September 15, 2013

16 Weeks, 5 Days: Pregnancy & Type 1 Diabetes

I don't blog often about having Type 1 Diabetes here on the Spanx. Deliberately. You see, I used to be extremely involved in the online community of Diabetics; I had a formerly well-known blog several years ago, started an online support group, was published with the JDRF, and a few other notable things that really don't matter. Hell, I went to college for a healthcare diploma with the end goal of becoming a CDE some day (a few years later I ended up going back to school to become an accountant lol)! I became so deeply submerged in everything diabetes and insulin pump related, that I ended up spending entirely too much time sitting in front of a computer rather than living life, finding love; you know the old song and dance. So I turned around and, with the exception of a few areas, I walked completely away from Diabetes on the internet.

I spent the several years in between then and now focusing on losing the weight that I'd gained from being so sedentary, dating and kissing frogs, finding Mr. Right, jumping through hoops to buy my house, re-establishing relationships with my closest friends... the important things. The things that I blogged about here, while my relationship with my disease remained steady and true and not really worth talking about. Until now. Until pregnancy changed everything.

Pregnancy as a Type 1 Diabetic is freaking hard.

I've had this disease for almost 24 years and I'm exceptionally good at managing it, and all it took was a few weeks of being pregnant to truly humble me. One of the very first symptoms that I had before I even knew I was preggers was low blood sugars. All the time. For no good reason. That started around week 4 if I recall correctly, and it's lasted for the duration. Now, imagine knowing that if you don't drink that glass of orange juice you'll pass out and possibly go into a diabetic coma, potentially resulting in the Seamonkey's death... except you know that if you drink that orange juice you're going to spew. Everywhere. {OJ can be substituted with Ginger Ale/Apple Juice/Everything with the same results!} Welcome to pregnancy as a Type 1 Diabetic... with HG.

I've had record lows; Mr. Right called me one Sunday from work, waking me up from a sickness-induced nap:

"Did you check your blood sugar baby?"
I didn't feel low. At all. And I've always had great sensitivity for lows. "Oh, yeah, good idea."
5 - 4 - 3 - 2 - 1...
My contour meter beamed this scary reading over to my pump: 1.0 mmol.

One. Point FREAKING ZERO. For those of you not in the know, a low BG starts at 3.9 mmol (70 for my American brethren). The reality is that I was extremely lucky to have woken up to that phone call, and I knew it. Had Mr. Right not called me... well, I hate to even imagine. I choked down a cup of ginger ale and managed to keep it down, and ironically once I hit around the mid-2's I started to feel shaky and sweaty and the spaghetti-limbs showed up. Fortunately I've only had a few subsequent low's in the high 1's; the rest usually beep in at a 2-point-something, thanks to this pregnancy-induced degradation of my hypo-awareness.

I'm happy to report that, with intensive monitoring and adjustments of my basal/bolus ratios, I have been able to limit and better manage the lows, and last week's A1c was a lovely 6.1% with a standard deviation (SD) of 41% of MBG! Not perfect though - I'm shooting for 5.5% with an SD of <40% by mid-October at the latest. A lot of Diabetics use the A1c as a benchmark for control, without realizing that the measurement is imperfect simply because it's a weighted average. Sure, my A1c might be great... but if I dig into the numbers behind that A1c, what I might find is that I'm having 6 highs a day and 6 lows a day and those are resulting in what looks to be a great A1c... but what is, in reality, terrible control. By using SD in conjunction with my A1c, I get a much better idea of how good my blood sugar control really is.

To explain SD, I've copied a little explanation that I wrote elsewhere on the www's:
"Standard deviation in reference to BG represents the variation of blood glucose levels either in excess of or below the average. It measures the range of the values that affect the average; if the values are close to the mean, then the SD will be close to zero. If a lot of the values are far from the average then the SD will also be further from zero.
The lower your SD, the more consistent your BG's are. The higher your SD, the more erratic and inconsistent your BG's are. Basically, the SD is a good way to evaluate how tightly controlled your BG levels are.

On average case studies, a healthy, non-diabetic person will have a standard deviation in BG levels of < 1.7 mmol / 30 mg with a MBG (mean blood glucose) of 4.5 mmol / 80 mg. This is a SD of about < 40% of the MBG. Diabetics should set approximately this same target SD to improve overall control (and decrease the risk of complications and yadda yadda yadda). Starting with a goal of <50% SD is a great way to begin."
I'm lucky because my Minimed pump downloads into a program that uses all of the BG information - including when I have my CGMS hooked up - to calculate SD. But Excel has a function to do the same if necessary. 

The past week or so has brought about some pretty significant changes that are making managing my blood sugars a bit more difficult: I'm starting to see the typical decrease in insulin sensitivity that occurs in the second trimester, and my HG is finally getting better! I haven't vomited for 2 whole days. Which means I've been eating! Which means... I've been bolusing for actual meat-and-potato meals. And it's been having mixed results. Yesterday my BG's were perfect all day long. My 1 hour post-prandial's (PP's) were consistently under 7.5 mmol without trailing lows. The line on my CGMS didn't go above or below my target ranges for the entire day, and I only had one low BG overnight last night. Today... well, this morning after breakfast I chased an 8 around for a few hours, then again early this evening I was fighting with a 7. Neither were PP's and they scoffed at the extra over-corrections that I hit them with, and even the temp basal of 130% that I resorted to at one point! So, I walked. I walked and finally started to see the downward pointing arrow on my CGMS status screen.

But what am I going to do when it's -35 degrees outside and there's 3 feet of snow to contend with, and I can't shake those freaking 7's?!? And my belly is sticking out to there?? I plan to walk around and around my kitchen and living room if I have to. Maybe talk to my Obstetrician about what sort of exercises I can do right at the moment in the event that this happens again... and I know it's going to happen again.

In the meantime, all I can do is the best I can to ensure that I have a healthy baby, and a normal birth.


1 comment: