Breast Milk, part two

So you know my last post on breast feeding? Thought I was done? Well, guess what? There's more!

Now that I've explained the complexity of breast feeding as a diabetic and how the balancing act is more a matter of self-care than baby-care, it's about time that I move onto the real impetus for getting around to writing these posts: Downton Abbey.  For those of you who watch the show, I've tried to give you all a few weeks to catch up on the fourth episode so as to not inadvertently spoil the plot for you, but seeing as this topic has been eating me up inside I just cannot wait any longer to vent about it.  Several Sundays ago, Lady Sybil died from eclampsia after giving birth to a beautiful, healthy baby girl.  I wept my freaking eyes out.  I simply couldn't believe that Julian Fellowes (the writer) would do something so horrible to the most wonderful character on the show... I mean for God's sake man, kill Bates if you have to, but not Sybil!

Many of you might find this to be completely random and not at all relevant to a diabetes related post about breast milk, but bear with me -- you see, when Mr. Carson, Mrs. Hughes and Mrs. Patmore began talking about the baby's need for a wet nurse I got to thinking.  While breast feeding is an extremely personal choice for mother's now a days and there are definitely social stigmas that go along with not just nursing, but sharing breast milk, the reality still exists that there are babies out there that need to be fed by other means than their own mothers.  Clearly formula is the go-to option now a days for such situations, but I'd heard tell about the practice of breast milk donation and wanted to check it out.

So off to Mr. Google I go to look into what organizations are out there and what it takes to become a breast milk donor (face it, with the image of Sybil Branson's baby fresh in mind who wouldn't want to help out?).  The search engine pops up with several different groups that collect donations for families in need and I delve into the mission statements, success stories and finally into the requirements pages... logically, the organizations insist that a donor have her own baby's feeding covered before considering donating extra milk; they also mandate that a donor's freezer be capable of reaching - 4 degrees Fahrenheit; and, oh yeah, donors under no circumstances can be diabetic.

Putting diabetes under the same category of disqualifying diseases as HIV (SERIOUSLY?!), using artificial insulin on a regular basis classifies me an "unhealthy" mother...  ouch.  Now I am not so irrational as to deny these organizations consideration of liability reduction in making this decision, but likening my milk quality to that of a disease that is actually transmittable from person to person and actually communicable through breast milk is just insulting.   Women with HIV cannot safely breast feed without taking antiretroviral medication to prevent transference of the disease to their babies, but women with diabetes - as I said earlier - are not only capable of breast feeding safely, but they are encouraged to do it!

Having the past several weeks to stew on this topic, I'm not angry with these groups because I cannot donate something I willing would under different circumstances, but I am furious with diabetes that it has taken something important away from me.  It never crossed my mind to donate milk while breast feeding GW, but now that I'm actively feeding GV and am in a physical position to do so now, it really stings to know what opportunity I missed and what difference I'll never be allowed to make for another mother.  Don't get me wrong, I know mothers today who can't or don't breast feed have alternative options with formula, but it's the principle of the thing...

While I understand that I have a disease I work tirelessly to manage it and make it as irrelevant as possible.  But, being of spiteful character, diabetes seems to take pleasure in continuously adding insult to injury -- making me wear a battery operated computer 24/7 was just selfish; forcing me to cut out cream of wheat was just rude; making candy a thing of necessity rather than pleasure was sick and twisted; and, worst of all, having my milk practically labeled as carcinogenic is just unforgivable.

Screw you, diabetes. And the horse you rode in on.

Six Week Check

Now that GV is officially eight weeks old, I should probably get around to writing about my six week post-delivery follow up with the Perinatal Associates of NOVA as that appointment really and truly acts as the finishing period to a very long, run-on pregnancy sentence.  A lot happened over the course of those 38 weeks that I didn't expect and coming into this appointment I had a list of eleven multi-part questions I needed answers to.  Fortunately, the office purposely scheduled my appointment with Dr. Bronsky and seeing as he cared for the majority of my case I was able to receive much of the information I was looking for... Since you all have accompanied me on this journey, it seems only right that you get closure to my questions as well:

1.  What results did the placenta pathology find?

Instead of sending the placenta to disposal as hazardous waste as is typical of most hospitals, Dr. Bronsky sent my placenta to the lab for pathological analysis in hopes of more in depth answers to why my AFP levels were abnormal, the extent of the abruption and why my blood sugars were atypically trending low.  Unfortunately, the report wound up being predominantly uninformative, save one factor: the placenta's weight.  Apparently a typical, healthy placenta for a typical, healthy pregnancy weighs nearly 1800 grams or, at a minimum, 1/6 the weight of the baby at birth - which in GV's case would have been about 600 grams.   This placenta weighed 298 grams.

This excessively small size for a placenta could be the reason for the abnormal AFP levels and my blood sugars dropping given it's insufficient capacity, but there is no way to know for sure.  Furthermore, there is no way of knowing why the placenta was so small in the first place - it is possible that the abruption could have caused its small size or it is conversely possible the small size could have played a hand in the cause of the abruption... it's just another version of the chicken and the egg debate. Only God knows.

The only thing Dr. Bronsky definitively said on this topic was that he is shocked that GV was as large as she was at 6 lbs 14 oz because such complications usually present issues of growth restriction -- which if you remember was the concerns we had with possible placenta calcification.  Guess this goes to show that placenta deterioration was an issue, not because it was prematurely breaking down but rather because it was abnormally petite.

2. What happened to the epidural?

There is no way to know why the epidural failed.  Dr. Bronsky said that there were clearly some mistakes made by the nursing staff in that they didn't attempt to fix the issue quickly or call anesthesiology to have them evaluate what was occurring. But given how quickly GV arrived their intercession would have likely been irrelevant in this case anyway.

3.a. Are additional pregnancies safe?

Assuming my blood sugar is under tight control prior to conception, Dr. Bronsky believes there are no reasons why future pregnancies would be inadvisable.  Granted, they will all be complicated and high risk because of my preexisting diabetes, but my safety and the well being of potential babies is not inherently in jeopardy based on what he saw with this pregnancy.

3.b.  Are there different timing requirements between pregnancies for a diabetic?

No, diabetics don't need to wait x number of months longer than non-diabetics to conceive again.  However, like with all women, it is advisable that new mothers wait twelve months before trying so as to permit their bodies time for full recuperation before attempting the physical stress subsequent pregnancies.

4.  At what age should I stop having babies due to compounding diabetes and age risks?

Knowing that pregnancies are considered to be high risk for women over the age of 35 due to an increased risk for birth defects, low birth weight, and macrosomia, Dr. Bronsky explained that while it's not exactly advisable the reality is that it all depends on how things go between now and then.  If over the next several years pregnancies go smoothly and I continue to stay healthy, then there is no reason post age 35 pregnancies can't happen safely.  Alternatively, if pregnancies become more difficult and present more serious complications, then fewer pregnancies, even before age 35, may be called for.

5.a.  Will multiple pregnancies as a diabetic increase my risk of diabetes complications?

No, but the longer that my body is exposed to the disease of diabetes, regardless of the number of pregnancies I may have, the more likely I am to have complications.  Fortunately the better controlled my diabetes the less probable complications are.

5.b.  Will multiple pregnancies as a diabetic increase the in utero risks for future fetuses?

No, the number of pregnancies I have as a diabetic is irrelevant to the degree of risk future babies may face.  The complications of previous pregnancies, however, will potentially increase this risk factor and should be considered after the completion of any additional pregnancies.   See question 11.

6.  Will the complications from this pregnancy be likely in future ones?  And can I do anything to proactively prevent them?

All of the complications I faced with this pregnancy are possible - and to one degree or another, more likely - in future pregnancies, but there isn't a definitive way of predicting what complications may or may not happen again.  Seeing as this will be discovered on a case by case basis, there isn't anything I can do now to prevent x, y or z complication except to be as healthy as diabetically (diabolically?) possible.

7.  Is there anything I can do differently in future pregnancies that will prevent complications?

No.  (Hmph)

8.  Can we expect my blood sugar to behave similarly in future pregnancies?

No.  It could be the same, it could be better or it could be worse.  (Hmph)

9.  Should I assume that the next baby will arrive faster that GV did?

As the skids are greased with GW's quick arrival and GV's 3 pushes, it is quite likely that the next baby will arrive quickly as well.  Dr. Bronsky advised we move closer to the hospital before then... I tend to agree. 

10.  Is there anything I should do perpetually to prepare for any possible future pregnancies?

Beyond keeping my diabetes in check with a stellar HgA1C, the only thing I can do regularly is take a folic acid supplement.  Since the majority of critical organ development happens almost immediately upon conception daily pre-pregnancy doses of folic acid decreases the likelihood of birth defects and ensures proper neural tube formation.

11.  Will I always be a class B diabetic or will that change?

Yes it will change, but background information first: there is a scale called the "white classification" used by perinatologists to classify diabetic women into various explanatory groups based on their diabetes and the risks associated with it.  I currently fall under the "class B" group as I am a person who was diagnosed less than ten years ago and after the age of twenty.  In eight years, however, I will become a "class C" diabetic because my exposure to diabetes will be greater than ten years and in eighteen years I'll once again be "upgraded" to a "class D."

The White Classification was created by Priscilla  White in 1949
to partially predict the course of treatment for a pregnant diabetic
and the chances of newborn survival.

And there you have it...

I'll admit to being extremely relieved that this appointment didn't shatter my dreams of a large family.  I've long been fearing that one complication or another may push me over the edge in terms of risk, but for the time being I'm alright and that is all I can ask for. I'm not sure how many kids we ultimately want in the end (maybe four? maybe five? maybe twelve? ... just kidding... sort of), but God willing however many healthy babies we can have we'll get - after that there's always adoption, HB willing.

Diabetes and Pregnancy

So back when I was first diagnosed with diabetes one of the most difficult things for me to hear the doctors say was that I couldn't have any more children for an extended period of time (several many years) because of the difficulty women have managing diabetes and pregnancy.  As HB and I had previously been hoping to begin trying for baby #2 around that time, the doctors took their time to explain the complicating factors my new disease has on the creation of fragile little embryos and maintenance of a healthy fetus. The white coats used big, scary medical terminology to indicate that abnormal blood sugars cause significant birth defects, that babies of diabetics are HUGE, that I'd likely wind up more sick because of the strenuous nature of pregnancy on my already damaged body and that there was no way a freshly diagnosed diabetic could understand the nuances of either the disease or the combo of the disease & pregnancy without several many years of diabetes management under the belt.

I remember feeling emotionally crushed.  I had been so looking forward to the feeling of a baby in the womb again, to holding another sweet little angel in my arms and to adding to the completeness my life newly feels because of my kid(s).  Having spent so much of my life prior to GW searching for a true form of self-expression and the key to my passion, I whole heartedly embraced the gift he gave me by honoring me in being my son... nothing replaces or ever could replace what he - and my future children - give me by simply being who they are.  So when the doctors pushed the "stop" button and placed my entire dream of a large family on hold, it hurt and I resented the failure of my pancreas all the more.

But now that the two year anniversary of my diagnosis (1/24/2011) is within counting distance and that I am close to finishing a difficult, but successful pregnancy with diabetes I understand what the doctors were saying back then.  Managing a pregnancy with pre-existing diabetes is tough and not something to be entered into lightly without serious preparation or comprehensive disease understanding.  I mean the consequences of diabetes alone on the health of a diabetic are serious enough, but adding the responsibility for another person - especially a little person - to the mix has a lifetime's worth of impact... indulge me with a quick explain:

With diabetes, by itself, there is a basic level of disease maintenance that is necessary to be considered healthy.  In the medical community, unfortunately, that is measured by the "low" bar of a HgA1C of 7% - which although it is better than the average diabetic (8% or higher) it is still considerably higher than a normal, non-diabetic's A1C (between 4% - 6%).  Whether on multiple daily injections of insulin or on an insulin pump, a diabetic must actively work to maintain some degree of glucose control to be a functioning person with limited knock on issues (such as blindness, amputation, heart disease, stroke - you get the point).  And - to speak generically on behalf of insulin dependent diabetics - that control can be extremely tough in even the most basic situation.

But when you throw pregnancy in on top of that (in all fairness, probably any other medical complication), diabetes gets more complicated and that's not a good thing.  Unexplainable changes, sharp spikes and dips in bg readings and larger than me implications for the baby make the juggling act of insulin, carbs and hormones all the more sensitive and important.  If I didn't know how to handle low blood sugars, how to prevent DKA, how to calculate a bolus or understand what a bolus rate is, I wouldn't know how to do what the fetus NEEDS me to do to keep it safe.  And since the placenta is constantly throwing in changing variables it's frustrating enough to be fine tuning my insulin needs without the overwhelming feeling that inevitably would result if I didn't "get it."  Especially since my bgs drop overnight (I've been in the 40s and 50s the last couple times I've checked at 3 AM), I need to literally know what to do with my eyes closed and in my sleep because the reality is that is life with diabetes and there is no down time!

Long story short, I was fortunate that my doctors had enough confidence in my self-care to grant me the "go-ahead" on this pregnancy as soon as they did.  But in retrospect I must admit that those doctors at Georgetown University Hospital had a point when they said that it isn't wise to mix the two until really ready.  I mean, I wouldn't forgive myself if something happened to my baby because I failed to take care of my disease or didn't understand it enough to be a good mother before birth.

Even now, at eight and a half months, diabetes and pregnancy is a scary mixture to me, but I'm grateful that there are materials available that helped prepare me for what my body would going through.  For those of you who are diabetic and thinking about becoming pregnant, or if you know and love someone who is, these are some great paperback (I like what I can hold rather than surf) resources worth checking out:

- Balancing Pregnancy with Pre-Existing Diabetes: Healthy Mom, Healthy Baby by Cheryl Alkon (click here) ** Most helpful to me **

- Diabetes and Pregnancy: A Guide to a Healthy Pregnancy for Women with Type 1, Type 2 or Gestational Diabetes by David A. Sacks, MD (click here)

- Diabetes Pregnancy: What to Expect by the American Diabetes Association (click here)

Diabetes at the Hospital

You know, it is funny, but you'd expect that disease management would be easier on a sick person while admitted to the hospital than otherwise.  As I found out this past week, that is sooooooooo not the case with diabetes.  Between the nursing staff bickering at every shift change about whether or not I am capable of being on a non-diabetes diet and the various different medications that screw with blood sugar, I don't think I've had that much trouble with bg regulation in months!

So when the doctors at Stafford hospital began the mag sulfate drip on Tuesday and they administered the first round of that lung maturing steroid, they put me on a clear liquid diet as a precaution in case I would require anesthesia for an emergency c-section.  While the menu options sounded so appealing - chicken broth and sugar free red or green colored jello (yes, that is correct, the color is the flavor) - I didn't really feel like eating any way so it turned into the longest basal rate test I've ever done. 

A basal rate check is where you don't ingest anything - that's right, nothing but water - over the course of nine hours to ensure that your blood sugar stays within the right range.  If it drops in that time frame, you know your rate is too high and so you eat something and reset your rate for a bit lower.  If your blood sugar goes high in that time frame, you need to do a bolus correction and increase your basal rate.  The goal is to have your bg be in perfect ranges for the entire nine hours, but if you have to correct for either hypo- or hyperglycemic reasons you have to stop the test and start again the next day until you get it right. 

As it turned out, my basal rates were off by a pretty large margin.  I think I went in last Tuesday with a total basal rate of about 12 units per day, now that I am out of the hospital and my rates have been adjusted (one, two, three times) I am at 16.5 units a day!  Considering my daily pre-pregnancy total basal rate was barely 8 units, it's definitely showing that despite my placenta's horrific display last week and its old appearance that it's still working well enough to put out pregnancy hormones and screw my bgs up so thank God for that!

Any way, I stayed on the clear liquid diet restriction until Wednesday evening when my contractions were spaced enough to be less concerning. At that point the MFM doctor put me on a normal diet since they weren't monitoring my diabetes (a vote of confidence if I've ever had one) and just said to go light with my meals.  Of course, it was at this point that my new nurse FLIPS out that they haven't been responsible for checking my blood sugar or monitoring my diet and insists that they be in charge.  So, trying to humor her, I let her check my sugars with their little machine and it reads 45 points higher than my test kit that I've been using since I got out of the hospital in 2011.  Making a huge deal out of this, she insists their meter is right and I've got horrible self-care (not so much on the vote of confidence).  Taking a deep breath and thinking to myself that my HgA1C probably speaks better to my self-care than her opinion does, I recalibrate my test kit and find that it's reading exactly where it ought to.  The nurse of course got all sorts of huffy because of this and sent their meter down to the lab for recalibration.

Well, as it turned out - they both read right.  So when my ("correct") meter says that I am at a perfectly healthy number of 106 and their ("correct") meter is reading that I'm at 151 we're left at an impasse.  Talk about brand and kit disparity!! Fortunately, my endocrinologist has privileges at UMW Hospital and said she was fine with my test kit results due to the consistency of the numbers she sees in my logs and with mg HgA1C checks (phew!).  But, dang, it makes so much more sense to me now why the MFM at UMW and at INOVA would say to just use my kit and to be responsible for my own sugars because with that kind of inconsistency, no wonder there are issues when delivering diabetic mothers!

Thus adding another level of drama to an already emotionally and physically overwhelming experience, I felt trapped between a rock and a very hard uterus. The hospital food that was provided didn't come with nutrition information so I was left to guess on items that I wouldn't normally touch with a ten foot stick without a carb break down... the long and short of it is that I pretty much resigned myself to a low-carb or no-carb "normal" diet just to avoid the miscalculations and new found scrutiny from the nursing staff.

And of course when you mix in the second round of steroids that they administered on Wednesday night, my sugars went off the charts on Thursday. I couldn't get them back down by either repetitive rage bolusing or temporarily increasing my basal rate to 110% of normal - none of it seemed to touch the excessive sweetness coursing through my veins.

Now that I am back home things are a bit better - my two hour post prandials are still consistently high and I'm having to administer correction boluses, but as that is a sign of a healthy placenta I'm actually okay with it.  I've reprogrammed my pump more and I've scheduled another endocrinology appointment for next week, so I guess you could say this is all just part of the show...

But, you know, I've got to say that this whole ordeal has been a lot to handle.  I mean this whole pregnancy has been a roller coaster of complications and concerns and this last week was enough to push me right up to the edge.  It's one thing to be diabetic, another thing to be a pregnant diabetic, but it is an entirely over the top, unnecessary and unwelcome thing to be a pregnant diabetic with so many complications...

So, God, if you happen to be reading my blog today please cut me some slack and give my nerves a break!  I'm 30 weeks now and I want to make it as long as I can before little Baby girl here arrives, so any help or guidance I can get, I'll take.

Diabetic Ketoacidosis

I was just surfing the Internet and came across an article that made me cry.  The title of the article is "People Dying of Diabetes Who Never Knew They Had It, Study Finds" and when I first clicked on it I fully expected the article to be about type 2 diabetes since it seems like everything in the media about diabetes is about type 2.  Much to my surprise, the article turned out to be about adult type 1 diabetics - like me - who die from diabetic ketoacidosis (DKA).

Check out the article here: http://news.yahoo.com/people-dying-diabetes-never-knew-had-study-finds-130911564.html

As you may remember from my diagnosis blog post (check it out here if you haven't seen it yet: My Diagnosis Post), DKA is what I was hospitalized for and within weeks from dying from.  It is an extremely serious complication caused by untreated diabetes and I wouldn't wish it on anyone.

Please, for your own information, read this article and recognize the symptoms of DKA.  If you or someone you  know starts to exhibit these kind of symptoms, get checked out immediately!  Even if you don't exhibit symptoms, please get an annual physical and blood glucose check just to be sure.  Diabetes doesn't have to be fatal if it is treated in a timely manner.

Type 1 vs Type 2 vs Gestational Diabetes

So I have received a couple really good questions inquiring about the different types of diabetes.  To save time I'll point out that there are basic definitions to the right in the vocab column, but for those wanting more of an explanation here you go...

So on the very basic level, diabetes is a disease that implies a person's pancreas is not functioning properly.  On a more specific level, the different types of diabetes distinguish the source of the malfunction.

TYPE ONE:  (what I have)

In type 1 diabetes, the body's immune system attacks the islet cells in the pancreas and destroys their ability to produce insulin.  As a result of this, a person with this type of diabetes becomes permanently dependent on external supplementation of artificial insulin in order to be healthy.  At this point, there is no cure to this pancreas failure and without regular injection of artificial insulin a type 1 diabetic will die from complications caused by hyperglycemia and diabetic ketoacidosis.

Type 1 diabetics are inherently at a higher risk for complications like heart disease regardless of their glucose control.  But the majority of other complications caused by this disease are predominantly avoidable with appropriate self-care.

TYPE TWO:

Type 2 diabetes, on the other hand, is as a result of lifestyle choices - specifically obesity, minimal exercise and poor diet - that cause the body's over-strained system to become insulin resistant.  In other words, the islet cells in the pancreas have not failed and still produce insulin, but not in the quantity necessary to compensate for the damaged body's increased insulin requirements.  As a result of this, most type 2 diabetics are put on oral medications that a) boost the islet cell's production of insulin and b) medically induce weight loss.  It is possible for type 2 diabetics with very poor self-care to require additional insulin via injection to maintain healthy blood glucose levels, so some may become both insulin-dependent and insulin-resistant.

With lifestyle changes and dedicated effort to weight loss, type 2 diabetics can in effect "cure" themselves of their insulin resistance.   However, using the word cure isn't entirely fair because even if the symptoms of type 2 are eradicated the reality of a predisposition for insulin-resistance makes it so that a type 2 diabetic requires a permanently diabetes-conscious lifestyle.

Some of you may have come across the phrase "pre-diabetic" at some point.   This phrase refers to the initial stages of insulin-resistance a type 2 diabetic exhibits.  If diagnosed with pre-diabetes a person can prevent their diagnosis with type 2 through significant, immediate lifestyle changes.   This phrase is not relevant to either type 1 or gestational diabetes.

GESTATIONAL: 

As a result of the complex hormones necessary to build a baby, the placenta can make a pregnant woman insulin-resistant and require the administration of medication or external insulin.  ANY pregnant woman can be diagnosed with gestational diabetes - it does not discriminate by lifestyle or any other factor than how an individual's body responds to the demands of pregnancy.   The vast majority of gestational diabetics do not remain diabetic after the end of their pregnancies and can return to living a normal, healthy life once the baby is born and the placenta is removed.

So does that make sense?   Essentially insulin-dependence vs. insulin-resistance vs. temporary insulin resistance... very different causes, but similar results if uncared for.  Let me know if you have other questions!

Obsessively annoying.

While lying on my hospital bed in the cardio-wing of the Georgetown University Hospital, scores of doctors, endocrinology residents and medical students paid me visits to talk about my diagnosis and the affect my condition would have on my life.  While the medical students used me as a guinea pig to practice their bedside manor, the attending doctors used their experience to define for me the long journey I would have from that very bed to a "normal life" on insulin.  Describing the transition difficulty I would experience going from a care-free healthy life to the comprehensive incorporation of blood glucose into my every thought, they laid out a time frame for typical diabetes maintenance and care:

• six months before I firmly established a diabetes routine and lived as a functioning diabetic
• one year, or more, before they would discuss putting me on an insulin pump
• at least two years before I'd be medically stable enough to consider adding the complication of pregnancy to my endocrinology care

Considering HB and I had just decided in the weeks prior to my diagnosis that we wanted to try for another baby in the new year, this time frame purely added insult to insulin-injury.  I was disheartened to hear it would be a year before a pump - a significantly more convenient insulin delivery option - would even be considered by my doctors.  And I was disgusted that the white coats assumed that something as straight forward as carb-counting, insulin bolusing and glucose reading would take this diabetic six months to figure out!

Quite obviously, this didn't go over well. My stubborn-headed necessity to beat the odds and control my life just didn't jive with anything less than go-get-em encouragement.  I wont lie and say there wasn't a learning curve associated with the differences between slow-acting and long-lasting insulin, how to inject, where to inject and how much insulin to administer for any given meal/day, but I was  motivated.  Essentially thinking "this is my new life, let's get on with it" I left the hospital and made it my J-O-B to make life normal again asap.

For the first couple weeks I had doctors appointments every week, then it was every other week, eventually working out to once a month.  By the third month of four injections a day, I walked into my endocrinology appointment at GTU in tears completely annoyed with the comprehensive hold diabetes had taken on my life.  It was at that moment, while looking at my glucose logs and new HgA1C reading of 6.1, that NP Su Chin looked at me and said "let's get you on a pump."

So... in three months I accomplished what the doctors initially told me would take a year to do.  I understood my disease, incorporated it into my life and was ready to take on the more complicated technology that would ultimately make my life as an insulin-dependent diabetic easier.  Go-frickin-me! Long story short, I take my disease very seriously and, as such, I've reclaimed my life from the time frame established by "those in the know." Logically following, I only want to work with competent medical professionals that take my aggressive control and my comprehensive treatment equally as serious.

Thus when HB and I decided we wanted to expand our family, we undertook a multi-month search for high-risk OBs and Perinatologists before beginning the journey we are now on.  By process of elimination we sifted through the chaff and finally selected the Perinatal Associates of NOVA as our go-to perinatologist of choice.  They (and the hospital I'll deliver at) are an hour away from where we currently live, but they are oh-so-worth it.  They treat me like I know what I am doing and they take my condition so seriously that Baby and I receive amazing, attention to detail care.  It takes a lot for me to say I am in good hands and, folks, I am in good hands.

However, as some of you know, I am in Vermont for six weeks this summer starting a new (may I add, really cool) graduate program at Middlebury and that means I need a VT-based doc while I'm here.  Seeing as this is a high risk pregnancy and I am here for several of the big-time pregnancy tests (the alpha fetoprotien test, the level III ultrasound and fetal echocardiogram), I shouldn't work with just any OB and - I kid you not - there is only one high risk OB in this state.   So Friday saw me driving up to Burlington for my first appointment with this doctor...

Beyond implying that I shouldn't be considered high risk because of my excellent diabetes self-care (thank you for the compliment, but my obsessive care doesn't reduce the increased risks as a result of insulin dependence...), this lady had the nerve to ask me why I consider myself to be a type-1 diabetic!  FIRST OF ALL, if you don't know the difference between type 1 and type 2 diabetes, you shouldn't be a doctor.  SECONDLY, if you really want to piss of a type 1 diabetic, call them type 2 - the conditions are NOT the same thing!!  Just because I was diagnosed later in life than most typical cases of type 1 diabetes does not mean that a) my islet cells are capable of producing insulin or b) I gave myself diabetes by poor lifestyle choices. HMPH.

Unfortunately this kind of ignorance (yes, even from medical professionals) about diabetes isn't uncommon. Between the misnomers given to each type and the type-2 centric public education campaigns that are prevalent today, type 1 diabetics are often left in the contradictory position of obsessively caring for themselves while fighting off completely-misguided assumptions of their self-care apathy.  And even within the endocrinology community, as I mentioned earlier, the expectation that diabetics will be apathetic to their condition is so prevalent that the time frame for disease comprehension is drawn out over multiple months if not years...  perhaps it is a lack of personal motivation for some that colors the disease for the rest of us, but speaking on behalf of all type 1s I know the lack of public education on insulin-dependence is simply annoying.

Ultimately this is one of the best diseases I, personally, could have gotten from the (silver lining) perspective that I am 100% in control of my well being.  That optimism aside, my skin isn't thick enough at this point to externally dismiss the uneducated references to my disease as "diabetus" or discouraging inquires about "my diet improvement."  Admittedly I am more hopeful of seeing my personal development of an immunity to stupidity because of diabetes than I am of seeing a cure to islet cell failure within my lifetime.  But let the record show that if the medical community would like to prove me wrong and beat me to the punch, I'll happily eat crow when that time comes.