Sunday, January 25, 2009

TODAY - A FEW MORE THINGS...

Well, that should bring you up-to-speed on this pregnancy as it stands today. There are a few things I wanted to touch on that didn’t really fit into the previous posts, so here they are now:

Cravings:
I have been SO LUCKY with cravings – especially considering my diabetes! My biggest cravings have been protein (especially salmon and eggs) and fruit (especially apples)! I do crave salt from time to time, and chocolate of course (but that was a pre-pregnancy craving too), but it’s this healthy stuff that really makes my mouth water! This has been especially good as I was trying to get my A1C back down and my bloodsugar back under control, and now when I’m trying to maintain that control!

Doctors’ Appointments:
Obviously pregnancy involves a lot of doctors’ appointments. So does diabetes. As can be expected, pregnancy PLUS diabetes, involves a LOT of appointments! This is my pregnancy-related roster of health-care professionals:

1. Family doctor: I saw him to get the initial pregnancy test, but then he passed me off to the OB and said he doesn’t need to see me about anything else pregnancy-related.

2. OB: I see him once a month for now – but will see him more frequently later in the pregnancy.

3. Ultrasounds: My first one was at week 19. Starting at week 24 I will be having “regular” fetal assessments. I don’t know exactly what they mean by “regular” yet.

4. Endocrinologist: I see her once a month for now, but in another couple of months I will start to see her every 2 weeks, and then every week when I get closer to the end of the pregnancy.

5. Certified Diabetes Educator (i.e. Michelle): I have been seeing her once a month too, but this is actually sort of on an “as-needed” basis. We communicate a lot via email too and she’s great at helping me problem-solve as I adjust to my changing insulin needs.

6. Dietician: I’ve only seen her once so far. Because she was happy with my diet I likely won’t go back unless I have concerns at some point. If she wasn’t happy with my diet, I’d be going back more frequently.

7. Ophthalmologist: I see him once every trimester. In 2007 I was diagnosed with, and treated for, proliferative retinopathy in both eyes, so he wants to keep a close eye on me (pardon the pun). The same growth hormones that run rampant in my body to help the baby grow can also cause vascular growth in my eyes, which is NOT what we want. So far so good, though! No changes noted!

8. Registered Massage Therapist: I see her every two weeks to help me deal with the aches and pains that come with my changing body, including my lower back and my knees (as well as a chronic shoulder problem that goes back well before my pregnancy).

Thankfully my boss is VERY understanding about all my appointments as a good number of them happen on work hours! Also, most of them are within a 3-block radius of my office building, so that makes the appointments nice and quick!

The Pump and the CGMS:
I won’t go on and on here, but I just wanted to reiterate how much of a help the pump and CGMS have been for me during the pregnancy. I am positive that I would not have been able to maintain the tight control that is required during pregnancy if I wasn’t on the pump/CGMS. That doesn’t mean that this is necessarily the “only way” for all pregnant women, but for me…I wouldn’t consider going back. There are adjustments to make between pre-pregnancy pumping and pregnancy pumping (e.g. I had to change the type of infusion set I was using, and I’ll have to work with some alternate sites eventually to keep my abdomen clear in case I need a C-Section), but in all it was a pretty easy transition to make, and well worth it.

Baby Stuff:
Totally non-diabetes related, but I just wanted to say how much fun I’m having accumulating baby stuff! It’s not cheap, so the more you can get used, the better. We were able to buy a number of things used, and we’re getting some used items for free! The rest we’ve bought on some really good sales! Our basements is now full of stuff that’s just waiting to be used – crib, high chair, swing, stroller, jolly jumper, etc., etc. So much fun!

Being Pregnant:
In spite of some of the frustrations (e.g. nausea, bloodsugar gymnastics, etc.), I LOVE being pregnant! It is such an amazing experience! To know that there is a little human growing inside of me, and totally dependant on me, is really something else! I can hardly wait to meet my little one!


And that’s all for now! I will do my best to update this blog on a regular basis. In the meantime, as I said in my initial post, feel free to contact me with any questions you may have (either through comments on the blog or through the email address in my profile)! Even if you have personal questions – give me a try, I might surprise you. If I’m not comfortable answering, I’ll let you know but I won’t hold it against you! I understand that diabetes and pregnancy is a tricky and sensitive subject, and if I can help clarify anything for anyone…especially to put your mind at ease about something…then I really want to be able to do that!

More soon!

WEEK 20 - MEETING THE DOULA AND FEELING THE BABY MOVE!

During week 20 we met with our doula for the first time. She is very nice and gave us a lot of good information. We'll have 2-3 more meetings with her yet before the baby is born. It's great to be able to ask her diabetes-related questions (remember, she's Type 1 diabetic too). I feel GREAT about working with her!

Also during week 20 I was finally quite sure that I was feeling the baby move! He/she tends to be active in the early afternoon and in the later evening (just before I go to bed). I’m looking forward to being able to feel these movements even more!

WEEK 19 - FIRST ULTRASOUND!

This was Ultrasound Week! Yay! We got to see the baby and it was amazing! He/she is a very active baby, and I think I will be feeling a LOT of movement once I can really start to feel it! The baby was kicking and flailing and turning and moving his/her head so much that the technician had some trouble taking all the measurements she needed to! (We may have our hands full when our active baby joins us "on the outside".)

Our technician was excellent and very friendly. She was so nice and answered all our questions and took us on a little baby-tour. We got to see him/her from all angles, and she pointed out his/her organs to us, and even his/her little beating heart (you can see all four ventricles pumping)! Technology is truly amazing!

We weren't able to talk to a doctor about the results when we were there, but the technician assured us that one of the doctors there would be reviewing the results when we were gone and that the results would also be sent to my OB. She did mention, however, that the baby was measuring a bit small. She said the measurements were consistent with a baby of about 17 weeks, not 19 weeks. So...we may be a bit off on the conception date (and, as a result, the due date). We were really pretty sure about the date, but there's always a chance that we're wrong.

I also had an appointment with my endocrinologist this week and spoke with her about the effect of diabetes on the size of the baby. She said that, while diabetics' babies tend to be bigger, some can be smaller too...but that the unusually small ones are typically those belonging to diabetics who are smokers (which I am not) or who have very bad control (which I do not). She really didn't seem to think the size was a diabetes issue, nor did she seem to think it was anything to be concerned about. She said she thinks everything's going well from a diabetes perspective and she's happy with my control (of course with constant "tweaking" necessary as the pregnancy changes my insulin needs).

Here’s my 20-week picture! Look! I look pregnant!!!!!


WEEK 18 - ACHES AND PAINS, MATERNITY CLOTHES, AND BACK TO THE OB

During week 18 I was able to further reduce my Diclectin for nausea. Unfortunately it was around this time that my lower back also started to get a bit sore and my knee swelled up for some unknown reason (most likely related to my joints loosening with the pregnancy). This made it even more difficult to get exercise than previously.

This was the week where I stopped trying to fit into my pre-pregnancy clothes and went out and bought some maternity clothes. I was pretty impressed with Motherhood Maternity. I was able to get some nice clothes there at VERY reasonable prices! Maternity clothes today are NOT like your mother’s maternity clothes…they’re pretty cute! And I have to say – they’re also pretty comfortable. I’ve warned my family not to be surprised if I wear maternity pants to Christmas dinner next year! :)

During this week I had my second appointment with my OB. We got to hear the baby's heartbeat again, which was great :) We also found out that, during my regular fetal assessments starting around week 24, we will find out the gender of the baby (which we have wanted to know). Other than that, there was nothing significant that came out of this appointment. Everything was progressing as it should be!

WEEK 17 - LOOKING MORE PREGNANT!

Nothing much in week 17, but here’s a picture of my belly starting to grow.





WEEK 16 - CHRISTMAS!

The holiday season was great! I was feeling really good (for the most part) and much more energetic than in the 1st trimester. My appetite was rather...hearty...which is good right around Christmas, I guess. :) I finally started gaining weight, and while on Christmas break, I "popped" and started looking quite pregnant! Managing my bloodsugar was a challenge (as being diabetic at Christmas always is), but with a lot of monitoring, lots of bolusing for food, and lots of compensating for exercise (even a walk in the snow drops my bloodsugar a LOT more now than it did pre-pregnancy), I made it through relatively unscathed! My husband and I definitely enjoyed our last Christmas with no baby, but are REALLY looking forward to next Christmas with a new baby! So exciting!

During this week I also tried pre-natal yoga. Keeping active has been a bit of a challenge for me because I had such low energy-levels during the first part of the pregnancy, and so little time between my work schedule and my increased sleep schedule! I enjoyed the yoga, but found it a bit hard to adjust to compared to the yoga I’m used to. (There are a lot of variations in poses to keep both me and the baby safe and comfortable.) Walking has been the best exercise for me for the most part (when it hasn’t been too cold out). Many women find that they can keep quite active during pregnancy if they’ve been active before they get pregnant, but some (like me), do find their energy levels greatly reduced, particularly during the 1st trimester. (Plus, I generally find it much more difficult to be active in winter than in summer, so that’s not helping either.) The best advice is to do what you can…and the further I get in my pregnancy, the more I find I’m able to do.

WEEK 15 - MORE APPOINTMENTS

Week 15 was fairly uneventful. I saw my endocrinologist during this week, as well as my CDE (Certified Diabetes Educator – or Michelle, as some of you know her). My A1C had come down significantly since my last appointment a month ago, which was really good to see. At this point my bloodsugars were also starting to drop, though. The high trends of the 1st trimester became low trends of the 2nd trimester. This, oddly, is the reverse of what most women experience, which just goes to show that pregnancy does NOT affect all diabetics the same way! There are no hard and fast rules about what to expect – it’s all about close monitoring and being flexible about making changes when they’re needed.

WEEK 14 - CONNECTING WITH A DOULA AND A VISIT TO THE DIETICIAN

The highlight of week 14 was that I got connected with my doula! She is from Birth Roots Doula Collective (http://www.birthrootsdoulas.com/). As I was looking at their website, I noticed that I recognized the name of one of the doulas as a woman from Steinbach (my hometown) who also has Type 1 diabetes! So when I registered with Birth Roots I asked if I could be paired up with her. Because she has 3 small children herself, she will not be able to be "on call" for the birth itself, but she was very excited at the possibility of working with me, so she will be my doula along with another doula from Birth Roots. I have my own little doula team! I feel very fortunate!

We will meet a few times before the birth and then this second doula will be with me for the whole labour and birth process (no matter what time of day/night). It will be so nice to have that support! Statistics show that using a doula greatly increases the chance of having a "positive birth experience", partially because of the support, but also because of the pain management techniques they teach, and I'm all for that! My OB was very supportive of this decision too, and actually knows my doula quite well (and even delivered two of her babies)!

By week 14 I had actually gained no weight at all yet, even though my stomach was definitely protruding. My metabolism has really changed a lot with the pregnancy, which means my diabetes care requires constant tweaking…but I’m managing to stay on top of it. I saw a dietician at the Youville Diabetes Centre during week 14 as well. She was quite happy with my diet – especially with the amount of omega-3 I’m getting, thanks to the salmon cravings I’ve been having! (More on cravings later.) It was good to hear that I seem to be on the right track!

Another good thing about week 14 was that I was able to start reducing my Diclectin for nausea! I probably could have done so sooner, but I’ve been so cautious because I get worried that making reductions too soon could give me nausea problems again and throw off my bloodsugar levels again…and it just hasn’t been worth the risk.

WEEK 13 - FIRST VISIT TO THE OB....HEARD THE BABY'S HEARTBEAT!

Because I have Type 1 Diabetes, I am considered to be a “high risk” pregnancy – no matter how well I control my diabetes. Being “high risk” means that I see an obstetrician (OB) throughout the pregnancy. During the 13th week, I had my first appointment with my OB. We got to hear the baby’s heartbeat!! It was so amazing! The doctor said it sounded just like it was supposed to. :)


It’s really something else to finally have that proof that there is really a baby in there!My husband and I both REALLY liked the doctor. He is a very kind and caring man, with a great sense of humour, and a willingness to give me lots of time to answer questions and put me at ease. He said that he is very comfortable with my level of diabetes control and feels that the baby will be fine if I continue with this level of control (which I still am striving to improve every day). He does expect to induce me at around 37 weeks (i.e. mid-late May), which is common for diabetics.

There are two factors that play into this early induction. First, it is common for diabetics to have larger babies. This is because my bloodsugar tends to be higher than that of a non-diabetic’s, and higher than that of my baby (no matter how hard I try to keep it at reasonable levels). As such, my baby’s body produces extra insulin to make sure that it can maintain non-diabetic bloodsugar levels, even with the added sugar coming from me. This extra insulin, being a growth hormone, causes the baby to grow larger. Second, according to the doctor (and this is something I was not previously aware of), with diabetic mothers sometimes the baby's heart will suddenly stop around week 40, and clearly that is NOT something we want to have happen. So as soon as the baby is fully developed, even if he/she is not an exceptionally large baby, the doctor would like to get him/her out of there. I was hoping not to have to be induced, but obviously the biggest concern is for the safety of the baby, and if that's what the doctor thinks is best, that is what I will do.


I will be having very regular appointments with the OB, as well as regular fetal assessments (i.e. a special type of ultrasound) starting around week 24 just to keep an eye on the baby and make sure his/her growth is reasonable and consistent.


My OB's biggest piece of advice during my first appointment was to get lots of sleep! Done and done! :)By this point I was finally starting a little baby bump! Here’s the proof:

WEEK 12 - PREGNANT AND SICK....UGH!

Week 12 was an eventful week. Unfortunately not in a positive way.

On Monday night I came down with a terrible stomach flu. By Tuesday morning I realized I needed to go to the hospital to keep from getting dangerously dehydrated or running into a risky situation of diabetic ketoacidosis. My bloodsugar wasn’t horribly high, but I was running some pretty bad ketones already (which I’m prone to do when ill). Thankfully 7am is a good time to show up in the Victoria Hospital ER because we didn't have to wait in the waiting room at all!

Long story short - they rehydrated me, gave me an IV antinauseant, and enough of a sugar drip that I could take a bit of insulin. The doctor ran a bunch of tests and came to the conclusion that it was most likely just a virus. He said that the baby would be fine and that, since I came in to get rehydrated, there was no danger to Bud. Whew!! (Note: Never let yourself get dehydrated while pregnant! It’s a very unhealthy situation for both mother and baby!)

Certain unpleasant aspects of the flu lasted for another day and a half or so (I won't elaborate...), but I was able to keep moderately hydrated even though I was in a lot of discomfort. I was also able to keep my bloodsugar at a reasonable level (not “good”, but “reasonable”), and to keep the ketones mostly at bay. During this time I was SO thankful for my insulin pump (I’m on the Minimed Paradigm 522). It made managing my diabetes during illness SO much easier! I don’t know how I did it in the past on Levemir…nevermind Ultralente or NPH! In fact (as a little aside here) the pump and the CGMS have been GREAT during pregnancy. The pump made it so much easier to deal with the nausea in the first trimester, as well as the “I-want-to-eat-now” cravings throughout the pregnancy! The CGMS has been great for helping me keep a close eye on my levels without doing tons of fingersticks every day, and lets me feel much safer overnight as it warns me if I drop too low or shoot too high. Yay pump and CGMS! (Now if only my insurance would cover the sensors…but that’s another story.)

Almost exactly 48 hours after it started, the worst was over, but I still had some lasting effects - most notably, my digestion seemed to be extremely slow for about a week after the flu, which caused some problems with my bloodsugars. Since I wasn’t absorbing sugars/carbohydrates very quickly, my insulin needs were much lower and on a totally different timeline than usual (i.e. CRAZY different!). I had a very scary low bloodsugar on a couple of days after the flu as a result. After the flu, I weighed less than I did before I was pregnant, but I did have a definite "roundness" to my belly by that point, even though my stomach was virtually empty. :)

So I made it through one of the worst stomach flus of my life – while pregnant! Whew! Since then I have been a very diligent hand-washer! J It’s not something I want to go through again!

WEEK 10 AND PRIOR - AM I PREGNANT?

The whole process of determining whether or not I was pregnant was an interesting and unusual one. During September and early October, I was finding that I was extremely tired and mildly nauseous from time to time, but I had been sick with a couple of cold viruses, so my husband and I assumed that was why I was feeling the way I was. Even so, since we had been trying to conceive (albeit for only a very short while) I decided to take a pregnancy test. Negative.

Still, I just wasn't feeling like myself and couldn't explain what was dragging me down so much. So, in another week or so, I took another pregnancy test - just to be sure. Negative.

A couple of weeks later, I was starting to feel a bit better, but still just not right, so I took a THIRD test. Negative! We were convinced that I was NOT pregnant, and that I was just fighting off a bug of some sort, and maybe just had the "winter blahs". Unfortunately, during this time my bloodsugar was all over the place – mostly too high (which is unusual, because low bloodsugar is actually more typical of the first trimester). My A1C went up and my stress went up, and my diabetes care went down as I just didn’t have the energy to think about it. (My endocrinologist wasn’t too happy with my A1C at my first pregnant appointment around week 10…and neither was I.)

Then in mid-October I started to get some abdominal cramping. I did some Googling (as I'm prone to do), and started to find a lot of information about pregnant women getting cramps around week 6. So, I did what I should have done earlier, and made a doctor's appointment. On October 23rd, we found out that pregnancy tests CAN be wrong - I was almost 8 weeks pregnant! After that, my pregnancy symptoms were actually very manageable. It was so much easier to handle now that I knew the reason that I was feeling the way that I was. I started getting a lot more sleep, which took care of the fatigue. The nausea started to get more intense around the 9th week, but I started taking a baby-safe medication for morning sickness called Diclectin, and after fiddling with the dosage a bit, it completely took care of the nausea. I was SO glad for this, because as a pregnant diabetic, it's so important to be able to eat properly in order to manage my bloodsugar. So as long as I got enough sleep and took my pills, I felt pretty good actually! It was around this time that I really settled into the pregnancy and started to enjoy being pregnant!

INTRODUCTION

My name is Bethany. I’m 30 years old and I have had Type 1 diabetes since I was 3. A few months ago, my husband and I decided we were ready to start a family. This is a big step in anyone’s life, but as a diabetic there were a number of additional factors to consider: my ability to tightly control my diabetes during pregnancy (especially during morning sickness), my health as a pregnant woman, the viability of the baby (i.e. potential for miscarriage), and the ultimate safety and health of my baby! Having heard many successful stories about diabetes and pregnancy, we were very optimistic, and also quite unwilling to let diabetes stand in the way of creating a child. With the go-ahead from my endocrinologist, we decided to try…and within a very short while I was pregnant!

Recently a friend of mine encouraged me to start a blog about my pregnancy in the hopes that other women considering pregnancy could have some questions answered and be encouraged that a healthy pregnancy IS possible as a diabetic! Of course, there is still the possibility that I may encounter some bumps and complications along the way, but this is true of ANY women – not just diabetic women. If you are a diabetic woman wondering if pregnancy is right for you, I hope my story can help you to figure that out.

Feel free to post questions in the comment section of the blog posts or email me (link in my profile)! Even if you have personal questions – give me a try, I might surprise you. If I’m not comfortable answering, I’ll let you know but I won’t hold it against you! I understand that diabetes and pregnancy is a tricky and sensitive subject, and if I can help clarify anything for anyone…especially to put your mind at ease about something…then I really want to be able to do that!

I do have to add one disclaimer, though. It is VERY important to note that both pregnancy and diabetes can differ significantly from one woman to the next. As such, my experience as a pregnant diabetic may be very different from yours. Please take my stories and comments (as well as any email responses from me) as an example only and NOT as medical advice. If you are considering becoming pregnant, or if you are already pregnant, please discuss your specific situation with your doctor.

As I write this, I am currently 21 weeks pregnant. Instead of bringing you into my story half-way through, I’d like to first bring you up-to-speed on the last few months. Following are a number of posts that summarize some of the more notable events during weeks 1 to 20 of my pregnancy. Once we’re caught up, I’ll try to post every week or two to keep you updated. I hope you enjoy following along!