The Home Stretch

This Wednesday, I’ll be 28 weeks pregnant, tiptoeing cautiously into my third trimester. It sounds insane, but I can’t believe I’m still pregnant — I keep waiting for someone to call this whole thing off, and so far, no one has. Instead, people keep giving me onesies and bibs and tidbits of advice, like I’m actually going to have this baby and bring it home to live in my house . . .

Anyway, a few random things:

  • I had an echocardiogram several weeks ago, just to ensure that the baby isn’t truly, literally sucking the life out of me. I didn’t really expect any major issues, since I’ve felt relatively okay, but I was surprised as all hell to hear that my ejection fraction is in the normal-person range for the first time in years. My cardiologist was similarly relieved and happy, but the same high-risk OB who warned of heart transplants and other bad things was a little more reserved. When I told her about the results, she was totally “no duh” about the whole thing. “Your ejection fraction goes up because there’s so much more blood in your system and your heart needs to work harder,” she explained, like maybe I’d asked her why sometimes it hurts to get punched in the face. In any case, I’ll take the normal EF all day long.
  • I guess I always thought that babies just hung out in your guts and calmly, slowly grew to their fully realized states, but as it turns out, they have lots of things to do in there! From what I’ve observed, my baby’s daily schedule is full of Jazzercise classes, jogging in place, signing the alphabet, doing the Elaine, rowing, and churning butter. I’m not complaining, though! I’m way too paranoid and superstitious to complain about such a thing — keep moving around, kid!
  • I do not have a birth plan. I fully intend on making my diabetes-management intentions clear for the day of the birth and the few days I’m in the hospital, but other than that? I have no idea. If there’s anything that diabetes has taught me, it’s that shit hardly ever goes according to plan, and the last thing I need is something to look back at and feel bad about after I’ve gotten this child out of my body — however that event comes to pass. (Also, it’s my belief that most people ask you about your birth plan just so they can roll their eyes and laugh about it later.)
  • When I first learned I was pregnant, I was cautious about keeping my plans for Children with Diabetes Friends for Life, but now that that shindig’s right around the corner, I am so looking forward to attending. I need a few solid days of DOC madness and pre-carb-counted meals in my life, even if my Diet Coke consumption will be far more limited than it was last year. I cannot wait to stay up late and eat ice cream and cry in hotel ballrooms with you kids.
  • I feel like I’m already planning my post-Type 1 pregnancy burnout period. How refreshing it will be to see the occasional blood sugar in the high 200s and know that the only person’s health I’m threatening is my own! Diabetes is so weird. And so am I.

Baby foot in your face! (And your ribs, and your bladder, and the inside side of your belly button, and your side . . .)

I Can Do This!

I’m not a person who seeks out inspirational or motivational things. I don’t have any paperweights with words of wisdom engraved into them sitting on my desk, or posters of soaring eagles on my walls. None of that stuff ever seems to stick.

With one exception! A year ago, redhead diabetic genius superwoman Kim Vlasnik introduced us to one simple phrase that has gotten me through more crappy diabetes days than I would have ever expected. “You Can Do This.” The idea? To collect stories from people with diabetes who had been doing “this,” and to share those stories with the people who most need to hear them — other diabetics.

I’ll admit that I’m a moocher. A year after the YCDT launch, I still haven’t contributed my own encouraging story. Instead, I’ve just sucked up all the sentiments of motivation and support when I’ve needed them. And boy, have I need them lately.

Here’s where I bring it all back to me: Being pregnant with Type 1 diabetes is a tremendous job. I am so damn tired of it — the technical number-crunching itself and the waves of guilt and dread and disappointment that come along with it when things aren’t perfect. But just today, as I was bemoaning the draining effects of last night’s low blood sugars on my energy levels, the words popped into my head automatically: You Can Do This.

The phrase is so perfect because it’s so simple, and because there’s really no way to argue with it. I mean, of course I can do this — what choice do I have? I’ve been doing this for more than two decades, and a ton of other people are doing it, too. Elizabeth Hughes, the first person to ever use insulin, did this — pregnancy and all! And that was even before the Internet!

Even better, Kim has done so much to make You Can Do This work for so many people. T-shirts! Videos! Written stories! Booths at Friends for Life 2012! And behind all of that, a genuinely kick-ass woman who’s driven by a real concern for other people.

Happy 1st birthday, you can do this! And thank you, Kim, for reminding us all that we can.

Overcompensation Nation

“It’s always safer to be on the high side than the low side.”

It was one of the first things my pediatric endocrinologist told me after my diagnosis in 1990, and it’s a refrain I’ve recited to myself dozens of times since then. I think a lot of us make a habit of cruising just a bit higher than ideal, whether it’s because we fear low blood sugars or we’re preparing for exercise or whatever. I’ve always felt further from the edge of the diabetes cliff when my numbers are closer to 120 (or higher) than 90-ish.

Of course, all of that has changed since I’ve started tweaking bolus rates and carbohydrate ratios to keep up with the insulin-resistant influence of the placenta I’m carrying around. (That sounds so gross. Sorry.) As my insulin needs creep ever-upward, and as the possibility of having to deliver a T-Rex-sized baby grows more immediate, I’ve started going out of my way to stay as low-ish as possible. Let’s put it this way: before, I was a moderate consumer of insulin, only bingeing on special occasions and always careful not to over do it. Now, I’m a junkie — a heavy user who’s growing less and less afraid of taking a few extra hits during the day.

It’s like I automatically add ten carbohydrates to any food item I’m counting, just in case. I’d rather have to eat a little more in an hour or so than watch the CGM graph on my pump jerk menacingly skyward. I think of it as preemptive rage bolusing. If I’m dealing with a sticky high, I’ve got no problem cranking my temporary basal up to 150% or higher until it comes down.*

I can’t tell if I’m making irresponsible and potentially dangerous decisions because I’m pregnant, or if this is the way I’m supposed to have been doing it all along.

After all, I haven’t passed out yet! I haven’t even had any crazy low blood sugars that I can attribute to this behavior. (The scary-as-hell 26 mg/dl I had a few months ago I attributed to unusually long periods of standing around.) And seeing that long, even CGM line over a 12- or 24-hour period brings me a sense of control and accomplishment that I haven’t felt since I found out I was pregnant.

For once in my life, fear and competition may actually be motivating me to take better care of myself. Each time I feel an extra-powerful head-butt from the inside of my belly, I imagine my baby growing to hulk-like proportions — feeding off of high blood sugars and lifting weights in her spare time. (She may be getting tattoos, too.) Then I see other Type 1 moms-to-be with A1c numbers in the low 5s. And although I know I shouldn’t compare myself to other diabetics (we’re all special snowflakes, after all), I want to be in the 5-point-something club, too.

I want to walk out of the hospital in September with a healthy, compact-sized baby and a birth story that reads like a fairy tale. I want to stand outside the sliding glass doors and give the finger to every doctor I’ve seen in the last 5 months who’s been lukewarm about my A1c or a fasting blood sugar number. I want to feel like a normal pregnant lady, and the only way I know how to get there is to keep taking a little more insulin than I might need. Pass the bottle.

*Special Disclaimer: DON’T DO ANY OF THIS STUFF. I am a crazy pregnant lady with no medical training.

Ode to a Type 3

Dear Ol’ Husband,

You know how it makes me feel all weird and itchy when people get overly affectionate in public forums. Those elaborate declarations of love and devotion and you’re-the-best-ness always seem tinged with notes of overcompensation. Or, you know, plain old cheese.

But my hand here is forced, husband! Today is not only the 40th anniversary of your arrival on this earth — it is also the eight anniversary of the evening we first met. Therefore, I have no choice but to tell you how wonderful you are, and to do it the only forum I’ve got: this blog.

When I handed you my phone number wrapped around a piece of watermelon gum eight years ago, I had no idea how much I’d get in return. I was barely ready to answer the phone when you called, but if I had known then what I know now, I probably would have answered with a terrifying level of enthusiasm.

You’ve given me a new appreciation for things big and small: birds, road trips, pork tenderloin, life in general, early mornings, concerts, bicycle rides, gin, family, well-constructed flip-flops, my health, our health, liquid fabric softener, good landscaping, porch swings, foreign movies, blueberry pancakes and red velvet cupcakes, weekends with friends — and more.

You’ve joyfully dragged me around the country and across the sea — to the top of the Sagrada Familia, where you called out, “Come back in from the balcony! It’s too high! You’re freaking me out!”, to the craft breweries of Vermont and Colorado, to the seal-dotted beaches of La Jolla, to the cold, wet post-Christmas landscape of Buffalo. You’ve shown me that it’s possible to have fun anywhere — as long as there’s a cold beer and some delicious cheese to be had.

You’ve helped me carry what seems like a thousand burdens, including such debilitating tasks as keeping my car clean and figuring out our income taxes. Short of taking it on yourself, you’ve done everything humanly possible to help me care of the ‘betes: picking up prescriptions, waking me up to check my blood sugar in the middle of the night, rolling out of bed to get me a bowl of cereal or a granola bar or a juice box at 3:00 in the morning, delicately asking if I’ve “remembered to insulize” for whatever delicious snack I’m in the process of mowing down. You’ve always encouraged me to take the best care of myself that I can — no matter what it takes. You are, indeed, the shit.

You do so much for so many people, and it makes me proud to be your wife.

I wish I had something truly mind-blowing to give you for your 40th. A private dinner hosted by Anthony Bourdain, a jug of 150-year-old whiskey, a trip to some crazy geological site or a HGTV backyard makeover.

Instead, I’ll offer up the whole rest of my life, plus dinner tonight and a Hendricks martini with blue cheese-stuffed olives. Oh, and this baby of yours I’ve been carrying around town.

Cheers, husband, and happy 40th Birthday. I love you a bunch.

Fantasy Diabetes Device: Take My Autoimmue Disorder — Please.

Tell us what your Fantasy Diabetes Device would be. Think of your dream blood glucose checker, delivery system for insulin or other meds, magic carb counter, etc etc etc.  The sky is the limit – what would you love to see?

This is a hard one. A really hard one, because my first, second and third inclination is to answer the Fantasy Device question with one answer: a normally functioning pancreas. How glorious that would be!

But “pancreas” is the obvious (and best) answer. And if I can’t have the shiny new insulin-producing organ I want, I can at least have some fun and flexibility with my diabetic life, can’t I? That’s where my imaginary device comes in: It’s as yet unnamed, but I have filed for several patents, and marketing focus groups are well underway.

Like the CGM, it’s an addition to the whole pump system I’ve got connected to my person, but it works more like a remote. My fantasy device allows me to bestow my diabetes on other people for abbreviated periods of time.

I’ve heard my loving mother and generous husband say it over and over again: “If I could take this disease on for you, I would.” I appreciate the sentiment, and I love them both so much for saying it, but I don’t know if I’d feel right giving them all the diabetes forever. I would, however, feel comfortable letting one of them borrow it for a  weekend.

They’d be responsible for the blood sugar control (or lack thereof), suffer the temporary consequences, count the carbs, inject the insulin, do the fingerstabs. And I’d spend the weekend sleeping and running and dancing around and eating and drinking and being productive. Then I’d take the diabetes back. It is my nasty little pet, after all.

Think of the temporary freedom! The empathy and understanding the device could foster. The fights, too: “I don’t want to take your diabetes next weekend! I did it last month!”

The most satisfying part, though, would be sharing diabetes with strangers. The next time someone made an idiotic comment about “diabetic folks who just don’t take care of themselves,” I could let them borrow mine for an afternoon — just so they can see how easy it is!

And if I ever again, God forbid, find myself stuck in a conversation with someone who’s all excited about their voluntarily carb-free, gluten-free, low-calorie, paleo raw diet of food items that begin with the letter S, I can give them my diabetes for a while. “Here,” I’ll say, “Sounds like you need a real problem to focus on!”

As soon as they started to whine too pitifully, I’d take my diabetes back. Everyone has their Stupid Life Thing they have to deal with, and for now, this is mine. I’m sure that just knowing I can give my diabetes away for an hour or a day would make the really tough days a little easier. Right?

One Thing to Improve: Emergency Preparedness

Yesterday we gave ourselves and our loved ones a big pat on the back for one thing we are great at.  Today let’s look at the flip-side. We probably all have one thing we could try to do better. Why not make today the day we start working on it. No judgments, no scolding, just sharing one small thing we can improve so the DOC can cheer us on!

Here’s a reassuring thought: if my trusty insulin pump were to give out right this minute — for any reason: water, trauma, old age, spontaneous combustion — I would have no idea what to do. I have no emergency plan, and that is something I definitely need to work on.

Maybe I’ve grown too trusting of this tiny robot on my hip. In the last 12 years that I’ve used the pump, I’ve only had one real malfunction, and looking back, I don’t even remember how I dealt with it. I’m sure I got on the horn with Minimed and used syringes until my new pump arrived in the mail (which is always ASAP — thanks Minimed), but I don’t recall any details.

And that’s a problem. Were my pump to die this instant, here are the steps I would follow:

  1. Curse. A lot.
  2. Complain on Twitter and Facebook, beseeching the input and wisdom of the ever-present DOC.
  3. Curse some more.
  4. Call my CDE for advice.
  5. Leave work to go home and curse.

There’s no long-acting insulin in my refrigerator, and all the syringes I have are ones that I inherited from my friend Tammy when her diabetic cat went to eat cupcakes in the sky. Worst case scenario, I figure, I’ll just stay close to home, snort cinnamon and jog in place as much as possible.

Of course, I’m assuming everyone else has a holy-shit-my-pump-broke plan, or something resembling one. What does it look like, and where do I get one?

One Great Thing: A Blood Sugar Check Before My Feet Hit the Floor

Here’s today’s Diabetes Blog Week prompt:

Living with diabetes (or caring for someone who lives with it) sure does take a lot of work, and it’s easy to be hard on ourselves if we aren’t “perfect”. But today it’s time to give ourselves some much deserved credit. Tell us about just one diabetes thing you (or your loved one) does spectacularly! Fasting blood sugar checks, oral meds sorted and ready, something always on hand to treat a low, or anything that you do for diabetes. Nothing is too big or too small to celebrate doing well!

It only takes a second (or 5, to be more precise), but the one thing I’m good at has made a huge difference in the way I take care of myself and my friend Diabetes.

I am so damned good at checking my blood sugar first thing in the morning.

I know there were great spans of time when I was not so dedicated to the morning check, and looking back, it’s hard for me to imagine how I functioned. These days, I don’t check my blood sugar first thing in the morning because it’s something I should do, I check it because it’s a compulsion, a habit that I can’t stop.

“Your blood sugar is two-seventy-what?!”

First-thing blood sugar checks are a little easier to take than others, I think, because they tend to come with a lot less baggage than checks at other times of the day. After all, all you’ve been doing is sleeping, right? If I wake up to a high number, it’s almost certainly not because I miscalculated the carbohydrates in the pizza I had a few hours before, or because I’ve forgotten to bolus for a midnight snack (nocturnal hypoglycemia notwithstanding). More so than at any other time of day, I’m able to look at my morning number and think, “Well, there it is.” (I should admit that it doesn’t hurt that my morning blood sugars are usually pretty nice to look at. But it took a lot of tweaking to get there.)

Checking my blood sugar before the day begins is almost like checking my horoscope for the day: neither are sure-fire predictors of whether or not my day will be frustrating or wonderful, but they offer little glimpses — tiny reassurances.

Let me add, too, that since I’ve been pregnant, my wonderful husband has perfected the art of waking my semi-comatose ass out of whatever super-deep sleep stage I’m in at 2:00 a.m. for a blood sugar check. And not only does he make sure I’m coherent enough to insert the strip into the meter right-side-in, he’s also kind enough to illuminate the process with the flashlight function on his iPhone. Those numbers are rarely perfect, but they’re informative, and I like being able to correct in the middle of the night without relying on my CGM.

So, yes: it only took 20+ years, but I finally mastered one of the basic tenets of diabetes care. Now, on to that lancet-changing thing.

Finding Friends

It’s Diabetes Blog Week again (yay!), and today’s topic is as follows: Think about the d-blogs you read that you think we may not know about and introduce us to one that you love!!  Let’s all find a new friend today!

This is hard for me, because I feel like all of the blogs I know and love I’ve come to know and love through the greater DOC.

I could go on and on about how much I love and admire Kim at Texting My Pancreas, or talk about how Jess’ empathy and kindness shine through everything she posts. We could discuss Karen, and how I draw on her pregnancy journey and all-around radness when I’m feeling defeated, or touch on the d-mom genius of Joanne and the way she writes about caring for a CWD day in and day out. I love everyone, but pointing them all out makes me feel like that person who just discovered Keyboard Cat and is like, “Hey everybody! Look at this new awesome funny kitteh that I found on the Interwebs!” Yes, it’s hilarious, but duh. Everyone already knows.

So, let me continue my string of obnoxious gestational posts and talk about my newest DOC friend, Katie at Princess of Pavement. A few weeks ago, I was complaining about the frustrations of being pregnant and diabetic and not knowing who to listen to, and Scully was like, “This other person is pregnant, too!” And poof! There was Katie, being just about the same amount of pregnant as me, and writing posts about it with all kinds of re-enactment pictures. Hooray for simultaneous life events and helpful DOC connections!

Katie pees in containers too! And she sends pictures of her pregnant belly to terrified strangers! And, she’s a runner, which I always pretend like I’m going to be one day, so she’s an inspiration, to boot.

Thanks, Katie — and everyone else whose blog I read — for helping to keep me sane. Or at least feeling a little bit less alone.

Halfway There! Or: My Steady Transformation into the World’s Most Boring Person

Last week marked a huge milestone in this unexpected pregnancy adventure of mine: I hit the official halfway mark — 20 weeks. Of course, several of those weeks were spent not knowing that I was pregnant, and for another couple of those weeks, I wasn’t really pregnant at all, but still. I’m happy to have the first half of the journey behind me.

People keep asking me how I’m feeling, and my very anticlimactic answer to that question is always, “Fine, I guess.”

I mean, does anyone really want to know how I’m feeling? Do they want to hear about the stubbornly high blood sugars that have started stalking me every morning, no matter how carefully I count the carbs in my wee bowl of cereal? Do they want to know what a relief it is to resign myself to the fact that I do need a big huge bra, and that I’m so happy I finally have one? (Because damn, what a difference.)

And when they ask more specific questions, like whether the baby will sleep in a bassinet or a crib, or how much time I might take off work, I want to say, “I don’t know! Let’s talk about fun things like baby clothes and other things my child really needs, like this stuffed animal:

Now, would you like to come into my room with me and watch me sleep?”

Sloth has always been a major interest of mine, and I’m not exaggerating when I say that all I really want to do anymore is sleep. Or read, with the intention of falling asleep.

I love all of my friends, and I miss seeing them more often, and I feel so lame and embarrassed that I’m not the “Go get ’em!” pregnant lady I always thought I would be, but I just can’t.

This is the hardest, weirdest thing I have ever done, and whether the causes are physical or emotional, I feel like every single day sucks the energy right out of me.

A big part of it all, I’m sure, is that diabetes is playing a bigger role in my day-to-day life than it ever did before. I mean, I always (kind of) counted carbs and checked my blood sugar and watched my CGM, but now I feel like the future of the entire universe hangs on every food-related decision I make. Every high blood sugar feels like a moral failing, and the lows are getting sneakier and more severe as the weeks progress. It certainly turns going out to dinner into a relaxing, enjoyable event.

Through it all, though, the baby has cultivated a love for dancing. Really, I’m half-expecting to see her perform an intricately choreographed routine to George Michael’s Freedom shortly after delivery. I can’t figure out which body specific body parts are in use, but the thrashing and poking and rolling and cabbage-patching are almost constant.

It makes me happy to know that someone’s picking up the party-animal slack, and that that someone is my own tiny daughter. Hopefully, 19 weeks from now, she can help me get my own groove back.

Memories of a Former Needle-Wielder

The test strips are everywhere.

I find them in the shower, on the living room couch, in friends’ cars. Stuck to my arms and legs when I wake up in the morning. Yesterday, my husband texted me a picture of a test strip he found in the dryer.

Can you find the squeaky-clean One Touch test strip in this image?

It’s a phenomenon I’ve mostly grown used to, but the other day, as I peeled a tiny blue rectangle from the sole of my foot, I stopped and thought, “There was a time when it used to be like this with syringes.”

Okay, not exactly. I don’t think I ever found a needle in my bed, and I sure as hell never bit into one in a sandwich, but at the height of my Multiple Daily Injection routine I was using up to 6 syringes a day. And those syringes tended to hang around.

They accumulated in my purse, my car, on my dresser and in the designated diabetes drawer in the kitchen. It probably wasn’t the safest arrangement, but hey — at least I was taking my insulin, right?

Hello, old friends.

There was the time I sent my poor sister digging in my purse for my wallet or a tube of Lip Smackers, and when she removed her hand, the needle of an uncapped syringe poked through the pad of her ring finger.

During my senior year of high school, the EJECT button on the tape player in my Plymouth Colt broke off. It didn’t matter how much I loved whatever mix tape was stuck inside. I refused to spend the foreseeable future driving around to the same 13 songs, and that’s how the B-D Insulin Syringe Audio System Controller was invented. I’d just shove the cap-end of a syringe into the space where the EJECT button once was, and out popped the tape.

Those syringes also helped me sell myself as a fearless badass to peers and colleagues. In the Plymouth Colt on the way to the Village Inn or TCBY, while my passengers marveled, I’d pause at a stoplight to draw up and inject a fat dose of Regular insulin into my thigh. I kept a 2-liter-turned-sharps-container on the back floorboards of the car, and I’d joke with new acquaintances about my heroin habit — and then wait at least 6 or 7 minutes to tell them the truth.

I’d fantasize about being a contestant on a Fear Factor-esque game show, where the final prize of a bajillion dollars rested on one contestant’s ability to bravely impale herself with a 31-gauge 1/2-inch-long needle. Guess who wins?

On occasion, I used the syringes as tools of evil, as well. At the height of what was almost certainly a fight about watching Oprah vs. Star Trek: The Next Generation, I chased my sister through the house with a syringe in my fist. We ended up in the corner of my bedroom: she with the remote, me with the semi-lethal weapon. I don’t remember what show we ended up watching, but I do know that I never actually stabbed her — and that nonetheless, she’s been psychologically scarred ever since.

I don’t miss using those syringes every day, but looking back, I can almost track my Type 1 diabetes career by the needles I used — what kind, how often, and with which insulins. I’ve gotten so used to having this pump at my hip, and to administering a bolus of insulin with just a few beeps and button depressions, that I forget what it’s like to rely on such a basic — and iconic — diabetes treatment tool.

Of course, a diabetic’s life is never completely needle-free. When my good friend’s diabetic cat died a few years ago, I inherited all of her unused insulin syringes, and occasionally I have to employ one to help beat back a stubbornly high blood sugar. And I’ll always have the infusion set and sensor needles, but those don’t have the same recognizability as orange-capped stand-bys. They’re less of a lifestyle than syringes are, if you know what I mean.

Sure, you won’t find them in my car, on my bathroom counter, or in my little sister’s fingertips anymore, but each one of those syringes I used helped make me the pump-using diabetic I am today. They’ll always have an honorary place in my subcutaneous tissue.