The Way it All Went Down

One year ago, if you’d told me I’d be putting my birth story on the Internet, I’d have totally thought you were drunk. But, what a difference a pregnancy makes. I feel like it’s important to share what happened, for my own mental clarity and for the sake of pregnant T1s all over the land. That said, I promise not to get gross here.

Picture it: Jacksonville, August 2012. It was a Thursday morning, I was hugely pregnant, and I’d been experiencing weird symptoms for a few days. Part of me felt like something had just shifted — I felt a bit more normal than I had in months, I was feeling a lot of Braxton Hicks contractions, and I had some suspicions that my water had broken. At the same time, I didn’t want to be that person who goes to the hospital 17 times with false labor, so I was trying to keep my cool. I had a standing appointment that morning for a non-stress test, so I figured I’d bring my concerns up as soon as I got to the doctor’s office.

Once I arrived, I explained my situation to the same nurses I’d been seeing twice weekly for the last four weeks. They hooked me up to the fetal heart monitor, and let the OB know what was going on. Everything was pretty much normal, except that the wee one’s heart rate seemed to take a brief dip every several minutes. It didn’t seem like anything to freak out about, they all explained: the baby could just be rolling around, or could have the umbilical cord all wrapped up in her fist. But, given my suspicions about my water breaking, they decided to send me down to Labor and Delivery, just to be safe.

I knew things were getting official when they loaded me into a wheelchair. I ended up in a bright little hotel-like room on the second floor of the building, and met Dana, the nurse who’d be taking care of me that day. Fully expecting to be sent home in a few hours, I changed into the worn blue gown the hospital provided and climbed into the Super Robot Bed 3000 in the corner. Had I known what was coming, I probably would have done a few push-ups first.

My other OB entered the room a short time later to assess the situation. She did a few tests, and sent them off to the local CSI lab, the Pentagon, and several other independent labs for extensive analysis. A few minutes later, the results were back: my water had indeed broken, and I would be having the baby in the next day or two.

The stuffed Peep I used as a focal point to help me withstand labor pains. This may be the only time in my life a Peep has failed me.

This, of course, was the moment that I realized I was not really ready. I hadn’t practiced the Hypnobirthing scripts as much as I’d meant to. I didn’t have my preferences for things like umbilical cord clamping procedures on record. I hadn’t even started writing my baby gift thank-you notes, and I was still lacking a concrete plan for the management of my blood sugars during labor.

My CGM graph the morning of Magpie’s birth. That Regular insulin isn’t so bad, after all.

I talked to my nurse and my OB about my pump and my CGM, and explained that I’d like to keep both of them on and functioning as long as I could, and they were okay with that. And then my blood sugar crashed. Not an hour after I’d been in the room, I was 64 and falling, and freaking out. Here I was, trying to project the image of a diabetic woman who was so in control, so on top of it all, that I could manage the rigors of labor and my blood sugar levels without outside assistance. I felt like a drunk person struggling to stand upright in the middle of my own intervention, insisting that I didn’t even like the taste of alcohol. It didn’t work.

I wasn’t supposed to consume anything but ice for the duration of my hospital stay, but I think that low scared the nurses enough to ensure a steady supply of apple and orange juice. “These are only for emergencies,” Dana the Nurse told me, stacking foil-sealed portions of juice on the bedside table. “You’re not supposed to drink anything, but if you need ’em, you need ’em.”

Contraband juice! And my fancy Fossil meter holder.

Several minutes and a few plastic cups of room-temperature apple juice later, Dana announced that they’d like to hook me up to an insulin drip and have me check my blood sugar every hour. I’d already gotten an IV for the administration of fluids and dextrose and antibiotics, so all it would take was another bag hanging on the little IV stand thingie. I called my CDE, who encouraged me to go along with the doctors’ and nurses’ recommendations. “They know what they’re doing,” she said. “They’ll take good care of you.”

And they did. I was doubtful at first, especially when the nurse walked in with an IV bag of Regular (Regular!) insulin.

“Are you sure about that?” I asked her. “I seriously haven’t used Regular since the mid-nineties.”

She was sure; apparently rapid-acting insulin like Humalog isn’t available for IV administration, so I’d be kicking it old-school for the duration of my labor. Hours later, after my blood sugar had stayed faithfully in the low-100s range, I’d feel like an insulin snob for doubting that bag of Regular insulin. In fact, my blood sugars were pretty much perfect for the rest of the time I was hooked up to their IV, with one exception: during the installation (if you can call it that) of the epidural.

Bob, me and Dana the Nurse. Look how much fun we’re having!

Six or so hours and several dozen deep, relaxing breaths into the labor process, I realized I’d be needing that epidural after all. Driven by curiosity and stubbornness and all the Hypnobirthing hoopla I’d been immersing myself in, I’d gone into the labor experience wanting to see how long I could make it without the meds. This was supposed to be the worst pain ever? But also perfectly natural and experienced by billions of women throughout thousands of years? Bring it on, I thought. Let’s see how I do.

I don’t think I was prepared for the kind of pain I felt. You know those weird little gas bubbles that you sometimes get in random places, like in your ribs or just under your shoulder blades? That’s what it felt like. But instead of a tiny gas bubble, this pain felt more like a giant, pulsating orb of wrenching pressure, almost all the way up my back. Making matters worse, I was tethered to the World’s Most Uncomfortable Hospital Bed by two IV lines and four tubes. There would be no warm showers or walks down the hall or leaning over the bed to ease the pain. I was stuck.

I started sweating. And shaking. And crying. There was wailing and gnashing of teeth — and that was before the anesthesiologist (his name was Dr. Kramp!) began threading the epidural into my spine. That’s, like, the bonus pain — an extra series of pinches and stabs before you can start to get comfortable.

After the epidural was in and my toes began to tingle and itch, my CGM chimed in with a “High” alarm, so I checked my blood sugar. Twenty minutes prior, I’d been happily coasting along at 110. Now I was at 327. Hello, adrenaline rush.

While copious quantities of Regular insulin were pumped into my arm, I settled in for the remainder of labor. I knew I was nowhere near where I needed to be, but the epidural was such a relief that it was almost fun, and I looked forward to hanging out with my friends and my parents while we waited for the Magpie to show up. Just in time to freak my parents out, the nurses strapped an oxygen mask to my face to help stabilize the baby’s heart rate. I mean hey — if you’re going to get into the “medicalization of childbirth,” you might as well go all out, right?

The night passed, and what I remember most about it are that a) I didn’t sleep at all, thanks to continuing hourly blood sugar checks, and b) I had another wonderful nurse, who remained suspiciously chipper and dedicated to my well-being even as the end of her 12-hour shift drew near.

I don’t remember much from the next morning, either, except that I saw the sun rise through the cracked window blinds and enjoyed an invigorating breakfast of ice chips and oxygen. Labor progressed, as labor does, Dana the Nurse returned for Friday’s shift, and my epidural started to wear off in weird places. My back was still killing me, and each time I pushed the magic button for more “juice,” I felt a burning and cramping sensation where the medicine dripped into my back.

It must have been around 10:00 when my primary OB decided that I was ready to start pushing. It was happening! For real! I was out of the “sit around and be uncomfortable” stage of labor and entering the “get it done” stage.

As it would happen, the “get it done” stage of labor and childbirth lasted about two and a half minutes – for me, at least. After just a few pushes, the Magpie’s heart rate started to drop again, and everyone completely lost their shit, to use a technical term.

Suddenly, my labor and delivery room was like a scene out of poorly recreated emergency-room show on the Discovery Health network. I would be having a C-section, and there were at least ten nurses, anesthesiologists, physicians and surgeons swarming around the room to make sure it would be in the next few minutes. A new anesthesiologist cranked about six gallons of extra-special C-section fluid into my existing epidural, and a nurse gave me a small cup of something bitter and disgusting “for your stomach.” They flung me onto a gurney, and as I began to sob uncontrollably, wheeled me into an adjoining operating room.

I’m not proud of how I responded, but I was terrified and pissed off — and I hadn’t slept, eaten, or had anything to drink since my bowl of Cheerios and Diet Coke 28 hours earlier. I began playing my favorite mental game, What Did I Do Wrong and How Could I Have Prevented This?, as the nurses hung up that awful C-section sheet and wrapped my upper body in folded towels. I should have taken my Iron supplement more faithfully, I thought. I shouldn’t have gone with the epidural. I should have waited to start pushing.

God bless the second anesthesiologist on duty that day. She sat next to me and tried to distract my pitiful self with stories about her family, questions about my work and my husband, and jokes about the towels that were positioned around my head. “You look just like Mother Theresa!”

It seemed to take an eternity, but I’m sure it was just a few minutes before she was born. I remember the anesthesiologist telling me that she was out, and then hearing a cry that sounded almost exactly like a kitten. And I was so jacked up on a variety of painkillers that I actually entertained the idea, just for a second, that maybe I’d given birth to a cat instead of a baby person.

After that, I crashed. I remember Bob bringing the baby over, clean and swaddled and be-hatted, for me to look at, and I remember the calm, interested expression on her face. I was still doing all the crying; she just looked at us like, “I’m here. Now what?”

As I struggled to stay awake and/or stop crying, Dana the Nurse accompanied me to my recovery room. I gulped and blubbered, and she leaned over the bed.

The Magpie!

“What’s wrong, honey? Why are you crying?”

I tried to go through all the feelings of self-blame and regret and also joy and disbelief that I was feeling at that moment, but I was too out of it to speak. My mouth wouldn’t work. After several attempts at forming a coherent statement, it was all I could get out: “I’m. So. Fucked. Up.”

And that was it. I passed out for what felt like a day and a half, but was actually just a couple of hours. When I woke, Bob was there with a picture on his phone of our little Magpie, and shortly after I was able to see and hold her myself.

Despite all the drama, I’m proud to report that we didn’t have any real problems — at least not the kind they make Lifetime movies out of. Her blood sugar dipped quite a bit shortly after birth, but she recovered. Also, she had jaundice, so Bob and I spent a few days force-feeding her and strapping her to a tiny tanning bed once we returned home.

It’s the champagne of diet ginger ales, really.

But I did it. I made it out alive, with a kick-ass A1c, a healthy (if early) baby girl, and a crazy new scar. We spent the next several days on the Maternity floor, introducing the Magpie to her new friends, enjoying scrumptious hospital “diabetic” meals, gulping pain medications and watching bad TV.

People always talk about that moment that you get into the car with your new tiny family member and wonder, “What are we doing? How are we allowed to leave with this baby?” I didn’t feel that, though. We clicked the Magpie’s car seat into its base and started our 3-mile trip home through the rain. We merged onto the highway, and I turned to Bob.

“I could totally do this again,” I said. “Couldn’t you?”

Having the Baby. And Diabetes, Too.

Several weeks ago, I insisted that I wasn’t going to bother with a birth plan. I may have been lying.

I’m at 34 weeks now — too swollen and exhausted, it seems, to keep up with much of normal life, including regular blogging.

All along, I’ve tried to ignore the fact that this child I’ve been growing actually has to get out of my body somehow, but I can’t really do that anymore. Faced with the reality of things like nature and physics and the miracle of life, I signed up for a few birthing classes. Those classes have done more than introduce me to words like “effacement” and “fontanelle” — they’ve opened up an entirely new can of gummy worms when it comes to how I think about my body, how sick it is, and what I can and cannot pull off as a person with diabetes. What fun!

Last weekend, we completed our hypnobirthing course. As batshit crazy as the name makes it sound, hypnobirthing is essentially just an approach to childbirth that emphasizes deep relaxation and trust in the capabilities of one’s own body. (Can you guess where this gets tricky?) The basic idea: the more educated you are about what’s actually happening with your muscles and body parts and your baby, and the less freaked out you are, the easier the birth. I decided I wanted to take this class because the group teaching it is supportive of necessary medical interventions and emphasized staying cool no matter what obstacles or twists might come up during the birthin’ process. I didn’t want to end up in a class where some nutso with dread locks would to try to shame me into having my child at home in a baby pool full of kombucha.

When I signed up, I made sure to let the instructor know what my situation was: that I was pregnant with Type 1 diabetes, that — so far — I had no reason to expect a cesarean section, and that I’d made it this far without any diabetes-related pregnancy complications. “Lookit me!” I thought. “I’m almost normal!”

As we went through the hours of instruction and homework assignments, I realized I was going to have to put my diabetes in its own little cage for portions of the process. The CDs we got, the reading materials we received and the instructor we worked with all repeat the same message: Relax. Your body knows what it’s doing. It’s a hard message for me to absorb — at least without a bit of maniacal laughter.

So I removed my pancreas from the equation. Yes, it’s true that I’ve spent the last two decades regulating the tumultuous relationship between my liver, my pancreas, the food that keeps me alive and almost every other system in my body, but this whole baby thing hasn’t been half as disastrous as I’d been led to believe it would be. Maybe my body sucks at keeping its immune system from attacking its own digestive organs, but has been waiting all these years to demonstrate how good it is at growing a person and then bringing that person into the world without any unnecessary drama.

The doula/instructor kind of blew me away when she posed the question to the class: “We’re all preparing for the bad stuff. But what if you have your baby and everything goes okay?” I realized it was a thought I’d never even considered, and what a difference it could make in the way I view the events of the coming weeks. Or hell — the way I look at my entire life, with and without diabetes!

But since I am who I am and because I have an OB who’d like to hang on to her medical malpractice insurance, things may not be that simple. When I saw her on Monday, I brought up some of the bigger issues that were floating around in my head. Like, can I move around when I’m in labor? (A little.) Will I be on a strict labor progression schedule while I’m in the hospital? (Pretty much.) How long can I go before you guys get all induction-happy? (39 weeks.)

I could tell she was getting flustered. “I don’t want you to have a vision of this perfect, ideal birth, and then feel like you failed because we end up having to do something different than what you planned,” she explained. She then went on to mention complications like intrauterine fetal death and placenta degradation and how it was her responsibility to avoid these things.

I get (and appreciate) that. I do. I love western medicine. I just don’t want to be treated like another faceless Type 1 diabetic mother from an outdated study — especially when I’ve worked my water-retaining ass off to keep my blood sugars as close to normal as possible and there’s no evidence of any diabetes-related badness taking place at this point. Does that make me prideful? Ignorant? Completely naive?

Here’s what’s hard: managing the day-to-day details of the world’s most intense do-it-yourself treatment plan — for 20 years — and then being expected to surrender complete control of your body and your baby to a team of doctors and nurses who may or may not make certain decisions for their own convenience.

Of course, I don’t know how any of this is going to play out. Maybe I’ll need a c-section after all. Maybe I’ll have one of those mythical 30-minute labors. Maybe I’ll have the baby in the back of a cab, even though I never take cabs, because that’s what happens in the movies.

I just need everything to be okay, and between now and September Whateverth, to be able to maintain the  assumption that it will be. Wish me luck.

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 . . .)

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.

You Can’t Munch This

“I can’t eat that.”

It’s a phrase I’ve spent two decades struggling not to have to say.

Yes, I have Type 1 diabetes, but I also have this shit (mostly) under control. So bring on the ice cream, and the marshmallow peeps, and the pizza and the cereal. Just please bring them with an accurate carbohydrate count and a few measuring cups. And maybe a food scale.

But now I’m pregnant (in case you forgot), and I’m finding it hard to maintain my cautiously rebellious relationship with off-limits foods. Which foods are off-limits for a Type 1 diabetic who happens to be harboring a tiny fetal passenger? It might be easier to talk about what’s not forbidden:

  • Water
  • Cashews
  • String cheese

It’s possible there are a few additional foods to choose from, but from my experience, the above three seem to be the only safe bets — especially when you consider the dangers posed by high blood sugars, low blood sugars, listeria, mercury, alcohol, caffeine, artificial sweeteners, and any other threats announced by the paranoid sadists at American Congress of Obstetricians and Gynecologists.

In times of yore (read: six months ago), I’d avoid a post-restaurant-meal high blood sugar by ordering something low in carbohydrates, but high in excitement: an ahi tuna salad with avocado and glass of wine. Perfect. But now the tuna’s out to destroy my unborn child, and the wine’s right there to back it up. It’s the same deal with meat and cheese plates, sushi, caesar dressing, turkey sandwiches, sprouts, brie — even SALAD IN A BAG, people!

Dun Dun DUUUUUHHHHHHN!!!!

Food that’s deemed safe for pregnancy tends to scare me on the diabetes front. After forcing down some quinoa salad or even a cup of yogurt, I can rest easy in the fact that I’m not directly poisoning my child, but the obsession over the blood sugar kicks in. Did I count all the carbohydrates correctly? Will I be under 120 in an hour? Am I dropping too fast? Should I have had more protein? Would a square bolus have worked better? How will all of this look when I upload it and print it out next week?

I’m trying really hard not to spend this entire 40 weeks freaking out, or complaining — or freaking my husband out with all of my complaining. I just want everything to be okay, and at the same time, I’m struggling to hold on to as much of my non-pregnant, semi-normal life as I can.

Only 170-something days left, and then I’ll be welcoming our little Wojcik into the world with a stick of pepperoni, a tub of raw cookie dough, and a big glass of champagne.

The Bigger Diabetes Picture

After months of struggling with my Minimed Continuous Glucose Monitor Carelink settings, I’ve finally done it. I’ve figured out how to upload all of my CGM information to the big Carelink cloud in the sky. And I’m uploading that information every few weeks, so that I, and my Certified Diabetes Educator, can look over all the pie charts and line graphs and color-coded calendar icons and make changes to my basal rates and carbohydrate ratios on a more frequent basis.

I should be proud of myself, and I am — to an extent. This whole baby-growing-in-my-diabetic-body thing kind of forced the issue, so I finally committed myself to spending an hour and a half on the line with Minimed’s technical service team. Some poor soul named Aaron patiently walked me through the wonky process of tricking Java into working on my home computer’s operating system (it’s a long, nerdy story), and for the first time since I’ve had the CGM, I felt like a full-fledged diabetes robot.

The first few uploads were thrilling, as ridiculous as that sounds. Here was my entire diabetic life, recorded in detail and illustrated in full color, ready to share with the world. Unfortunately, it only took me a few weeks of uploading and reviewing to realize: here was my entire diabetic life, recorded in detail and illustrated in full color, ready to share with the world — and that picture isn’t always a pretty one.

Skiing, anyone?

I call it “Still Life with Dead Pancreas.”

During my first pre-natal visit to my CDE, she brought out several weeks’ worth of printed records. The lines on the graphs peaked and plummeted, jerking up and down according to those diabetes variables we all know and love: food, stress, exercise, baby-building hormones. A devastatingly narrow green rectangle ran the length of the chart, representing the range that those lines should have been confined to. Instead, they were dancing all over the place.

“What do we think’s going on here?,” my CDE asked, gesturing to a mountain range that spanned the 6 p.m. to 10 p.m. landscape of the chart.

“I’ve been low a lot in the late afternoon,” I guessed. “I think some of this may be me over-treating the lows right before dinner. And I had pizza a couple of those nights.”

She pointed out a few other trouble areas, and we made some small changes to my afternoon and overnight basal rates — no big deal. But ever since then, I can’t look at my 3-hour or 24-hour CGM display on my pump and not imagine how it will look when it’s printed out in a few weeks at the Mayo Clinic.

It’s not particularly healthy, but I’d gotten used to viewing my blood sugar fluctuations in tidy little easy-to-swallow snapshots.

This never happens, by the way — which is why I took a picture of it.

The ridiculous thing is that this is why I signed up for this CGM adventure in the first place — to get this vulture’s-eye view of how diabetes behaves on a day-to-day basis. It’s just that now that I have it, I miss my days of relative ignorance.

Diabetes is just one of those things that’s infinitely easier to deal with when you take it one niblet at a time. If I woke up every day thinking about all the blood sugar checks it’ll take to keep me on track for the rest of my life, I would never get out of bed. It’s the same thing with these graphs, even though they’re retroactive. I look at those lines and that little green rectangle and, even though I’ve been doing this for 21 years, I think, “Wait — this is my job? I’m supposed to control this shit? Every day?”

Yes, the graphs are useful — even the Pac-Man pie charts that show you how much your management sucks or succeeds on any given day — but each one challenges the “A1c is just a number!” mentality of self-forgiveness I’ve worked so hard to cultivate.

The perfect response here, I understand, is to view this information as motivating. After all, it’s there to help, right? I need to remember, especially now, that even though everything’s not completely within my control, I’m lucky to have the technology it takes to kick diabetes’ ass, no matter how unattractive the big picture is.