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Day in the Life of a New (Old) Mom … with Diabetes.

Six years ago, I was adjusting to motherhood for the first time during Diabetes Blog Week, and one of the post prompts was to write about a day in the life with diabetes.  My day in the life was flanked on all sides by figuring out what to do with a newborn, so I chronicled that.

And just before my son was born, I thought maybe – maybe? – I’d be less of a mess this time around?  Maybe I’d have things a bit more figured out, and a day in the life post wouldn’t read like a desperate plea for help?

Once again, ha.

A Day in the Life of a New (Old) Mom … with Diabetes.

6.30 am – Hi, little baby!  Let’s do this feeding/changing diaper thing … again, because it’s not like 6.30 is the first time our tiny tomato goes off.  On the overnight, the baby wakes up around 2.30 and then again around 6, so we’re hardly breaking a fast when breakfast time rolls around.  The main diabetes thing I do at this point is check my CGM graph, because the baby is usually fussing for food, so even the 45 seconds it takes to check my BG is not happening.  (What – did you want me to lie and say I am totally on top of my diabetes stuff?  Nope.)

7.30 am – It takes me about 30 minutes to change and feed the baby, and then I go into the bathroom to clean teeth, find face, etc.  It’s at this point that I should be pricking my finger to check my fasting BG, but my alarm usually goes off (set for 7.30 am, just in case, even though it is redundant when pitted against the baby) and then I have to run back into the bedroom and turn the alarm off so that it doesn’t disturb the sleeping babe.  At this point, I forget what I was doing and am only positive I brushed my teeth based on the delightfully minty taste in my mouth.

7.33 am – Check my CGM graph again.  Showing 60 mg/dL.  I’ll check my BG officially when I go downstairs to make breakfast, but for now I need to get ahead of that low and have something to eat before the breastfeeding aftermath hypo moment kicks in.  Hi, banana.  I’ll eat you.

7.35 am – Time to wake up the Birdzone and get her sorted for school.

7.40 am – “What do I need to do again?”  “Brush your teeth, go to the bathroom, and put your clothes on for school.”  We have the same conversation every.  single.  morning.  Hasn’t changed in two years.  Yet she still wonders what the morning routine involves.  (Note:  now the morning routine involves my head popping off and the subsequent reassembly of aforementioned head.)

7.41 am – Dexcom alarm is still going off, but I drank the half-kicked juicebox that has been on my bedside table for the last three days.  Relieved it hadn’t turned to wine after sitting out that long.  Or maybe I wish it had turned to wine.  #jesusjuicebox

7.45 am – 8.20 am – This is a messy pocket of time during which Chris and I orbit around one another in the kitchen, making breakfast, making school lunch, assembling work bags, finding shoes, checking on baby (who is usually asleep in the bouncy chair in the kitchen, blissfully unaware of the circus), etc.  Usually, I check my blood sugar during this time, and most often calibrate my CGM.  At 8.20-ish, Chris and Birdy head to the bus stop and I think about combing my hair.  (I do not actually comb it, though.)

NOTE:  I forced myself to ditch the extra-strength Tylenol prescribed to manage post c-section pain because it rendered my Dexcom useless.  The data from my CGM is beyond instrumental in helping me keep my wits intact in this postpartum period.  Blood sugars are very unpredictable as I adjust from pregnancy insulin rates to postpartum rates, in addition to the chaotic ebb and flow caused by breastfeeding.  I could manage without the CGM, but it’s much, much easier to feel safe and like I have some semblance of a clue when the graph data is streaming.  Dexcom gives me the 30 lives I need on some days, Contra-style.

[And I do have a relationship with Dexcom – disclosures here.]

8.30 am – noon – My intentions are good in this block of time.  I usually boot up my computer and open my email, letting the messages come flooding in.  I read every single email, and in my head, I compose useful responses … that never end up being typed and sent, because this block of time also includes a baby who needs to be fed twice.  I use the breast pump once (to build a supply stash for when I start traveling for work again).  I try and check my blood sugar once or twice more.  I spend at least half an hour coordinating the next round of pediatrician appointments, surgery follow-ups, and attempts at assembling a medical team here in Rhode Island (moving my care away from Boston now that I’m done pursuing pregnancies … more on that another day).  Oh, and there are baby snuggles.  MANY.  Because I did not work this hard for a baby to not snuggle the hell out of him.

So basically, I get a lot of important things done in this timeframe as it relates to keeping my son happy and cared for, but I’m spinning my wheels in a lot of other departments.  That’s okay – it’s Baby Time for the next few weeks/months, and I’m happy about that.

Noon-thirty – Tomato Man and I go for a walk around the neighborhood (using the stroller on days when I’m trending lower blood sugars, and on days when my BG is more stable, I wear him and walk that way).  This walk is necessary because it gets me out of the house and ups my mental health and happiness.

1.30 pm – Hey, lunch would be awesome, right?  I’m still trying to cook more at home/make some vegetable-based options, so my culinary creativity is at a high (despite cooking talent remaining woefully low).  I am not ravenously hungry most of the time, but I do want to snack/eat a small meal every two and a half hours or so (modeling my behavior after that of my son’s).  I’m kind of into protein balls (uncomfortable phrase) these days, and one version I like a lot is a peanut butter/pumpkin seed iteration that’s easy enough on my blood sugars but packs a caloric punch that keeps me from falling asleep.  (Will post the recipe tomorrow!)

2.00 pm – Baby snuggles.  And let’s feed him.  Oh, and snuggle him again. And restock the ever-waning supply of diapers and wipes.

3.15 pm – Use the breast pump.  (Our boy lost a fair amount of weight after delivery, so our pediatrician has been following his weight gain with interest.  We’re back up to birth weight, but our doctor has encouraged us to supplement breastfeedings with bottles of pumped breastmilk in order to ensure the little guy is getting enough.  So when he’s not attached to me, physically, the breast pump is.  Thankfully, he bounces easily from breast to bottle, so we’re thankful he’ll eat in a variety of ways.  Also, if you have dissenting opinions on how babies should be fed, can we just agree that babies should be fed, and leave it at that?)

4-something ish – Birdy’s school bus comes roaring through the neighborhood, and she comes scrambling off it, regaling me with stories about first grade and how much she missed her brother.  “I missed you, Birdy!”  “Yeah, but I missed HIM!”

4.30 – 6.30 pm – Another mangled window of time during which the baby is fed, changed, and snuggled.  Chris usually arrives home in this pocket.  Birdy (and a cast of characters from our neighborhood) rotate from house to house on their bikes, the embodiment of every gang of kids on bikes from 80’s movies.  I remember that I haven’t checked my blood sugar in a few hours, so I do that.  Dinner is assembled.  Dishes are ignored.  Loopy builds a biplane.

7.30 pm – Birdy gets a bath or a shower, and while she’s in there, I charge my CGM receiver or my pump (depending on which one is more depleted).  I’ve been trying to stick with changing my pump site every three days (the reminder for the site change on the t:slim is very useful these days, as I forget my name, nevermind when I last put an infusion set in).  Changing the site is hard sometimes because I hate wasting insulin, and sometimes my reservoir (even half filled) will last four days without any trouble.  I like using every last drop.

8.15 pm – Birdy is tucked into bed.  (When she actually falls asleep remains the mystery.)  Chris and I start to get punchy, realizing we haven’t properly slept through the night in weeks, and we know another long night is on tap.  And then the baby wakes up because hey, it’s getting dark out, and that means it’s time to wake up!

9.30 pm – I look at my email, cry, and shut my computer.  I eat a yogurt and wonder if it’s okay to eat these chickpea things straight from the bag with a spoon.

9.31 pm – I grab a spoon.

10 pm – Medical onslaught time.  As I’m getting ready to close up for the night, I need to take my blood thinner injection (thank you, Factor V Leiden and c-section combination – three more weeks of shooting up and then I’m DONE), my blood pressure medication (back on that as of last week), check my blood sugar, make sure my pump has enough insulin to last through the night, make sure my CGM receiver is charged, and that my bedside table is stocked with a glass of water (breastfeeding makes me dehydrated as eff) and something to treat low blood sugars with.  Baby is fed and changed, and tucked into his proper bed (in our bedroom).

And as I’m about to fall asleep, I realize we made it through another day, and we’re adjusting the best way we know how.  The exhaustion will give way to more sleep, and eventually we’ll be a few months out from life with a newborn and more in the swing of things.  (I know I will miss the warm, snuggly newborn cuddles a ton.)

We don’t have everything figured out, because our son is completely different from our daughter, so what we knew to expect is braided with a hefty dose of “what the hell do we do with that?!” sort of sentiment.  I have realized that all the preparing we did for our second child doesn’t actually prepare us … we’re still hot messes of exhaustion and confusion and hope.

And I also realize that it looks like I’m into some kinky stuff, considering the bag of marshmallows on the bedside table.  Whatever.  When you’re hypo, anything goes.

Releasing the Kraken … Into Our Home.

… he’s definitely not the Kraken.  That nickname will never stick because so far, our littlest friend is mild mannered.  He’s more Clark Kent than Kraken.  (Mixing my superheroes and myths this morning; feel free to blame the sleep debt and my attempt to repay it with caffeine.)

But he’s home, and even though he’s a sweet boy, he’s still an infant and our house is ROCKED by his presence.  My body remains equally as rocked by his escape, and my diabetes management is so confused that my pancreas, were it to have a head, would be scratching it with confusion.

OUR HOUSE:  Remains in the middle of our street, only it’s bursting at the seams with burp cloths and tiny little articles of clothing that require origami skills in order to snap up.  The laundry this little man produces is astounding, as are the number of diapers he rips through … and the number of times he’d like to eat during the course of a day.  For someone so small, the baby came with a lot of stuff.

(But I’m so glad he’s here.  I’ve never been so happy to have my house turned inside out in my life.)

MY BODY:  Is slightly less than a wonderland.  I talked about the c-section and cannot stress enough how different it was from my first surgical birth experience.  When I examined myself after having Birdy, I had a sizable scar and serious gas pain, but didn’t feel as though I’d been put through the wringer.  Ringer?  (W)ringer.  This c-section was very different because it felt busy during (lots of pressure and they actually needed to use the vacuum to assist in removing my son from the womb, poor kid) and the aftermath was not pretty.  I had a lot of bleeding after this one, more than the first time.  I also didn’t get a good look at my scar, etc. while I was in the hospital (they are smart to keep full length mirrors OUT of the postpartum recovery rooms) so I saw the mess for the first time when we came home.

Holy shit, the bruising.  The three or four inches of skin real estate underneath my incision was entirely black and blue and it looked as though I was wearing blue underpants.  I (am embarrassed to say) that I cried when I saw it because it looked so frigging VIOLENT.  Thankfully, 15 days later, the bruising is entirely gone and all that remains is the incredible shrinking uterus and the healing incision, but for the first week or so, I had a hard time checking the incision because it looked so Frankenstein’s monsterish.

And aside from the obvious diabetes stuff, I’m currently taking a blood thinner (thank you, Factor V Leiden) for six weeks, and am also unable to drive for six weeks.  The blood thinner is a little painful but totally manageable (one injection every night – easy enough).  The not driving thing is MAKING ME GO BANANAS because my freedom is entirely MIA.  I’m relying on friends and family for trips to the pediatrician, picking up prescriptions, getting groceries … every little thing requires assistance from a volunteer chauffeur.  And since I don’t want to trouble anyone more than I already have to, I’m placing some screwball orders on Amazon … like for the dry erase board eraser required on my daughter’s back-to-school list.  Or the long sleeve, size 0-3 month onesies for my son.  Or coffee, damn it.  I’m really excited to be able to get back behind the wheel and reclaim some semblance of independence.

DIABETES HEY OOOOH:  I cannot complain about how diabetes did its thing during the 38 weeks of pregnancy.  I didn’t have any tragic lows, there weren’t unmanageable highs, and the lack of pre-eclampsia was an excellent change of pace for this round.  During delivery, even though I was terrified, my blood sugars stayed solid.  And throughout my stay at the hospital, my blood sugars were without issue.  It was kind of awesome, and surely will stay that way forever, right?

HA HA HA HA HAAAAAAAAAA … now that my placenta has been kicked out of my womb and I’m breastfeeding a newborn, all kinds of diabetes hell has broken loose.  My blood sugars – once calm and dare I say predictable? – are now pinging and ponging all over the damn place.  My insulin:carb ratios are 1:20 (versus pre-pregnancy 1:11 and during pregnancy rates as low as 1:5) and my basal rate is 0.3u per hour (versus pre-pregnancy of .5u and during pregnancy rates as high as 1u per hour).  And absent the breastfeeding, these rates would probably hold tight for a few weeks until they started to require increasing, eventually bringing me back up to where I was pre-pregnancy … at least ish.

But breastfeeding is its own circus.  The act of breastfeeding does not make me hypoglycemic, but the act of producing milk does, so I’m going low mostly while my milk supply is filling up.  If this was a predictable cycle, I could plan snacks/meals around my son’s appetite and my anticipated refilling, but the cycle isn’t one I can map.  I can’t even guess.  Some times, I go low 15 minutes after feeding him.  Other times it takes up to an hour and a half for the low to hit.  I’m not sure when I should eat, causing my CGM graph to look all Ms and Ws.  If my experience with Birdy helps inform this round, I should have a more predictable blood sugar response around the time that my son is a month old.  Which means that I have two more week of letting my body ebb and flow and get all confused before it aligns to some kind of schedule.

The madness of a newborn added to the mix of an already all-over-the-place family is exactly what we had anticipated.  We’re exhausted.  (While driving home from a pediatrician appointment, Chris turned to me at a stop light and asked, “This is really happening, right?  Like this isn’t a dream?  We’re actually driving right now?”  The lack of sleep is like we’re on the tumble dry setting in the dryer, all jumbled and confusing and warm and is this real life?)  We’re adjusting.  (Birdy is doing her best to make sense of the new little creature in our house.  She loves him.  But I’m on the watch for sibling angst as well.)  We’re grateful.  (Issues like a messy house? Exhaustion? Sore body?  Bring those issues on, because I’m happy as hell to have these as my problems.)  And we’re in love with this little guy, who despite being only 15 days old, feels like he’s been part of the party forever.

 

Four Chairs.

Our kitchen table has four chairs, and for several years, we had our family of three at the table for four.  But three chairs filled felt right at the time.

Except when it didn’t.  A few years ago, that fourth chair became this thing for me, like it should have A Person for it.  There was a feeling that someone was missing nagged me through many breakfasts, lunches, and dinners.  Someone was supposed to be there.  I had no idea who, but I knew someone was missing from our lives.

The empty chair started to hurt to look at, especially during the years of negotiating infertility.

But last week … on August 23, after two years of trying for a baby, after 38 weeks and two days of pregnancy, after staring at that fourth chair for all of those days and wondering if anyone would ever claim it, we finally found Our Person to fill the seat.

(His bum is very tiny at the moment, but he’ll grow into the chair eventually.)

Welcome to the world, my sweetest little boy.  We love you in ways and for reasons too numerous to count.

Spring-Loaded Navel Gazing.

(Edit: I had originally written “naval gazing” instead of “navel gazing.” Thus illustrating the point of this post, which is that my mind is quickly becoming mush. Thanks, Bobby, for the edit. 🙂 )

It’s week 35 of this fetus party.  All I have left to give are bullet points.

  • My stomach moves.  Often.  To be more precise, it’s my baby who is moving, and making my stomach look possessed in the process.  It’s jarring to look down and watch the swirling storm of baby boy moving around happily in there.
  • It was also slightly jarring to be onstage for a panel last week in NYC and to have the baby going berserk while I was trying to talk.  I hope attendees thought I was trying to emphatically state my case instead of trying to dislodge the baby from my ribcage.
  • (I may have been doing both.)
  • At this point with my daughter, I was already in the hospital on pre-eclampcia instigated bed rest, so it’s weird to be home.
  • Don’t get me wrong:  I AM HAPPY TO BE HOME.  Bed rest sucked and I have no desire to repeat that experience.  But the last time I was 35 weeks pregnant, I was trapped in hospital; this time, I’m home and trying to be a productive member of our household.  I have no concept of what I should/shouldn’t feel up to doing.
  • Problem is, I have a bit of a nesting problem.
  • If you click on that link, notice the picture of the lady who is showered and wearing make up and has combed her hair and is happily – serenely! – dusting the front of her cabinet. That’s not the kind of nesting I am feeling.  No serenity here.  I want to rip all the weeds out of the front garden with my bare hands, name them all, and then jam them into the compost bin.  I want to paint the upstairs hallway.  I want to crochet a tea cozy big enough to put over my car to protect it from bird shit.  The urge to reorganize the books in my office by color and then by author’s favorite ice cream flavor is taking over my brain.
  • And yet I can’t sit still long enough to answer more than five emails at a time.  There’s a disconnect between “productive use of my time” and “full-out hormonal spazzery.”
  • Being home instead of the hospital is great, but is bringing about a new set of worries that I didn’t experience with my first pregnancy.
  • Like “what happens when your water breaks?”  My water never broke the first time. My daughter arrived via scheduled c-section after a few weeks of close monitoring, so I never even had a contraction.  The first contraction I ever experienced was when I miscarried last summer, making me feel even more uneasy about contractions.  Mentally, I’m unprepared for labor.
  • Physically, I’m as prepared as I can be.  I am delivering at a hospital that is about two hours from my home, so the journey there can’t be delayed.  I have a suitcase packed.  So does my daughter (so she can spend a night or two with my mother while we help her brother escape).  But the idea of that drive on top of potential labor stuff makes me twitchy.
  • (Of course we have a more local, true emergency, plan, but I want to deliver where my established care team is, so that’s our goal.)
  • I am also in bi-weekly appointment mode with my high risk maternal fetal medicine team, which means I am in Boston twice a week to check on the baby and for any potential issues.  I have been told to bring a suitcase to those appointments, too, as they may decide it’s go-time based on a single appointment, and I won’t have another four hours to go back and forth again.
  • Which means I’ve been living out of a suitcase for the past week, and will continue to pack-and-repack the same suitcase until the baby is born.
  • Thankfully, I only have about three outfits that fit somewhat properly, so it’s an easy cycle of packing and unpacking.
  • And I still have diabetes.  Yep, still there.  Still chronic.  Still want to shove it into a tin can and send it down a garbage chute.
  • My total daily dose of insulin is up significantly from pre-pregnancy numbers, but not quite in the triple-zone that I hit before giving birth to my daughter.  With Birdy, I was taking just about 100 units of insulin per day to achieve solid numbers.  This round, I’m taking about 65 units per day so far, though numbers still might climb as these last few weeks progress.
  • My insulin:carb ratios are getting crazy, though.  I was at 1:12 before pregnancy, and am already down to 1:6 so far.  That ratio change is increasing my TDD the most, as my basal rates aren’t too ramped up.
  • A1C remains exactly where I want it.  As does my blood pressure.  My weight is … weighty, but my son is in a very good percentile, so that’s my main concern.  I’ll gain a few extra here and there so long as he is fine.
  • And I remain afraid to put my infusion set into the taut, bulbous chaos that my stomach has become, so my insulin pump has been rotating around my hips and arms for the last few months.  Thankfully, as I get bigger, real estate options expand as well, but it gets harder to install new sites when I can’t exactly bend at the waist.
  • HA!!  Waist.  I don’t have one of those anymore.  It was left behind back in May sometime.  See ya.
  • Siah thinks the baby’s room is HER new room, which is bullshit.  Even when we have the door shut, she picks the lock and eases herself in there, sleeping on the toy box in the corner and burping occasionally.
  • These cats have no idea what they’re in for.  Again.
  • Truly in the home stretch now.  “Stretch” being the operative word, as I have real concerns about the stability of my belly button.  I fear that if I cough or roll the wrong way, it will launch from my body and hit the wall, like a champagne bottle cork.
  • Bring it on, kiddo.  I’m ready to meet you soon.  And to be reunited with a view of my feet.

 

Diabetic Pregnancy: Third Trimester.

Ten weeks left until the little man arrives, which means I’m in the third trimester and ready to fast forward through the summer.  FAST.  FORWAAAAAAAAARD!!

Swelling.  So far, so good.  I don’t have any swelling to speak of, which is a far cry from my first pregnancy, when I was in StayPuft mode starting around 28 weeks and stayed there until I delivered.  But thankfully, I’m a little more comfortable this round.  I can still wear my wedding rings, all my shoes, and my feet look like feet (instead of inflatable kayaks).

And I’m grateful to be back home from Utah, which was the scene of the swelling crime six years ago.  Something about being that far above sea level seemingly kicked off my incoming preeclampsia last time, and I’m glad Utah this year didn’t bring about any repeat performances.  (Also, I’ve only been to SLC twice, and both times I was seven months pregnant.  Weird theme.)

Blood sugars.  I still have them.  And they haven’t been entirely pleasant lately.  Some high numbers are returning in the evenings, which caused me to kick up my insulin : carb ratio for dinner as of this morning and I’m also side-eying my basal rate a little bit.  Still attempting to pre-bolus for as many meals as I can manage, which is working out pretty well.  I am aiming to keep my A1C in the same range it has been for as long as I can.

Some lows are back, only without symptoms at all, and those suck.  The other night, my CGM was screaming LOW for about an hour and I woke up the next morning with glucose tab dust all over the bedside table, a text message conversation on my phone that I have no recollection of having, and a low hangover that kicked my ass for hours.  Also, there was a missing burrito, which I can neither confirm nor deny responsibility for.

(Have I mentioned the Comfort Burritos that have lived in my freezer for the last five months?  Cravings were weird and intense during the first trimester, and there was a specific day when I NEEDED to have a burrito but didn’t want to eat so many carbs in one sitting, so I bought a frozen one and threw it in the fridge next to Animal.  It’s been in there since, comforting my cravings without having to be consumed.  I will plant it in the backyard after my son is born.  Perhaps a burrito tree will sprout?)

Baby kicks.  My daughter is strong and quick now, but I do not remember her being such an athlete in the womb.  However, her little brother is a storm of flying feet and hands at all times.

“Are you pregnant?” asked the lady next to me on my flight over the weekend.

“Yes, I am,” I confirmed, grateful for people who don’t assume/don’t say “WHOA! ARE YOU DUE TODAY?!”

“I thought so.   Your baby has been moving like crazy since we took off.  You have an active little one in there!”

Awesome.  You can see my son moving around through my shirt now.  And he clearly digs long flights.

Doctor’s appointments.  We’re turning up the dial on doctor’s appointments for this last trimester, moving to weekly appointments next week and then twice-weekly appointments until delivery.  My team at Beth Israel and Joslin are in sync and tracking me closely, in addition to keeping tabs on any eye disease progression (holding steady), kidney issues (none to speak of), and blood pressure spikes (still not back on BP medication yet, so feeling good about that).

I’m grateful to have so many medical professionals at the ready and tracking my baby’s progress.  (But I can’t lie; I’m looking forward to never seeing any of them again, post-delivery.  I’m emotionally done making that frigging drive to Boston.)

August.  We’re still working towards a late August escape date, with my body cooperating so far.  If the weather holds in this lovely 72 degrees and no humidity pattern for a few more weeks, I’ll be the happiest third trimester lady of all time.

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