Where has the time gone? I am sure many of us are asking this same question, pregnant or not.
My first pregnancy, Dex was born August 6, 2013, and I could pretty much recite the weeks, day and perhaps the hour of time I was pregnant, and this go-around I am finding I have to track it in my calendar or the ask the nurse at my monthly appointment. Perhaps this is due to the fact, I have been a little behind the 8 ball with baby Schmidt #2’s arrival from the get go. I didn’t know I was pregnant until about 8/9 weeks; and yes, this can be a dangerous thing being type 1 diabetic. Thankfully I had a decent A1C at the time, it was about a 6.2% and now I am riding in the 5’s.
So what is the blog post all about? Well, the title is a little obvious, but I have been wanting to write out and publicly share my experience with pregnancy and type 1 diabetes because the last 24 plus weeks haven’t been easy, and perhaps my experiences can help another. I also hope to continue writing quick posts, in a style of writing in a personal journal, and if this is something that is beneficial for you, please share your feedback. To start, maybe I’ll explain my journey thus far…
Early October (24ish weeks ago) I was packing my suitcase for a trip to Los Angeles to present at a conference on blood sugar control, diet and diabetes for DiabetesSisters.org. As I was in my bedroom loading my things, my 14 month old son was being “busy” exploring all my accessories in all my draws in the bathroom. A few items he kept pulling out and showing off to me included a pregnancy test. Geesh, I haven’t used one of those in quite some time; 14 months actually. And for some reason I thought, I should take it. In the last few days leading up to this moment I had an appetite like a triathlete and while I didn’t think I was pregnant, my cycle hadn’t arrived, which wasn’t too off due to it still balancing out from breastfeeding. So I took it. What do you know, it was positive. I immediately told me husband. His response? Take another one. I took another one. His response? Are they accurate???
So there I was. Focusing on a trip, 2 presentations and now having a minor freak out if my blood sugars were good enough, as well as, having a moment because my pump hadn’t been working out for the summer and I was currently on MDIs (in diabetic jargon this is multiple daily injections). Oh snap, I should call my mom, I should call my nurse, I should breath. Wait, is this really happening? Yes.
(Tangent, mom and dad, if you are reading this, sorry my news of expecting is never lovey dovey. It’s usually an immediate phone call of worries and tears and your support has been beyond appreciated. Maybe if I have a third, I will be a little more traditional. Oye.)
Next, I got on the flight the following morning, put my ducks in a row, and drew back on my memories of my last pregnancy. Well, this pregnancy and my first haven’t been a lick alike. The first pregnancy I was low in the beginning all the time. I had to cut my insulin basals and with this current pregnancy I was running high and actually had to increase my daily insulin needs. Secondly, while MDIs can do the job, I wanted back on the pump. I needed to make it work and I wanted that security knowing I could have the insane tight control of an average of 5.4% A1C I had with Dex. It also didn’t help I was puking like it was fashionable this go around. Are girls always tougher??
Long story short, I did the conference, I was in bed by 8 every night! And returned back to Chicago and put myself back on my Minimed pump as soon as possible. Ahhhh, the Quickset infusion set hurttttttttttttttttttttttttttt. But hey, I thought, I’ll do WHATEVER I need to do, regardless of pain. I stuck it out, but oh crap, absorption sucks, sugars ran high, ketones!!! Ketones, not ketones! I call my doc and she recommends I use the steel needle infusion set called the Sure-T. I get some from Minimed and gave it a whirl. Yes it worked. Oh, but only for about 24 hours. I changed my site sometimes 3 at a time. And this happened for days. Every few it would work, and then I’d have moments where I had to change it again and again. Meanwhile, and in retrospect, I was having absorption problems with my infusion sets, but I also was banking on the fact my first pregnancy I was bloody low all the time in the first trimester, and that wasn’t happening this time. I no doubt was jumping the gun with changing my site and not being patient with my insulin, but I was worried. Every high blood sugar could honestly mean birth defects, or worse. It was hard to calm down. Until my first appointment I was constantly holding my breath. Side note – I am thankful for how advance insulin is these days, but it surely has room for improvement, esp with my impatience at the time in pregnancy.
Next up, I finally get to my first appointment to learn if I was 11 weeks or more; I was 12, and thank the heavens for my CDE. I think I have the best one in Chicago, she encouraged me to do what is best for me in the moment and if need be, we would figure out how to do MDIs and have optimal blood sugar numbers. I switched back to MDIs – I needed a break, and I needed to sleep, and we worked it out.
Since then, I got a Dexcom or a CGM (continuous glucose meter) and the data is magical. Well, when it works. Another twist with pregnancy is that a CGM is less accurate and there isn’t research done on using a CGM in pregnancy. I had a similar experience in fighting to find a spot on my body for a CGM to accurately read, but over time I have found my upper stomach is my only accurate site. Post pregnancy perhaps, I can use my backside, arms and thighs. Not now, and that’s okay, as long as it works.
So I am on the Dexcom, on MDIs and by about week 23 I am finding that with creeping insulin resistance, as it happens around this window, I was taking anywhere from 10-16 shots a day. I felt like my quality of life was dwindling and my CGM, shots, blood sugar pricks and being married to exact meal time for every meal was affecting my personality. I was surely declining social events because dinner dates did not line-up with my dinner time, or if I did attend, I’d fight blood sugars all night. I talked to my CDE and we switched back to the pump….and it was not easy, but I was and am persistent and was on top of it.
So far in this pregnancy I have been on MDIs, to MDis with a Dexcom (quick learning curve there obviously as I have never used one), to various Minimed infusion sets, and I will add the silhouette manually inserted is doing me the best, back to MDIs and then back to the pump. I’ve continued to assess and analyze what daily changes I need t make, including the number of carbs to eat at each meal, when to have snacks or not to, to how long dependong on the time of day I need to take insulin before eating. Right now I wait about 30 minutes for bfast, lunch, 40 for an afternoon snack and about 50 minutes for dinner. I’ve moved my diet from a low low carb eating plan to a daily intake that is still considered low carb, but higher to meet pregnancy needs of 100 grams a day. I have also tried to drop my protein down, closer to 80 grams per day. My fat intake is somewhat the same. I do not restrict and indeed during this pregnancy butter, eggs, and nuts are my main cravings.
It has not been easy, but this entire journey has really made me appreciate every tool I have to control my blood sugar and to be able to grow a baby. A century ago my life expectancy would have been a week and these days, I can not only grow up and be what I want to be (the best dietitian!!!), but a mom and to have a family. For this I am forever grateful, and while there are challenges, sleepless nights (already) and worries (who doesn’t worry while they are pregnant), it makes the end result that much more special.