Monday, April 25, 2011

It's a damn wrecking ball~

Frankly, this is how I feel regarding this bloody disease lately.

To continue on with the 'building' metaphors, I feel like I built such a strong foundation in my body last year as I prepared for pregnancy. And ya, the building went up, strong as granite, built to protect my sweet Littlebird. He grew and grew and I stayed healthy all throughout.

Then he was born.

I can barely begin to describe the havoc that post-pregnancy hormones wreak upon a type 1 diabetic woman's body.
Sigh. Guys have it so much easier.
Combining all of the pregnancy regulating hormones still processing out of the body, on top of the ones it needs to produce all this milk, let alone the mess type 1 creates in and of itself on a daily basis...I'm a wreck. I feel like a wreck.
Then I got my bloodwork back last week. I was honestly really freaked out about my thyroid panel results. I know that type 1 and autoimmune thyroid disease often go hand in hand (nice) and that women's thyroids often get wonky after pregnancy in I feared the worst. But I kept talking to my body (I'm really into mind-body medicine) and kept saying to myself how I rejected getting another autoimmune disease (go ahead and laugh). Maybe it worked. Or maybe I was just lucky this time around, but my results came back fine.
And my A1c was 5.6%
Good? You readers might be jealous, but I'm honestly not sure how to take it. I know that number is due to a lot of post-breastfeeding lows that I'm still trying to work out. I've found that if I do a temp-basal of 80% for 2 hours after each feeding at night, it prevents the impending low. My CDE wanted me to just snack, but I was like, "um, all I'm thinking about is sleep, not eating at 2 a.m." So that's how I tinkered that temp basal right. But during the day I make sure I snack because otherwise I'll not be replacing the calories I lose through feeding him. I'm already starting to lose weight a bit too fast (I only have a few pounds to go until I'm my pre-pregnancy weight....not exactly a good thing considering I'm such a small gal, ugh!) So I'm trying to monitor this issue closely so I don't become like er, 1995 Kate Moss.
Then last week, I started having more post-partum bleeding. Not heavy, but it upset me because immediately my blood sugars started to go NUTSY. We're talking insulin resistance that caused my numbers to skyrocket. I even hit a 400. So I changed out my site and did a major pump and dump session of breastmilk. Talk about waste. And diabetes guilt. I was so mad. I was so tired. I felt so....disgusted.
Are you getting the picture? I'm up, down, up, down. Like one of those freakin' circus hammer bell games.
The most frustrating thing is that I'm generally a healthy eater. (Point: we went out to eat with a friend Friday night and I ordered Beet Loaf. You read that right: BEET LOAF. Why? Because I happen to like the damn stuff!) and I ended up with BGs in the near-300's. (Yes, it was a balanced meal. And yes, it had protein.)
Then, just as I was thinking about this stupid post and possibly freaking out more about this stupid freakin' blood sugars stabilized. Interesting that it happened right as that extra postpartum bleeding I'd started having stopped. That's why I hate hormones. Pregnancy was hard, but this....this is sometimes just pure insanity.
Because I'm caring for another little human being. And the irony of it is that I'm no good at caring for him if I don't take care of myself first. There's no healthy Littlebird if there's no healthy Mamabird to take care of him.
So I'm trying to refocus. To stay calm when things skyrocket or bottom out. To keep positive because I'm actually not doing that bad (read: it's not like every blood sugar's been 300). It just takes time. My superwonderful OB told me at my postpartum check up, "it's kind of a lie to tell women that they're fully postpartum and ready to 'move on' at the 6 week mark. Like it's this magic number where your body's just back to normal. It's more like 3-6 months!" So as my body recovers, I need to remember the process is not just from the physical act of giving birth, but all of the complex, chemical, internal processes that had to occur to make a baby, let alone feed one now. With my own body, (yeah that's amazing, right?!)
I'm just trying to stop judging myself so harshly. I've always been my worst critic. Not a good disease to have with perfectionism, I'll admit. :) The ways I've been easing things now are just by keeping my foods really, really simple (whole foods like yogurt, almonds, wild rice, cheese, dark greens, eggs, apples...and keeping a lot of snacks on board to prevent those breastfeeding lows and also so I can keep my meals small to prevent any spikes.) I've also promised myself a 30 minute walk each day during the week just to clear the babyfog. It's nice because I get to listen to my Ipod while the tinyman sleeps in his stroller. A good time for headspace.
As my CDE said, "we're getting there" and she's right. It's a journey, not a destination. I need to remember that. This is a day-to-day thing. I made it through one of the toughest scenarios with this wrecking ball of a disease (a pregnancy) and managed to build a damn palace out of it (my son) so I think I deserve a little credit after that week of pure hormone hell that I had last week. So my CDE's gonna be saying 'we're getting there' as long as I'm alive with this disease.
And I plan on being alive with it for my little birdy for a very, very long time.

Monday, April 11, 2011

guidance for planning a type 1 diabetic birth (just my 2 cents) ~

I wanted to write this post because now that littlebird and I are settling in, I know there are still a lot of unanswered questions and/or thoughts regarding my pregnancy and birth. There were certain things (especially towards the end) that were very, very helpful that I think gals can take advantage of and try doing in an attempt to have as healthy and natural a labor and delivery as possible. Of course, as you can read from my birth story below, not everything always goes as planned (ie, I ended up getting an epidural and some pitocin assistance even though I went into active labor on my own). As far as getting my body into natural labor though....hmmm, well, you can leave that up to the "experts" if you like, but I truly believe that many of the things I was doing during my pregnancy and especially those couple of weeks before littlebird's delivery (weeks 37-39) assisted in essentially opening my body up for his arrival (ie, going into natural labor rather than being induced).

[Added later: I just thought of this, but feel it's really important and helpful. If you can, please buy Cheryl Alkon's book "Balancing Pregnancy with Preexisting Diabetes". No, she didn't pay me to say that. :) It's really just the most informative book out there on the subject and you won't regret her guidance.]

Things I think are essential to a healthy Type 1 diabetic pregnancy:

Plan it. Don't ignore the things you need to work on.
Yes, it's that easy. And that hard. Give yourself at least 6 months to do this. Whether you need to get your weight under control, your BG in better control, or your emotional state...just plan it. Go after it with fire and fight if you have to. If you want a healthy kid, the best thing you can do for them and yourself is go into it with your best state of physical and emotional health. If you don't do this and just "wing it" (like my CDE told me some gals do because they're just so frustrated and drained and just want a baby---can I hear a collective W.T.F?!) you will end up being extremely stressed out that first trimester. As if you won't be enough. Don't add fuel to the fire! Not only will you be nervous from knowing this is the window most common for 'regular' miscarriage---a fear every woman has---but also all the fears your diabetes brings up. Increasing diabetes-induced stress is a big no-no, in my humble opinion. Don't do that to yourself. It's not worth it. I was so nervous when I got pregnant but....I knew my body and mind were healthy and doing well. I knew my type 1 was in control when we got pregnant. I knew it wasn't an issue. I was better equipped to handle those common 1st trimester lows. I was also not sitting there royally freaking out during those early 1st trimester ultrasounds wondering if his brain, heart, and spine (those most affected by out of control blood sugar during conception) were ok. Deep down, I knew my kiddo was ok and if not, it was most likely not due to my type 1 and we'd just deal with all that from there.

Pick your OB and pregnancy CDE (and if you can, Perinatologist) before you conceive.
The OB is most important, I think, because they make the final calls on how and when you deliver...and will actually be delivering your baby. Trust me, you need to love them. Not just be "ok" with them. You need to really respect and be comfortable with your OB---and feel they give you the same. These are, most often, the 3 you will see---depending upon your state of health, you may have other specialists assigned to assist you. I just saw these 3 providers. Also, your CDE absolutely needs to know pregnancy and diabetes inside and out. If not, you're going to have a very hard time. While I loved my OB, he also didn't know the ins and outs of how to deal with my type 1. You will, with a good CDE, be talking to them weekly (or moreso) to make adjustments...especially when you hit that insulin-resistant phase during the 2nd trimester and literally might need changes every few days.
*A note on perinatologists: I met several before I got pregnant in my planning phase the year before littlebird was even conceived. Now, if any perinatologists are reading this, please don't be offended. :) Honestly, I felt that many of them took the same approach. They all wanted to automatically induce me at 38 weeks and due to their training, obviously, they are not really around "natural" birth a lot. They're dealing with high-risk pregnancies all day long, after all. So what I'm saying is that you need to keep this in mind if you end up with someone a bit *ahem* high-strung. It's their job to worry a lot and make recommendations based on the reason you've been referred to their clinic, ie, your disease process[es] present. If you're not into natural birth, most of their suggestions and input will be welcome. In my case, I felt mine went overboard a bit; however all in all it went very well. My point: I think choosing your OB (the person who would actually deliver your wee one) is more important than the Peri---the doc making recommendations from your ultrasound and fetal monitor results.

Decide if you want to manage your Type 1 DM via your pump (yourself) or via IV insulin drip.
My recommendation is that you use your pump (if you have one). I never met resistance with this idea at the hospital I ended up choosing. Strangely enough, at the local University hospital when I was interviewing OBs there, they preferred IV insulin. The problem with IV insulin during labor is that, as we already know, insulin's pretty difficult to measure. It's got quite a window of error with syringe measurements. We also know that IVs aren't that accurate as far as giving you a dose (that really needs to be as accurate as insulin needs to be). Think of how it is when you try to give yourself a quarter of a unit via insulin syringe. Difficult, right? So, my point is that if you can get on a pump or use your own pump, do it. You'll be able to make small corrections as needed or even disconnect completely if you're so sensitive at the time---giving birth is like running the marathon of your life. You'll be under a lot of stress though, too, so that's why it's important to be able to give yourself those minute corrections, if need be. Also, just think of how nice it is to not be hooked up to an IV the entire time you're in active labor at the hospital....ugh.

Hire a Doula.
This is a woman who assists and advocates for you during birth. I don't care if you're having the most medically intensive birth you can imagine. It's helpful to both you and your partner to have someone there to qualm fears, tell you you're doing great, offer guidance---other than your partner. They're going through their own "labor and birth" in a way. They need just as much support as you do! If you give your partner a job (MAC's was to check my BG every 30 minutes+ and to also love me up as much as possible [believe me, you need positive reinforcement when in active labor!]) they will be a TON more helpful to you than if they just stand there and have the opportunity to freak out more. They need a job; it makes them feel a helluva a lot better about watching you in a situation they've never seen you in.

Pack your own snacks and juice boxes.
Then, if you have a low, you know the exact carb count on the juice box and snacks and don't over-treat because you just eat or gulp from some random cup the nurses hand you! I don't recommend your favorite low BG treatment, whatever it is, i.e., Skittles. If your nauseous (which you will most likely be) I suggest apple juice: it's neutral in flavor mostly and non-acidic. Don't bring orange-juice---way too acidic and most women will vomit from it. Sorry to be so graphic, but that was some good advice from my own doula---because when the time came to need juice in labor, I was so damn grateful for that plain apple juice!

Drink Raspberry Leaf Tea all throughout your pregnancy.
This herb is one of *the* women's herbs. It's specific to the uterus and while it does not bring on labor, it certainly makes it more efficient as far as contractions go. It also tones the uterus (as it is smooth muscle) and is just soothing in general. It is also astringent, so will assist
postpartum with your bleeding.

If you want to try to go into natural labor, use Evening Primrose Oil capsules.
You will insert 3 of these up by your cervix every night before bed starting at week 37. They'll just dissolve over night as you sleep. They release prostaglandins (which is also in semen; hence why doctors tell you to have sex to 'induce' labor if you can tolerate it) which essentially "ripens" your cervix. EPO (and prostaglandins in general) soften the cervix, which is essential for dilation and effacement. Think of your cervix as being hard during the pregnancy (keeping the baby inside) and needing to soften in order to open to allow the baby to come through. Only makes sense, right? I did this and truly believe it helped me to go into natural labor during week 39. Maybe it won't work for everyone, but from what I've read and researched, it seems to help most women. In the least, it helps with the softening and so if you need to be induced, will help things along so you are not having an induction on a hard, completely unready cervix.

Don't freak out, you're doing great.
Seriously. I can't tell you how many times my OB and my pregnancy CDEs told me this. And you cannot hear it enough. Keeping your eye on the target (a healthy you, a healthy baby) is the goal. Just remember that. You sometimes think you're going through hell and back because of the unpredictability of the situation, but with the right healthcare support team you will succeed! No matter what happens (and you need to be flexible with whatever "birth plan" you have in your head or create on paper because pregnancy is like the 'last frontier'---you simply cannot plan and predict its outcome) remember to be flexible. Your body and baby will thank you. Before you know it, you'll have a wee one of your own to take care of---and as all type 1 moms can tell you: that's a whole other ball game to learn how to play. ;)