Monday, April 2, 2012

Type 1 Diabetes and Pregnant

 As of this week, I am 23 weeks pregnant!  That's almost 6 months!
Though I am very excited, I find that being a Mamma that's pregnant with diabetes is much harder the second time around!

Here's what's different between Pregnancy #1 and Pregnancy #2
When you are expecting your first child: you have much time to sit and read popular fiction and chic lit novels with your feet up.  When you are expecting your second child, you have many toys to pick up off the floor or trip over.

When you are expecting your first child: friends, family, and colleagues will not let you carry anything heavier than a phone book.  When you are expecting your second child, you carry child number 1, plus your purse, and your gym bag, and your briefcase. plus your child's lunch box.

When you are expecting your first child: to have optimal blood sugars, you inject your dose of insulin a full 20 minutes before eating your first bite.  When you are expecting your second child, you learn that 20 minutes before your first bite is a nice concept, but spilled juice, dirty diapers, temper tantrums, and pre-meal hand-washing can magically turn 20 minutes into 40, so you inject with your left hand as your right hand shovels a forkful into your mouth.

Here's what's the same between Pregnancy #1 and Pregnancy #2
I am again a high risk pregnant lady.

So I go to the Antenatal Clinic for high risk pregnant ladies every 2nd or 3rd Tuesday. 
I am there as of 7:00 AM, along with 30-50 other women
I have a massive bag: filled with breakfast, lunch, a book, my laptop, a file dedicated to all my medical pregnancy related follow ups.
1. I go in and I wait in line with my hospital card and my medicare card.
2. I weigh myself (my boots weigh a whole kilo!  thank god, because I really packed on the pounds).
3. I wait for my turn in the bathroom so that I can pee in a cup: they need to check for ketones (incredibly dangerous bi-product of running high sugars that can cause you to miscarry) and proteins(that's a regular pregnant thing, not a diabetes thing)
4. I wait to have 2 vials of blood drawn: I don't turn away when they poke into the juiciest vein in the inner side of my right elbow. It's uncomfortable, but whether I look or not, or bruise or not, or hurt or not, they still got to do it, so might as well HAVE the experience
5. I claim my space in the waiting room (my spot for the next 4-5 hours) and I inject and I eat my breakfast.
Breakfast at the Antenatal Clinic
I always bring the same thing, it's 25g of carbs and it's an activity to eat and I always loved it as a child:
- 1 pack of Multigrain melba toast 20g carb
shmeared with
- 3 low fat laughing cow cheese 2g carb
- a bottle of 500mL unsweet soy milk that I flavored with my chocolate sugar free syrup 3g carb
 (the soy milk with chocolate syrup is shaken to perfection; that's shaken not stirred, eat your heart out James Bond! and keep your olives!)

6. I see one of the nurses.  She checks my blood pressure and asks me a ton of questions for which she updates my file.  Questions like: cramping? contractions? Water retention?  Heart burn? Headaches?  Eyesight?  Frequency of urination? Constipation? Average blood sugars before breakfast? after breakfast?  Before lunch? After lunch? Before dinner? After dinner? Before bed? Middle of the night?  Average insulin use for each meal... Name, rank, serial number.  And she updates my file with all that.
Then I go and sit and wait
7. I wait to be called by the nutritionist.  We go over my average carbs per meal, my carb consumption per day, my weight gain since last visit  (it's not me!  The scale lied!)  The sweeteners that are not safe for pregnancy: sugar alcohol oK, yes for maltitol, yes for sorbitol yes for Splenda and sucralose, no for Stevia (what!  But it's a plant??? But it hadn't been tested safe...since no one will foot the bill for that FDA study) No for aspartame, no for Sodium cyclamate (poison!), no for acesulfame potassium, and no saccharin. 
This means, no Nestea Zero, No diet softdrinks except for Crush, no gum, no Sugar Twin
Yes for canned tuna, no expensive tuna steak??? (mercury levels...)

8. I go back to wait to have another 2 vials of blood drawn -it's 1 hour since I finished my breakfast and they want to see how that went.  I don't turn away when they pokethe inner side of my left elbow.
For some reason, I am always out of range after the breakfast where I sit in the hospital waiting.... Most of the other pregnant women around me are too.

I go back to wait. I compile the notes from my last 3 weeks of meetings, I answer e-mails.  I read 2 chapters.  I watch the woman in front of me test her blood sugars, clumpsily (clearly a newly diagnosed gestational diabetic)  she sighs and then opens a Hershey cookies and cream chocolate bar and eats THE WHOLE THING!  (What?  And I got scolded for gaining 1.5lbs over the last 3 weeks?  I didn't eat an entire family size chocolate bar!  4 squares, maybe)  I take a mental note to send a case of samples of Dex4 glucose tablet to the clinic and to ask the nurses and endocrinologist to explain to their patients about correctly fixing lows.
I count how many women are knitting.  I observe the ratio of pink yarn to blue yarn  (pink is the majority, actually)

9. The endocrinolgy student calls me.  She takes me to a makeshift office and starts asking me information on my insulin use.  She asks me questions as though I was newly diagnosed.  I tell her I've been diabetic for 6 years and am on an insulin pump.  She is impressed because she hasn't ever seen a pump. What?  No problem.  I explain how it's used, about a constant drip of fast acting insulin.  She jots down notes on blood sugar problems I've been having then she takes me in to see the Endocrinoligist.
10.  I sit down with The Endocrinologist.  This doctor is QUEEN of insulin pumping!  I show her a weekly log that needs someone to fix it, it has some ugly high readings which could be because of my increased insulin needs, but increased how?  More for what I eat?  More to fix the high?  More to drip 2 hours before the high?  and the subsequent lows.  Too much insulin for what I ate?  Too many corrections?  Was it the exercise?  This brilliant woman sees patterns and figures it out!  And all of a sudden, it makes sense!  I have some new levels to program, I have a new plan for when I exercise over the next 2 weeks.
- Updated Basal program: this is the insulin that drips steadily to counteract my blood sugars
- Updated bolus ratios: this is the insulin for when I eat
- Updated insulin sensitivity: this is the insulin needed to crrect a high blood sugars
I'm telling you, this doctor is BRILLIANT!  I consider myself quite skilled at pump programming due to what I've learned from her.
She tells me to come back in 2 weeks. I note it down in my agenda

I go back to my chair and and wait.  I answer the 6 or so e-mails I got while I was speaking with the specialists.  I write up a recap of my departments sales activities for the last month.  I eat my walnuts, and look longingly at my orange. I play around with an idea for a product launch strategy and a list of products I want my sales reps to focus on. I read another 3 chapters.  
11. Eventually, I get called to meet with the high risk Obstetrician.  We listen to the baby's heart beat.  He asks me questions on my general health.  I ask if I can continue my Zumba classes.  He looks over my blood work and vitals.
Then, I either can leave, or go back to wait to be called by an ultrasound technician.
This time I get to leave.
12. I go back and wait to speak with the receptionist to confirm my much covetted spot for another round at the clinic in 2 weeks.

I leave incredibly happy and excited.  I'm doing well!  I'm healthy, the baby looks healthy, I can go back to living my pregnant life with my new insulin programs.
As I walk across the massive parking lot I call my husband to give him the news.  Then I call my mom, then my mother in law.  I wince when I pay the $26 parking fee.
Then I get into the car and drive to work, and call my sister and my 2 best friends to update them too.  But I use my hands-free dialing of course.........