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.

Breast Feeding and Diabetes

For months now I've been saying that I'd write a blog post about breast feeding as a diabetic.  I'd skipped the topic while still pregnant since it wasn't quite relevant at the time and for the past 11 weeks since GV was born I just haven't made a priority of writing about it since doing it seemed more important.  But seeing as she's happily asleep in her swing chair and GW is at least pretending to nap in his room, I'm going to take this opportunity to tell you about it since I know you all must have been anxiously loosing sleep over it since I first mentioned I'd write about the topic back in 2012.

No? Just me? Ah well, c'est la vie.

According to the American Diabetes Association, the best thing that a diabetic mother can do for her new born child is to breast feed.  Citing multiple research studies, the ADA explains that babies that are exposed to diabetes in utero and are breast fed for upwards of six months after delivery have a decreased incidence of respiratory infections, a lower risk of asthma and atopy, tend to have lower blood pressure and are less likely to develop childhood obesity.   All great things, right?  Well, combining these medical benefits with the fact that the disease is not transmittable, that there have been research studies connecting certain types of baby formula containing bovine protein to the development of autoimmune diseases like diabetes and that I thoroughly enjoyed breast feeding GW, the choice was easy for me.  The practice of breast feeding with diabetes, however, is not so easy.

Blood sugar affects everything we do in our daily lives because it provides us with energy, so it seems only logical that there be some relationship between blood glucose and the natural formation of breast milk.  While you've probably heard that breast feeding burns calories, you may not have taken the next mental step to connect that with blood sugar... Essentially, in a similar way to how our bodies burn both calories and glucose when we exercise, a mother's body burns both fuels to create milk for her infant. So while a non-diabetic mother can singularly reap the weight loss benefits of nursing her little one due to her self-regulation of glucagon and insulin, a diabetic mother needs to monitor her blood sugar with extreme caution so as to not put herself (and by extension her baby) in danger of hypoglycemia.

To prevent this and to keep blood sugar stable, it's important that I eat before, during and sometimes after feeding GV.  But that brings me to the next topic of difficulty: weight gain and nursing.  Because of my sugars I need to eat more to keep my blood sugar up to be able to safely nurse -- but then that means that although I am burning calories while nursing I am required to ingest more calories to nurse which means any weight loss I should have with breast feeding is replaced with weight maintenance, if not additional weight gain.  Obviously this creates a source of stress for someone as physically self-conscious as me, but to take it to a less superficial level, weight gain can change a diabetic's chemistry enough to change the body's response to glucose and therefore its artificial insulin requirements.  So... to keep this complicated... that means that I need to eat more to nurse more and that I must exercise more to compensate for not only remaining pregnancy weight (15 lbs to go) but the extra calories necessary to nurse (and exercise) all in order to keep my sugars stable enough to nurse in the first place.

Furthermore (because why, really, would it end there?) not only should my blood sugar be kept from going low while breast feeding, but they should not be permitted to go high either.  While the majority of perinatologists, pediatricians, obstetricians and diabetes organizations insist that there is no connection between a mother's in-the-moment blood sugar and the quality of her breast milk, there is a school of thought out of the Sansum Diabetes Research Institute in Santa Barbara, CA that believes the value of a mother's breast milk decreases when her bg is over 150 mg/dL.  According to these researchers, such deficient breast milk can cause infants to have "reactive hyperglycemia" which causes them to vomit, be excessively irritable and require more milk to satisfy their nutritional needs.  While there aren't additional studies to backup these claims and I've never seen such negative effects in GV's behavior when I have nursed her while high, a lack of evidence doesn't necessarily refute the possibility and I've decided to play it safe rather than sorry.  Admittedly it voluntarily adds another level of complication to breast feeding, but what does it really cost me?  If it is no big deal, then oh well.  If it actually matters, then it's worth the effort.

The bottom line is, I am thrilled to be nursing; it's a very personal choice and I find it completely satisfying. But breast feeding and diabetes take a lot of conscientious thought -- and at 3 o'clock in the morning when GV wants to nurse that is a lot to ask for.  Don't get me wrong, glucose control is definitely less critical and requires far less attention to minutia now than in pregnancy, but it's still exhausting to continuously consider.  I could let it go and give myself an easy DKA-sponsored trip back to my skinny jeans, but I cannot justify cutting myself any self-satisfying slack on my sugar control since a lax take on it would imply irresponsible parenting at best.

Seeing as I take my vocation as wife and mother extremely seriously, I guess this is just another one of those necessary "diabetes says this is how it is going to be" horse pills to swallow and get over it... now if only they made that in a gummy I'd be happier.

Why take a horse pill when you can have a gummy?