Sunday, March 21, 2010

wayward travels~

So the guy and I are headed to Arizona this week---only one state away from here. While I'm excited about this trip (we love being outside hiking, camping...) I'm also nervous. Last year we went to Seattle (I was still on injections though, mind you) and while I didn't have absolutely terrible numbers, I do remember having a hard time because it seemed like my basals were off. Heavy on the corrections. Then again, I was on Lantus...when is your basal ever right with Lantus? ;)
All of the literature out there says that going west is easy because you're gaining hours and just cover for it. Apparently going east is the worst. Any advice for how to make traveling a smoother transition when you're on the pump and do have the option to fiddle with your basals a bit?
I'm just a bit sad of late because my first post-pump A1c is coming up and it seems like a dreaded exam. I work so hard to keep my numbers in check with this disease and I just can't get a break on my averages ever since going on the Ping. I mean, I love the pump: it's made my quality of life easier and better, I love being able to turn my basals up and down according to activity or place in my cycle, and the wave patterns, while I'm still figuring them out, make me a happy camper (post-topic pun intended) :)
But my work has more than the I'm-trying-to-stay-healthy-for-my-own-sake purpose now. I'm trying to get my numbers back in check to plan for a baby, for pete's (who's pete, anyway?) sake. And it's stressful. And everyday, the harder I try, the worse I seem to fail. Ok, that's not completely true. But after having a great week, my numbers suddenly blew up in my face. Again. I was so proud of myself! But that's always when the D-bomb explodes: BAM! Have a great day, Emily! I'm here to remind you that you will never have it easy!
I know it'll never be easy. There are easi-er days. But don't we all live for those days? I know I do. You know the ones: your 'type 1 stress' decreases, and just by nature of seeing those non-diabetic numbers pop up on your meter, your mood increases and you feel like twirling. Ok, maybe not twirling. Rock climbing, if that's what you do. :)
I don't mean to sound like a downer. It's just that a trip is supposed to be fun and exhilarating and refreshing...sometimes now, with this disease, it just feels like a whole lotta mess to plan, you know?
Well, enough of that. BLEH!
I'm hoping this time outside will have a positive effect. Lots of sunshine, hiking, visiting friends, seeing my first saguaro cactus....did you know it takes them hundreds of years to get so tall? They work so long and so hard to become what they are: elegant, tall, reaching for the sun above and the moisture below. Often pocked and scratched and scathed, their limbs tell a story.
We weather the storm, folks. We can always weather the storm.

Monday, March 8, 2010

Book Review: "Balancing Pregnancy with Preexisting Diabetes" by Cheryl Alkon (available in April!)~

There are books.
And then there are bibles.
You know how everyone buys everyone "What to Expect When You're Expecting"...because it's (apparently) the "bible" to read... when you're expecting? Well, Cheryl's book is going to be the bible for women with diabetes trying to plan a pregnancy....only better. Not only because it's for women living with either type of diabetes trying to plan [mostly their first] pregnancy, but because she doesn't skim. Anything. Her book is that book. You know the one. The one Every Woman With Diabetes (especially type 1) has been eager to get her hands on regarding this topic, but without any luck. Sure, there are mini sections included in books about managing diabetes in general, but those were mostly written by men and while they'd offer hints about it (read: It's Gonna Be Hard!) there's never been anything beyond this and oh, my personal favorite: talk with your doctor.

Cheryl Alkon is a type 1 diabetic. She also experienced the trials and tribulations of infertility. She is incredibly open all throughout the book about how difficult it was for her to get pregnant, and purposefully uses the interviews of countless women that experienced the "fun" that pregnancy brings with a disease like diabetes. While she really lays it out on the table for her readers, she is also incredibly encouraging and intelligently weaves the difficulties together with the absolute possibility that you can make this happen. On that note, you can trust that she did her research, knows where you're coming from, and truly wants to be a mentor to all women in this sometimes mind-boggling pursuit.

The book is broken into 4 main parts:
How to plan your pregnancy (preconception issues), the First Trimester, the Second and Third Trimester, Labor&Delivery, and (rather than dropping the ball on us right when we need her) discussions of Postpartum care. She then goes on to offer an Appendix focusing on Infertility and Pregnancy Loss. The Glossary, Resources, and Notes are also very helpful in helping you to go and find specialty books, blogs, groups, etc that center on your needs.

Preconception-
  • Questions to ask doctors (especially those you think you might have deliver).
  • Ways to bring your A1c down.
  • Different insulin therapies and what might be best for you (especially if you think you need to change, ie, from MDIs to a pump).
  • How to eat while planning.
  • Dealing with your health insurance, especially so you know what will be covered and what won't be (a very important point not often made, I felt.)
  • How to deal with an unplanned pregnancy with high blood sugars and risk factors involved (she really does keep it real!)
The First Trimester-
I love that the first thing she tells us is "Enjoy the Moment". She really lays out your biggest fears and frustrations after seeing that positive test result, but goes on to really pump you up for the challenge ahead.
  • The importance of self-advocacy, knowledge as power, getting support, and how to deal with annoying people who still think diabetics die trying to have children.
  • What to eat, what not to eat...with heavy input from other women on how they managed cravings/aversions, morning sickness, and the changes beginning to happen with basal and bolus needs. I have to say though, the food issue is woven all throughout the book. Very helpful!
  • The many tests you will go through initially (great preparation!) and throughout, but also optional tests offered. This is an important section because knowledge truly is power. The more we know going into this, the more you will be able to understand why providers are doing it---let alone how knowing what to expect decreases your stress level.
  • Alternative birthing options: I nearly fell out of my chair when I saw this section. I have been working to plan as natural a birth as possible, and it was just amazing to see that Cheryl knew there are women out there who would like to know if this is an option. So she researched it, discusses the pros/cons and best candidates, and as always, offers story after story to provide examples.
The Second and Third Trimesters-
  • She really breaks down how blood sugars [typically] react during each trimester. Through the many examples, she offers readers strategies for dealing with the fluctuations. While you will hopefully have a good team of providers, I found all of the women's examples to be extremely helpful.
  • Suggestions for testing more often (since this is the time of greatest insulin resistance.)
  • More eating suggestions (one of our biggest concerns! Cheryl rocks!)
  • The importance of, but also the how to of exercise modification in these trimesters.
  • The possibility of going to 40 weeks (or not).
  • The pros/cons of a birth plan.
  • The many options for labor and delivery and how your disease plays a role in the decision.
  • How to prepare for going to the hospital as a diabetic: what to pack, wear, extras to bring.
  • The benefits of working with a doula and how to find one if you like the idea.
  • The option of cord blood banking (something I'd honestly not thought about until this book.)
Labor and Delivery-
She prepares you for the best and worst.
  • Options for insulin infusion: the pros/cons of IV drip vs Pump Delivery (depending upon your situation.)
  • Managing through a more natural labor&delivery process.
  • What usually occurs to your blood sugar and suggestions/stories about how to manage highs and lows no matter what type of delivery you have.
  • What happens if you need a c-section and how your BG will react, food issues, healing, etc.
  • What to do if baby comes out low and how to emotionally manage a NICU stay, if it is needed.
  • How your insulin needs change immediately after birth (especially the lows!)
  • A huge section on breast-feeding, including tips and discussion by other moms.
  • Formula-feeding and the concerns women often have about it surrounding diabetes.
  • Dealing with lack of sleep, the possibility of developing Postpartum Depression, returning to exercise and work, and even birth control options.
Appendix: Infertility and Pregnancy Loss-
I think this section was very heartfelt and necessary in a book about pregnancy and diabetes. Because we have so many concerns about having healthy babies, the possibility of not being able to get pregnant or stay pregnant is definitely on our list of concerns with this disease. But Cheryl offers a lot of real encouragement (she went through it herself) and reality-based information about what to do if you are faced with this added complication...especially in how infertility treatments and stress itself interacts with your diabetes. The section on miscarriage, while short, is something I think women should read and remind themselves of if they're on the "family quest" and it hasn't worked out yet. All too often, it is only the negative we are made to focus on, but the author does a lovely job of sharing support through tips and stories from real women who have gone through it.

On a personal note, this book came at just the right time for me. I am 29 and planning my first pregnancy with type 1 diabetes. I was completely freaked out and frustrated there was so little information out there regarding managing the disease while pregnant. When I took her suggested questions to my preconception appointment, the doctor was very impressed and excited about her book. More importantly, I've been excited and impressed! The tips and stories she weaves throughout the book are better than any textbook discussion on diabetes and pregnancy that I've ever seen. Her writing style and voice, while intelligent and articulate, are easy-going, funny, and approachable---truly like a girlfriend who goes out to talk about it with you. But the best, the very best thing about this book is that she makes managing pregnancy with diabetes possible. She actually cheers you on throughout her work; tells you that you can do this and that you know more than you really give yourself credit for. There were honestly times I got tears in my eyes while reading it.