Pregnancy & Motherhood

Pregnancy & Motherhood

A Couple of Updates

Pregnancy and Diabetes Blog

November 30, 2011

I think I’ve reached the point in pregnancy where I am going to have to make frequent adjustments to my basal rate. My blood sugars haven’t been horrible, but they have definitely been higher throughout the day so I inched up my basal rate settings again this week. Trends are hard to follow, but in general I know my numbers are higher so I’m just going to continue to make small adjustments as necessary.

2.  I saw my OB yesterday and had another ultrasound to see how Baby Girl Williams (affectionately referred to as B-Dub in our house) is growing.  The good news is that she is right on track as far as growth and development.  Based on ultrasound she is measuring in the 32nd percentile for size so she is on the small side of normal.  Also she is very active, and I feel her moving around throughout the day.

3.  The fatigue of the first trimester seems to be rearing its ugly head. My job requires a good deal of physical activity and some days are just longer than others.  On the days that I am on my feet all day long I have zero energy when I get home.  Hopefully I can make some adjustments to my work schedule over the next few weeks so that I’m not so tired at the end of the day.

4.  The third trimester has arrived and along with it I also have been experiencing heartburn.  It’s really odd because the heartburn is only the evenings starting around 5:00 pm and going through the rest of the night. Surprisingly I feel better when I lay down to go to sleep so at this point it’s not affecting my sleep (thank goodness because I am trying to get as much uninterrupted sleep as possible before B- Dub arrives).

5.  Technically I’m 7 months pregnant (i.e. 28 weeks) but I came to the realization the other day that pregnancy actually lasts 40 weeks (which by my calculation actually equals about 10 months).  Needless to say I’m starting to feel a little “big” and slightly uncomfortable so the idea of this pregnancy lasting 3 more months is a bit discouraging.

All in all I think I’ve been very fortunate and I have had a fairly easy pregnancy.  I am grateful that I have made it this far without too many issues with my diabetes.  I am also thankful that all of my pregnancy “symptoms” have been pretty mild.  I’m starting to get excited about B-Dub’s arrival because it’s just around the corner.  I can’t wait to see what she looks like and welcome her to our family.

 

 

Times are a Changing

Pregnancy and Diabetes Blog

November 23, 2010

Well it seems times are a changing on the diabetes front.  I have successfully made it up until this point in the pregnancy with very small tweaks to my insulin dosage (both basal rate and bolus rate). In fact the only change I’ve made so far is to decrease my total insulin dosage.  But it seems that my blood sugars have been inching up throughout the day ever since we got back from vacation.

Initially I blamed the higher blood sugars on vacation and all things related – no regular schedule, different foods and meals with unfamiliar carb counts and my daily dose of banana pancakes.  Then I lived in denial for a about a week or so thinking that I must be eating differently or that somehow I had just forgotten how to count carbs in all my regular foods.  I also went through the mental checklist of: bad site/poor absorption, air bubbles in the tubing, not enough exercise or not enough sleep.

Then it occurred to me that maybe, just maybe I was still doing everything “right” and the blood sugar issue is one caused by my pathetic pancreas.   Last week I decided to make some small tweaks to my basal rate starting around noon and going throughout the remainder of the day.  This seems to have helped, but in general I have seen some higher numbers than I’ve seen during the entire pregnancy.

I’m trying not to get too nutty about it because I was fully aware that my insulin needs would start to go up as the pregnancy progressed.  I must admit that for some odd reason I equate “taking less insulin” with better management of my diabetes. I know this is an absurd thought, but every time my insulin needs change I freak out a little and have fleeting thoughts that my diabetes is getting “worse.”  Note that I also have the reverse line of thinking when my insulin needs go down and have thoughts that my diabetes management must be “better.”

I know this line of thinking is irrational because there are no hard and fast rules to managing diabetes. In fact I think the only real constant in the whole scenario is change so I’m working hard to just accept the increased insulin and adjustments as a proactive step in taking good care of myself and the baby.

On a side note I just want to say Happy Thanksgiving to everyone. I know this holiday can often be difficult for those of us that live with diabetes and have to be so focused on managing blood sugars.  I encourage you to view Thanksgiving as just one day (in fact just one meal) and if you eat a little too much or you are surrounded by delicious desserts that wreak havoc on your diabetes management then you can get back on track on Friday. Let’s all work hard not to be too hard on ourselves and truly enjoy the day for what it is – a day of thanks and time with family and friends.  I wish you all the best this holiday season.

 

 

 

Looking Back

Pregnancy and Diabetes Blog

November 16, 2010

Sunday was World Diabetes Day, and as irony would have it November 14, 2010 also marks exactly 5 years since I was diagnosed with diabetes.  I will never, ever forget the day I was diagnosed and the fear, sadness and loneliness that followed over the next few days and weeks.  At the time I had no idea how to integrate diabetes management into my daily life so it seemed like my whole world kind of shifted on its axis.

I remembering thinking that my life was over and that nothing would ever be the same again.  Well I was right about nothing ever being the same again, but my life was far from over. In fact the way I see it the past 5 years have been some of the happiest times of my entire life.  Don’t  get me wrong because everything related to diabetes pretty much stinks, but I do truly believe life is what you make of it and there is no need to worry and/or complain about things beyond your control.

When I was first diagnosed I had no idea if I would be able to have children or not. Now I’m 26 weeks pregnant and expecting a little girl in February 2011.  I also worried that I would never be able to eat desserts again, and I’m happy to report that I’ve managed to still eat sweet treats from time to time without any dire effects on my blood sugar. I was afraid that I would have a tragically low blood sugar (think Julia Roberts in Steel Magnolias), and today I’m grateful that I’ve only had a few scary low blood sugars that I have luckily been able to treat on my own.  I wondered if people would treat me differently since I had a chronic health condition, and I think it’s safe to say that my friends and family have been behind me every step of the way and don’t act any differently towards me.  Basically I feel like diabetes is just a small part of who I am and hasn’t prevented me from living a happy, healthy and full life.

If you are newly diagnosed with diabetes I encourage you to find ways to integrate diabetes management into your lifestyle and not let diabetes define you or prevent you from being the person you were meant to be.  It takes time, but eventually managing diabetes becomes the new normal and it’s almost like brushing your teeth – it’s just something you do.  I also encourage you to find a source of support whether it’s through the online diabetes community, DiabetesSisters or another group of women living with diabetes so you don’t feel so alone in the day to day management of diabetes.

I have learned a lot about myself in the last five years, and I’m looking forward to what the future holds as I move into this new phase of my life as a “mommy.”  I know there will be good days and there will be bad days when it comes to managing diabetes, but I’m excited for the ride.

 

 

 

A Baby Moon

Pregnancy and Diabetes Blog

November 8, 2010

My husband I just returned from a short vacation to Jamaica to spend some time together before the baby arrives.  We had a fantastic time and it was nice to take a break from our day to day lives. I love to visit new places, but sometimes travelling makes diabetes management a little more complicated.

My husband gives me a hard time about how much I pack, but I always blame it on my diabetes supplies.  I do tend to over pack, but it is true that I must dedicate a portion of my bag to my diabetes supplies.  I keep a travel bag packed, and I usually include twice the number of infusion sets and cartridges that I might actually need.  I learned the hard way that high heat and humidity causes my infusion sets to peel off therefore I need a few extra.  I also pack extra batteries, several vials of insulin, a back up Novolog pen, a Lantus pen, syringes (just in case the pump malfunctions) and a bag full of snacks to last through the entire trip.

Another “issue” with travelling is the irregular meal times and food choices available. Sometimes it’s hard to know how many carbs are in particular ethnic foods and to gauge how the serving size.  Mostly carb counting is a guessing game at best and I just try to do the best that I can.

Over the years I’ve learned a few tricks of the trade when it comes to hanging out in my bathing suit all day.  I prefer not to have my pump attached when I’m lounging on the beach so I usually bolus myself the equivalent of my basal rate about once every hour.  It’s certainly not scientific, but it usually works for me and it allows me to be pump free for a few hours.

Also I’ve been on several international trips since I’ve been diagnosed with diabetes, and I’m always curious as to how diabetes is managed around in different areas around the world.  On this trip I got to talk to one of the locals about how diabetes is one of the leading causes of death in the Caribbean.  We talked about how many people lack the education about how to manage their diabetes and also how access to insulin and other medications is often difficult to obtain.

After talking with this local for a while about many of the social issues in Jamaica including access to healthcare I felt a tremendous sense of grief for people in developing nations that have to manage a chronic disease.  It just reminds me that no matter how challenging things get for me and how frustrated I get with diabetes that in the grand scheme of things I am actually pretty fortunate.  I’m lucky to be an informed patient that takes an active role in managing my diabetes. I’m lucky to have reasonable health insurance that makes my diabetes supplies accessible and affordable. I’m fortunate to have access to healthy food options that make diabetes management a little easier.  I’m lucky to have an insulin pump and extra supplies in the case of an emergency. But most of all I’m lucky that diabetes hasn’t prevented me from experiencing life to the fullest.

 

 

 

Five years

Pregnancy and Diabetes Blog

October 26, 2010

In a few weeks I will mark my five year anniversary of being diagnosed with diabetes, and over the last few days I’ve been thinking a lot about how my life has changed during that time.  I can honestly say that these past five years have been the best years of my life.  I met and married my husband, I started and grew a successful business with one of my best friends, I have traveled and visited places I’ve never been before, and now I am just a few months away from having a baby girl. I honestly could not have scripted my life any better if I had the opportunity.

Recently I’ve been thinking a lot about the grieving process that followed the diagnosis. I remember those first few days and weeks when I literally was in a state of shock and could not even begin to synthesize what the diagnosis meant. I remember feeling this tremendous since of loss for the “old me” and for the way things used to be.  I went through all the stages of grief - denial, anger, bargaining, depression and finally acceptance. And sometimes when things get particularly difficult I cycle back through those stages before I finally land back at accepting diabetes as just part of my life.

I think back to what helped me finally get to a place of acceptance – when I could finally say “I’m happy, and this is not so bad.”  In the very early days I would consciously have to tell myself to get up and go to work and to just try to figure out the new normal.  I relied on strength I learned from grandmother who lived for almost 30 years with the debilitating effects of Multiple Sclerosis. When I was a little girl my grandmother was interviewed by our local paper about the impact her MS diagnosis had on her life (as a side note my grandmother worked as the executive director for the local MS chapter prior to and after her diagnosis and took a very active role in making a positive impact in the lives of those living with the disease).  Because of all the good she was doing in the community our local reporter asked her, “Do you ever wonder ‘why me’ when it comes to this diagnosis.”  And my grandmother replied, “Why not me?”  I can honestly say that every time I started to feel sorry for myself I would hear my grandmother’s words in my head, and I would somehow find the strength to keep moving forward.  Still to this day when things aren’t going my way or I’m feeling like there’s a big black cloud hanging over my head I lean on the strength that grandmother taught me so many years ago.  Sadly my grandmother lost her battle with MS in 2007, but she will always hold a special place in my heart for teaching me that sometimes life deals you a hand you didn’t expect, and you just have to make the most of it.

Also my boyfriend (now husband) played an integral role in helping me get to a place of acceptance.  We were in the very early stages of dating (like 8 weeks into the whole ordeal) when I was diagnosed, and he was (and still is) a solid rock when it comes to dealing with difficult situations.  On one hand I was elated that I had met this great guy that I enjoyed spending time with, but on the other hand I was deeply saddened that I had this new diagnosis to deal with. I tried very hard to put my best foot forward and maintain a positive attitude because I wanted to make a good impression.  But some days I would just be so overcome with grief that I just couldn’t hide how I was really feeling.  One day about two months after I was diagnosed I was feeling particularly sad, and he sat me down and he looked me straight in the eye and said “you can do this, and I will help you.”   I can’t say it was an immediate about face in attitude for me, but I do remember that being a pivotal moment when I snapped out of my funk and tried to get on with living the rest of my life.  To this day he takes a very hand’s off approach to my diabetes and lets me navigate all the twists and turns unless I ask for his help. He doesn’t police me or question my decisions regarding food intake, exercise or insulin injections.  He just keeps his cool and calm demeanor and somehow knows the right words to say when I’m feeling particularly down.

So I’m sure there are some women out there that were just recently diagnosed and you are going through the grieving process.  And there are women out there that have lived with diabetes for years that still go through these stages of grief from time to time.  I encourage you to allow yourself to feel the emotions you need to feel and then find the support system you need to lift yourself up and help you continue to put one foot in front of the other.  It does get better with each passing day.

 

 

 

It's Not the Shots

Pregnancy and Diabetes Blog

October 18, 2010

During the course of my pregnancy my friends and family keep checking on me to see how I’m handling pregnancy and diabetes.  Up until this point I feel like diabetes has been no more invasive than it was before the pregnancy and equally as much as it will be once I deliver.  For the most part I just tell everyone that things are fine and the only real change is that I had a lot of low blood sugars during the first trimester and the beginning of the second trimester.

However this weekend I was talking to a friend about my pregnancy and diabetes and she commented, “I could never deal with all those shots and finger sticks.”  So I started thinking what is it exactly that makes diabetes so annoying, inconvenient and difficult to manage.  And I came to the conclusion that it’s definitely not the “shots or the finger sticks.”  Trust me in the beginning it took me about 10 minutes to actually get up the nerve to actually prick my own finger and about 20 minutes to talk myself into giving myself an insulin injection.

Fast forward to today almost five years after diagnosis, and it seems like checking blood sugars and taking insulin is such a habit for me that the “shots” are definitely not the problem.   For me the most intrusive and difficult part of managing diabetes is that it requires so much planning and constant monitoring to maintain good control.  I hate that it’s really hard to be spontaneous with exercise ,food choices, travel or just about anything else.

At the time when we were having the conversation it had been about 3 hours since we had eaten lunch. I explained that I couldn’t just go for a 30 minute walk (or any type of exercise for that matter) if I wanted to without first going through a mental and physical checklist.  Is my blood sugar ok right now? Will I go low while I’m out on the walk? Should I eat a snack now or should I bring a small snack on my walk?  Maybe I should turn my basal rate down on my pump for 30 – 60 minutes and THEN go on the walk?  Or maybe I’ll be ok if I just hit the door without doing anything?

And then the same thing applies to every morsel that goes into my mouth.  Is my blood sugar too high or too low?  Is it on its way up or on its way down?  Do I need a correction bolus in addition to bolusing for the food I’m going to eat?  Maybe I don’t need a bolus at all? How many carbs are in this?  Is this worth it?  And the list goes on.

For the most part I try to remain positive because I honestly believe that negative thoughts are not helpful at all.  But sometimes I just get down and miss the spontaneity of a life without diabetes.  Luckily by nature my personality is that of a planner, and I think my organization and attention to detail is an asset when it comes to managing diabetes.

So my question to all the other Diabetes Sisters out there is what is the most challenging part for you when it comes to managing your diabetes?

 

 

 

Slipping Through the Cracks

Pregnancy and Diabetes Blog

October 13, 2010

At this point I am almost 22 weeks along, and everything is pretty quiet on the pregnancy and on the diabetes front. I still have a few low blood sugars from time to time, but the nagging lows that plagued me during the first trimester seem to be a thing of the past.  Also apparently I officially “look pregnant” now because even random strangers are starting to make comments about the baby and even a few have reached for my belly.

I’ve seen my OB approximately every four weeks, and I am scheduled to see my endocrinologist every 3 months, but I  must admit that I’ve been feeling little in the dark about what to expect for the remainder of my pregnancy.  I decided very early on in the pregnancy that I was going to let my OB handle the pregnancy side of things and that I would let my endocrinologist handle the diabetes side of things. So far this system is working fine for me, but I am starting to feel like I am slipping through the cracks and I’m not being followed closely by either one.

Up until this point it seems like “my advanced maternal age” is more of a concern than the diabetes.  I just turned 35 two weeks ago so I feel like worrying about my age is unnecessary at this point. However my diabetes is very real and it’s here to stay, so I definitely want someone to talk to me about what to expect through the remainder o f my pregnancy.

I went to the OB today, and I saw a doctor that I have not seen before (my practice rotates the different doctors so you have the chance to meet the doctor on call when you go into labor).  Even though it was a just a regular check-up he spent some time discussing our plan for the next few weeks.  We talked about when I might start experiencing insulin resistance and will start to require more insulin. (I am mentally trying to prepare myself for the increased insulin needs because for some odd reason I equate more insulin with being “out of control” with my diabetes).  He said I can expect some changes in the next few weeks, and that I should check my blood sugars often just to be sure.

Over the last few weeks I’ve been worried that she is getting too big too quickly so the OB allayed my fears and told me everything was on track. He also wanted to see me back in about two weeks for a “growth ultrasound” to make sure she is not getting too big.  I know there is some controversy out there about getting too many ultrasounds and the possible negative effect on the baby, but I would rather know that her growth and development is on schedule.  Originally I was not scheduled to have a “growth ultrasound” until 32 weeks so I am thankful that we will get another sneak peek at her a little sooner.

We also talked more about the labor and delivery process and whether I should leave my pump connected or should I go on an insulin drip.  I am planning to keep my pump attached and manage my insulin needs myself, but I’m just happy that we were discussing it so I can start thinking about my options.

I appreciate that my doctors have been very calm and feel confident that everything is going to be ok. I like flying under the radar when it comes to doctor’s appointments, but there is definitely a fine line between just cruising along and being proactive about managing diabetes through this entire process. As for me I like as much information as possible so I can be an informed patient. It feels good to have a general idea of what to expect over the next few weeks and what we (the entire medical team) are going to do if anything seems off course.

 

Body Image

Pregnancy and Diabetes Blog

October 5, 2010

Apparently I have successfully transitioned into “looking pregnant” because several people have commented on my growing belly and changing size.  Unfortunately sometimes innocent comments can be misconstrued as being critical and/or negative. For example one person blurted out “you’re fat,” another person said “you’re getting bigger, mostly in your belly, but kind of all over too,” and finally one person said “ah how cute, a baby bump.”  These are all true statements but I must admit that one of my concerns about gaining the baby weight has been how to lose the baby weight when it’s all over.

I think it goes without saying, but most women I know struggle with negative thoughts about their body image on some level. We can all find fault in our own bodies and sometimes we fail to see the characteristics that make us unique.  I can’t help but wonder if women with diabetes experience more negative thoughts about their body image than other women.  After wrestling through these thoughts in my head I started to think about the role diabetes plays in my overall body image.

When I was first diagnosed I remember feeling a sense of disappointment in my body. I felt like I had always led a healthy lifestyle complete with regular exercise and a balanced diet so why would my body let me down.  Initially it was thought that I had Type 2 diabetes and I was educated on how to manage my diabetes by incorporating more exercise into my daily life and how to make healthy food choices.  Now I do agree that we can all learn something new and there is always room to incorporate healthy behavior into our lifestyle, but I was completely insulted by the recommendations I was receiving.  I felt like I had already committed to a living a healthy lifestyle and therefore somehow I should be exempt from being diagnosed with a chronic disease until sometime later in life.

Fast forward a few years – I have been appropriately diagnosed with LADA or latent onset of Type 1 so I have received proper education about how to manage the disease. It’s not that I did something wrong or if I had exercised a little more or stayed away from sugary foods then this would have never happened (not that that is the case for women with Type 2 because there is a genetic component and other factors that influence diagnosis, but I must say it is implied that you can prevent diabetes).

I decided to go on an insulin pump about 16 months ago, and I must say that was a huge hurdle in my mind in regards to body image.  I felt like I was making an outward statement to the world that I had a medical problem and just to prove it I have this sexy little device that I must wear 24/7.  I can honestly say that I haven’t made much progress in that realm because still to this day I am always trying to hide my pump.  Mostly I don’t like having it on the outside of my clothes because I feel like it adds “girth” and that’s just not an image that I like to see in the mirror.  Also I am very active, and I find that anytime I wear my pump on the outside of my clothes then I inevitably get the tubing caught on something and jerk out my infusion set.  As for now I wear my pump in my bra strap underneath my arm, or if I’m wearing a dress or skirt then I have this nifty little thigh thingy that has a pocket sewn in for my pump that I can just wear on my leg. I ordered online through http://www.tandjdesign.com/, and I absolutely love it.  Most people don’t even know I have an insulin pump.

As the pregnancy progresses I am having a lot of conversations with myself about how weight gain is a normal part of pregnancy and it’s actually required in order to have a healthy baby.  I’m almost 21 weeks, and I’ve gained about 9 pounds so according to all the charts and guidelines I am right on track.

As women we are always faced with unrealistic images from the media and sometimes people say things that make us feel insecure about our bodies and how we look. Sometimes diabetes also has a way of making us feel self conscious about our body because of all the outward markers such as insulin pumps, injections, finger sticks, glucose tabs and more.  The next time that little negative voice enters your mind I encourage you to choose one thing about your body that you do like and replace those words of criticism with words of praise.

Insulin Resistance

Pregnancy and Diabetes Blog

September 27, 2010

At this point I am about 19 ½ weeks along and so far everything seems to be going fine.  My blood sugars seem to run consistently low which means I’m drinking lots of juice boxes, eating lots of Smarties and just trying to stay on top of it. I am the World’s worst at using any kind of logic to figure out trends in my blood sugars so I took at stab in the dark and reduced my basal rates and my insulin to carb ratio simultaneously. The low blood sugars are not gone, but I seem to be having fewer of them so that makes me feel good.

Up until this point I’ve taken a pretty relaxed approach to the pregnancy and the diabetes, but all of the sudden I find myself worrying about how things are going to go for the second half of the pregnancy.  I have always heard and read that my insulin needs will increase dramatically as the pregnancy progresses, and at this point I’m just waiting for the day when my blood sugars start running a little higher.  Today I woke up at 104 as opposed to 70 – 80 fasting as I’ve experienced over the last few weeks. Now I know 104 is nothing to sneeze at, but all of the sudden my mind went to a place where I started to wonder if today is the day that I start the steady climb towards requiring more insulin.

The intellectual side of me reminds me that nothing is constant when it comes to managing diabetes, but I’ll admit that I’ve become accustomed to dealing with the frequent lows.  Even though I hate how they make me feel and I hate treating a low blood sugar I find some comfort in knowing that if I go too long between meals or a snack then there’s a good chance that I will experience a low.  It’s almost like there is a pattern and managing diabetes is suddenly predictable.

So does anyone know when the insulin needs increase dramatically during pregnancy? My endocrinologist said it may or may not happen for me, but I am curious to know if there are other women with Type 1 diabetes that did not require increased insulin as their pregnancy progressed?

 

 

 

 

Level II Ultrasound

Pregnancy and Diabetes Blog

September 20, 2010

Last week was very exciting because we found out that we are having a little girl.  I was going to be happy with either a boy or a girl, but I am so excited that we are going to have a daughter in just a few months.  As I mentioned in my last blog post, I was having a hard time bonding with the entire pregnancy experience, and I suspected that knowing the baby’s gender would really help me feel more of a connection.

Boy was I right. Suddenly I can envision my life with a little girl.  What will she look like? Will she have straight or curly hair? Will she be laid back like her father or a little high strung like me (I’m hoping for the former)?  What will she be when she grows up?  Can I convince her to go to UNC over NC State against her father’s better wishes?  Most often I think about how exciting it is going to be to be a mom and to have a daughter, but I must admit that I’ve wondered if she will develop diabetes just like I did?  On a side note I learned that there is only a 4% chance that my daughter will develop Type I diabetes.  Somehow I find those odds comforting, and I hope and pray that she never has to worry about managing diabetes or any chronic disease for that matter.

In addition to learning that we are having a little girl, we also got a lot of feedback from the Level II ultrasound.  The ultrasound tech spent over an hour taking a thorough look at her heart, kidneys, spine, brain and more.  I learned that there is an increased risk of heart defects and spinal disorders in women with diabetes so the ultrasound tech spent a lot of time looking at her heart and her spine for any abnormalities. I am so happy to report that everything looked normal on the ultrasound and our daughter is right on track as far as her development goes.

In regards to my blood sugars I am continuing to run on the low side. It seemed that I was often going too low both after meals and between meals so I decided to reduce my basal rate and increase my insulin to carb ratio. I think that did the trick because while my blood sugars are a little higher, I feel like my current settings have reduced the number of scary lows. I’m entering into a point in the pregnancy when my body is changing quickly so I expect that I will need to make minor adjustments to my insulin for the remainder of the time.  As for right now I’m just going to bask in the glow of thinking about our baby girl.