Tuesday, April 30, 2013

Food introduction

Although it may not seem like there is very little method to my madness, I believe we've hit a tipping point where counting GV's age in terms of weeks is no longer rational.  Up until this point she has been, for example, "twelve weeks old" rather than "three months old" because, at least in my mind, a week is so much shorter than a month and the sound of just a handful of weeks drags her infancy out perhaps a moment longer in thought than it is in reality.  But now that we need more than ten fingers and ten toes to count the number of weeks she is old, the tides turn and twenty-two weeks sounds audibly cumbersome compared with a "mere five month" reference.

So, at five months old, our beautiful little Dolly is doing wonderfully and it's been a week full of notable milestones: she rolled over from front to back and then from back to front for the first time and, after glowering at GW for eating waffles in front of her, she's had her first introduction to solid foods.  I'd initially planned to only breast feed her until six months given the positive research such a diet has shown for infants of type one diabetics, but seeing as that date is technically two weeks away (24 weeks old on Tuesday May 14) I decided that she is ready given her ernest protestations when she too isn't presented with a full plate of food at the dinner table.  (Honestly, I think that if she truly had her own say in things, she'd be running and eating steaks already...)

But once again, in spite of the fact that she's child number two, I feel completely foiled in my parenting knowledge and experience by the role diabetes is playing in our family (not just my) life.  When GW began eating solid food, I remember the momentous weight of the occasion being thoroughly placed on his act of eating rather than on my choice of cereal products.  With GV, however, I'm spending hours of time surfing online medical journals and diabetes resource pages trying to make sure that the external environmental factors I actually have control over don't unintentionally exacerbate the biological possibility of islet autoimmunity.  So while I am completely thrilled that she has (proudly) eaten three full bowls of rice cereal, I feel the weight of my off the shelf selection as a consumer each time I lift that tiny spoon to her gleeful mouth.

GV's first solid food

Now, to reiterate my disclaimer, I am not a medical professional --  I am only a mother 
making as informed of choices as I can in the hopes of doing what is best for my children.  
I have absolutely zero knowledge as to whether what I am doing is right or if - Heaven forbid - 
it is wrong,  so if you're like me and searching for a "recipe for success" you need to use
your own best judgement and ask your pediatrician or endocrinologist for their medical advice.  

That said, back when I was researching what impact my diabetes would have on breast feeding I learned that there is a possible correlation between the introduction of cow milk proteins and the later life development of type 1 diabetes.  Seeing as this whole line of thought started with my research on formula and since it is typically the first non-mother's milk food to be introduced to infants, I'll start there:

The American Journal of Clinical Nutrition published a 2010 research study that indicates the large size of bovine protein may be too difficult for infants at "high risk" for diabetes (children of type 1 diabetics, with type 1 siblings or those that have tested positive for autoimmune antibodies) to digest and may lead to the onset of islet autoimmunity.   In an effort to reduce the possible impact of this environmental factor, the study suggests that such infants be fed breast milk as long and as much as practical but if formula is warranted to only use highly hydrolyzed, hypoallergenic forms like Alimentum, Nutramigen and Pregestimil due to the smaller, non-cow milk proteins used.

I admit the repetitive use of "may" and "possible" doesn't provide much comfort to the concerned parent in me, especially in light of the price tag assigned to hypoallergenic formula, but seeing as this is the only study I've come across with anything remotely close to a definitive "cause" for diabetes (even these researchers state more studies are necessary) I'm willing to work with their results.  I mean, even non-diabetic parents are cautioned against the introduction of cows milk in the first year of life anyway.  Straight cows milk is significantly more difficult for infants less than 12 months old to digest and, even if the correlation to diabetes is uncorroborated, there is conclusive evidence that indicates early introduction of cows milk leads to iron deficiency anemia, an increased risk of a milk allergy and potentially life threatening dehydration.  In my mind, those risks alone are worth consideration and avoidance of bovine proteins!

Having learned this about the liquid end of things, I obviously looked into solid food introduction as well and, unlike formula, I learned the most important factor about cereal introduction is not necessarily what but when it is started.  So working with the general medical community's consensus that all parents should start all infants on iron fortified rice cereal (again, to avoid iron deficiency) -- I chose an organic brown rice cereal based on the nutrition label you see here -- I used my pediatrician's guidance to start solid foods around 5-6 months, the age infants are physically ready for more than breast milk.  Before this time frame, infants don't have the proper gut bacteria necessary to break down solid food safely and there is no nutritional need for more than breast milk or formula then anyway.  Not to mention, starting cereals any earlier than 5 months is linked to an increased risk of not only developing diabetes but obesity, eczema and celiac disease!!  But, all cautionary fear-mongering aside, assuming a baby is at the very least 20 weeks old and showing physical signs of interest in solid foods - putting hands in mouth, practicing a chewing motion, watching and mimicking eating motions - go ahead and get your camera ready!

I know what you're thinking: all of these baby-feeding guidelines seem completely overkill.  And, you know what, I am with you.  I feel like I have opened the medical journal version of Pandora's Box and am falling insulin pump first into a rabbit hole of hypochondria... but I made the active choice to learn everything I can about my disease, for better or worse, so that I can run it instead of the other way around.  I can't passively wait and see what my pancreas has in store for my kids with clear conscious, so overkill or not, at least this degree of research helps me sleep at night.

Monday, April 29, 2013

You have ...

While walking around the INOVA Fair Oaks Hospital last week doing this test and that scan an unwelcome knot began to coil in my stomach on top of the other obnoxious symptoms I've been experiencing.  But unlike the unidentifiable pain in my back, twinge in my abdomen, all encompassing fatigue and plummeting blood sugars, I know without a doubt the cause of this gnarling, rancid, snaking sensation: sheer dread.

The idea of more white coats, of being hospitalized and generally of being sick again makes me thoroughly miserable.   I'm 27 years old for goodness sake!  I'm supposed to be spry, youthful and energetic - you know, able to leap tall buildings in single bounds and all that jazz.  But, as sorry as I am to admit it, ever since I got sick in 2011 there has been a persistent shade of gloomy-blue in my life...  I'm sick and, until they discover a cure, I'm not going to get better.  Of course, it's unfair of me to say that I haven't gotten better with the use of my insulin pump and incessant glucose testing because the fact is that I no longer have DKA and my diabetes is not getting worse.  However, when my chronic condition regularly gets me bumped from "I'm sorry you are sick, but wait your turn" to practically having "STAT" stamped on my forehead the moment I walk into medical buildings for efficiency purposes it's a little disheartening.

Now, I fully appreciate that my doctors are thorough and that they never feel comfortable labeling anything as "just a virus" or whatever because of the possible worst case scenario, but dagnabbit people! With absolutely none of the tests coming back with clear results, my GP advised that I come back into the hospital on Friday to be rehydrated.  When I flat out said "no, I can drink my own dang water, thank you" she then requested that I at least follow up with the following morning at their immediate care clinic, which I thought perfectly reasonable.  But then, on Saturday morning, when the next two doctors to examine me found zero trails to follow they seemed to be pursuing the medical equivalent of an invisible yet mischievous pooka down random rabbit holes... worth it? I think not.

Now I might be stubbornly calling the hunt off too early and there's still a possibility that I may have to eat some hospital version of humble pie sometime in the next couple weeks, but without a reason for more poking and prodding I'm done being the poor, pitiful patient.  If it's something as simple as a virus, then sleeping on the couch a while longer should put me right.  If it is more than that, then, well, I'll have some more definitive symptoms to follow and we wont waste our time trying to track down something it's not.

With that, it's nap time.  GV in the crook of my arm and GW in "the boat."    

Friday, April 26, 2013

Wait and see.

I apologize for the hiatus in posts over the past two weeks. Between my shear bewilderment over the Boston Marathon bombings and a horrific stomach pain that has had me sleeping since Monday I've been quite without comment.  But after having spent the majority of yesterday and this morning at the doctor's office running tests, it's about time I get back to it.

So Monday afternoon while driving with HB to get landscape rock for our yard my stomach and lower back began searing with pain.  Leaving him to load the 4 tons of river rock in to the truck, complete the landscaping and generally do everything that involves moving, I've been on the couch and barely eating ever since.  Finally opting to go see someone about it yesterday, the doc found my bilirubin levels to be high and ordered a complete blood panel and abdominal ultrasound that was completed this morning.

Thus far we haven't learned anything from the lab results and the ultrasound found nothing conclusive, but we have learned one thing: with an underlying, chronic condition general practitioners seem to automatically assume that diabetes is the cause of all of my problems.  Now, if my HgA1C was high and I truly had "poor diabetes management" as they accuse me of, then I'd nod my head in silent resignation that I've made myself worse with apathy. However, since my A1C is stellar and I test my sugar so often I have perpetual bruising from my lancets I refuse to sit passively by and take undo criticism of my self-care.  I mean at one point this morning the sonographer went so far as to ask if my stomach pain is because of "improper use of my infusion site" - perhaps a logical question if it wasn't in a completely different abdominal quadrant from where the pain is!

The thing is, while diabetes could be a problem and is regularly a bitter annoyance of mine, right now my diabetes is a reassurance that something beyond the norm is wrong and here's why: Before I began feeling ill on Monday, my blood sugar was completely stable, but especially over the last two days my bgs have been falling lower and lower without a relevant diabetes explanation...  Yesterday afternoon my glucose levels were low (63 mg/dL) so I corrected with a handful of saltine crackers.  But when I checked my blood sugar a few hours later at dinner and it was even lower (61 mg/dL), so I adjusted my basal to 70% of it's usual amount to account for being sick and I skipped a meal bolus for the minimal food that I ate.  Assuming this would set me up for stability via hyperglycemia over night since I had to fast for the ultrasound, I checked my post-dinner two hour postprandial, my bg was still low at 68 mg/dL... I grabbed a quick correction snack, adjusted my basal rate even lower to 50% and went to bed.

You'd think with half of my normal basal rate and a correction I'd have woken up this morning with my blood sugar well into the 100's - if not higher - but nope.  For the second day in a row, my blood sugar was down even farther to 41 mg/dL!  Since I couldn't even have water before this ultrasound I couldn't correct with either solid or liquid carbs, so at 7 AM I suspended my pump and removed it with the assumption that my sugars would naturally go up without my persistent basal dose.  Makes sense, right?
Well, yes, but it didn't work. Three hours later at 10 AM my blood sugar had merely gone up to 48 mg/dL... not awesome.

I've since had breakfast and found a temporary fix to my hypoglycemia, but that's beside the point.  The silver lining of my exhaustion, pain and zero appetite is that my diabetes is providing another quantifiable symptom to go from.  Typically when diabetics get sick the body releases extra hormones that cause a decrease in insulin efficiency and therefore causes unavoidable hyperglycemia,  but for whatever reason, something else is going on right now.  How obnoxious.

I guess we'll just have to wait and see what comes to pass.

Tuesday, April 16, 2013

Friday, April 12, 2013

3.5 Year Update

Okay, let me get this straight... not only is my itty bitty baby no longer itty bitty, but GW's birthday was six months ago already?!  Are you fricking kidding me?! That means Halloween is only six months away... that he starts school in five months... that he's practically four years old already!

Remind me not to blink ever again... too much changes each time I do.

GW and HB next to Daddy's 1986 outline self-portrait
Having outgrown multiple physicals a year at the pediatrician, we're doing our best to keep tabs on the growth spurts this kid continues to have.  As of this morning, GW weighs in at a slender 38.5 pounds (85%) and 42.75 inches tall (~105%)!  That's up three fourths of an inch since February!  Wow.

I'm thrilled that he's growing so beautifully and that he's putting on height rather than girth given how much he eats (are you kidding me?), but I'd be lying if I didn't say that I'm somewhat worried about how huge he is.  He towers over kids his age and big kids regularly confuse him for a five or six year old; and while I am thrilled he is invited to play and that he's so eager to interact with other children, the reality is that the combination of his big size and that he's not developmentally where his "peers" think he is works against him.  Often more rough than he wants to be, GW doesn't quite have full coordination or control of his body and despite his good, playful intentions he, for example, is accidentally pushing kids down when he simply means to play tag.   I fully recognize that he just needs time to learn that he's bigger than most of the other kids, but for the moment I find myself harping at my truly sweet child to be "nice nice" and "gentle."

GW watching over GV and wearing his self-made
 Bunny Friend carrier (HB's heart rate monitor)
The good thing, thank God, is that GW is not sharing challenged and when little guys come around, he's often the first to offer a toy or to ask "want to play with me?" And, still very much GV's champion, he sweetly makes sure his baby sister has what she needs and he purposefully checks to make sure "she is smiling" amidst his wildly creative adventures.  To which, as a sappy, gushy parent, I must say warms my heart more than any other random pop tarts and rainbows out there.

You know, he often reminds me of the character Big G in the movie That's What I Am (2011) and while I ardently pray that he never faces the bullying that Big G does, I am proud that GW demonstrates similar personality attributes of Alexander Walter's kind, self-assured, gentle giant character.  I only hope that I can parent him well enough that as he grows he becomes the person that he, himself, is happy with and proud of.

Happy half-birthday, my angel.  Love you lots.

Monday, April 8, 2013

4 Month Check Up

Left:  First family walk, December 4, 2012; GV one week old.
Right:  An everyday snuggle, March 20, 2013; GV week 20.
Oh my goodness. 
You know how some parents mistakenly turn away for a moment and find that when they come back their babies have rolled off the couch and are lying somewhere under the coffee table? Well, I know not to leave the baby unattended, but some how I turned around and inexplicably found that my little bitty baby isn't where I left her ... and in her place there is a gorgeous four and a half months old.  It doesn't seem like so many weeks have passed, but GV is 18 weeks old already and there is officially nothing about her that resembles a new born babe.  She's able to bear all of her weight when standing if you provider her balance, she giggles when you tickle her chin, she smiles whenever GW interacts with her and, even with her first tooth coming in (top right, poor thing!), she cries rarely.

She's turning into Little Toughie, Jr. 

We took her up to see the pediatrician this morning for her four month check up and, despite a mild case of cradle cap and a lingering cold, she's doing remarkably well.  She's growing and developing like any healthy baby ought to -- today she measured in at 16 pounds 1 ounce (96%), 25 inches tall (85%) and a head circumference of 16.5 inches (75%).   That's just shy of ten pounds in weight gain, 5 inches of added length and a whole three inches in head size since she was born in November!  So regardless of the complications that happened in the pregnancy, diabetes related or plain and simple bum-luck, she appears to be unphased by inutero trauma and perfectly thriving.  Thank God!

I must admit, however, we are having one problem with her...  With a beautifully even temperament and wonderfully chubby cheeks, GV is regularly accused of being "fake."  Because she's more often than not quietly, comfortably just watching the world around her from the safe vantage point of our arms or laps, passers by often jump (seriously) in surprise that our doll is "OH MY GOODNESS! REAL!" I have no fricking clue why people so regularly think that we'd burden ourselves with actively parenting a baby doll when we have a very, very active and curious 3.5 year old to wrangle, but given the fact that there are those out there that pay good money for life like, adorable baby dolls I take it as a complement that they assume my GV is perfect enough to mistake her for a dolly!