First, a short follow-up note; I realized that, in my last post, I linked to an article from the BMJ (formerly the British Medical Journal) that requires payment for full viewing. The little lead-in leaves a person hanging (of course): A woman with an A1c of 7.9 discovers she's pregnant. Well, assuming you don't want to pay for the full article, I'll ruin the suspense: The woman (it's unclear whether she's real or hypothetical) ends up having a baby with a heart defect that must be fixed with surgery soon after the baby is born. It seems the baby is fine in the end, but the case is supposed to be a cautionary tale about preparing for pregnancy if you have type 1 diabetes.
The article discusses a lot of interesting (to me, anyway) data about just what A1c to aim for, ideally before getting pregnant, and about just what the risks are with higher levels. But of course, "risk" is a difficult concept; just because the risk is somewhat higher as your A1c goes above 6.0 doesn't necessarily mean you risk is "high." I certainly wasn't anywhere near 6.0 when I got pregnancy, despite my best efforts to prepare; I did get down that low (and even a little lower) during most of my pregnancy, though. In the end, my diabetes wasn't the biggest factor - it was my apparently familial risk for pre-eclampsia (a.k.a. toxemia; high blood pressure during - and sometimes after - pregnancy). Yes, diabetes does increase the risk for pre-eclampsia, but it's common in other pregnant women, too; in fact, it's not very clear why women develop it.
What I've really been thinking about this week, though, is the extra level of multitasking that diabetes adds to parenting. Figuring out how many carbs are in the meal I'm about to eat, plugging that and my blood sugar level into my pump, and accounting for any other factors, like the walk I went on a few hours earlier, or the sprint up the stairs that I'll probably have to do right after my meal to get a toy or book; all while making sure my daughter eats her soup instead of putting it up her nose, and figuring out when she's going to be ready for her nap or bed before she upends the soup bowl as her definitive signal of the meal's end. And that's on the days I'm not working from home, when I'm also keeping in mind word deadlines. Still, work-at-home days are a relief from all the extra planning that it takes to get myself and my daughter out the door.
I've come up with some time-and-energy savers to help simplify - mostly just by making the things I need more accessible, so I don't have to run around so much or think about where they are. For example, I have three blood sugar monitors: One for my upstairs bathroom, one in my purse, and one in my car. I just got one more, so that's going in my suitcase. The one in my purse is the primary one, so I can keep track of most readings that way. But when I'm elsewhere, I can still test whenever I need to. If I were on one floor of my house and my meter were on another, and I was with my daughter, it would be impractical (sometimes impossible) to reach the meter. I admit I haven't tried to keep a log of my sugars in a while; but my pump now lets me download my readings onto the computer, so almost my readings (which I plug into my pump myself) are recorded together there. This does miss the low readings, which I don't usually plug into my pump (because it would just say 'Hey, idiot, don't take insulin right now!' or words almost exactly like that). I tend to remember the real lows, though.
We also have a diaper-changing station in our living room; I know, nonparents are probably grossed out just by the concept, but it helps to avoid those unplanned-for extra runs up and down the stairs that make my blood sugar drop. I've duplicated lots of little items upstairs and down that my daughter uses a lot, too, like sweaters, shoes (too bad she has one particular favorite pair that always seems to be on the OTHER floor from wherever we are), pain reliever, nail trimmers, and some clothing. We have a phone system with an intercom; my husband's used to the near-nightly buzz with the requests I call in for blanket, water, etc. (This system was his idea - I just hope he's not regretting it, but I think he secretly likes his role as runner!).
You know the old saying about necessity being the mother of invention? Well, as a diabetic mother, I've had to do a lot of inventing. Inventing (and constantly reinventing) seems to be a necessary skill for all parents, anyway, especially working parents; hence the reglorification of the crock pot! If you've got other time-and-energy savers you find useful, I'd love to hear about them!
Showing posts with label pregnancy. Show all posts
Showing posts with label pregnancy. Show all posts
Thursday, February 18, 2010
Thursday, February 11, 2010
Moments of grace
I've had a few days of grace: The infusion set in my arm worked, and the next one, in my other arm, is working now, too (knock on wood). I know I'll need to find more sites that work. But not today!
I like that, with the infusion set in my arm, I don't have to worry when I pick up my daughter and she wraps her legs around me. I still get twinges when I used to put the infusion sets in my abdomen, but then I remember I don't have the set there, and I breathe easier. I probably really do need to let those sites rest for a good, long while. I haven't had the problem of her grabbing the site in my arm, say, when I'm getting her dressed. Maybe I have it far enough back on my arm. Maybe it's just luck.
Why did I use my abdomen so much, when we all have it drummed into our heads that you have to rotate sites? Well, for one, I was rotating all over my abdomen; and it worked quite well for almost 10 years. For another, when I'd tried the other sites before (well before pregnancy), it really, really, really didn't work; my BG went way out of control.I think there were far fewer options for infusion sets at the time. Even with several options during pregnancy, when I had this same problem (apparently not because of having a pregnant belly - some women have the set on their abdomens right up to, and even during delivery), I think it contributed to my BG going higher.
Now, I seem to be doing better, although it's only been a couple of days, and I wouldn't say my BG has been perfect. For example, my BG suddenly went to 49 after a dinner I've eaten often and know the exact card count for. Go figure. That quote comes to mind, "You are not obligated to complete the task, but neither are you free to desist from it." (apparently, this is from the Hebrew, from the Talmud). I feel like Sisyphus. If only the task were less mundane than keeping myself alive. But I guess it is more than that, because I have others to live for.
I feel I need to respond to the recent comment about losing a child (fetus) at 10 weeks (and whether you feel it's a child at that stage or not, the feeling of loss is no less). I have not had that experience myself, but I know several women who have (and at much later stages, too) - none of them diabetic. That stage of things is so emotional to begin with. Add the guilt of diabetes, and you've got a real emotional stew. I hope you come to peace with that, Amy. I can't imagine an A1c of 7.1 would, by itself, cause a miscarriage. Geez, I remember when I was on injections, I would have been overjoyed to get that number. I'm still there sometimes now. Yes, it's clearly still in the diabetic range, but who among us isn't, at least before pregnancy? If you want a straight-up discussion of A1c and pregnancy, there was a decent article in the BMJ a couple of years ago. Of course, the article doesn't convey just how hard it is to get the A1c down below 7!
I was so nervous during my entire pregnancy that I wouldn't tell anyone the sex of the baby until about 7 months along (though we knew it very early). We told our parents a little earlier, but no one else. I was so afraid of others in the extended family getting attached before we were sure there would even be a baby. I was so nervous, right up to the birth; I could not let myself believe it would even be possible, until my pregnancy was about 6 months along. Others seem so cavalier about it - as soon as they're pregnant, they're picking out names, making plans, worrying about exactly which baby items would be just right for them. I think I over-focused on my sugars as a way of avoiding thinking about that. I just figured I would do my best, and that was all I could do. But I could not start making plans until pretty late in the game.
From working in the medical publishing business, I know just how often things can go awry in human development - diabetes or no - so I know that actually having a relatively healthy baby is truly miraculous. Our culture gives us a false sense that it is ordinary. I know that is no great comfort when things go wrong; hey, I'm not happy to have happened to get this thing called diabetes, and no explanation of its cause would make me content about it. It's more like context; just because we have diabetes doesn't mean that's the cause of all our ills, though it sure seems like it sometimes, and it does create a gray zone of uncertainty.
I like that, with the infusion set in my arm, I don't have to worry when I pick up my daughter and she wraps her legs around me. I still get twinges when I used to put the infusion sets in my abdomen, but then I remember I don't have the set there, and I breathe easier. I probably really do need to let those sites rest for a good, long while. I haven't had the problem of her grabbing the site in my arm, say, when I'm getting her dressed. Maybe I have it far enough back on my arm. Maybe it's just luck.
Why did I use my abdomen so much, when we all have it drummed into our heads that you have to rotate sites? Well, for one, I was rotating all over my abdomen; and it worked quite well for almost 10 years. For another, when I'd tried the other sites before (well before pregnancy), it really, really, really didn't work; my BG went way out of control.I think there were far fewer options for infusion sets at the time. Even with several options during pregnancy, when I had this same problem (apparently not because of having a pregnant belly - some women have the set on their abdomens right up to, and even during delivery), I think it contributed to my BG going higher.
Now, I seem to be doing better, although it's only been a couple of days, and I wouldn't say my BG has been perfect. For example, my BG suddenly went to 49 after a dinner I've eaten often and know the exact card count for. Go figure. That quote comes to mind, "You are not obligated to complete the task, but neither are you free to desist from it." (apparently, this is from the Hebrew, from the Talmud). I feel like Sisyphus. If only the task were less mundane than keeping myself alive. But I guess it is more than that, because I have others to live for.
I feel I need to respond to the recent comment about losing a child (fetus) at 10 weeks (and whether you feel it's a child at that stage or not, the feeling of loss is no less). I have not had that experience myself, but I know several women who have (and at much later stages, too) - none of them diabetic. That stage of things is so emotional to begin with. Add the guilt of diabetes, and you've got a real emotional stew. I hope you come to peace with that, Amy. I can't imagine an A1c of 7.1 would, by itself, cause a miscarriage. Geez, I remember when I was on injections, I would have been overjoyed to get that number. I'm still there sometimes now. Yes, it's clearly still in the diabetic range, but who among us isn't, at least before pregnancy? If you want a straight-up discussion of A1c and pregnancy, there was a decent article in the BMJ a couple of years ago. Of course, the article doesn't convey just how hard it is to get the A1c down below 7!
I was so nervous during my entire pregnancy that I wouldn't tell anyone the sex of the baby until about 7 months along (though we knew it very early). We told our parents a little earlier, but no one else. I was so afraid of others in the extended family getting attached before we were sure there would even be a baby. I was so nervous, right up to the birth; I could not let myself believe it would even be possible, until my pregnancy was about 6 months along. Others seem so cavalier about it - as soon as they're pregnant, they're picking out names, making plans, worrying about exactly which baby items would be just right for them. I think I over-focused on my sugars as a way of avoiding thinking about that. I just figured I would do my best, and that was all I could do. But I could not start making plans until pretty late in the game.
From working in the medical publishing business, I know just how often things can go awry in human development - diabetes or no - so I know that actually having a relatively healthy baby is truly miraculous. Our culture gives us a false sense that it is ordinary. I know that is no great comfort when things go wrong; hey, I'm not happy to have happened to get this thing called diabetes, and no explanation of its cause would make me content about it. It's more like context; just because we have diabetes doesn't mean that's the cause of all our ills, though it sure seems like it sometimes, and it does create a gray zone of uncertainty.
Tuesday, October 20, 2009
It's the little things...(warning: female talk)
...like a hug from your two-year-old that takes her whole body, wrapped around you. And her grin that lights up her face, and body, and everything around her. And her little voice that whispers sweetly one minute, then shouts "happy" as loud as possible the next, as she stands on the highest (gulp) climbing block on the playground. These little things make it all worthwhile.
And all is a lot, in the case of a diabetic mom. I'm pleased to find out, there are a lot of us sharing our stories out there, and they seem to confirm that this is a crazy disease that upends your life, but that there's a lot we can do to make it work, and a lot we can do to help each other - both in simple support and actual information. It seems we have a lot more in common than doctors realize - it's not just "work with your doctor to tailor your medication and diet to your individual needs," though of course we are all individuals ("I'm not!").
I only wish I had known about all of you when I was pregnant, and reading "What to Expect..." It was more like "What you would expect - if you were normal." We diabetics get relegated to about chapter 500 (OK, I exaggerate, but only slightly). There's a little bit of helpful information, like don't exercise to more than 70% of the "maximum safe heart rate" for your age (and a way to calculate that). But otherwise, it's a list of information written for someone who's never heard of diabetes before - not someone who's lived with it for, say, 20 years.
One reason I'm thinking about this is my sister-in-law is pregnant (actually, both my sisters-in-law are - how great!!). A couple of days ago, she was asking me about my experiences during my pregnancy. And we kept coming up with these points where a regular pregnancy and a diabetic one diverge. Like, what did I think of the advice to avoid all artificial sweeteners during pregnancy? That's one of the pointers I just had to laugh about while I was pregnant. You want me to test my blood sugar 12 times a day, eat like a bird despite massive cravings (nothing like a regular diabetes diet), AND avoid artificial sweeteners (and coffee, while I'm at it)? I don't think so. Not to plug a product, but I had been using Splenda before pregnancy, and I figured, since it doesn't actually get metabolized and passes right out of the body, it was okay, as long as I wasn't guzzling diet Cokes all day. I drank one (strong!) cup of coffee every morning throughout pregnancy, with Splenda, and tried to avoid artificially sweetened drinks and food otherwise, but I did have diet Coke occasionally - better than a margarita, right? (Maybe the coffee is what made my daughter so lively!)
Another diversion from the norm (warning: the faint of heart might want to skip this paragraph): My sister-in-law is getting a bit nervous (as any woman in her position has a right to be) about the impending birth, worried about when she'll go into labor and how she'll handle the pain. I had little advice to offer. For me, the "when" was just "when is the doctor going to fit me in?" because I wasn't allowed to go past my due date and would be induced if it went that long. (Actually, I ended up being induced a week ahead of my due date, because I developed pre-eclampsia and I looked so swollen, I think the OB just took pity on me.) And after 22 hours of labor, I had an emergency C-section (probably just because my baby's head was, well, huge, but also because I didn't progress). I experienced some of the pain (during those 22 hours), with an epidural that didn't quite stay in right (but I was glad to have something!). But of course, when it came time, I had complete pain blocking for the C-section. That said, plenty of women have C-sections, so maybe my experiences will help my sister-in-law after all. Still, not all women have an IV drip (glucose and insulin) attached to them, right from the get-go, and get plopped in the bed, with no chance to stay upright, walk, or do any of those things that move labor along.
It just seems like, with every little thing, diabetes creates an alternate universe, so that you can feel connected to others only up to an extent, but then suddenly your experience veers off and is completely foreign from everyone else's. I love being a mom, obviously because I love my child, but also because it's given me a chance to connect to other women in a way I've never experienced. Yet all these little differences remind me it's not quite the same.
And yet, when my daughter smiles at me, none of that matters.
And all is a lot, in the case of a diabetic mom. I'm pleased to find out, there are a lot of us sharing our stories out there, and they seem to confirm that this is a crazy disease that upends your life, but that there's a lot we can do to make it work, and a lot we can do to help each other - both in simple support and actual information. It seems we have a lot more in common than doctors realize - it's not just "work with your doctor to tailor your medication and diet to your individual needs," though of course we are all individuals ("I'm not!").
I only wish I had known about all of you when I was pregnant, and reading "What to Expect..." It was more like "What you would expect - if you were normal." We diabetics get relegated to about chapter 500 (OK, I exaggerate, but only slightly). There's a little bit of helpful information, like don't exercise to more than 70% of the "maximum safe heart rate" for your age (and a way to calculate that). But otherwise, it's a list of information written for someone who's never heard of diabetes before - not someone who's lived with it for, say, 20 years.
One reason I'm thinking about this is my sister-in-law is pregnant (actually, both my sisters-in-law are - how great!!). A couple of days ago, she was asking me about my experiences during my pregnancy. And we kept coming up with these points where a regular pregnancy and a diabetic one diverge. Like, what did I think of the advice to avoid all artificial sweeteners during pregnancy? That's one of the pointers I just had to laugh about while I was pregnant. You want me to test my blood sugar 12 times a day, eat like a bird despite massive cravings (nothing like a regular diabetes diet), AND avoid artificial sweeteners (and coffee, while I'm at it)? I don't think so. Not to plug a product, but I had been using Splenda before pregnancy, and I figured, since it doesn't actually get metabolized and passes right out of the body, it was okay, as long as I wasn't guzzling diet Cokes all day. I drank one (strong!) cup of coffee every morning throughout pregnancy, with Splenda, and tried to avoid artificially sweetened drinks and food otherwise, but I did have diet Coke occasionally - better than a margarita, right? (Maybe the coffee is what made my daughter so lively!)
Another diversion from the norm (warning: the faint of heart might want to skip this paragraph): My sister-in-law is getting a bit nervous (as any woman in her position has a right to be) about the impending birth, worried about when she'll go into labor and how she'll handle the pain. I had little advice to offer. For me, the "when" was just "when is the doctor going to fit me in?" because I wasn't allowed to go past my due date and would be induced if it went that long. (Actually, I ended up being induced a week ahead of my due date, because I developed pre-eclampsia and I looked so swollen, I think the OB just took pity on me.) And after 22 hours of labor, I had an emergency C-section (probably just because my baby's head was, well, huge, but also because I didn't progress). I experienced some of the pain (during those 22 hours), with an epidural that didn't quite stay in right (but I was glad to have something!). But of course, when it came time, I had complete pain blocking for the C-section. That said, plenty of women have C-sections, so maybe my experiences will help my sister-in-law after all. Still, not all women have an IV drip (glucose and insulin) attached to them, right from the get-go, and get plopped in the bed, with no chance to stay upright, walk, or do any of those things that move labor along.
It just seems like, with every little thing, diabetes creates an alternate universe, so that you can feel connected to others only up to an extent, but then suddenly your experience veers off and is completely foreign from everyone else's. I love being a mom, obviously because I love my child, but also because it's given me a chance to connect to other women in a way I've never experienced. Yet all these little differences remind me it's not quite the same.
And yet, when my daughter smiles at me, none of that matters.
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