3 Month Check Up

So I am having a really hard time believing that it has already been 3 months since my last endocrinology check up, but since GV is already 14 weeks old and time just seems to be flying past I guess I buy it.  Originally, my appointment was scheduled for two days ago, but seeing as this is Northern Virginia and any sign of snow makes the entire region shut down, the "snowquester" got it pushed back to this afternoon.

With GW, GV and Grandmama in tow, I met with the wonderful Dr. Rogacz for a routine diabetes check-up for the first time!  Pleased with my weight loss and new HgA1C number of 5.8 (that is down from 6.2 mind you), she announced she wasn't concerned about my diabetes care in the slightest and that I am doing remarkably well.

Inquiring about my longer term plans for additional pregnancies and care planning purposes, I told Dr. Rogacz I intend to spend the next 12+ months training for and running in endurance races.  Since pregnancies, diabetes and running don't work together in the slightest, she seemed a bit relieved to know we wouldn't be putting my body through more of that any time soon, but it did cause her to use a term that I dread from endocrinologists: CGM.

Pump with infusion site on right; CGM on left.

CGM, Continuous Glucose Monitoring, is a technology that works with insulin therapy to keep a diabetics blood sugar as tight as possible.  As an additional attachment to the body, the CGM tests blood sugar every four minutes and logs the results so as to indicate the trending direction of your blood sugar and therefore making it easier to catch it as it goes up or as it goes down.  It'd be incredibly helpful for me on my training runs, it'd ensure my safety overnight by alerting me to lows before they happen, it'd help me keep my A1C lower by giving me constant readings and I'd generally be armed with much more information than I currently get with just my Free Style Lite test strips.  Essentially it is an extraordinarily handy tool and wonderful technology to have... I just don't want it.

Here's my logic:

Because I wear an insulin pump and have an infusion site adhered to my body 24/7/365, I constantly carry a 2" by 3" by 1" visual reminder in my pocket that I'm diseased.  Granted it is an extremely helpful piece of plastic to have and I'd be worse off with out it (multiple injections are so not my thing), but I resent the fact that I LOOK diabetic because I wear this tubed device everywhere I go.  Now, if I were to add a CGM, not only would I be attached to the insulin port that is necessary for my pump to operate, I'd have this transmitting device inserted into my subcutaneous jiggle that would make it all the more difficult to hide my disease under my clothes.

I understand that it is incredibly superficial of me to be concerned about "looking diabetic" and how this beneficial technology would impact the fit of my sweaters, especially since most people don't know what they're looking at anyway, but hasn't diabetes already consumed enough of my life?  I mean I can't even have a cup of coffee in the morning without needing to compose my little grey cells enough to test my blood sugar and calculate my bolus, why should I give another portion of my abdomen over to yet another accessory for my broken pancreas?

Don't get me wrong, that was an entirely rhetorical question and I understand the benefits of it.  I mean, okay, there is something to be said for having an HgA1C estimate whenever I want and, hypothetically, it'd protect me from severe hypoglycemia by averting it's onset in the first place, but I'm incredibly sensitive to lows as is and assuming my daily readings stay within a certain range I know my A1C is where I want it to be without knowing exactly where it is.  Perhaps I am being stupidly stubborn on this, but STILL.  I'm just not ready for that.  I feel diabetic enough as it is.

Maybe sometime down the line I'll come around and will willingly participate in the next level of self-care, but for the time being my answer is HELL NO.    Sorry to disappoint you, Dr Rogacz, I'd love to be your shining star patient with all the bells and whistles, but I'll take my low-tech stellar A1C and go on my way.  See you in June.

New shoes!

Well, I knew the day was coming and, sadly, it is finally here: my Asicis Landreth are officially retiring.

I've had this pair for longer than I ever expected I would thanks to my nine month, GV-requested exercise hiatus, but with broken laces, worn tread and innumerable miles they're starting to cause a new twinge here, straight up pain there and simply need to be replaced.

While I am sure there are those out there that could not possibly care any less about my foot wear issues, I am positive that the runners among you can appreciate the physical necessity of a good pair of shoes and can identify with the brand loyalty that develops one you find the perfect Cinderella-fit.  For me, Asicis Landreth have been my glass slippers.  They've been my s(tr)ide-kick, running-buddies for some of my best races and one-on-one ego challenges with HB: the time I wound up beating him after he coaxed/dragged me (and the stroller) through a 5k; the race where I fell on the backstretch, was passed by a competitor and came back to beat her and win our age group; and, of course, my first half marathon.  Bottom line is that I thoroughly loved this design and I'd wear them forever... if I could.

The unfortunate, big time bummer is that Asicis stopped making this shoe.  For whatever reason they got it in their pea-brains that it wasn't selling well enough and that people who don't need extreme arch support don't need these kick-butt neutral shoes... I'm not bitter, really.   Anyway, I was completely heart broken to realize I'd have to start over in my search for running kicks, BUT trying to optimistically take a look at the bright side (odd, I know) I figured this was a great opportunity to try something new: minimalist shoes.

For those who are unfamiliar with running shoes, most, typical shoes have an 8-12 mm rise in the heel that provides cushion when your foot hits the pavement.  By switching to a minimalist shoe - or variation there of - you loose that height difference and force your body to create it's own cushion and stability by reducing heel strikes and forcing greater turn over through shorter, toe-dominant strides.  Essentially, these shoes change your gate and train your body to run with increased efficiency.

So there we are, no shit, at the running store and I'm picking out a pair of my own.  I looked at a bunch of different brands, heel heights and scoffed my way through the ridiculously colored women's shoes that are currently available on the market (seriously, what's with the neon?!).   Since all of the shoes were ugly and that held absolutely no weight in my decision, the test runs back and forth in the parking lot helped me make my final choice -  my foot strike is quieter in the 0 mm rise Mizuno Wave than any of the other 1-4 mm rise shoes available.  Since that indicates better form, volia! I found my new shoes. As you can see in the picture they have ZERO tread on the heel and should be 100% different from my Landreth, may they rest in peace.

Of course the warning that comes along with swapping from traditional running sneakers to minimalist shoes is that you should NEVER use them all of the time and you still need a normal pair as you transition.  So despite my reluctance to shy away from Asicis, I wound up getting a pair of New Balance 1080V2 to try out.  Admittedly they are significantly more ugly than the Landreth were, but until I've put several miles under our feet I'm going to keep the jury out on their success as a replacement training shoe.  I'll probably wear these for all of my longer runs and save the Miznuo for three mile or less "off days."

For better or for worse, I'll keep you posted.

Lent Recipe #3: Tuna Casserole

With a refrigerator stocked full with massive amounts of meat-filled left overs - veal bolognese, pesto-steak sandwich fixings and sausage stuffing - my motivation to cook yet another dinner was minimal.  However, seeing that it is Friday and it is still Lent, I needed to come up with something that was more than cereal to feed the gang... finding the vegetable drawer nearly empty and the pantry fresh out of just about all of my go-to ingredients, I decided that we'd pull out one of HB's hot dish recipes from Minnesota - the good, ol' tuna casserole.

We've tweaked the recipe some to fit our tastes and give it more substance, but it maintains the intended flavors of the original in the Better Homes and Gardens Cookbook so I'll give it all the credit.

4 ounces noodles (I use fusilli or something like it)
1 cup chopped celery
1 cup chopped carrots
1/2 cup chopped onion
1/4 cup butter
1/4 cup all-purpose flour
1/2 tsp salt
1/2 tsp dry ground mustard
1/4 tsp ground black pepper
2 cups milk
5 cans tuna in water, drained
1 cup shredded cheese

Cook noodles according to package directions. Drain and set aside.

For sauce, in a medium saucepan cook celery, carrots and onion in the butter until tender.  Stir in flour, salt, dry mustard and black pepper.  Add the milk all at once; cook and stir until slightly thickened and bubbly. Combine sauce, tuna and cheese with the noodles.  Transfer to a casserole and bake, uncovered at 375 degrees for 20 to 25 minutes.

Work out buddies...

I was reading a blurb recently from Real Simple Magazine about how thin people stay thin and I was particularly struck by one point the article made: thin people have thin parents.  Citing that only 30% of this is genetic, the rest is environmental factors I am hopeful that HB and I are on the right track to keep our kids within healthy BMI ranges.

By modeling healthy choices and an active lifestyle, GW and GV are growing up with exercise as a regular, normal thing rather than something they'll have to learn about after possibly accumulating excess weight.   HB and I constantly take them out with us when we go for runs and they both seem to take their role in the process quite seriously - GW always yells "go go GO!" and GV wails whenever we slow down or stop, so it's definitely a family event.  Ultimately, when they're big enough, I fully plan to take them out jogging with us but for the time being their motivation is enough participation to keep us all satisfied.

Course, now that we are four days into Insanity both little ones are figuring out just how to be involved in our new exercise routine.  GW has decided that he's big enough to get his interval training groove started and, GV, well, as long as she's within arms distance (if not actually in arms) she's happy.  Perhaps it is not exactly the best way for us to do the work out and perhaps they're both trying to run before they can crawl (figuratively for one, literally for the other), but hey, they're at least starting down the road of a good habit and it's time together.    

Insanity!

Alright, people, the time has come... Sean T has officially re-entered the building!

For the first time since Fall 2011, HB and I restarted the Insanity work out routine today and, seriously, there is a reason the program is named what it is!  For those who aren't familiar with it, this 60 day program combines plyometrics, body-weight lifting and cardio interval training in a way that would make even the most fit, manly, stoic marine cry.  Constantly encouraging quicker speed and therefore more reps, Sean T makes a 30 minute work out feel like a three hour lifting session... it's insane!

The first day of the program is a fit test that is comprised of eight exercises lasting one minute each.  So along with before pictures (over my post-pregnancy body will those be posted until I have after shots to post as well!), this is a way to track your physical improvement as you progress week by week through the program.  While I am not exactly happy with my initial results here they are --

Switch Kicks: 84

Power Jacks: 49

Power Knees: 99

Power Jumps: 35

Globe Jumps:  8

Suicide Jumps:  15

Push-ups Jacks:  33

Low Plank Obliques:  53

The last time we did Insanity, we made it about four weeks into the program before we were worn out and in need of a much needed break (which we took as running a half marathon).  I'm really hoping that we can physically last longer this go around and get the same - if not better - trimming and toning results as before. Starting with a BMI of 20.3 and body fat reading of 18.3%, I have 6 lbs to go to get back to my pre-pregnancy weight and 14 lbs left before I am back to my ideal weight.  We'll see how long this takes.

That said, I am disconnecting my pump, putting on three bras (so not kidding), rolling up the living room rug, and cursing Sean T for the ridiculous awesomeness that is INSANITY!

Lent Recipe #2: Mushroom Tart

So it seems like there is this misconception in pop culture that whatever you forgo or alter for Lent must make you miserable in order to be a true expression of piety -- almost as if we socially expect Catholics to desperately stand in the pouring rain outside of the local bakery and lustfully gape at the shelves of tantalizing, seductive cupcakes until Easter when the poor, starving soul can finally be rewarded with dessert.  And while I readily acknowledge that it is difficult to give up a worldly comfort for the sake of spirituality (and no, I will never give up sugar), I fully reject the connection of misery with the practice of abstinence. 

You see, at just about two weeks into Lent, I am feeling like my family isn't necessarily missing anything in our lives by eschewing restaurants.  Don't get me wrong, I've thoroughly screwed up dinner a couple times and the other nights certainly aren't five star quality, but I am finding the experience to be a worthwhile exercise of "plan B" -- which, admittedly, is something I am not very good at.  It seems to me that the value of Lent is in recognizing something tangible or excess that we place far too much value in and essentially resetting our lives in a bigger context.  By using the opportunity as a learning experience to better ourselves, we are attempting to find "... glory in our sufferings, because we know that suffering produces perseverance; perseverance, character; and character, hope" (Romans 5: 3-4). 

By giving up restaurants and any form of prepared food, HB and I are without the convenience of just grabbing a bite wherever, but we're starting to recognizing the superfluous nature of going out.  We can make what we like at home and, frankly, the cost of only eating what can be purchased at the grocery store seems to be more time together... and I like those prices. 

So... the recipe for this week is for an awesome mushroom tart.  I originally got the recipe from Bon Appètit magazine, but I've been tweaking it over the years and I think I've finally found the combination of ingredients that I think is easiest, healthier and tastes better than the original (whatever you do, don't skip the Cognac or change the chesse!).  I typically make my own pastry crust, but for convenience sake I've listed a store bought crust to save you precious weeknight time:  

Single pie crust 
1 roughly chopped maitake mushroom (AKA "Hen of the Woods")
1/4 cup minced shallots
2 Tablespoons Cognac
2 Tablesppons chopped fresh rosemary and thyme
2/3 cup grated Gruyère cheese
3/4 cup milk
2 egg whites
1 whole egg 

Melt butter in heavy large skillet over high heat. Add chopped maitake mushrooms. Season with salt; sauté until deep golden, about ten minutes. Add shallots and sauté for two minutes. Add Cognac and boil until absorbed, about three minutes. Mix in 1 tablespoon of the herbs. Cool.

Preheat oven to 375° F. Line crust with foil. Fill with dried beans; bake until golden, about 15 minutes. Maintain oven temperature.

Sprinkle 1/3 cup cheese in crust. Cover with mushrooms. Whisk cream, yolks, egg and remaining herbs in bowl. Pour custard over mushrooms. Top with remaining cheese. Bake until filling is set and top is golden, about 30 minutes. Cool on rack 15 minutes and serve. 

12 Weeks

I cannot believe that GV is twelve weeks old already, time is just flying by.  She's growing beautifully (up to 14 lbs 6 oz) and is a gorgeous roly poly, chubby baby who is full of big smiles, adorable "ah-goos" and, in her opinion, all too many hiccups.  Although she has her moments, I feel thoroughly blessed that she is such a sweet, happy baby!

The last couple weeks have been rough on her though -- all of us actually -- because each of us have had the winter scuzz.  Despite our best efforts, we've played hot potato with these germs and, considering her tiny immune system, it seems like GV is bearing the brunt of it with a significantly congested nose.  She hasn't been running a fever or anything super serious, but when your three month old baby sounds like a snuffleupagous and develops a previously undiscovered knack for screaming you're justified in excess concern.

So with this in mind and hearing GW's wet cough, I took both the kids up to the pediatrician this past Friday to make sure that they weren't developing something more serious than whatever this blah started out as.  Reassuring me that it hadn't gone to their lungs and that their ears still looked fine, the doctor suggested I give GW honey for his cough and that I try a Nosefrida on GV.  Well, as you can imagine, the spoon full of sugar went down smoothly with GW but I struggled with the "snotsucker."  This thing is designed so that you place the end of a tube against your infant's nose and use a mouth piece to suck out whatever is blocking their nasal passageways.  Well, I must not have much in the way of lung capacity or something because I found that sucker to be extremely difficult to use.  I think it'd probably work well for a simple runny nose, but for the full on congestion GV has going I am having to rely on the good ol' bulb syringe.

Course I am sure most parents out there are familiar with the screaming, unhappy baby that goes along with the use of an aspirator -- but for those who don't have first hand knowledge, just imagine snot being forcibly sucked from your nose and the disgusting tugging feeling that must accompany it (there's a reason we don't remember these things from our own childhoods).  Well, oddly enough, my beautiful little weirdo here likes it.  She gets all sorts of excited when she see me pull out the aspirator and, although I know she's not developmentally there yet, it's almost like she already rationalizes that it's good for her and that the discomfort is a temporary solution to her problems.  Granted she gets annoyed after a while and gives a good "waaaaaaaah" to let you know she's done, but the picture says it all folks.

Weird, right?  I'll take it, but that is absolutely bizarre.

You know, in a lot of ways, GV reminds me of her brother when he was a little guy.  He wasn't a fan of having his nose cleaned like she is, but otherwise they have a very similar temperament -- and given that he is turning out to be a very kind, thoughtful child I am over the moon about this!  He's adjusted to his big brother role so well, I am very proud and grateful that he is who he is.  (Yes you, GW.)

Of course, I must say, he's shocking the heck out of me right now with his growth spurts.  Since the beginning of January, this kid has grown half an inch (42" tall now) and he's officially out grown toddler size shoes.  Now wearing a boy's size one there is only a four centimeter difference between the size of his feet and mine.  He is three. I am two weeks shy of 27 years old.  How ridiculous is that?!

Whenever we look at height predictors that estimate how tall your child will be when full grown as an adult, the math comes back that GW will be somewhere around 6' 6" give or take two inches for a margin of error! Can you imagine trying to feed a teenage boy who will likely be between 6' 4" and 6' 8"?!  I can't... perhaps I should just purchase a supermarket.

They are great kids.  I wish there was something more I could do to make them feel better right now, but I'll admit I appreciate the scuzz induced extra snuggles.  Some day they'll be too big and they wont want their Mommy to dote on them or stick an aspirator up their nose when they're sick... but even with as big as they're getting, that day isn't today and, for that, thanks be to God.

Postprandial Hyperglycemia Continues...

Much to my disappointment, I guess my endocrinologist had a point when she said high glycemic index food is out.   I'd initially hoped such a food restriction would be a fluke suggestion for my recent hyperglycemia, but it is unfortunately turning out to be something I actually need to consider.  Bummer.

As per our usual weekend morning tradition, yesterday before mass HB got up and made the family his famous pancake breakfast with a side of bacon and - hallelujah - coffee.  It's not often that I willingly hand over the reigns to my kitchen, but if he offers I always take him up on making this breakfast because it's just so darn good!  I think the special trick to his recipe is the 50-50 split of white flour to wheat flour and his inclusion of melted butter and cinnamon right in the batter... they are so amazing.

Anyway, after HB finished slaving away at his new griddle, he put the plate of gorgeous golden brown pancakes and our three maple syrup variants on the table and lead us in grace.  I set GW up with two pancakes and once they were cut into toddler sized pieces, I turned back to my own plate for calculation.  Taking three pancakes (20 g each), about 1/4 cup of sugar free maple syrup (10 g) and my coffee (20 g) into account, I bolused 5 units of insulin to cover the 100 grams of carbs in front of me (20 g carb per 1 unit insulin).   Back when I was first diagnosed, I remembered thinking that 100 grams sounded like an embarrassing amount of carbohydrates to eat in one sitting, but now that I have a better idea of the composition of food it really isn't difficult to rack up carbs quickly with a couple pancakes or a simple glass of juice.  So eating just barely more than my 3 year old, I finished breakfast and off we went to Sunday Mass.

Returning home an hour later, I checked my blood sugar at the two hour post breakfast mark: 202 mg/dL.  Requiring only 0.90 units for a correction, HB and I were thoroughly agitated to see I still had 3.4 active units in my system.  Sighing deeply, I waited another two hours before checking again and my glucose at that point was down to 71 mg/dL -- which as I have said before, is slightly on the low side but within the correct range of where I want it.

I'd peaked early, again.  I'd calculated my carbs correctly, I'd eaten what I intended to eat and my glucose was eventually were it ought to have been, but not without a cost.  Going up into the 200s isn't healthy and regardless of the temporary nature of it, I cannot afford to go high if I want my HgA1C to stay under tight control in a "normal" person range.  I need it to be normal -- and not just for me and my sanity, but for any unplanned children we may possibly have. I mean I trust God to be looking out for us and our current & future children, but that doesn't mean I should take his care for granted and disregard my responsibility and role in the process.

It's frustrating that after two years of a steep learning curve with diabetes management that things are changing all over again.  My body is responding entirely different to carbohydrates now at three months postpartum than it ever did before or during the pregnancy and, despite my irritation with the idea of the glycemic index, I capitulate that it is completely necessary.  And while my e-whining about cream of wheat and pancakes may indicate otherwise, I think the fact of the matter is that I am more emotionally attached to the luxury of choice than I am to the specific carbs I'm losing... my world is shrinking even further because of diabetes and the reality of my new condition and its limitations causes me great sadness.

Completely unintended.  You'd think it is smiling because it knows...
sick sense of humor pancake, just sick. 

Lent Recipe #1: Israeli Skillet

So it is the first Friday of Lent today and, as a practicing, soon-to-be baptized Catholic, that means fasting and abstinence (no meat).  Since HB and I have decided to abstain from eating at restaurants for the next 40 days - which, if I may say, is not only a oblation of convenience but a sincere sacrifice of worldly foodie indulgence - I've resorted to the HB-tested, GW-approved bag of home cooking tricks I've built up over the last couple years.  Most of my recipes are for things like slow cooked lamb shanks, pesto-steak sandwiches or veal bolognese, which clearly are not vegetarian or fish options, but I've got a few Lent appropriate meals up my sleeve that will satisfy even these picky eaters. 

The thing is, although fasting cuts out the main source of protein in meals by restricting meat, as a diabetic I don't exactly relish the idea of serving up a big plate of plain old carbs.  Plus, if you tie in my desperate attempts to loose the extra baby weight and my interest in actually have something tasty on the table, creativity and nutritional research become key... because, let's face it, cereal has never exactly been my forte.

So in an attempt to share the work I've done to combine these food-factors, I'm going to post the recipes for our Friday night dinners throughout Lent in case something strikes your fancy.  Tonight's was an "Israeli Skillet" recipe from Bon Appetit magazine that I've tweeked a bit.  It's got chickpeas, tomatoes, feta and eggs -- and, if I've never raved the value of the garbanzo bean before, let me do it now! Not only does this recipe have phenomenal flavor and come together in a jiff, but the chickpea has a stellar carb:protein ratio that beefs up (ha) its substantive quality in this dish - I mean one 4 ounce serving size has 15 grams of carbs and 5 grams of protein! And to top it all off, HB - the meat and potatoes, corn fed, muscle man from MN - says he loves it...  

Alright, enough preamble, here ya go:

Ingredients: 

1/4 cup olive oil

1 medium onion, finely chopped

2 garlic cloves, coarsely chopped

1 can chopped green chilies

1 15-ounce can chickpeas, drained

2 tsp Hungarian sweet paprika

1 tsp ground cumin

1 tsp lemon peel; 1 Tbsp lemon juice

Dash ground cinnamon

1 28-ounce can diced tomatoes

Kosher salt and freshly ground black pepper

1 cup coarsely crumbled Israeli feta

8 large eggs

1 tablespoon chopped flat-leaf parsley

Warm pita bread with honey (watch the carbs in pita, it's higher than you'd think at roughly 36 g per slice)

Directions: 

Place souffle dishes on a cookie sheet and preheat them in oven to 425°F.

Heat oil in a large ovenproof skillet over medium-high heat. Add onion, garlic, and jalapeños; cook, stirring occasionally, until onion is soft, about 8 minutes. Add chickpeas, paprika, and cumin and cook for 2 minutes longer.

Add crushed tomatoes and their juices. Bring to a boil, reduce heat to medium-low, and simmer, stirring occasionally, until sauce thickens slightly, about 15 minutes. Season to taste with pepper.

Pull souffle dishes from oven and evenly separate the tomato sauce between the dishes. Sprinkle feta evenly over sauce. Crack eggs one at a time and place over sauce, spacing evenly apart (two per souffle dish).

Transfer dishes back to oven and bake until whites are just set but yolks are still runny, 8 - 10 minutes. Garnish with parsley.

Serve with pita for dipping, honey on the side.

"Doubt the stars are fire;

Doubt that the sun doth move;

Doubt truth to be a liar;

But never doubt I love."
~ Shakespeare's Hamlet

You're my everything, HB. 

I love you. 

Happy Valentines Day!

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.

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?  

Farewell, my beloved breakfast.

This past Saturday at just before 9:00 in the morning, two hours after my breakfast, my jaw hit the floor when my blood glucose meter read 312 mg/dL.  Having calculated the carbohydrates in my breakfast precisely and then failed to drink my coffee my blood sugar should have dropped low, but like so many early day meals lately my glucose was off the charts.  I'd adjusted my pump settings last week in an attempt to self-correct my post-breakfast hyperglycemia, but seeing my meter read a clearly unhealthy, wholly intolerable number in the three hundreds (THE THREE HUNDREDS!!) I placed a call to my endocrinologist on Monday morning for some much needed help.

Since my two hour postprandial numbers have been high, but my four hour postprandial numbers have been low/almost low she didn't recommend changing my morning bolus ratio and, because my breakfast isn't always at the same time, she said my basal rates shouldn't be the issue.  I inquired about whether I should go back on the symlin injections, but because I am breast feeding she insisted that I do not since there isn't any information about whether or not artificial amylin is transmitted in breast milk and, if it is, it'd create an unsafe situation for GV.

Removing all the "simple solutions" to the issue and still without a clear path forward, Dr. Rogacz inquired about what I usually eat for breakfast.  Telling her that my everyday (yes, the same thing, everyday) go to breakfast is a bowl of cream of wheat and a cup of coffee, she made an "ah ha" sound and proceeded to break my heart by saying "your problem is probably the cream of wheat."  Citing the high glycemic index of wheat, as we loving call it in this house, she instructed me to drop it and similar "dense" carbs out of my diet in order to keep my sugars under better control.

(Insert mopey, pouty face here)

So what is the glycemic index (GI)?  The GI is a measurement of how much each gram of carbohydrate in a certain type of food raises a person's blood glucose level once it is consumed.  Foods that breakdown quickly in digestion and rapidly release glucose into the bloodstream are "high" (over 70) on the GI scale, where as foods that break down more slowly will gradually release sugar into the bloodstream and therefore are considered to be "low" (under 55).   Here are some examples for you:

High:  Rice, plain white bread, potatoes, breakfast cereal and watermelon.

Medium: Sweet corn, bananas, raw pineapple, raisins, pita bread and regular ice cream.

Low:  Raw carrots, peanuts, raw apple, grapefruit, peas, skim milk, kidney beans and lentils.

Because a lower glycemic response usually means less insulin is required to maintain a healthy HgA1C, foods that are low on the GI tend to improve long-term blood sugar control and cause less spikes in sugar like I am currently seeing at my two hour postprandial.  So, you see, on top of needing to be carbohydrate conscious on the basic this is bread that is pork level, my body has decided for the first time since becoming diabetic that it cares what carbohydrates I am eating and is forcing me to forfeit the lusciously dense carbs I emotionally love.

I know my doctor is right in making this recommendation and I'm only just beginning my research on what this actually means as a lifestyle choice, but my first response is that I am thoroughly peeved.  I am annoyed with my diabetes for messing with me again and on something so indulgent as my favorite breakfast.  I mean at least the doc didn't tell me to give up coffee (Lord knows THAT would have been impossible) so I at least still have that, but what to have with it will take some time.  I expect after an adequate period of mourning that I'll come up with something else to whip together in half sleepy delirium, but for the time being, in a state of melodramatic protest I refuse to replace it with something sub-satisfactory.

Running, sans supervision!

The last couple weeks have been over cast, cold and dreary - more or less the meteorological embodiment of my state of mind and energy levels.  I've avoided leaving the house without HB in an attempt to reduce the overwhelmed feeling I get when GW is melting down, GV is hollering to be fed and Lord knows what else is pulling me in six different directions and making my back seize with stress.  Fortunately when HB is home I've got the backup I need, but, I tell you, when it's just me and those clouds I couldn't feel more unmotivated to complicate my life with a trip to the grocery store or rainy playground outing.  But today things were different.  It was the nicest, warmest weather we've had in Virginia in ages - seriously the sky looked fake it was so blue! The sun was shining and, even though HB wasn't here, I decided to take my chances and get out of the house.

Going through the pre-outing check list, I tested my post-breakfast blood sugar to make sure it'd be stable enough to take the kids out on my own.  My meter beeped and it read 230 mg/dL; way high.  Now, granted, hyperglycemic blood sugars ensure I wont randomly pass out and leave my children unsupervised on a walking trail or vulnerable on the swings, but for someone who takes pride in tight glucose control such high numbers are horrific.  I don't know what's causing them, but I've seen several high readings like this lately - I mean I am not under bolusing, miscounting carbs or over eating... I'm just off.   I'll need to talk to my endocrinologist about this...

So I punch in the bg numbers into my pump to see if a correction dose is necessary; which it isn't.  I've got 2.3 active units of insulin left in my system from my breakfast bolus and I only need a measly 1.3 units to get back down into my ideal blood sugar range.  But not wanting to wait for it to take it's sweet time (haha, get it?) to come back down I decided to throw out the mental debate I'd been having between taking GW for a bike ride or simply going to the playground and opt to go for a run instead. 

Now, I've never done this before... "this" being running with the stroller and "this" also being running by my-diabetic-self because HB always pushes the stroller and HB always runs with me.  You might think this is mean of me for not helping tote the extra weight around (stroller: 34 lbs + GW: 38.5 lbs + GV: 13.3 lbs + GV's car seat: 11.7 lbs = 97.5 extra lbs!) or you might think I'm genius for creating a scenario that "requires" HB to exercise, but the reality is the stroller makes my hands go numb (a sensation I loath) and I am terrified of the worst case outcome when combining diabetes with exercise, passing out.  If I pass out with HB around he knows what to do, but if I pass out without him the what ifs start to pile up and I typically don't find the risks worth running. Literally. 

But with my blood sugar sky high, the weather this nice and my mood more zipp-a-dee-doo-dah than normal, I detach my pump, place it on the night stand, lace up my Asics and we head to the car.  Since exercise works to improve insulin efficiency in the body, I know that by running my glucose levels will drop and by starting with my blood sugar so high, removing my pump and strategically checking my bgs along the way I can get back down into a healthy range sooner and then consume quick acting carbs as necessary to prevent going too low.  So without my babysitter and child-pusher, I put my music on and hit the pavement... within one mile my blood sugar was down to 138 mg/dL and by the end of the three mile loop it'd gotten down to 65.  

Admittedly I failed to keep my sugars in the safe range, but I accomplished everything else.  I'd put a mental block in my head about my ability to push that stroller and run on my own that didn't need to be there.  So what that my hands loose sensation? And, yeah, my diabetes still requires conscientious treatment, but oh well, c'est la vie. The point is I can do it - and not half badly either!  Granted I'm not about to let HB off the hook now and run on my own all the time, I'd still prefer to have him around... it just goes to show that the lesson learned today is that I run with HB because I want to, not because I have to.  

Two month update

GV is two months old already.  I don't really know where the past eight weeks have gone, but they have and, to be honest, the drama of the pregnancy feels like years ago. Our life with GV around feels so natural and normal - albeit crazy at times, but that is typical.  We've found a battle rhythm that seems to keep everyone happy, most of the time, and despite GW's lectures to GV that she "needs to poop in the toilet, not the diaper!" I think they're doing remarkably well together.  He is very eager to help out with her and she just lights up whenever he is around - lectures and all.

We took GV into the pediatrician today for her third well baby appointment and, despite the tears she shed over her three vaccinations, I am glad to report that it went really well.  She's a very healthy, happy baby and the doctor had nothing but positive things to say about her development and growth.  Check out her stats:

Weight: 13 pounds 3 ounces (96% up from 22% week two)
Length: 23 inches (75% up from 50% week two)
Head Circumference: 15 3/4 inches (81% up from 26% week two)

Despite the diabetic baseline and the number of additional complications we had in the pregnancy, it seems that the care I took to make sure she'd be safe both in utero and after birth paid off.  She's a perfectly normal baby and that is the most any mother - diabetic or not - could hope for!  I just continue to pray to God that she stays healthy, happy and safe for her whole life... and may it be a long one.

 

Love you GV - xoxo

Honesty: a scary policy.

I have been struggling the past few days with very conflicting interests.

On one hand I create these posts with the intention of providing family, friends and strangers alike with a comprehensive view of what my life is like as a type one diabetic.  I mean for them to act as an educational tool and a running commentary on my daily trials and tribulations so as to prevent perpetual ignorance about my disease and to demonstrate the breadth of impact diabetes has, regardless of the topic.  Of course this has been somewhat embarrassing at times, but in light of the goal I set out to accomplish with this blog I've been striving to say whatever I ought to say that is relevant to the subject.  Face it, one can't "comprehensively" talk about such things as pregnancy and diabetes without mentioning such socially uncomfortable details as one's cervix.

Which brings me to the other hand. The reality is, there are topics that I am quite self-conscious to cover and I avoid for fear of other's judgement and censure.  Not to mention, if I don't write about a topic, then I avoid acknowledging it and inadvertently providing validation to pieces of myself that I'd rather didn't exist. The lens that I voluntarily create, therefore, has the ability to insulate me from vulnerability by allowing me to share information on my own terms, edited as necessary.

But in placing my concern for criticism above my goal for "comprehensive" topic coverage, I stifle any self growth I could otherwise achieve and I might as well resign a career in creative writing before even starting! What's that old saying? If you can't stand the heat, get out of the kitchen.  Well... I like to cook and I like to write... so I'd better work on tougher, more heat resistant skin.  That said, I find myself being untrue to you, the reader, by purposefully not writing about something that is central to my current life with diabetes: postpartum depression.   

I'd suffered from chronic depression a lot when I was younger and, mainly due to the social stigma around the condition, I've always found it very difficult to talk about being unhappy and why I was so.  I remember a conversation I had with HB early on in our relationship where I tried to openly share this part of my world and he dismissed the diagnosis as snake oil and advised that I attempt "keep more busy." Obviously that hurt, but that was then and we've since had time to come to terms with the factual existence of complications caused by chemical imbalances and to build a more constructive, supportive relationship.  (To his credit, I must say that such a quote seems horrifically misattributed to him and I very much appreciate his new found open minded approach to me and the world.) 

There is no appropriate time to talk about depression and there is certainly no easy way to go about it, but seeing as I've written about every other pregnancy complication I've experienced, it seems disingenuous to omit this one from the record simply to spare my own discomfort.  The fact of the matter is that postpartum depression is a childbirth complication that is caused by hormone changes and imbalances... and I seem to be struggling with it.  I'm moody, withdrawn, fatigued and frustrated.  Don't get me wrong I love being a Mom and some of these feelings are standard operating procedures for the job, but when showering sounds like too much work, the couch is my new best friend and I have no will to fight my son watching Chitty Chitty Bang Bang for the billionth time it is time to admit something isn't quite right.

I don't recall having issues with this after my first pregnancy, but in doing some reading about the condition, I am not at all surprised by its occurrence now.  As it turns out, a 2009 research study competed by the Harvard Medical School and University of Minnesota School of Public Health found a definitive link between diabetes and postpartum depression.  Among the 11,000 women who were tested, those with any kind of diabetes - be that type 1, type 2 or gestational - were two times more likely to develop depression during or after pregnancy.  Unfortunately the research did not extend farther to identify the connection between the two illnesses, but it is the first study to demonstrate the existence of a relationship and it certainly warrants further inquiry on the topic that I ardently hope they'll do.  Until then I guess I just happen to be one of the lucky 1 in 10 diabetic mothers who get to figure out how to deal with it... 

I wish I had a plan of action that would spell out S-U-C-C-E-S-S in treating this complication, but I don't want to be on medication and I can only guess at what other changes might be effective. I think writing about it here is at least one step in the right direction because no matter how hard it is for me to admit its exists or how much I dread what people may say, it is part of my reality and ignoring it wont make it disappear.  And if I am scared to write about this then what else am I going to be too afraid to publish?  I can't afford that fear and there shouldn't be a place for it here. 

I'm not perfect, but I am honest.  As terrified as I may be in saying these things, I believe it's the right thing to do and, on the off chance there is a diabetic Mom out there reading this and experiencing what I am, you're not alone.  It's not the best hand to be dealt, but we've got to face it and keep moving. If not for us, then at least for our kids. 

Two Year Anniversary

Two years ago today, at some forgotten hour in the afternoon my existence changed with a diagnosis of diabetes.  I remember the relief I felt that day when the doctor announced my newly acquired accessory (because, let's face it, diabetes manifests itself as battery operated, pocket sized baggage) as if I'd some how dodged a bullet and gotten off easy -- it's not cancer, after all.  But sitting here 730 days later I can't help but feel very sad that I wound up in such a serious, long term committed relationship with artificial insulin.

In a lot of ways I feel like I am married to my pancreas and not in a happily ever after, ride off into the sunset kind of way -- it is more like the drunken, bad idea, spur of the moment Vegas wedding with divorce banned in the prenup kind of way.  I was a happy, healthy and independent woman before January 24, 2011 and then BAM! I woke up and found myself in bed (one that I did not make, by the way) with a disgustingly lazy pancreas that is inexcusably and exhaustively high maintenance.  I don't like it, I certainly don't love it and I'm sick (literally) of it.

Honestly folks, I am tired of being diabetic.  I am (postpartum-exacerbated) depressed about being diabetic. I mean when you get the flu it is horrible and you curl up in the fetal position for a week or so and then you're back up on your feet, good as new.  But with diabetes, it's emotionally like I've had the flu ever since I left Georgetown Hospital.  I rationally understand that the disease I have could be a worse one and that my diabetes is not nearly as bad as it could be (or as the flu feels), but the work it takes to keep it this way and to prevent all of the worse diseases that diabetes can cause takes constant attention.  And I am tired.  I want to be done.  But there is no cure, there is just treatment.  Maybe someday this will change, but until then the unfortunate relationship continues.

So, my non-honey, anti-sweet, not-so-dear pancreas, happy anniversary.  Seeing as this is year two, I guess I'm supposed to give you something cotton and I think any one of these t-shirts expresses my true sentiments about you.  Take your pick!

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.

Inabilities.

For the past several weeks I have been fighting tooth and nail with the word "can't."  I can't cook dinner with a migraine.  I can't nurse GV and "rock-a-baby" GW simultaneously.  I can't test my blood sugar one handed.  I can't find a spare moment to write more than a sentence or two at a time.  I can't fit my new books onto the already full bookshelves.  I can't get GW to take his (much needed) nap - and consequently I can't take a (much needed) nap.  I can't get a quality resolution picture of GV with my camera phone.  And, the cherry on top of it all, I can't stand GW saying the word "can't."

I guess my little sponge has picked up on my repetitive use of the word lately and has usurped it for his own use.  I shouldn't blame him for adopting the vocabulary he hears - I mean, at least we don't use vulgar language around him - but you can imagine my annoyance with his perfectly quipped and quick response to "go to time out" being a simple "I can't." Fortunately, being infinitely wiser than he at age 3 (wiser sounds much better than older, don't you agree?), I have miraculously found maternal ways to overcome such toddler identified inabilities; unfortunately, the limitations I find myself facing aren't quite as easily solved by sitting in the green and white striped chair in his room for some predetermined number of minutes.  Granted, GW regularly tries to send me to said chair and I'm sure he would love to see me work through my "case of the can'ts" from the corner, but the double sided nature of being Mom is that while I'm immune to such punishment, my problems are as well.  Seeing as I can't shake my troubles that way, I'm forced to find alternative methods of treatment... which appears to be gripping about them here.

Now, I could spend the next several paragraphs writing about any number of things I can't stand or can't fix, but when it comes down to it there is only one thing that has me completely infuriated: my inability to make air rise.  Scientifically speaking this should be a God given faculty that I share with every other human being on earth - I mean it is a known fact that warm air rises and that density has a correlational relationship to gravity - but for whatever reason I am physically impaired in this department.  Let me explain:

Scenario One:  When I do an infusion change, I have to attach a new reservoir to an insulin vial in order to fill it with the appropriate number of units to last me two to three days.  I make sure that the reservoir is full of air, I attach it to the top of the vial, inject the air and invert the vial.  By doing this I create pressure in the vial and enable the insulin to transfer containers more easily when I pull the plunger back down and suck insulin into the reservoir.  At this point I need to get all of the remaining air in the reservoir back into the vial so that I do not wind up with air pockets in my pump tubing, so I tap the side of the reservoir to make the bubbles rise and then I inject them back into the vial.

Only problem is that I can tap, flick, even bang the reservoir until my fingers bleed, my pencil breaks or the reservoir flies off at impact on the table and I still can't get those fricking air bubbles to rise.  They stubbornly stick to the bottom or side of the reservoir and I can imagine them cackling at my frustration each time they evade my scientific understanding of liquid vs. gas.

It's maddening.

Scenario Two:  My little GV is a phenomenal eater.  At seven weeks old, she has put on just under four pounds since birth and she's starting to put 2 + 2 together and she makes a beautiful smile every time I pick her up to nurse.  She usually nurses for twenty to forty minutes at each feeding and, typically, she needs to be burped once in the middle and once at the end.

Unfortunately, however, no matter how I attempt to burp her or how many times I pat her on the back I can't get that gorgeous little girl to eruct! I'll spend an infuriating amount of time attempting to fix my loosing record, but every time I wind up needing to pass her off to HB who immediately gets her to burp within seconds of the exchange.

Again, maddening.

After attempting what feels like every possible technique change known to man, I don't know what else I can do to change such obnoxious inabilities.  I've tried hard to be creative in my solutions (and yes, I've even tried time outs) but sometimes it just seems like the deck is stacked against me and there is just no winning.  I'm trying my darnedest to cut the can'ts out and to implement a more can-do optimism to my naturally pessimistic self, particularly for GW's vocabulary sake, but with frustration and annoyance I am throwing my hands up and leaving the raising of air to the rest of humanity.

Perhaps there is something else, like the completion of this blog post for example, I actually can do something about... take that can't I'm attempting a come back!

Left: My fall 2009 can-do solution to GW wanting to be held
and the necessity to finish a grad school research paper.
Right:  My can-do solution to GV wanting to be held and
the need to complete summer 2013 course reading.   

Coming soon...

So I've been working on a blog post titled "Inability" for about a week now and I just seem unable to finish it.  How ironic.