SOME DIFFICULT NEWS

Thankfully the difficult news is NOT about the baby....but it is about the pregnancy. This is a difficult post for me to write because my hope in starting this blog was to be able to be encouraging and inspiring to other diabetic women out there who weren't sure they could have a successful (dare I say "normal") pregnancy. I wanted to show you that we CAN do it. I wanted to be an example of a complication-free diabetic pregnancy. Unfortunately, as of this week, I can't be that example.

It concerns me that posting this may discourage some of you from getting pregnant....or even that it may just discourage you in general. I really don't want that to be the message here. This is a set-back, but it's not a failure. I am still pregnant with a very healthy baby girl, and am determined that she will be a success. This doesn't change that.

So at the risk of being less-than encouraging, I do feel that it's important for me to remain true to the intent of this blog, and give you the whole story - not just the easy stuff. So here it is....


A couple of years ago I needed laser treatments in both eyes for proliferative diabetic retinopathy. For those of you who don't know what that is (or who need/want a refresher), here's the quick explanation of proliferative diabetic retinopathy and the laser treatments - if you already know this, feel free to skip ahead:

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Basically, long-term and/or badly controlled diabetes can lead to problems with blood-flow to the retina. (Note that even people with well-controlled diabetes CAN experience retinopathy, although controlling your diabetes carefully does greatly reduce the chances of this happening. Also note that diabetes care methods are MUCH better now than they were in the 70s, 80s, and even 90s, so those of us diabetes-veterans have lived through a time when it was much more difficult to have tight diabetes control, and unfortunately do have a greater risk of complications like this as a result, even if we have much better control now. Anyway...) When the retina doesn't get adequate bloodflow, it doesn't get adequate oxygen. Because the retina needs oxygen, the brain sends signals to the retina to make new blood vessels to help move the oxygen around. This is called "proliferation" (hence "proliferative diabetic retinopathy"). Sounds good, buuuut....the new blood vessels are weak and fragile. They break easily, and when they do blood leaks into the retina and can cause vision damage. (Also note that not all diabetic retinopathy involves proliferation. In the early stages there may be blood vessel leakage, but no proliferation of blood vessels. I'm not going to go into that here, though.)

Retinopathy is not curable, but it is treatable to help slow (and hopefully stop) the process. Treatment involves getting numbing drops and/or gel squirted into your eye(s), having a glass lens pressed up against your eyeball, putting your face in a machine that makes you feel like you should be on A Clockwork Orange, and then getting a couple of thousand (yes, thousand) of laser zaps on your retina (called pan-retinal laser treatments). It's not as painful as it sounds like it could be, but it is painful, and it's VERY stressful. The light is very bright, and with every zap it takes your breath away and makes your other eye want to roll back in your head. It only lasts a few minutes, but it's pretty low down on most people's list of enjoyable ways to spend a few minutes. :P

The point of the treatment is to kill off a portion of the retina. It sounds counter-intuitive, but it basically allows the less-important parts of the retina to be sacrificed to save the more important central part of the eye (i.e. the macula), and hopefully protect your (my) vision by doing so. You end up with a grid-like pattern of scars on your retina (permanent), and typically a bit of damage to your peripheral vision and your night vision, but the end result is (or should be) that your retina then requires less oxygen, so your brain no longer sends signals to make new (fragile/leaky) blood vessels...reducing the risk of bleeding and vision loss. And that's a quick retinopathy lesson. Now back to our regularly scheduled blog.
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So, this past Sunday, I noticed a new "spot" in my vision of my left eye. I got in to see my ophthalmologist on Monday and the news wasn't great. There is bleeding in my retina that my ophthalmologist says is due to more proliferation (i.e. new growth) of the blood vessels. He said the pregnancy (i.e. the growth hormones running rampant in my body) and the slightly elevated blood pressure that I've been having are likely both coming into play here. (I'm not too surprised re: the growth, given that my baby has grown 1.5lbs in the last 2 weeks according to the fetal assessment - a normal level of growth for this stage of pregnancy.) We knew this was a possibility during pregnancy because of the growth hormones, but we had hoped for the best. Everything was going so well before the pregnancy and during the first two trimesters - no sign of proliferation or bleeding since my last laser treatment in September 2007 - but I guess I just didn't quite make it through the third trimester.

So, I had more laser treatments on Monday - 1000 zaps in my left eye. It sucked. A lot. (I didn't get woozy at all, though, which was a BIG problem for me last go-around.) I'm going back next week Thursday for more, but it should just be the two treatments, and he is just doing my left eye. He has a new machine since last time, though, that does multiple shots at once, so 1000 zaps is much faster now than it was before. I guess that's the silver lining on this cloud. It's still pretty miserable, though, and my eye was sore and a bit red/puffy for the next day or so.

So, I suppose the good news is that, since the ophthalmologist feels it's so directly related to the pregnancy, I don't necessarily have to expect that I will continue to have bleeding every few years for the rest of my life. The bad news is that this calls into question how wise it is for us to try for more children in the future as there's nothing to say it won't happen again with another one - maybe even worse next time. The doctor says not to worry about that now - it's not out-of-the-question. We realize that it will depend a lot on how the next 6 weeks go, how the years after this baby go (i.e. when I'm not pregnant anymore) and how my eyes are doing before we would be ready to try for another one. Either way, it will likely be a very difficult decision to make. For now, though, we are focusing on the fact that we have one beautiful baby on the way and are VERY lucky for that. We refuse to let this setback get in the way of our joy and excitement about our little girl!

Another development related to this is that my ophthomologist doesn't want me to push during labour (i.e. to avoid more bleeding of these weak blood vessels in the retina), so I will be asking my OB for a c-section. The baby is still breech, though (and apparently unlikely to turn since she's been in this same position for so long now), so this is likely a moot point anyway.

I'm seeing my OB on Friday and will discuss the bloodpressure issue with him then. We'll have to talk about ways to reduce it....which may or may not involve leaving work early or figuring out some other work option between now and my scheduled mat leave.

So, it was a less-than-good day on Monday, and a frustrating experience - especially so close to the end of the pregnancy. I feel like we ALMOST had a perfectly successful diabetic pregnancy, but didn't quite make it. But this too shall pass. Anyway, just wanted to keep you all updated.

At the end of the week I'll post more about this week and the new fetal assessment pictures (she's got some chubby cheeks!)

Until then, please don't let my experience this week be a discouragement for you. I just really felt the need to share this here.

WEEK 31 - TRIMESTER THREE DISCOMFORTS

This week I have been really reminded that the "easy" trimester (i.e. T2) is over - most notably with respect to my swollen feet/ankles. We had our prenatal classes last weekend. They were a compressed version that was all evening Friday and all day Saturday. Sitting in a chair for that long without much walking around made my feet balloon up, and unfortunately they didn't want to go back down in size after the classes were over. (As an aside, the classes were actually quite good. We took them through the Youville Centre and found them quite interesting and informative.) I worked from home for a day this week to try to keep my feet up and give myself plenty of chances to walk around, but the thing that finally worked was compression socks. They're expensive and really hard to put on, but they work (and thankfully they just look like regular socks)!! My doctors still aren't concerned about the swelling and tell me it's normal, but since it's uncomfortable, I really needed to do something about it.

In addition to the swelling, I've also had heartburn and indigestion. I had never had heartburn before pregnancy, but now that I have experienced it I have new respect for those who deal with it all the time (including my husband and some of his family). I also no longer sleep restfully as I'm up every two hours to pee. And then on top of all of this I feel big and clumsy. I think it's a bit of a cruel joke to make someone drop things all the time when she can't easily pick them up. :P Oh the joys of the third trimester.....just giving me more incentive to want to get her out in 6 weeks :) Wow....6 weeks....so soon!

The baby is still moving around a lot and seems like she's maybe shifted positions, but it's hard to tell. Apparently it's quite normal to have heartburn and indigestion with new baby positions, so I guess that falls right in line with how I've been feeling. It seems like she may be bum-up now, but I think still feet down (based on where I'm feeling movements), so it's hard to say. She definitely seems to mostly be on my right side, and she seems to think she's cramped in there because she very often is pushing outward on my belly, trying to make more room for herself. (Personally, I think she has plenty of room - more than my organs currently have, anyway.) We have another fetal assessment on Monday, so we'll find out exactly how she's positioned, and how much room she has, then.

I just had one doctor's appointment this week - with my endocrinologist. It went fine. We did a bit more problem-solving, but everything is still going well overall. My insulin needs are still going up, which is causing some evening highs and night-time drops still, but we have a few strategies to fix that.

Other than that, there's nothing much new. I've started back into my prenatal yoga and find it more difficult than it was 5 weeks ago when I stopped doing it, but it still really does feel good. I managed to go for some longer walks this week too, which helped my feet feel better and gave me a good dose of fresh air. :)

And, finally, here is a picture of me at 32 weeks.

WEEKS 29 & 30 - APPOINTMENTS...

The frequency of my various appointments is really increasing now. It's a lot to juggle, and it's making me a bit tired, but it's WONDERFUL to know that I have such a good group of health professionals looking out for me and for my baby!

First, the non-appointment-related stuff.

I've been starting to feel more tired again. It could have to do with this stage of pregnancy, but I've also been very busy, so that could explain it too. Also, the baby has been putting more and more pressure on my bladder, so my visits to the bathroom are becoming more and more frequent - including during the night, which probably also helps to explain the tiredness. I'd really LIKE to be sleeping well NOW because a good night's sleep will be nothing but a memory once the baby is actually HERE - but it's getting more and more difficult to sleep soundly at night. Oh well...such is the life of a pregnant woman, I suppose.

The baby is moving more and more all the time. Lately it's been a lot of pushing by her, instead of so much kicking. Often I can feel exactly where her head is, but I haven't managed to pin-point any other body parts. Just her cute little head that's still on top (I'm urging her to put in down, but she's not listening to her Mom...practice for the future, I suppose). She still has been getting the hiccups from time to time, which is a funny feeling.

Last week I had an appointment with my endocrinologist. It went very well. My bloodpressure was high, but it's always high there, even though it isn't nearly as high at my OB appointments. There's actually not much to mention from this appointment. I had a couple of things I wanted to discuss with her (e.g. I'm having some mild lows at night), but also had a couple of suggestions for fixing these things. She agreed with my suggestions and said she had nothing else to recommend. I'll be back to see her again next week (the schedule is every 2 weeks now).

This week I had an appointment with my OB again. My bloodpressure was still a little elevated there, but he's still not worried about that. It was pretty soon after I got there (walked), so I'm not surprised it was a bit elevated. Like I said, it was much lower than the reading last week at the endocrinologist. The baby's fetal heart rate was good. Fundal height (i.e. uterus length) is 32cm. Interesting b/c I'm 30 weeks, so it would normally be closer to 30cm. Which begs the question.....were we right about the due date the first time?? Hmmm.....more on that in the Fetal Assessment section below. My ankles are swelling a bit, but he's okay with it. Baby is still breech from what he can tell. He showed me how to feel her head and it's definitely on top! I asked him what the reasons would be for inducing any earlier than 38 weeks, and he said if (a) the baby is big (re: diabetes), but he said that is very unlikely given my good control (all my hard work is paying off!), or (b) if she's no longer getting adequate nourishment from the placenta. So it sounds like 38 weeks is definitely what we're aiming for.

We also had another fetal assessment this week. The baby is over 4lbs now (we can't remember if she said 4lbs or 4.5lbs). She is at the 60th percentile, size-wise. She was 40th last time, but they said the difference is due to the margin-of-error, and that her growth is perfect and that she's still definitely the right size for her age (i.e. new due date is still considered correct). This is a much more precise measurement than the fundal height measurement at the OB's office (i.e. a tape measure on my belly). They said everything looked great and there were no concerns. It is SO good to hear this! I know I've been taking very good care of my diabetes, but there's still the worry at the back of my mind - Is it enough? So far it's definitely been enough because she's doing GREAT! She is still breech, and has her feet up by her ears (she's doing yoga already!), but still has plenty of time to turn. We only got one picture and it's very hard to distinguish because she was being very difficult and moving around a LOT. I'm attaching it anyway....you folks can see if you can decipher it any better than we can. The resident doctor who was observing could see my belly moving from about 4 feet away. They seemed surprised, but pleased, at how much she was moving - although it made taking some measurements difficult, and made a good face-picture impossible, unfortunately. Maybe next time.

I also had a massage therapy appointment this week. I can't remember if I've mentioned this previously, but I have been getting massage therapy every two weeks and I HIGHLY recommend it during pregnancy. It really helps my back and my hips during pregnancy, and it's very rejuvenating too! I think I'd be curled up into an achy little ball by now if I wasn't doing this! I also recommend prenatal yoga for the same reason...but I do have to admit that I put off doing it for about 5 weeks (tsk tsk)...so do as I say, not as I do! ;) That said, I did really feel that it was helping in a lot of ways while I was still doing it, and I have noticed some discomfort creeping back since I stopped, so I can definitely vouch for the value of it! I did it again last night finally and am going to aim to do it at LEAST twice/week from now on. (I've even asked my hubby to hold me to it!)

Another appointment I had this week was with a counsellor from the Youville Diabetes Centre here in Winnipeg. I've been seeing her from time to time for a while, and realized that I should be making the most of her services during the pregnancy and in preparation for labour! This week she did a "hypnotherapy" exercise with me that I REALLY liked! (To clarify - "hypnotherapy" is not "hypnosis" as you would see on TV or in the casino or something like that. During hypnotherapy you are fully conscious and know what is happening, but you're in a deep state of relaxation that allows you (and the counsellor) to tap into your subconscious as well. It's very interesting and I have had some amazing success with it in the past too! Email me if you want to know more about it!) Anyway, this session brought me to a deep state of relaxation, and then helped me to "imbed" in my mind a number of positive thoughts about the pregnancy, the upcoming labour/delivery, and about being a mother. My counsellor recorded the session, and now I have it on my blackberry so I can listen to it (and do it) anytime I want! It's really great and really relaxing!

As an aside, I just want to put in a plug for the Youville Diabetes Centre! This week they celebrated their 25th Anniversary, as well as the re-opening of their newly renovated offices (which are BEAUTIFUL)! Congrats to them!! I always have such a great experience at Youville and have made use of so many of their services - from their Certified Diabetes Educator (three cheers for Michelle!), to a dietician, to a counsellor. Everyone there is so friendly and so helpful and they are a FANTASTIC support for me! (And don't forget that they count on donations from the public - they're a very worthwhile cause and you'll get a tax receipt!) There's my plug - RAH RAH YOUVILLE! :)

Anyway. Long post this week, but that's all for now. Here's my latest fetal assessment picture - maybe you can decipher it better than I can!

WEEKS 27 & 28 - SOME IMPROVEMENTS!

Overall, the past two weeks have been pretty good.

My energy is starting to wane a little and I'm definitely starting to feel bigger and more awkward. Sleeping is starting to get less comfortable too. I wake up everytime I have to turn over, and I also wake up to pee a lot. My right hip has been bothering me still, but it's managable. I'm still craving fruit like CRAZY - mmmmm....pineapple! mmmmm....apples! - and the newest craving is now bread & butter pickles (which have a lot more sugar in them than I thought!), and now coffee (decaf) too! The baby is kicking LOTS - unfortunately many of her kicks are directed at my bladder - my poor tiny bladder! Last week I'm SURE she had the hiccups. It's the first time I had noticed a feeling like that, but it was sure funny! Apparently that's very common at this stage.

My mother-in-law was in town staying with us for a while, so she and I did a bunch of baby shopping. We are now ALMOST done with the shopping! The crib and the changetable/dresser are set up in the nursery now too, but the computer desk is still in there. (We'll be losing our "office" when the baby comes.) It's a bit crowded right now, but that will change soon enough.

The baby is still VERY active, and is putting a lot of pressure on my bladder. On Thursday I had an appointment with my massage therapist and the baby got so active during my massage that my massage therapist could actually SEE my belly moving! Crazy! Also, this week without thinking, I gave my belly a little smack with my hand - not hard, but I guess hard enough because she JUMPED inside me! I must have really startled her!

Last night, my husband and I went on a date! We're not sure how many more chances we'll have for that, so we thought we'd better make the most of a free weekend! Thankfully he's not opposed to dating a pregnant woman :) We had a very nice dinner at Joey's and both ate waaay too much. It was just impossible to pass up the banana bread pudding! Mmmmm...... Thankfully I've gotten pretty good at managing my insulin around little indulgences like that and had a pretty stable bloodsugar evening - even after a decadent dessert! (Have I mentioned how much I love my pump and CGMS??)

I've had two baby-related appointments in the last two weeks. Last week was the endocrinologist appointment. It went very well! My A1C was even better than last time, and is now the lowest it's ever been! (Yes, I rock!) Also, my endo signed my Disability Tax Credit forms (yay!) so now all that's left is for the CRA to sign off on it too. I really REALLY hope they do, because the refund could buy me a lot of sensors!

I had been having some problems with high bloodsugars in the afternoons and evenings and then low bloodsugars at night, but my endo and I devised a few strategies to deal with them, which I have put into practice since the appointment and which really seem to be working! Another yay! :) I also realized that I have a surefire way to keep almost completely stable morning bloodsugars. One word: oatmeal. Yes, from now until the baby comes, breakfast is oatmeal and only ever oatmeal. It's boring, yes, but it's worth it. Thankfully I like oatmeal, and thankfully even instant oatmeal seems to work (even though it has a higher GI value than the non-instant stuff), and thankfully instant oatmeal comes in a wide variety of flavours. I'm also subbing in Red River Cereal from time to time because it seems to work too. With this sort of breakfast, I can get my 2-hour post-prandials under 7.0 and still not go low before lunch! I really never would have thought that I could do that! Thank you Mr. Quaker! :)

The small bit of bad news at my appointment was that my bloodpressure was a little elevated. We're going to keep an eye on that. Hopefully it was an anomoly. It wasn't way too high, or anything, but definitely something to watch, especially because I am seeing some occassional swelling in my ankles. (None in my hands/face, though, so I have no reason to suspect pre-eclampsia or anything.)

My baby-related appointment THIS week was the OB. Everything was A-OK! I'm still healthy and the baby's still healthy! He checked my bloodpressure too and said it was fine. It was still a tiny bit high, but he wasn't worried about it. All of my latest bloodtest results came back just fine too, which is always a relief!

I'm at the point now where I'll be having OB appointments every other week, endocrinologist appointments every other week (not the same week as the OB), and fetal assessments every other week! Ack! Busy! And at some point at least some of these will be moving to EVERY week! Thank goodness my boss is very understanding and accommodating! I'm very lucky in that respect!

Another piece of good news is that my infusion sites are working again! Yay! I'm still using thigh sites with the Silhouette sets. If I put them in too shallow they can be uncomfortable and bruise, but as long as I get them in at a deep enough angle, they've been good! I haven't pulled any out yet either! I still am putting the CGMS sensors in my abdomen, but it's really been a good break to not have the infusion sites in there too!

And now for something I have learned this week: Accurate Carb Counting Makes A Difference!

I was having a lot of trouble understanding why I kept going high in the evenings. I weigh a lot of my food on a food scale (the kind with the database of foods in it that'll tell you how many carbs a certain weight of food has), but I"ve taken to eyeballing a lot too. It turns out that, even when you're a good eyeballer (or think you are), it's worth checking from time to time. It also turns out that some of those standard carb-values we're taught in Carb Counting 101 aren't always accurate. Just to test it out, I measured absolutely everything carb-y on my scale for one meal. It was 20g of carbs more than I would have counted it!! Ridiculous! These days I'm on a 1:5 ratio at supper, so that would have meant I would have underbolused by 4 units!!! That's a big difference! Some of the biggest mis-counting culprits were fruit! A small apple (emphasis on small) was 20g of carbs! I figured a medium apple would be 15, so a small might be 10! I was also miscounting pineapple, and TOTALLY underestimating the carbs in bread & butter pickles! When I actually counted the carbs right and took the correct bolus for them, my bloodsugar was fantastic in the evening! Who would have guessed?!

So, from my lesson, here are some suggestions I would like to offer to you other carb-counters out there who are looking to refine your carb-counting (and, in turn, your diabetes control). Take 'em or leave 'em, but they're making a big difference for me!:

1. Invest in a good food scale - the kind with the database. Mine was about $40 at Canadian Tire, so they're not TOO terribly expensive. They are FAR more accurate than the measuring-cup method. For example - how do you measure a cup of spaghetti? How do you squeeze those wiggly noodles into a measuring cup, and how tight do you pack them in? How do you measure a cup of Corn Flakes when they're at the bottom of the box and broken up vs. the top of the box and whole? A good food scale makes this SO much easier and SO much more accurate! It's also good for measuring anything that has nutritional information on the package, if it's not in the database (or even if it is). For example, a big container of yogurt tells you how many carbs are in 125g of yogurt. Instead of looking it up in the database, you can just weigh 125g and figure it out that way. The one caveat to all this is that you have to make sure you're only weighing the part of the item that you're eating. This is particularly important to keep in mind for fruit. For example, if you put a whole apple on the scale it will count the weight of the core and include those carbs, even though you're not going to eat the core. To weigh it properly, you really have to cut out the parts you aren't going to eat and just weight the parts that you are. But then, if you have a whole bag of apples all the same size, you really only have to weigh one like that, and then you can assume that the rest will be the same. Anyway, I'm a big supporter of the food scale! Rah rah food scales! :)

2. Don't assume that the "standard" carb values we're given in Carb Counting 101, or even on packages of food, are accurate. Don't get me wrong, these standard values are a GREAT place to start, and are MUCH better than nothing, but if you're looking to fine-tune, they may not cut it. My apple example is a good one, but also a piece of bread. There are so many types of bread out there now, and so many sizes of slices, that you can't really assume they're all going to be a standard 15g of carbs (and most of them aren't!) Even when you're reading the bag for nutritional information, you need to consider if all the slices are the same size. With rye bread, for example, they usually aren't. This is another place where a food scale comes in handy.

3. When you think a food is likely low enough in carbs not to matter, read the label anyway! I thought bread & butter pickles would have negligible amounts of carbs - I mean how much sugar could they REALLY pick up from the brine? Well, it turns out that one slice has 2g of carbs! So if I eat 6 little pickle slices, I've just eaten 12g of carbs! That's significant! The same applies to sauces - e.g. BBQ sauce. There are carbs hidden everywhere!

Anyway, if what you're doing is working for you, feel free to ignore all that, but if any of you are trying to fine-tune and could benefit from the lessons I've learned, then great!

(It's funny how I'm still learning so much even after 27 years with this disease.)

Alright, that's enough rambling for this time. Finally, here's a picture of me at 29 weeks, ready for my date last night :)