freaked out slightly.  And talked to fruit.

"What am I supposed to know?  I mean, there's so many do's and don'ts when it comes to this baby gestation adventure - how can I figure out what I'm supposed to be doing?  And how come I keep finding out about suspect foods AFTER I've already eaten them?"  I asked the pineapple on my plate.  It did not offer a useful answer.

I have heard that I should avoid shellfish.  (Not that big of a problem, as my new food cravings seem to be for shrimp only).  I've heard to keep the caffeine tapered to a minimum, which I managed to get under control before we left for Spain in August, so that's cool.  And I have also been told, many, many times, that I can't eat cold deli meat anymore, so anything involving cold cuts needs to be "piping hot." 

But after those few bits, I get a little foggy.  Should I not be eating pineapple?  Someone else told me to avoid things with gluten in them because it can affect the baby.  Then I was told to avoid eggs unless they were whites-only.  And not to eat any sugar substitute except for Splenda.  And to steer clear of soft cheeses (which to me is everything except the cheese that you forget to wrap in saran wrap and ends up all nasty hard).  And to only eat while hanging upside down in my closet, like a bat.  While wearing galoshes.  

What the heck am I supposed to eat???   Or supposed to avoid?  And will eating pineapple really make my body flake out?  Because while Google is a great place to find information, I don't trust it nearly as much as I trust real people.  For now, I'll be chugging orange juice and bolusing accordingly.  :)

December 08, 2009

BSparl: 19 Weeks.

Baby Sparling, 19 weeks and counting.
Bsparl, 19 weeks.

We're at the 19 week mark with our baby, and things are starting to change again.  My belly is hard and high, completely obvious now and forcing me to rock NBF's maternity jeans.  (She rocks, because she can provide some very useful hand-me-downs these days.  And NBF is due any day now!!  Ahem - sorry, I'm so excited!)  Pregnancy symptoms, like that heartburn I've read about and my new appreciation for the power of fiber and the need for some new bras, are in full force, and I'm feeling busy in the body these days.  Not to mention the weird leg cramps that crop up without warning.  I'm out of breath going up flights of stairs, thanks to the pressing of my uterus against all my other internal organs.  And my hair, which used to shed at least a few strands after every shower, has stopped shedding entirely.  (The cats in my house cannot make the same claim, however.)  These changes are taking some time to adjust to, but I am so thankful to be experiencing this.

The biggest change I've noticed, aside from the belly, is that now my blood sugars are starting to resist insulin a bit.  I haven't been able to nail down a definitive pattern yet, but my morning basals need some adjusting.  For the last four months or so, I've been waking up at numbers close to or under (sometimes waaaay under) 100 mg/dl.  My Dexcom showed a flatline on the overnights, and I felt pretty confident.  Until the last week or so, when I've started seeing a spike around 5 am.  I'll go to bed at 80 mg/dl, then wake up at 5:30 am or so to use the bathroom, and ring in at 160 mg/dl.  Consulting with the Dexcom shows that around 5 am, things go haywire.  For a few days in a row, I was waking up, correcting the high, and then getting up "for real" at 8 am to see a number back under 100 mg/dl. 

Is this the insulin resistance I've heard so much about?  I'm just over 4 1/2 months pregnant and have gained (honestly) about 12 lbs, and the baby is growing by leaps and bounds, so I'm sure my diabetic body is freaking out from all this change.  Insulin-to-carb ratios are oscillating between 1:12 and 1:9, depending on the week, and my basals apparently need a kick in the morning.  (Of course, this morning I was a steady 70 mg/dl all night long.  Hard to find a pattern when it doesn't remain as one for more than five days!)  I'll be at Joslin next week for a full fetal ultrasound and an eye dilation (fun) and several other prenatal tests, so I'm sure my medical team and I will make some changes, but still - this is seriously like trying to hit a moving target.  Hopefully my A1C is still steady and in the low 6's (for BSparl's sake), and I just want to get to May with all of us in good health. So I can hug her.  :)

I've also been waiting for her to kick, and my doctor told me that I might be able to feel something when I'm lying still and relatively quietly.  So the other night, I was in bed and the house was silent.  I thought it might be a good time to connect with BSparl.  

I placed my hands on my lower abdomen (where I saw her in the ultrasound last week) and pressed my palms firmly against my belly.  Nothing.  I waited a bit - maybe a few little flutters, but it's hard to tell what's her and what's me this early in the game.

It was getting late, and I was starting to fall asleep.  My eyelids were closed and the house was silent and I could smell the Christmas tree from the bedroom. 

"Tomorrow.  I'll try and find you tomorrow, baby love."

She responded with a sharp, definitive kick.

December 03, 2009

Bumped!

BSparl is now the size of a large mango, according to the What to Expect site.  A large mango makes sense to me, because all of a sudden, my belly is way more sticky-outtie this week than ever before.  

BSparl at 18 weeks and 2 days.

This past ultrasound was, by far, the longest one I've had yet.  The technician spent a little over an hour taking a close look at the different parts of the baby, from the spine to ensure that it was fully enclosed to the mouth to check for cleft palette.  (Thankfully, no issues on either front there.)  He scanned her top to bottom, making sure she was developing on schedule.

"Everything looks good.  It's great, because when type 1 diabetic women would come in pregnant just a few decades ago, some of the complications to the mother and the baby were tough to manage and difficult for everyone.  But now, these babies of women with diabetes are just as healthy as the ones born to mothers without.  It's a wonderful thing."

I grinned.  "I agree."  

"So do you want to know the sex of the baby?"  The technician asked us.

Chris and I both responded, almost in unison:  "Yes!  We do!"

So the tech scanned up to my belly button (because BSparl has been hanging upside down in there like a bat, head down and feet towards my ribcage) and went to check for the baby's ... goods, I guess. 

Only the legs were crossed.

"Hmm.  This baby is a little on the shy side.  They don't want to show us anything yet."  And on the ultrasound screen, I could see my little kiddo, sitting in there with their legs crossed.  Almost like she was waiting for hot chocolate to be brought to her and for a story to be read.

"Come on, baby.  Let's see what you are ..."  He scanned for a few more minutes.  "Okay, guys.  Ready?"

Chris's hand held mine.  "We're ready."

"It looks like you're having a baby girl.  A little girl."

I didn't have a preference for what this baby would be.  As soon as we found out we were having a child, my mind immediately left the realm of pinks and blues and I just hoped and prayed for a healthy, happy baby.  I didn't care whether it was a boy or a girl - I just wanted a healthy baby.  No matter what.

But as soon as the lab technician said "Girl," my heart swelled to the point where I couldn't breathe.  A baby girl.  A daughter.  My best friend.  I thought about her little face and the tiny heart beating inside of me that belonged to her and there was this moment of complete and utter warmth and comfort, and I fell in love with her completely.

Of course, my mouth wouldn't comply with the musical going on in my head.  And all I could stammer out what, "Okay, that's something."  But the tears just kept coming, and Chris's hand closed tightly around mine as he kissed my forehead. 

The lab technician smiled.  "I'm sorry that it took so long to see everything.  But with a girl, we have to make sure we're right - takes a little longer than with a little boy."

"It's okay,"  I said.  "I'd rather she be on the shy side.  She doesn't really know you, you know?"  

The technician scanned back up to the baby's face, where she was hiding with her hands covering her face.  Five little fingers.  And then she moved and we saw her mouth, and she has these big, pouty lips already in there, pursed in a little bow.  And I couldn't stop staring, because this was my daughter.  We've only known her for four and a half months and we haven't even held her hands yet, but Chris and I are beyond smitten with her already.  And terrified.

"You're all set, Mrs. Sparling.  Everything looks great.  Congratulations."  The door closed behind him.

"Our daughter.  We're having a little girl."  

Chris and I sat in the dark for a minute, letting the idea of our daughter wrap around us like warm fleece.  Realizing how much we loved her already. Realizing how truly lucky we were.

Realizing how much our lives had just changed. 

December 01, 2009

Update on BSparl.

I love BSparl.It's been a long, wonderful day at Joslin, and I have a lot to say, but for now, Chris and I are going to decorate our Christmas tree, drink sugar-free hot chocolate with marshmallows, and grin about our daughter, who is due on May 4th.

A little baby girl. I love her so much already.

I couldn't feel happier right now if I tried.

Boy or Girl?

We're heading to Joslin today to find out the sex of the baby (providing that BSparl isn't feeling shy today.)  I don't have a single gut feeling about what this baby is, and Chris and I cannot wait to find out.  Because we're tired of calling the baby "it."  :)

See you in a few hours!

November 24, 2009

Baby Flutters.

"Is it too early to be feeling the baby moving?"  I asked my pregnant best friend.

"What are you, fifteen weeks along?  No, it's not too early.  Does it feel like fluttering, or butterfly wings?"

I remember when the NBF was at my house over the summer, about five months along in her own pregnancy, and she was convinced she had felt the baby move for the first time.  She and I sat on the couch for 20 minutes, our hands pressed against her swollen belly, hoping the baby would wave at us.  She felt it more strongly than I did, but I did feel that whisper beneath her skin.  Slight dancing, like a butterfly was trapped underneath her skin.

"Yeah, sort of like what we felt with you.  Only ... well, weirder, because it was in me this time."

She laughed.  "It could definitely be the BSparl.  Or gas."

"I love that this is either my baby moving around in there, or it's just a rockin' gas bubble.  Classy, as always."

This was about two weeks ago, and for the last two weeks, I've been checking constantly for signs of the dancing BSparl.  (Don't tell anyone, but I even busted out the stethoscope we have at our house, searching for sounds of the baby.  All I heard were the sounds of my body bustling around, but still - I tried.  I also listened for Siah's heartbeat, just for kicks.  She has a heart.  Just no brain, it seems.)  Sometimes, I think I can feel something, always on the right hand side, down near my pelvic bone.  Other times, I realize that I'm feeling my own heartbeat in my fingertips, mistaking it for BSparl.  I have no idea what's going on in there, but I know that the last time we saw him or her, there wasn't much room left for him to scuttle around, so I thought I'd feel him any day.  I'm hoping to feel a definitive dance from Baby Sparling soon, one that is definitely not passed off as "gas" but instead "Wow, that was the baby moving!"   For now, I'm waiting patiently and constantly checking.  (Patiently for me, anyway.)

BSparl at 17 weeks
(Here's where you get to see my extensive and sad sweatpants collection. 
And my banana plant, there on the right.)

I'm now just past 17 weeks along, and I feel happily porkchoppy.  My belly, though popped out and my waist is quickly disappearing, is firm and solid and feels so warm to the touch. 

Diabetes-wise, my numbers have settled down a little bit.  The lows aren't nearly as frantic as they were, and the overnight ones have tapered off, thanks to some slight basal adjustments.  (Granted, I have 6 different basals rates throughout the day ...)  I'm going to bed at a number around 90 mg/dl and waking up around 80 mg/dl, with the Dexcom confirming a flatline all night long.  And believe me - I'm not boasting in the slightest.  These numbers are blowing my mind, and I've never had such solid control before.  My last A1C, taken two weeks ago, came back at 6.1%, which is officially the lowest I have been since my diagnosis in 1986.  A few highs have crept back into the rotation, but I'm stalking them and they don't hang around for more than an hour or two.  Again, this isn't because I'm doing "all the right things" or because I'm suddenly paying rapt attention - something about this baby is making my numbers fluctuate less wildly.  I have heard some horror stories about insulin resistance and the third trimester, so I'm going to stay very thankful for this steady second trimester.  

One thing I'm having a little trouble with is keeping my insulin pump sites stuck to my body.  I'm changing my site every three days like clockwork, but with all the lotion and moisturizer I'm slathering on my itchy, stretching belly, the infusion sets aren't holding like they used to.  I'm currently wearing them on my lower back, but I need to rotate out to my arm more frequently in efforts to use a little more real estate (and also so I can finally and properly rub my hips with this fine smelling cocoa butter!). 

This is going by so fast.  In a week, I'll be at the halfway point in this pregnancy, and I can't believe how quickly this is happening.  Next week we'll also hopefully find out whether this BSparl is a BoySparl or a GirlSparl, providing they aren't being all shy in there during the ultrasound.  And also for next week, we're hoping to have an announcement of an entirely different kind, so just bear with me while I spazz out for the remainder of the month of November - it's a wild time in the Sparling household!  

November 18, 2009

Unrealistic Expectations.

BSparl is getting bigger.  (And so am I.)

The BSparl at 16 weeks, 2 days

I spent a lot of time planning this pregnancy, starting from back in 2003 when I decided to go on an insulin pump.  And even though preparation didn't begin in earnest until Chris and I were married, having a child has always been something I've wanted with my whole heart.  So I read up on what to expect, and what to do to help improve my diabetes control, and what prenatal vitamins to take.  

What I didn't do much research on was the actual pregnancy itself.

I didn't expect the low blood sugars that hit hard and fast in the first trimester.  I had heard that I could run a bit lower, but I didn't think my blood sugar and my age would be in sync so often.  And I also didn't expect the exhaustion of the first three months.  I had heard that I'd be "sleepy," but I didn't think I'd be driving home from work on my lunch break to take a nap, and then to collapse back into bed right after work for another hour or two. 

I also didn't expect the weight gain to affect me so emotionally.  I'm starting to feel like a porkchop.  (Thrilled to be pregnant, but shocked by how fast I'm growing.)

I've never been a twiggy little thing, but I have managed to fight the fat that seems to want to cling to my body and instead maintain a healthy, slightly athletic build.  (And for those of you who have ever seen me play sports, I'm begging you to stop laughing.   Just let me go with this, okay?)  Just never skinny, and never without hips or thighs.  The gym and I needed to be friendly in order for me to stay in any kind of shape.  And with the help of Chris's dedication to his own workout routine, I have been holding steady for the last five or six years. 

Except for the last few months.  Because my beloved BSparl is rocking my world with this whole weight gain thing.  Today, I'm four months and 2 days pregnant, and since finding out I was pregnant on August 31st, I've gained 8 lbs.  May not sound like a big deal, but it's definitely an adjustment, not being able to button my jeans (for weeks now) and living in the blue sweatpants I snagged from the Gap.  The weight isn't all just in the belly, either.  I can feel it on my hips, in my arms, and in my face.  And now, in the second trimester, I've entered the "pound a week" club, which means that by the end of this pregnancy, I could end up gaining almost 40 pounds.  

Chris reminds me constantly that this isn't "fat," but "pregnancy."  And it's what's supposed to happen.  My doctor says the same thing.  And believe me, I eat when hungry and I'm not taking any measures to skip meals or skimp on calories.  Even if I gain 40 pounds, so long as my baby is healthy, it's a win. 

What frustrates me are the empty calories I had to consume in the first trimester, which caused me to gain a lot of that weight.  Gulps of grape juice almost every night to treat low blood sugars, glucose tabs by the jar, and an influx of fruit carbs (which were among the only kinds of foods that would keep me over 100 mg/dl for more than an hour) - it's all showing on the scale.  Diabetes is making this pregnancy difficult, and excessive weight gain only adds to it.  And for me, the weight is making me feel a little emotionally bummed out.

Exercising is only just now starting to return to my regimen, since I'm not fall-down tired anymore.  Chris and I have been going for bike rides on the bike train down the street from our house, and we're clocking in a good 7 - 8 miles easily, which makes me feel like I'm accomplishing something.  That, coupled with the ellipmachine that I'm trying to use a few times a week (while watching Glee and Family Guy on Hulu - love Hulu) is making me feel like I'm at least getting some movement in.  It's just an uphill battle.  And honestly, seeing all the magazines with the stupid celebrities who are "Back in their skinny jeans just 10 days after giving birth!!!" makes me want to put blinders on when I am in the grocery store checkout line.

What's the point of this post?  I'm not even sure.  I'm just ranting, I think.  I'm having a hard time adjusting to getting bigger, and I know this is only the beginning. 

But Chris, again, reminds me of what matters.  He puts his hands on my belly and makes me focus.  "This is our baby.  And you are doing everything you can to protect him.  [Or her.]  Stop worrying about the way you look and enjoy this.  You've worked so hard for this."  

What can I say - the guy has a point.  And when I look in the mirror and see that blooming bump, I can't help but picture the baby growing inside of me, and how smitten I am already with this kid. 

Love you, BSparl.  All 40 lbs of you.  :)

November 13, 2009

Pregnancy Progress.

Tomorrow is World Diabetes Day.  While my best friend's baby shower is this weekend and I'll be busy preparing for and helping with that event, I know there are lots of events taking place to celebrate the big, blue circle (including the Big Blue Test ... more on that later).

But today is just another day in diabetes management, and it happens to be another endocrinologist appointment for me and the ol' BSparl.  BSparl is getting bigger, as evidenced here:

BSparl, 15 weeks and 2 days

I am now sporting my first baby bump, and it's becoming more and more pronounced every day.  (Pronounced baaabeee buuuhmp.)  Clothes don't fit, maternity jeans are necessary, and when I zip up my sweatshirt to head down to the gym, the zipper strains a bit over my belly. 

But is it all baby?  Or could it be some weight from treating all these lows?

One of the things I'm talking to my endocrinologist about today is low blood sugar.  Specifically, the crazy-ass low blood sugars I've been experiencing over the last four months.  The other night, I woke up to the BEEEEEEP! of the Dexcom and a pool of sweat in my clavicle.  Blood sugar was 33 mg/dl, and I wasn't even entertained by the Larry Bird reference

Instead, aside from the sweat, I was completely symptom free.  And that scares the hell out of me, because there have been several lows in the last few weeks that clocked in under 50 mg/dl without a single symptom.  Last week, it was a 29 mg/dl that just sprang up on me, and even yesterday I had a 41 mg/dl with my only symptom as thirst.

THIRST?  That is my low symptom now?  Come on, diabetes.  That doesn't even make any sense!!

In preparation for my Joslin appointment today, I have two weeks worth of blood sugars all logged and ready to roll, and as I was printing out the logbooks, I noticed that there isn't a single trend.  These lows are cropping up at 3 am, 10 am, 4 in the afternoon, while I shower, while I'm at the grocery store, during conference calls ... you name it.  No reason for these pesky lows (and also no reason why I shouldn't just buy stock in glucose tabs, seeing as how I've wrecked through a bottle in the last week alone).  Plenty of other type 1 diabetic women who have been pregnant have told me about the epic low blood sugars they've experienced, but I had no idea what they meant until the 20's and 30's started pestering me at all hours of the day.

I have high hopes that my endo can help me peel back some of these lows without sacrificing the excellent post-prandials that I've been working my butt off to achieve.  I'm willing to let my A1C creep up a bit in order to bring my machine average back up into the triple digits.  I just need some help in making these lows stop.

(I also have high hopes that I can stop sleeping with a bottle of honey next to my bed, because when I slap my hand against that instead of the alarm clock, it's all sticky.)

November 12, 2009

Let the Eating ... Begin!

Evil pregnancy cravings.The second trimester (not semester, as I keep mistakenly saying) is in full swing.  According to the baby books I am reading daily, it's time to start putting on 1/2 a pound to a pound a week - oh what a weird concept!!!  For those of you who have been reading me for a few years, you know I work hard to keep the poundage OFF, so the concept of gleefully adding 20lbs in the next 22 weeks is foreign to me.

The weight gain is a weird adjustment.  I log in to the What to Expect (When You're Expecting) site daily to see the progress of the BSparl and because it helps me keep track of how far along I actually am.  I'm now in the 16th week of my pregnancy and the site says the following:

"It's hard to watch yourself gain weight during pregnancy, even when you know there's a wonderful reason for it. The challenge, though, is to try to embrace your body's new shape and think of every pound you put on as a sign of good health for you and your baby. As long as you eat right during pregnancy (minimize junk and maximize nutrient-dense foods) and get regular exercise, you'll be fine in the long run. Remember, every woman is different and gains (and loses) at her own pace."

Eating right has been a little bit of a challenge because what I'm craving is changing hour to hour, it seems.  Earlier in my pregnancy, I could have devoured an entire fruit stand in a week, craving anything with a high volume of vitamin C in it.  Kiwis, orange juice (yes, with pulp!), blackberries, and raspberries by the fistful.  Healthy choices, right?  But now, with about 7 lbs on board already and closing in on the fourth month of BSparl, my tastes are turning towards less ... diabetes friendly options, shall we say.

Like the other night.

"I want a McDonald's cheeseburger, like you read about."  I said this to Chris from the safety of our home, away from the tempting glow of any golden arches. 

"Really??"  He knows I'm not one for fast food, especially McDonald's. 

"Yup.  It's twisted."

The thing about that craving is that it didn't go away.  No sir ... that one was on board for 72 hours, until Monday, when Chris and I were coming back from an errand and I knew there was a McDonald's around the corner.

"Dude, I'm caving."

He grinned.  (He finds this whole thing amusing, from the potbelly to the bizarre things I want to eat now.)  "It's time."

While he waited in the car, I ran into McDonald's and ordered a cheeseburger from the lady behind the counter.  

"One cheeseburger, please!"  I think I looked euphoric.  I must have.

"One cheeseburger, happy lady?"  

"Yes, ma'am!"

"One cheeseburger for the happy lady!" she said, punching the order into her register and calling back to the guys in the back.

"Cheeseburger coming up!"  A minute later, the cheeseburger I'd been craving slid down the counter and was tossed into a paper bag. 

"Cheeseburger for the happy lady!"

"Thank you!"  (Everyone speaks in exclamation points at this McDonald's, apparently.  And there's nothing wrong with being the "happy lady," in my opinion.)

I went out to the car, my face glowing with pregnancy cheeseburger happiness.  Chris was already laughing at me, but I can't care.  This is part of the process, I guess, all this very odd food stuff.  I bolused 3.5 units for this culinary disaster and ate it in one gulp.  An hour later, 109 mg/dl. 

I swear BSparl was in there, clapping his little hands, the whole time. 

November 09, 2009

Two Heartbeats on D-Blog Day.

Diabetes Blog Day, 2009.  Holla ... and whatnot.The first time we saw him (or her), it was at the emergency room back in Connecticut.  We were only seven weeks into the pregnancy and barely had caught our breath from finding out when the bleeding happened and I panicked.  We spent five hours in the emergency room, poked and prodded and with an IV line at the ready, only to finally be wheeled into the ultrasound room. 

"Just relax, Mrs. Sparling.  And we'll take a look and see if everything is okay."

And the screen switched on and Chris and I saw our baby's heartbeat, strong and steady and fast, beating inside of me.  Everything changed forever, even though nothing had changed yet.

The bleeding stopped that day, and we moved forward, cautiously, frightened, and so hopeful.  A few weeks later, my mother and I (Chris was in LA on business) were at my Joslin appointment for the first "official" ultrasound, hoping to see the baby growing strong and steadily.

"Oh, there it is.  There's your baby.  Those parts there at the end?  The feet.  Those are the little feet, ready to kick."

And I watched as the teeny, hamster-looking creature inside of me kicked his little feet.  So small.  So ... surreal.  I couldn't wait to see him again.

Two weeks ago, Chris and I were at the Joslin Clinic for the first of a few second trimester ultrasounds, and from what my eight months pregnant best friend had already told me, this ultrasound was very different than the first one.  "It looks like an actual baby at that point," she said, her blue eyes wide.

Chris and I talked with Dr. T, the OB/GYN, for a while about how I've been feeling, my numbers, and overall how the pregnancy is progressing.

"I feel good.  Tired a lot, and doing a bit more traveling than I'm used to these days, but I'm feeling better now that I'm in the second trimester and past that fall-down exhausted bit from the first couple months."

"Good, sounds like you're doing great.  So ... wanna see the baby?"

"Yes!"

I hopped up on the examining table and Chris took a seat by the ultrasound monitor as Dr. T. moved in with the external ultrasound wand.  "A little bit of this warm gel right on your belly and ... okay, there we go!"

On the screen was a baby.  A whole baby, all big-headed and waving arms and kicking legs.  Our baby.  Hands with fingers, legs with knees.  This baby looked like a real baby.

"Oh my God, is that him?  He's so big!"  I couldn't believe this was the same little hamster from just a month or so ago.  He took up the entire space of my uterus, which was a big change from all the room he appeared to have a month ago.  Now he looked like he was out of room in there (and I knew that meant my own expansion was coming fast).

"Yes, that's the baby.  Calling him a 'him,' are you?  We'll find that out next month, right?"

I watched as the baby turned and squirmed, raising his arms up and his body lurching just a little bit every few seconds. 

"Dr. T, does he have the hiccups in there?"

She looked closely and smiled.  "Yes, that looks rhythmic and steady.  Looks like hiccups to me.  Would you like to hear the heartbeat?"

She turned a knob on the ultrasound machine and suddenly the room was filled with a steady whump whump whump sound - the sound of our child's heartbeat.  It was incredible, hearing my own heart thudding in my ears with excitement as my baby fluttered along inside of me.  Chris held my hand as I brought the other one up to my eyes to catch the tears that collected there.

Two heartbeats, both inside of me.  

And today, on D-Blog Day, I wanted to share this story with you guys.  You have been with me from when Chris and I first moved in together, back when the dream of a heartbeat other than my own was something I only hoped to one day hear.  Now, every day that passes brings BSparl closer and closer to meeting his mom and dad.

When I was diagnosed, they said that children would be near impossible for me.  And while I know that nothing is certain until that baby is in my arms, I am already so proud of where we've come, as a Sparling family and as an even larger diabetes community.  We have hope now, hope for lives that are wonderful and meaningful, despite diabetes.  Diabetes is a heavy load to carry, but with the support we get from this community, the burden is so much lighter.

Happy D-Blog Day, you guys.  And thanks for being part of my extended family.

November 04, 2009

Dexcom and Desperation.

For a few weeks, I had a tough run with the Dexcom.  Out of the five sensors I'd used in the last three weeks, three of them had gone kaput on me.  And by "kaput," I mean that I'd put in a new sensor after Las Vegas and it instantly gave me "???" instead of blood sugar results.  I've seen the triple question marks before, but usually the sensor synchs back up and rights itself.

Dexcom tossing "???"

But this time, the question marks hung out for ages.   Like hours, and then when it would finally ask me to calibrate, it would work for about 45 minutes ("work" being a loose term here, because it had numbers that were over 180 points off from my actual blood sugar) and then the SENSOR FAILED error would come ringing up.  Stupid error. 

Dexcom sensor - FAILED!

I thought it was just the one sensor, but it happened three different times in three different weeks.  Using the Dexcom, it seems, has helped me get my A1C act together, and since becoming pregnant, the Dex has helped bail me out of many, many unpredictable low blood sugars.  (Lows plagued me during the course of the first semester, relentlessly.  50s, 40s, and 30s coming to stay for a visit without calling first.  No symptoms, no warning, and no predictable time frame.  Without the Dexcom, I wouldn’t have woken up in time for those lows, and I don’t like to think about how far I could have dropped while sleeping.  Whoops, digression.  Sorry about that!)  

So I called my contacts at Dexcom, because they are aware of my pregnancy and how paranoid I’ve become about things lately.  (Actually, I emailed them at 2 in the morning because when the third sensor in a row kicked out on me, I flaked.  I sent them one of those “Sorry I’m a lunatic, but …” emails, and thankfully they got back to me early the next day.)

After a few email threads, Dexcom decided to FedEx out new sensors and help get me back on track.  And for some reason, these worked.  I’d heard from the Twitter crew and from some comments here on SUM that there appeared to be a certain batch of sensors that just weren’t cutting it.  I don’t have the “official word” on what the deal actually was, but I do know that a certain box of sensors just weren’t working right.  And now that I’m cracked into a new box, things appear to be working okay now.  

Which is a relief, because the Dex caught a 29 mg/dl as I was getting ready to leave the house the other day.  

“Holy shit, I’m 29?”  

Chris wasn’t home at the time, so I panicked a little bit.  Not a single symptom was on board, and I was freaking out.  I tested again to make sure, as I drank grape juice straight from the carton.  Yup, 31 mg/dl.  Dexcom was blaring its head off.  

Weird things happen when you’re low and don’t realize it.  Like you find yourself sitting at the kitchen counter, eating a whole bowl of Puffins cereal in one gulp.  Chris came home as I was inhaling carbs.

“Are you okay?”  

“Yeah.  I’m 29.  No symptoms.  This sucks.  I seem fine, don’t I?”

“You do.  You seem completely fine.”  The Dexcom went off again.

“Good thing that’s working again.  Did you have juice?”

“Drank it. I’m eating the whole box of Puffins now.”  Grinned through a mouthful of carby goodness.

When it works, it works.

I’ve been wearing the Dexcom on and off for two years now, but almost 24/7 for the past six months.  And not having it on, or having its integrity compromised through technical failure, etc. makes me feel absolutely naked.  It’s not a cure, it’s not a guarantee for tighter blood sugar control, but it’s the safety net I was hoping for, and now that my basal rates, insulin:carb ratios, and blood sugar trends seem to be unpredictable during these months of pregnancy, I’m leaning on it more now than ever before.

[Dexcom disclosure]

November 03, 2009

Lovenox, Heparin, and WTF.

What the hell am I supposed to take?During my endocrinologist appointment last week, I brought up that itchy, scratchy Lovenox rash to my OB/GYN, Dr. T.  And she wasn’t comfortable with how my body reacted.  

“That rash is from two weeks ago?  How does it feel now?”

“Less itchy, that’s for sure.  But it got all hivey and wouldn’t relax, not for about a week.  It itched like mad.”

“I don’t like that.  I don’t want you to continue to take Lovenox, especially if it gave you that reaction.  Who knows how bad the reaction could be the next time?  I want to switch you to something else.”  She started to write on my chart.  “Heparin could be another alternative for you.”

“Okay, what’s the difference?”

She told me that both Lovenox and Heparin are large-molecule drugs that don’t pass into the placenta, so Bsparl is safe, and also that they both serve the same purpose:  to protect me and my baby from blood clots (the risk of which increases with both Factor V and pregnancy).  

But you guys know how I am by now.  I feel weird taking extra drugs, and I’m very conservative about adding more and more Rxs to my daily routine.  Also, consulting with Dr. Google brings me all this scary information about how Heparin is a category C drug, meaning it could have effects on the baby.  I don't know what's what, but I do know that I need to trust my doctor and her years of experience over a Google search.  (Right now, I'm wondering if I can bypass these drugs altogether and just work out in the airplane bathroom for the whole flight.  Kidding.  Sort of.)

Yet I still find myeslf feeling uneasy, and looking to see if any of you have had personal experience with Heparin.  I'm very WTF about this and confused as can be.  Right now, I’m only on insulin, pre-natal vitamins, and blood pressure meds (don’t worry – safe for baby), but according to Dr. T, I’ll be taking something to help protect me from clots for six weeks after BSparl is born.  (Great.)  So now is a good time to figure out what works best for me.

Once again, I’m clueless about what to expect.  I’m sorry to keep pestering you guys with all these questions, but when it comes to anything other than insulin, I’m lost.  When I wrote about Lovenox before, you guys were invaluable and I learned a ton (even brought some of it up to my doctor).  Now I’m asking once more – has anyone ever taken Heparin?  Any weird, itchy side effects?  Any burning at the injection site?  Any … anything?  

(And BSparl says hi.  He just sent a messenger pigeon to me from the womb.  He is baking cookies in there.  Busy little peanut.)

November 02, 2009

H1N1: Fighting for the Vaccine.

The one needle I can stand. :)Last week, I toddled my pregnant self up to the Joslin Clinic for my endocrinologist appointment and an ultrasound with my OB/Gyn.  And as excited as I was about the ultrasound and the opportunity for Chris and I to see our baby kicking around in there (more on that later), I was just as excited about the H1N1 vaccine.

I know. 

I can't believe I'm saying that, either.  Yes, this is the same Kerri who wrote about feeling "eh" about the flu shot a few weeks ago.  But a few things have come to light in the last couple weeks that have changed my outlook on things.

Like the fact that the Joslin Clinic has been riding me about getting this shot because of my high-risk situation, being both type 1 and pregnant.   

Or the fact that every healthcare professional I spoke with at last week's ePatient conference kept asking me, "You are getting the H1N1, right?" and the look of concern when I said, "I haven't received mine, yet."

Or the very scary fact that pregnant women, regardless of any chronic illness, are singled out as one of the highest risk groups out there.  

I'm not one to leap without looking.  But I'm also not one to put my baby at risk if I can help it, so when Joslin said there was an H1N1 vaccine available to me, I jumped at the chance to get it.  Seems like this vaccine, for some completely ridiculous reason, is not being made readily available to people who need or want it, so if there was one available to me, I was taking it.

It was unnerving, knowing they were injecting me with a virus.  A dead one, of course, but still, with all the information circulating out there about the pros and cons of the H1N1 vircus, it's hard to know what's true and what's just speculation.  Or, unfortunately, what's purely fabrication.  In any event, when I heard about a little girl in my home state who, at the age of 12 had being diagnosed with H1N1 and then died from it just a few days later, it was enough to scare me into rapid and determined action.

But even at the Joslin Clinic, I had to jump through a few hoops in order to be viewed as "eligible."  

"No, I'm sorry.  That vaccine is only for patients who are 24 weeks pregnant and up."

"Really?"  I said, my hands against the counter.  "I was told that being 14 weeks and also having type 1 diabetes made me a shoe-in for this vaccine.  It's like my prize for being the in double risk pool.  So there isn't one for me?"

She checked her chart again.  "Type 1?  14 weeks?  Okay, you can have a seat over there and we'll call you in for your injection in just a few minutes."

It felt so odd, fighting for something I wasn't even sure I wanted in the first place.  But I kept thinking about the pregnant women I'd heard about on the news who had died from H1N1.  And then I thought about all the public transit I'd taken in the last few weeks, and my upcoming travel plans for this week.  Did I want to take the chance?

If it was just me, I may have.  I may have waited or put off the shot or taken my chances.  But I'm responsible for this baby.  And when we heard the heartbeat, loud and strong, and saw him (or her) kicking around in there, I knew that I needed to do whatever it took to take the best care possible of my child.  

So they shot me up with the H1N1 vaccine.  Oddly enough, I felt grateful.

And that night, I promptly felt ill and slept for about 15 hours straight, waking only to test, snack, and drink water.   I wasn't experiencing any full-fledged sickness, but the weather was above me enough that I hid out all weekend long, missing any Halloween festivities and instead camping out at home with hot tea, chicken soup, and Kleenex.

Today?  Feeling much better and on my way to speak at a seminar in New Jersey.  But I keep hearing about others who are seeking out the H1N1 and still haven't been able to gain access to a vaccination.  What does it take to get protection when you need it?  How are there H1N1 clinics in some states but not in others?  Are you someone who is trying to get this vaccine but can't?  Or are you avoiding this shot, and why? 

I've already jumped, so my opinion is moot on this one.  I'm pregnant, my doctors told me this was best, and I (for once) listened.  But this issue is getting bigger and bigger, and with diabetes month just getting started here, I want to know how the diabetes community at large feels about this H1N1 vaccine.  

October 26, 2009

Ground Control (Solution) to Major Tom.

Get in control.  Cheesy photo description, no?(That’s just a cool song and I’m in the mood for a little David Bowie.  Humor me.)

I’ve learned a lot in my frequent visits to the Joslin Clinic over the last six months or so, which just goes to show that it doesn’t matter how long you’ve had diabetes – there’s always something new to learn.  As I was preparing for pregnancy, there was a lot of focus on blood sugar control, and frequent monitoring.  That, I knew.

But what I didn’t realize was how often I should have been checking my meter with control solution.  

I have to be honest:  Before Joslin told me to get my act together re: using control solution, I never used it.  Ever.  It would come in the meter kits when I first opened them and it was the first thing I removed.  I ran on the assumption that my meter was the diabetes equivalent of “the customer” – it was always right.

The Joslin CDE disagreed.

“No, you need to be checking the accuracy of your meter with the control solution at least once a week, Kerri.  That’s important to make sure everything is in range.  Think about it – you’re dosing insulin based on these results, and you’re calibrating your Dexcom, too.  Don’t you want to make sure the numbers are accurate?”

Good point.  But how naïve am I to assume that the numbers ARE accurate?  Sometimes I get a result on the meter that I know is way off, and I usually test again to see what the deal is.  But I never thought to bust out the control solution to keep tabs on the accuracy, as well.  

Since I was (and am) trying to be Captain Compliance when it comes to Joslin instructions (thanks to the ever-growing BabySparl), I dug up some bottles of control solution and started double checking my meter.  And yes, I do feel soothed when the control test comes back right on target, because it reinforces my faith in the meter.  And no, I haven’t seen any wonky control results come back yet, but at least I’m looking out for them.  

If you’re already checking your meter with the control solution, bravo!   Just wanted to pass this info on, in case you were like me and tossing the control solution into a shoebox to reside with dust bunnies under the bed.  (Or with Siah bunnies, depending on how much your cat sheds.) 

As I’ve mentioned, I’m learning so much now that I’m in constant contact with my doctors, so I want to pass on all the tips I find to you guys.  Because it’s quite obvious that while I try pretty hard, the rules of the game seem to change overnight.

October 22, 2009

Diabetes, Lovenox, and Bathroom Jane Fonda.

The flight to Las Vegas from Boston is a long one – six hours on the way there and five on the way back.  I talked with my doctors before taking the flight, and being pregnant, I’m dealing with an increased threat of deep vein thrombosis.  The Factor V Leiden gene in my body is also a red flag, so these longs flights caused some concern for my medical team.

“We’re not worried so much as we have some rules for when you’re flying. The first is that you need to get up and move around about once every hour to keep your circulation steady and your legs moving.  And the second thing is that we’d like you to take Lovenox on the days that you’re flying.  That will help combat the Factor V risk.”

Take a shot?  No problem.  At least that’s one thing I can commit to without fear.

So about an hour and a half before my flights took off, I snuck into the airport bathroom and pulled out the pre-filled syringe of Lovenox.  Lovenox is an anti-coagulant drug that helps to prevent blood clots.  I don’t know much about it, other that it’s safe for pregnant women to take and it was one of the conditions set forth by Joslin, so I pretty much do what they say these days.  I’ve never taken anything like it before, so Wednesday evening was my first time.

Fellow diabetics, I just need to say that we have it good with our teeny, ultra-fine needles.  This Lovenox needle was clumsy, long, and thick.  “Inject it right into your abdomen, where you’d normally take an insulin injection,” the doctors recommended, so I did just that.  But it sucked a little bit.  One of the side effects of the injection is bruising and soreness, and they’re not kidding.  Within 15 minutes of taking the injection, a deep red thumbprint popped up on my abdomen, tender to the touch.  

But that seems to be the only side-effect I’ve experienced.  Except for a little bit of paranoia.  And now, a few days after the trip, I have the itchiest, red rash at my injection sites. 

Once a doctor tells me that I could be at risk for something, I do what I can to help mitigate that risk.  For these flights to Las Vegas, I took the Lovenox injections and made sure I was up and about once an hour, but I also did something else.

Every time I went into the airplane bathroom, I did some weird kind of calisthenics.  Thanks to BabySparl, the need to pee is hourly (making me test my blood sugar all the time, wondering, “Is this because of Baby or am I high?), so I’d use the ladies’ room and then face the mirror.  And then do this bizarre mix of high knee raises, running in place, and stretching.  Thankfully, being barely 5’4” gives me enough room to move around in there, but I felt like a tool.

“And stretch!  And stretch!”  I heard Jane Fonda in my head as I faux-exercised in the airplane bathroom.   

I prayed that the stewardesses couldn’t hear me thrashing around in there.  How the hell would I explain that?  “I don’t want a blood clot so I’m doing a little dance here in the bathroom.  That's legal, right?”

The itchy frigging rash from the Lovenox injections.
 
The flights were fine.  (If you don’t count the flight from Boston to Las Vegas, which included an extra hour on the trip due to a strong headwind, expired food, not enough meals for passengers, no movie, and no working radios.  US Airways, you sucked it up on that one.)  Lovenox was a success.  And now I feel like I’ve managed to fit in a workout, even at 35,000 feet.  But I’m curious to know if anyone else has ever taken Lovenox, or another kind of anti-coagulant.  And if anyone has ANY tips at all on dealing with this frigging itchy rash.  It's starting to go away, and I know it's just part of the side-effect fun, but it's making me scratchy-crazy. 

It’s all new to me, and I’d appreciate any feedback from someone who’s been there.  (And if you have airplane exercise tips, share those, too.  I’m heading to Florida in two weeks and am wondering how I’m going to embarrass myself on that plane, too!)

October 21, 2009

Unpacked and Vlogging.

Here we go:  diabetes vlogging about the potbelly, our new apartment, sharing a bathroom with the cats, and a craving for Apple Jacks.

And please excuse my belly rubbing fixation.  It's new, so I keep touching it.  :)

Some Pregnancy (and Diabetes) Stuff.

Do you know how hard it was to not tell you guys I am pregnant?  Sitting on that information for three months was one of the most challenging things I’ve ever done.  There were SO MANY questions I wanted to ask, and so many stories I wanted to share, but I knew it was best to keep my mouth shut until we were past a certain point.  And it is still early in our pregnancy, all things considered, so I shared our news with hopeful optimism and in hopes of some positive thoughts being sent our way.

And holy crap do you guys deliver.  I’ve read every comment on the Dear Baby post, even though I’ve had to take breaks to grab tissues because you made me tear up quite a bit.  My husband, my mom, and my mother-in-law are reading the comments, too.  And they say thanks for the support as well.  :)

So now you know.  And now I can talk about what the past three months have been like.  (Video to come this afternoon.)
 
I referenced the exhaustion before, but I must mention it again. BabySparl makes me want to spend the majority of the day snuggled up against a cold pillow and a warm down comforter.    I keep reading in all those “Hey, You’re Pregnant!” books about how tired the baby building can make a woman, but I thought they were sort of kidding or at least over-exaggerating a little bit.  Not the case.  Naps are my friend.   I take them constantly, and sometimes I’m skipping the gym in efforts to snag a random hour of sleep.  

Low blood sugars also appear to be my “friend,” only I’m not as happy about those.  Over the last three months, I’ve had some very persistent low blood sugars.  My A1C is down to 6.2% as of my last endocrinologist appointment on October 9th, but it’s not without the nudging of these lows.  (Thankfully, the highs have tapered off to almost nothing, but still.  THE LOWS.)  Other diabetic women had told me that my A1C will be at its lowest during the course of my pregnancy, but I always thought it would be because of all the blood sugar stalking.  I didn’t realize that building BabySparl was going to make me burn more energy than I ever have before.  A few weeks ago, I had a blood sugar of 60 that stayed with me for 12 hours, regardless of the carbohydrates consumed.  I’ve made some headway in peeling back on some of  the lows, but I’m sure once I have it sort of figured out, my basals will change AGAIN.  (They have changed every three weeks since I found out I was pregnant.  Unpredictable body of mine.)  

And the food cravings.  For the first month and a half, I didn’t have any cravings at all.  Nothing new appealed to me and I wasn’t even having any food aversions.  But by the time I hit the 8th week of pregnancy,  I was all over the map.  Just to prove how confused my body is, I’ve gone from despising seafood in all forms to craving grilled shrimp.  SHRIMP?  I even ordered scallops at dinner the other night.  There is something wrong with me.  In addition to the suddenly-seafood cravings, I’m also fiending for fruit.  Vitamin C-heavy fruits in particular.  I think the ideal meal these days seems to be grilled shrimp and scallops with sliced kiwi and whipped cream for dessert.  Orange juice (with pulp - the best!) to drink.  And in even odder food news, I am completely turned off from coffee in all forms.  (I KNOW.) It’s not the caffeine I’m trying to avoid, but the taste of coffee in general.  It makes my stomach do flip-flops and that boggles the hell out of my brain. 

Three months pregnant.  And a banana plant.  It's how we roll.

And now, as of early last week, I’m seeing a baby bump that I can’t suck in anymore.  Earlier in the pregnancy, I had some bloating that made me ask, “Whoa, am I showing already?”  But it would come and go throughout the day, so I knew it wasn’t actual baby bump.  Now, though?  Pants don’t button.  There’s a definitive bump just below my belly button that is hard and protrudes just enough.  It is the most amazing thing I’ve ever felt, and even though it’s hard to adjust to the whole concept of “getting rounder” when I’ve fought an uphill battle to “get smaller,” every time I look at the ultrasound photo on our fridge and feel the hard, rounded belly forming under my shirt, I feel a rush of excitement.  There’s really a baby in there.  That very concept just blows my mind.

I’m beyond thankful to have resources like you guys to help me through the next six months.  And I’m thanking you in advance for being tolerant of all the questions!  This is the coolest thing I’ve ever had the honor of building, and I’m hopeful every day that BabySparl is having a grand ol’ time in there.

October 14, 2009

Dear Baby.

Dear Baby,

I've been thinking about you for a long time.

My doctors told me it would be a challenge to have you.  They said that diabetes would be a tricky hurdle as I planned for you.  They said you might not happen.  There were so many reasons to be scared and so many reasons to doubt, but I never gave up on you, Baby.  I have always wanted you and have worked so tirelessly to make my body safe for you.

And at the end of August, at the Joslin Pregnancy Clinic appointment several weeks ago, I thought you could possibly be there.  I thought there was a chance, because your dad and I were ready to try for you, so we took that leap.

"It's so early, so the test might not show a positive result, but we should do one anyway.  But remember, it might not be positive because you wouldn't be very far along."  The CDE gave me a warm smile while the nurse went to test the sample.

Your dad went into the waiting room to sit.  We didn't know how long it would take to get the results back.  And while I was waiting, the CDE and I were talking in the hallway about how great it would be if you really were there.

Then the nurse opened the door of the lab and came out with the test in her hand.

"Oh, she's definitely pregnant.  Look!"

I'm pregnant!!!

And I saw two lines.  And the CDE began to cry.  And then the nurse began to tear up.  I cried, too, because I was so scared and humbled and in love with you already.

"Chris, Chris!"  Even though we were in a waiting room with people who were there for their own appointments, the world sort of stopped for a minute so we could have our moment.

Chris heard the commotion from the waiting room, and came over, his eyes shining.  And Baby, I wish I told him about you with even a scrap of grace.  That I'd whispered, "We're pregnant!" or "We're having a baby!" or even, "Oh my God!" 

"It's on!" is what I said.

Super classy.

We hugged.  And we kissed.  And the family in the waiting room burst into a quiet applause.

There have been many weeks that have passed, and they haven't been the smoothest.  There have been some very scary moments, and I'm still scared to be writing this all down.  There have been so many doctor's appointments since that day.  Thankfully, everything seems to be just fine and on track, and my diabetes is under the best control I've ever achieved.  (Last A1C, taken Friday, was 6.2%!)  You are growing fast, and we've slowly told our friends and family about you.  Everyone is very excited, and I'm working really hard to make sure that we both remain safe.  You're coming next spring  and we couldn't be happier.  Being your mom is the most important job I will ever have, and I'm ready.  

When I looked in the mirror this morning, I saw the rounded baby bump and felt such a surge of happiness.  I don't know if I'll be the best mom, or the most "together" one, or even if I'll be one who has any clue what she's doing.  But I'm so excited for you to arrive, even though I am scared and careful and preparing as best I can. 

You are so wanted.

Baby, I can't wait to meet you.  I've always wanted to be your mommy.  And in just under six months, I'll be able to hold you in my arms instead of just in my heart.

I love you so much.  And now everyone knows.

Love,
Your Mommy

September 10, 2009

A1C Payoff.

Oh hell yes.I've worked very hard over the last few weeks.  There's no denying that.  

I've logged blood sugar numbers on the Kevin spreadsheet and busted my butt to keep up with the maintenance of those logbooks.

Chris and I have counted carb after carb, making sure that I'm dosing accordingly.

I have changed some of my "bad habits" here and there in efforts to get crap under better control in pursuit of BabySparl.  (I even gave up coffee.  For anyone who knows me, THAT is a huge thing.  Huge-r than logging numbers.)

And yesterday, after spending the entire day under the weather, my phone rang.  Dr. CT was calling with my A1C results.

"Kerri?  This is Dr. CT.  I have your blood work back."

I was napping off my illness just before she called, so I had to shove the cat off my head and rub the sleep from my eyes.  "Okay.  How'd I do?"

"Wonderful.  This is just great - such progress!  You're at 6.3%.  You have done a fine job."

"No kidding?  6.3?  That's the lowest I've had in years.  Ever, maybe."

"Well I wanted to call and tell you personally.  I saw these results and said, 'Oh.  This will be a fun call!'"  

"Thanks, Dr. CT.  Thanks for calling."

And that's that. 

There's so much swirling around me right now and so much change on the horizon that I'm excited, ready, scared, and overwhelmed and all I can think is that tomorrow marks 23 years that I've been living with type 1 diabetes and I'm still learning so much every.  single.  day.

September 03, 2009

Goin' Decaf.

I did it. 

I started my mission while we were on vacation in Barcelona, because between the time change and our eating schedule and the fact that sleep was a hot commodity, it was a good time to let go of the caffeine addiction.  No real withdrawal, no extreme headaches, and no unrighteously sassy moments where I can't function "WITHOUT MY CUP OF COFFEE DAMNIT!" 

This is a big step for me, because coffee and I were buddies.  

Love it. 

Bestest pals.

Still lovin' it. 

Friends all day long.

But now, I have a new pal.  Someone who can still be part of the collection of stupid iPhotos that the editorial team snaps every few days. (These photos are known as the Friday Face-Off, where we take one photo to emulate, like this one (my version) or this one, and we all recreate it ourselves, then paste them together as a college.  My favorite so far was when we all tried to look like my chubby-cheeked niece.  But I've once again digressed.  Ignore me.) 

My new pal is decaf, and I have embraced the change.  The coffee shop downstairs makes a mean iced decaf coffee, and just a short walk away from my office is a fabulous graham cracker flavored coffee that comes in delicious decaf.  I am finally weaned off the caffeine, but I still get to enjoy the taste and the "coffee runs" that are part of the social routine in my office.

My new love.

It's nice to feel free.

It's also nice to not drink so much coffee that my fingertips actually jitter to the point where I can't type a sentence without mangling most of the words.

FutureBaby, I hope you appreciate this.  Because it was HAAARD.  But I know it was worth it.

August 21, 2009

Staying Accountable.

It's been three weeks since my Joslin appointment and in that time, the accountability train, and thankfully, it hasn't derailed.  Or smashed into me. 

Yet.

But also in that time, I traveled to Spain, had plenty of wonky lows while traveling, didn't have internet access, and battled the time-space continuum, in addition to working plenty of hours at dLife before the trip and upon my return.  Stress levels?  Not at their lowest.  Also, logging opportunities?  Minimal.

But DUDE.  I'm still doing it.  

Thanks to the power of the Kevin Spreadsheet and the fact that I sit on my rear end all day long, staring into the abyss of my work Mac, and also thanks to the jazzy little Ann Taylor flashdrive I picked up at BlogHer, I actually have logbooks that mean something.  And I've actually stayed up on them for the last three weeks. 

Note:  I hate logging.  I always have.  I may always hate it, but the undeniable fact is that logging makes me accountable, too.  Seeing those numbers and the patterns they form forces me to recognize tricky trends and gives me enough perspective to make tweaks.  But I do so despise it.  It's a pain in the arse

The toughest part has been logging day-of.  Before we went to Spain, I was at work and able to keep the spreadsheet open on my desktop and update it as needed, never really breaking from work to fill in the gaps, but just keeping up with things as they happened.  And at night, I'd plug in the flash drive late at night, fill it in, and then start again the following day.  It was a tedious system, but I kept up with it.

Spain, on the other hand, was much harder.  No computer on hand during the day, difficult to track and log food (nevermind counting the stupid carbs) while we were exploring Barcelona, and even though the clock said 6 pm, my body was screaming, "Midnight, woman!!!!!"  If it hadn't been for the Dexcom, I would have completely lost control.  But since that Bad Larry was keeping me between the lines - literally - it helped me stay reasonably even.

Upon our return, it was hard to get back into the swing, but knowing my next Joslin appointment is next Friday helped get my priorities straight.  Right now, I have three neat little spreadsheets on my Flash drive, with 100% of the blood sugar results and about 70% of the insulin doses and food logs intact.  Chris is helping with my food and calculating carbs for me so that there isn't so much SWAG bolusing.  This, my faithful readers, is flipping progress for this girl. 

My 7 day machine average is down to 125 mg/dl.  My 30 day is 130 mg/dl.  This is with fewer highs and fewer lows (aside from a few episodes while traveling), which makes me feel more confident that I'm truly holding steady and not just averaging out.  I feel sickly when my blood sugar is 180 mg/dl, which means I'm becoming more sensitive to highs and also not as used to them.  (A major plus.)  My A1C came back at 7.1% last time - a .5% drop from the time prior - and I'm certain that next week will show even more improvement. 

I'm not messing around.  I can't.  I'm on a mission.  :) 

Another Stupid Note:  I'm not posting these numbers to brag.  Or to elicit criticism.  For me, these numbers are - for the most part - an improvement and I am using both Joslin and SUM as my tools for accountability.  So when you see the graphs and you see my machine average, don't think I'm inviting your commentary on my actual results.  Your diabetes may vary, and mine sure as hell does, too.  Cool?  Cool.

So next week, I'll toddle off to Joslin with four spreadsheets crammed with information and hopefully a cool head.  Chris and I will talk to them about making changes, and I'll leave feeling more in control.  Even if the numbers don't improve as fast as my attitude towards them, I still need to move forward as efficiently as possible.

Good control is RIGHT on the horizon.  I can feel it.

August 03, 2009

A Diabetes To-Do List.

I stood there with my best friend as she rubbed her pregnant belly.  The whole waiting room was filled with these lovely women and their round beachball bellies of varying sizes.

And I felt oddly self-conscious with my lack of roundness.

Last Friday was my first official appointment at the Joslin pregnancy clinic.  It's located at Beth Israel in Boston and is a beautiful hospital, different from the Joslin Clinic across the street that feels like home at this point.  I'm not pregnant, and we aren't trying to become pregnant YET, but this appointment puts things into full swing to bring me to a safe level of pre-pregnancy health. 

Sigh.  This all sounds redundant, even to me.  I've talked the Big Talk before.  "Oooh, look at me!  I'm going to really wrangle in my numbers and have an A1C you can bounce a quarter off!"  And I'm all gung-ho for a week or two, armed with my little log book and my good intentions, but within a few days, Other Things start to creep in.  Like work.  And stress.  And getting to the gym.  And social stuff, like hanging out with my friends and going to RI on weekends.  Eventually my good intentions end up in the spin cycle, and my log book starts to gather dust.  My workload piles up.  And my stress levels skyrocket.

I'm so frustrated because I want to have a career.  And I want to have a baby.  (I'd also love some tight control of my diabetes, too.)  These things would be excellent, but it feels like tightly managing type 1 diabetes is a full time job unto itself.  Slacking off is easy, and frustrating, and not healthy for me or any baby I'd like to have.   

But I also realize this is one of my biggest hurdles when it comes to pregancy planning - the whole "sticking with the pre-program."  This becomes more and more obvious to me when I go back and re-read old blog posts where I'm so excited to get back into better control, only to be derailed by those Other Things.  So during the course of my appointments on Friday with the endocrinologist, the registered dietician, and the certified diabetes educator, I admitted my faults freely.

"I need help being held accountable."  

They didn't quite hear me at first.  "We can do some tweaking, and in a month or two, we can revisit your A1C and see if it's lower and then we can give you the green light for pregnancy."

I knew I needed more than that.  I had to be completely honest. 

"Guys, I really need to be held accountable.  I know this sounds crazy and I seem very compliant, but I have trouble following through.  I'm great out of the gate, but I lose steam after a few weeks and I'm at the point where it isn't good enough anymore.  I'm out of excuses.  And I'd really like to join the ranks of those pretty pregnant ladies out there.  Please help me?"

And they listened.  We spent the rest of the day working out a plan for me.  One that will actually make a difference.  One that will get me there.

I'll be in Boston every three weeks until I'm pregnant.  This is a huge commitment but I need to make diabetes a priority without fail.  I want this.  I want to succeed at this more than anything else.  I'll have my blood sugars logged for those three weeks and we (my husband and my diabetes team and I) will all review them together.  Chris is in charge of my meals, in that he'll be helping me plan my day, food-wise, and he'll be counting carbs and measuring things for me. I'll be eating relatively similar items every day so I can manage the trends and control them.  I'll continue to test all the live long day and wear the pump and the CGM, but I'll actually use these devices to their fullest potential, instead of just going through the motions. 

With these appointments spaced just a few weeks from one another, I hope I can stay tuned in to intense diabetes management for three week stints.  Being sent out for three or four months is too much for me.  Obviously, because I burn out well before my follow-up appointments.  I just plain can't pay rapt attention for that long.  But three weeks?  Can I do that?

I have to do that. 

I will do that. 

It's a long way down from here.

June 30, 2009

Penguin Truck.

We're planning for a pregnancy, so I've been working tirelessly to stalk my blood sugars.  I'm wearing the Dexcom, testing regularly, and really aggressively chasing highs and lows in pursuit of that nice "between the lines" look on my blood sugar graphs. 

So when I changed my infusion set last night and neglected to take the 1.0 u bolus in anticipation of the high (which seems to be the only way I can keep the highs at bay after a site change), I knew I was in trouble.  Sweaters on my teeth, and my tongue thick with dehydration, confirmed by the 254 mg/dl on my meter.  I cranked up a correction bolus and sent it cruising in, along with some frustration and a few choice curse words. 

A few hours later, I was on the steady but seemingly safe decline, with the Dexcom keeping tabs and my meter serving to confirm.  No worries.  I ate a snack (cottage cheese with some frozen raspberries) before bed and snuggled against the pillow (read: cat) at a blood sugar of 187 mg/dl.  Higher than normal, but I knew it would continue to come down.

Didn't anticpate the 3:30 am wake-up call of BEEEEEEEEEEP!, though. 

I have no idea what my blood sugar was.  The Dexcom showed me only as "low" and I woke up crying, for some reason.  Chris was next to me, fast asleep, but I didn't wake him up.  I don't know why.  A bottle of glucose tabs sat on the bedside table but I didn't reach for them.  I don't know why.  The shape of my body was outlined in sweat on the bedsheet and my hair was sticky, and for some reason combing my hair down before I went to get juice took priority over eating something to correct the low. 

I don't know why.

I don't remember a lot of this low, and that scares me.  I was dizzy.  I was stupid for not waking Chris up and asking for his help.  I remember hearing the Dexcom wailing from the bedroom as I stood at the fridge in the kitchen.  I drank the juice directly from the carton, drinking well past my eight sips and gulpinThese guys can just go right to hell.g until I couldn't catch my breath.  Yet, I remembered to wipe down the floor to clean up what I spilled.  I don't know why.

Hitting that stride, hugging close to the center lane of 100 mg/dl, is really what I'm aiming for.  I've been doing better lately, so every time I'm way off target, I feel the symptoms too late for lows and very intensely for highs.  I know this is a signal that I'm in tighter control, but once I'm stuck in the spin cycle of high-to-low-to-high and back again, it's hard to climb out.  And a lot of time my morning number sets the stage for the rest of my day.  Last night's low blood sugar left me at 199 mg/dl this morning, and I still haven't settled back into range.  I feel frustrated, knowing my A1C is being drawn at the end of July.  But last night's events kicked my ass too thoroughly for me to focus on anything other than muddling through the day.

It's that pesky penguin truck again.  I hope the tire tracks aren't too visible this morning.  

April 17, 2009

Guest Blog: Diabetics Have Healthy Babies All the Time

Baby advice for diabetics, brought to you by not-doctors. Thanks to Jessica Hickok for offering to guest post today (I'm still in Tucson with the fabulous Dr. Val).  Jessica wrote a post about something that is definitely on the forefront of my diabetes mind, namely diabetes and motherhood.   Jessica offers up her thoughts on her diabetes pregnancy and advice on managing all the emotions.

*  *  *  

Quoting a line from the movie “Steel Magnolias” for the title of this post seems only fitting when guest blogging about what it is like to have babies and type 1 diabetes. 

You see, I am type 1 and currently 31 years old.  When I was 22, my husband and I had been married 2 years and decided it was time to fulfill our dreams and have a baby.  And the biggest piece of advice I can give to everyone who has seen the movie “Steel Magnolias” … it is important to remember that life does not always imitate art.

We did the planning and really worked hard on keeping my blood sugars regulated.  We spoke to my doctor and with an HbA1c of 6.8% we were given the green light to have a baby. <insert cheesy, romantic interlude here>.

However, when I found out that I was pregnant with my first child, I was both elated and scared at the same time.  I knew it was coming, but I immediately thought to myself “what if something goes wrong?” 

When other PWDs ask me about my child-birth experiences, I feel compelled to share my story and the following advice of what you can expect or should consider: 

1.    Do not let diabetes steal your thunder.
Be happy for yourself, you’re having a baby!  Just because you have a chronic condition, does not mean that you cannot enjoy the pregnancy and anticipation of motherhood.  Nor can you let your dreams be ruled by fear or guilt of your disease.  So you have to work a little harder at staying in a healthy glucose range, big deal, you’re going to do that anyway.

2.    Be comfortable with your doctor.
Being diabetic automatically puts you in a high-risk category.  However that doesn’t mean that you should lose sight of your basic rights as a patient.  Find a doctor that is comfortable with your disease and one that is willing to work with your diabetes doctor or endocrinologist. 

3.    Expect that your baby might be big. 
High sugars can spill over into the placenta feeding the baby and causing a large birth weight.  Both of my boys were born approximately 3 weeks early and the first one weighed 9lbs 12oz and my second was 10lbs 14oz.  No, I am not looking for a prize, but I do point that out just to prove that all of my complaining during pregnancy was justified.

4.    You may have to have a c-section.
C-setions aren’t bad, they just sound scary.  Yes, it will take you time to recover, but just think with your tightly controlled blood sugars that you had during pregnancy, your recovery time should go relatively quick. I had both of my babies delivered c-section and I wouldn’t trade it for the world…I did tell you that they were big babies, right?!

5.    Expect that your sugar readings will roller coaster after having the baby. 
While my hormones were bouncing around back into place the few weeks after having the baby, it caused my sugar readings bounce along with it.

6.    Diabetics have healthy babies all the time. 
Today, my first child is 8 years old and my second is 5 years old.  They are bright, healthy and so-far diabetes free. (knock on wood).  And the good news is that my story didn’t turn out at all like the one in Steel Magnolias.

I was lucky to have my insulin pump while I was pregnant.  And because there have been so many advances in diabetes technology (enter CGM!), I know that it has only become better and easier for PWDs to have children. 
 
The moment I held that precious newborn, my fears were all washed away.  For those amazing first moments of holding my new baby, I was not diabetic … I was a mother.

Disclosure from Jessica: Please keep in mind that this post is written purely based on my opinion and my personal experiences with pregnancy and childbirth.  I am not by any means a medical doctor.  Nor do I share my story as medical advice. Please talk to your doctor about your plans to have children.

Editor's note:  Thank you for posting today, Jessica!  There are guest blogger spots I'm looking to fill, so if you'd like to guest blog on SUM, email me!

April 15, 2009

Deflated.

Yesterday didn't go as well as I had hoped.

The nurse came in first and took my blood pressure (fine), weight (slightly higher than last time but I can deal), and my A1C.

(Yes - Joslin is finally giving their adult patients A1C results day-of!  I was abnormally excited.  "You mean I'll know in 15 minutes?  Really?"  The nurse looked at me like I was new to the planet.  But for a minute, I was ecstatic.  I hate waiting.)

While the results were being spun, my endocrinologist came into the office and she and I spent almost two hours together going over numbers, plans for improvement, and the specifics of pre-pregnancy appointments.  While we were talking, the A1C result came through.

"Okay, so you're just where you were four months ago."  

And I felt like crying.  It's overly-dramatic and pretty sad to feel so affected by this number, but it has always been the standard I judged everything against.  It was the number that defined my health. It was the only number in my diabetes world that mattered, and a result that was too high tarnished my spirit.

It spoke to my success, or failure, as a person.  

Or at least that's how it's always felt to me.  

So I felt very teary and felt totally deflated.  And my endo kept talking, moving on past this number and instead trying to isolate patterns in my blood sugars that could be contributing to this result.  We went over my January lab results, and she was very happy with my cholesterol and my heart health.

"You're exercising how often?  Five days a week?  That's great.  I wish more of my patients were into their cardio that way.  Your resting pulse is very low.  That's good."

I couldn't stop thinking about the A1C.  Even though we're not actively trying for a baby, I wanted to get the green light, at least diabetes-wise.  I want to be a mom, and I don't want diabetes being anything that makes me decide to wait.

"Yeah, but the A1C.  I mean, that's the same as last time.  I felt so sure that I was doing better."

She looked at me.  "7.5% is not where we want you. Under 7, if we can, and even closer to 6, if possible.  But it's time, isn't it?  You feel ready?"

I nodded.  A little afraid to speak because this is something I've always wanted.  To be a mom.

"Okay, so it's time to schedule the pregnancy clinic.  Let's get this in motion and we can make everything fall into place.  And I want you to meet with Doctor Boston because she's the leading high-risk maternal fetal medicine ob/gyn out there, and she'll be able to handle your type 1 diabetes, Factor V, and hypertension.  You have more than two decades of diabetes under your belt, so I know you're feeling vulnerable.  We'll schedule this for June?  Does that sound okay to you?  Between now and June, you and I will work together to make this A1C happen."

"So the three of us will be together on this appointment?  And she'll see me through my pregnancy?"

"She'll actually be delivering your baby.  She's the best.  You'll be in very good hands, Kerri."

I had this moment where I clearly pictured this moment of delivery, when I will go from Kerri to "mom" and Chris becomes "dad" and in that instant, diabetes won't count.  It will be about me, and my husband, and my baby.  I felt hopeful that maybe, with enough help, I could really do this. 

"June.  And if I'm good in June, we can actually decide if Chris and I are ready to get pregnant?"

"Some mommies, I worry about.  I worry that they won't be willing to give it the best try they have in them.  But you, I don't worry about.  We can get you there.  You aren't going to do this alone."

"Okay.  I can do better.  I really need to do better.  I'm ready." 

She printed my prescriptions.  They took photos of my retinas to send to the pregnancy clinic.  I paid my co-pay.  I asked Chris to wait for a minute while I ducked into the bathroom.

I closed the door behind me and cried.  I'm so afraid that I can't do this.  I'm so afraid to do this wrong.  I'm almost afraid to try.  I'm afraid to hope.  But I'm so sure that I can overcome these obstacles, just like other women with diabetes have done before me, and become a mom. 

Cried so hard I thought my heart would break because I think this can really happen. 

Hopeful.  Damn it.
 

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