Light at the end of the Tunnel

This week is officially the start of my third trimester. I cant wait for September to get here. Between insulin resistance, uncomfortable/sleepless nights, constant pee breaks and the summer heat, I’m more than ready to meet our little guy.

I keep reminding myself that I don’t have it as bad as some people do in terms of this balancing act: Type 1 diabetes and pregnancy. I had one pretty bad week of constant high blood sugars that left me feeling defeated and depressed. Everyday I worried whether or not my highs would result in high birth weight or delivery problems. Everybody told me that I was doing my best, but it didn’t feel good enough. After numerous daily texts and emails to and from my endocrinologist and my CDE and appointments with my OB and CDE, resistance has reverted back to an occasional spike here and there which I am completely ok with. I know that I’m only just starting the third trimester and will probably have more tough weeks ahead of me. As long as I keep checking in with my doctors, I will try not to stress.

Not stressing is the name of the game in terms of blood sugar management. As difficult as it is for me, I need to try to relax and rest as much as I can these last few months. I’m typically very go, go, go so this is easier said than done. My doctor hasn’t sentenced me to bed-rest yet (hopefully never!), but I find that when I take it easy my blood sugars cooperate. (Light, low-impact) Exercise also really helps. I’m still walking a few miles a day, some days more than others. I try and get a couple long walks in during the week, but besides that I’ll do about a mile with Wilfred 2-3 times a day. Long walk days usually mean steadier blood sugars for the rest of the day.

I’m really hoping that the next 12 weeks fly by. Everybody says they do…

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Slow and Steady Wins the Race

Between doctors appointments, prenatal classes, nursery prep, baby-registry building and keeping my blood sugar between 70 and 130, I haven’t had much time for anything else. I’m ashamed to say that my kitchen floor hasn’t seen the broom in weeks. It’ll all get easier once the baby gets here, right? Right?? RIGHT?!?

I still can’t exercise. Even if I had the time too I can’t. I had hoped that once my a1c got better, (as of last week I’m at a 6!!!) I would get the all-clear to ease back into my active lifestyle. I’m not talking running marathons or any races for that matter. All I really wanted to do was a short, easy hike with a few friends, but I was denied.  Endo said that she has no idea what any kind of exercise will do to my blood sugars. I’m already insulin resistant and she doesn’t want me to attempt mixing exercise in. I argued that exercise increases insulin sensitivity. She said, nice try. I need to be consistent and eliminate as many variables as I possibly can. So it looks like I’m going to be stuck walking for at least 4 more months.

With my limited schedule I can still get a good walk in, and I absolutely do. A couple times a week I plan a long, (about 1.5 hours, usually over 3 miles) hilly walk with Wilfred. I’ve noticed that when I do this, that whole day and the next, my blood sugars are near perfect. I’m sure it also helps that I’m eating clean foods, because why would I want to ruin the only workout I can manage. I do a long walk to and around a local park.  It’s about 2 miles away. I also drive to the beach and walk the Santa Monica Bluffs with a friend. We start on a walking path, cut down to the beach, back along the sand and then finish with some killer stairs. Sand, sun and crashing waves to start my day.

So for now it looks like my hiking shoes will be collecting dust and my bike will stay tucked away under its bike cover. At least Wilfred is getting plenty of fresh air and sunshine. September can’t come soon enough!

A Day in the Life of a Pregnant Type 1 Diabetic

After reading about all the things that can go wrong in pregnancy if you have Type 1 Diabetes, I consider myself to be very lucky. I love being pregnant. Fortunately, I haven’t dealt with any complications and besides unbelievable exhaustion, my pregnancy side affects have been fairly minimal. At the same time, I can’t wait for this to be over. I know that I have years of worrying ahead of me, but I want to be able to eat a burger with fries and not worry how it will affect the baby or panic every time my blood sugar goes over 150.

Here is a glimpse of what I have to do and what I have to worry about every single day. It never ends, even while I’m sleeping (I’ve heard similar things about parenthood…).

  • wake-up at least 2x a night to check my blood usually at 12 and 3
    • sometimes I need a snack
    • sometimes I need insulin
  • check my blood before breakfast and calibrate my CGM
  • weigh food, calculate carbs, bolus (the foods I can eat and that don’t spike my sugars change all the time)
    • If blood sugar is over 100- wait at least 20 minutes to eat
    • If blood sugar is between 70 and 100- wait 5 minutes to eat
  • check blood 2 hours later, if high- correct or set temp basal
  • exercise fluctuates my sugars too much, but I can walk my dog; check blood first
    • too low- eat a snack, set lower temp basal and always carry snacks with me
    • too high- correct and wait until it’s below 140
      • depending on length of walk possible temp basal will be needed, snack definitely needed
  • check blood before snack; weigh, calculate, bolus and wait
  • check 2 hours later, correct if needed
  • if possible, take a nap (I’ve never felt this tired before)
  • drink at least 60 oz. water daily
  • pee 100x a day
  • check blood before lunch; weigh, calculate, bolus and wait
  • check 2 hours later, correct if needed
  • go to weekly doctors appointment at either endocrinologist, obstetrician/MFM, nutritionist, certified diabetes educator, or retinal specialist as well as occasional dentist and  chiropractor– frequency of appointments will increase once I reach the third trimester
  • check blood before snack; weigh, calculate, bolus and wait
  • check blood 2 hours later, correct if needed
  • walk dog; check, correct, wait
  • check blood before dinner; weigh, calculate, bolus, wait
  • check blood 2 hours later, correct if needed
  • make sure I’ve had at least 100g carbs, eat third snack if not
  • plan meals for the next day (makes calculating much much easier)
  • check blood before bed and calibrate CGM

 

I have learned a lot in the 5 months I’ve been pregnant. I can have everything figured out perfectly with my basal rates, carb ratios, sensitivity, and the foods I can eat , and the next day it all changes and I’m running super low, swinging hi-low all day or I cant bring my sugar down within range no matter how many times I try to fix it. Even with a CGM, I need to check my blood at least 10x a day with finger sticks- before pregnancy I was testing maybe 3x a day and relying heavily on my dexcom, that’s too risky now. Planning my day out makes blood sugar management way easier. And finally, while I try really hard to maintain a structured schedule, life happens and I need to be flexible. 21 weeks down, 19 to go!

Imagine walking a barbed wire tightrope, barefoot, over a zombie-shark infested lava field. That’s what pregnancy with Type 1 Diabetes is like.

 

Halfway There

I’m 5 months pregnant as of tomorrow and so excited to meet our little guy. We did the Harmony blood test at 2.5 months which checks for chromosome issues and tells us with 100% accuracy what the sex is. We know for certain that we are having a boy- so it looks like I will be completely outnumbered.

As far as balancing pregnancy with my diabetes, every day is a challenge. There is so much that has to go into my daily and weekly meal plan and exercise routine. The easiest thing by far has been sticking to a structured schedule. And I say structured very loosely. I don’t eat at the exact same time everyday (although I definitely try to!), but I do eat the same, or similar, foods everyday and stick to things I know work for me. Most of the time I spike when I eat something I probably shouldn’t have, when I miscalculate my carbs, or when I don’t allow enough time for the insulin to start working. The challenge is that those things are always changing. My insulin needs are always changing. My hormones are always changing. So as hard as I try to keep things the same, it’s a losing battle. I just do the best I can every single day and check in with my team of doctors (Endocrinologist, Diabetes Educator, Nutritionist, Obstetrician, Ophthalmologist) a few times a week.

I remember reading an article many years ago about a woman who was a type 1 diabetic and had 3 kids. She had her endocrinologist live with her during her pregnancies and manage her diabetes for her.  She didn’t have the same technology I have today-an insulin pump, a continuous blood glucose monitor (CGM), or data sharing websites (Carelink and Blip).  I think a big reason she didn’t have any complications is because her endo was right there, doing and calculating everything. While plenty of women with type 1 had children before any of the modern medical advances I’m fortunate enough to use became available, it really felt like the only way to do it successfully was the way she did. I had been told many times growing up that I wouldn’t be able to have kids and just accepted that it wouldn’t happen for me.  So the fact that I’m halfway through my pregnancy and am able to deal with the day to day challenges that come with it is a miracle.

Big Things for 2016

We are already in March. I feel like just yesterday I was celebrating the holidays with my family and ringing in the new year! Big news for the Keller family for 2016…I’m pregnant!!! It was a bit unexpected in that we definitely wanted and talked about having kids, it just happened sooner than we thought/anticipated/were really ready for. I know that no matter how much planning you do, you will never be fully ready for kids, which is why we are facing this new chapter of our family head-on. Diabetes or not, I’m going to do everything I can to ensure a successful pregnancy and a happy and healthy baby!

I officially found out I was pregnant January 6th. Before even telling hubby, I emailed my endo and CDE. While waiting for their response I started jumping up and down, dry heaving, shaking, grinning and worrying and tried to figure out the best way to tell Sean. My endo was a little less enthusiastic than I was. My a1c was not in pre-pregnancy, let alone pregnancy range. She said that my blood sugars couldn’t go over 140.  It was at that point that I started thinking I was in over my head. I got really sick New Years Day and because my sugars were so high during the holidays she was worried about what damage I had already caused for baby. That brought me down to reality fast. I made an appointment with her top choice high risk OB for the very next week. I also made an appointment with her for the next week (for the near future I would have to see her once a week until we brought my blood sugars back into range).

Telling hubby the news didn’t really go as I had planned. I was too excited and couldn’t wait to share the news. I had originally wanted to get some kind of infant dodgers memorabilia and wrap it along with the (sterilized) pregnancy test, but I couldn’t find anything that worked. I would have had to order something online and I couldn’t sit on this news for a week. I’m not good at keeping secrets. So I drove to his work and told him right before he finished for the night. He was very excited and happy, but like me surprised and worried.

Since January 6th I have learned that my baby has an amazing heartbeat and while we didn’t get a chance to record it (we’ll be doing that next time!), it’s not difficult for me to remember that beautiful sound. His/Her due date is September 19th and I’m going to do everything in my power to carry to term– I have heard/read horror stories about type 1 mom’s who had to delivery early for one complication or another. I don’t like the sad stories, but it’s important for me to know the risks and work with my amazing team of doctors to prevent anything bad from happening to baby and me. I learned that every pregnancy is different especially if you’re a type 1 diabetic. I’ve learned that I am very strong and that I can absolutely get my blood sugars under control. My endo is amazed at how well I’ve turned my numbers around. By the end of the second month I was able to go back to monthly appointments, however, I still send her my pump and CGM data every 3 days.

I have developed a rhythm to my Diabetes management. A great amount of work and energy and thought goes into what I’m eating, when I’m eating and what I’ll be doing after I eat. I will say that this is the hardest thing I have done and probably will ever do. As of last week I brought my a1c from a flat 8 to 6.8.  I finally beat my goal of getting my a1c to 7.  Who knew it just took pregnancy to do it?

Wrapping it up

I can’t remember the last time I sat down to write a blog post. I feel terrible about it. With a new dog/ dog training, and the holidays, plus my non-stop job search, it appears I’ve put my blog on the back burner. One thing I haven’t done is put my diabetes on the back burner. We are almost halfway through December and the last time I checked my a1c I was down to 7.7. I’m still not at my goal, but I’m so close I have no doubt that I’ll reach it! I don’t check my a1c this month. I will need to wait until January’s appointment but hopefully it will be even better. 

I worry that it either hasn’t moved or its gone up a bit because I’ve been incredibly stressed the last couple months. Searching for a job is hard work. Fine tuning your resume and writing brilliant covers letters is not an easy task. And it takes a lot of work! I met with Donna Miller, the amazing RN/CDE/lifesaver at my endo’s office and she made me feel a lot better. I need to take care of myself now because when I do find that amazing new job I need to already have a working routine for my diabetes. 

I’ve learned that bolusing 15-30 minutes before eating really helps. Sound advice that my endo has told me repeatedly but I’m just now listening to. I’m beginning to notice a pattern. It’s tough when I’m starving or when I don’t know what I’m eating right away. But most of the time I can handle waiting a bit before chowing down.

The second thing I’m focusing on now is pretty much what I always focus on. Making the right choices with what I eat. During the holidays that’s easier said than done. I allow myself a little bit extra on Thanksgiving or Christmas because for the most part, I’m really careful every other day. I’m still eating low carb and low glycemic foods. However, I haven’t used my cookbook hardly at all. Hoping to change that before 2015 comes to a close, but even if I don’t, I can always just make that my 2016 New Years resolution!

And now for the obligatory dog photo…

  
That was after a 5 mile run. Knocked out!

Keeping Things Pretty

diabetes supplies

Just because I have to carry around medical supplies everyday, doesn’t mean that it has to look like I’m carrying around medical supplies. Taking some inspiration from the beautiful jewelry travel bags my mom has given me over the years, I took the biggest one and used it to store my meter, test strips, lancets. I’m much more excited to check my blood when I’m taking out the pretty red case instead of the standard, medical, black or grey zip case. I also wanted something cute to carry everything else I need, which as one of my friends put it, ‘is kind of intimidating’.  In comes a cute little 2 sided makeup bag from Target. I store insulin pump supplies (infusion set, reservoir, inserter) on one side, and sensor supplies (sensor, inserter, adhesive) on the other. I also have a bottle of insulin, alcohol prep pads (2), an extra battery, a syringe, glucose tablets, keytones strips, large Tegaderm (2), a pen, hand sanitizer and balm. My kit is adorable, compact, has everything I need and fits nicely in almost all of my purses. I’m probably going to add a granola bar today.

Now I have no excuses. I don’t ever have to experience the dread I feel when my pump runs out of insulin or battery and I’m at work, or running errands or in another state! and all my supplies are at home. Universe, bring it on!