Carb Counting Challenge Results

So, to make things standard and therefore fair for everyone, I only used the CalorieKing.com website to gather the numbers.  Here's the final break down:

Thomas brand cinnamon raisin bagel - 58 grams carbs
3 oz cream cheese - 2.3 g
Starbucks blueberry scone - 61 g
Grande coffee with milk - 24 g
Two sugar packets - 8 g
Two medium slices bacon - 0.2 g
Two scrambled eggs - 1.5 g
Two slices white bread toast - 23.9 g
1 cup home-made hash browns - 54.8 g
One medium banana - 27 g
1 cup 2% milk - 12.4 g
1 cup multi-grain Cheerios - 24 g
Seven 4" home made buttermilk pancakes - 76.3 g
1/2 cup real maple syrup - 108 g
1 Tbsp butter:  > 0.1 g (not added to total)
12 oz fresh orange juice - 37 g

Total:  518.4 grams carbs

Pizza protest.

And so it starts.   I am officially facing irrational insulin resistance for the first time.  Dum dum dum! 

I've read about this part of pregnancy countless times and I knew this was coming, but it's still disappointing to have it begin.  One woman I read about would bolus for a full serving of oatmeal (roughly 25 g carbs for a cup) but would eat only a tablespoon of it and her blood sugar would surge so high that the rational carb:insulin ratio for everything else would be completely irrelevant and impossible to calculate for that particular food.  Scary....

Well, I've been on a serious Greek olive kick for the past couple months (I hated them previously, gotta love pregnancy cravings) and so HB and I regularly pick up this Greek pizza from a local pizzeria that scratches the olive itch and satisfies the quick easy meal when I am slacking and don't feel like cooking (Julia Child, please pardon me for this).  According to the pizzeria's nutrition information, each slice of this Greek pizza has 17 grams of carbs and, starting yesterday, no matter how much I bolus per slice - whether I double or even triple the amount of carbs per piece - I unavoidably shoot up into the 200s.  Dang.

Even with the cravings and ease of it all, such unpredictability isn't worth it and I'm bummed that this means pizza is out...

Back when I was pregnant with GW, I had pizza pretty much every day because it was just about the only food that didn't make me feel sick and we conveniently lived next to a fantastic Italian restaurant on Pentagon Row in Arlington, VA.  All I had to do was show up and sit down and this wonderful waitress named Monica would deliver to our table these amazing (pasteurized) goat cheese and spinach salads and one of these individual size pizzas with homemade sauce and ridiculously fresh toppings... yes, I was that predictable; yes, I was there that often; yes, HB was that supportive.

I guess I can say thank God that I live an hour south of that restaurant now and that pizza isn't my only source of sustenance this go around, but none the less it's frustrating to be diabetic, it is frustrating to be a pregnant diabetic and this irrational carb juggling simply sucks.  If it wasn't hard enough already, here's a new curve ball for ya! Boo hiss!

I hope someone out there - whoever you are - orders a pizza tonight and thoroughly enjoys it in absolute protest of my pancreas' tyrannical dictatorship and its cruel and unusual rejection of what ever it so capriciously whims!

Bon Appetit!

And that, my friends, is the Webster's definition of amazing.

So my endocrinology appointment on Monday came and went with next to no fanfare.  I anticipated the doctor to tell me that my numbers this past week were atrocious and that my body is obviously becoming insulin resistant, but instead she looked at my numbers over the past three months and decided that I actually need to turn my sensitivity levels down from 80 ml/dl per unit of insulin to 85 and that if I continue to see regular lows I should decrease it even further to 90.  Fair enough...  beyond that she had nothing else to say about my self care and asked to see me every three weeks until the baby  is delivered.

Unfortunately their office was out of the in-office HgA1C test kits and they were unable to tell me right away the most important information of the appointment.  HB, GW and I trotted down stairs to the hospital lab to have them run the test and I must say that I had the best phlebotomist I think I've ever encountered draw my blood with absolutely zero pain.  Maybe I'm getting too used to needles, but seriously this girl managed to get four vials of blood without even the smallest pinch!

Any way, I had to wait and wait and wait and wait and... wait before finding out what the number was.  But instead of eventually receiving a random phone call from the nurse's assistant, the doctor herself called to deliver the news. My HgA1C is down and that it is the wholly impressive number of 5.3!  Yes, people, that is in non-diabetic range and, yes, I have been doing that well with my blood sugar control.  Little party for me!

For the time being, I'm continuing as is until my next appointment with her on September 14. The reason she wants to see me every three weeks until delivery is to make sure that my sugars are in the range they need to be in for the third trimester of pregnancy.  It's particularly important that my blood glucose be under control now because if they are too high too often then the baby will grow larger than she ought to and that could lead to issues with delivery.  Furthermore, it is very important that my sugars are in control with regards to my other pregnancy complications because if Baby could arrive whenever it is extremely important that my sugars are normal so that the baby is born with normal blood sugars as well.  If my sugars are high, that glucose is transmitted via the placenta to the baby and causes her pancreas to increase insulin production to combat her resulting high bgs.  But if she is born while I am hyperglycemic and she is subsequently disconnected from the placenta (aka the source of extra glucose) she will be born hypoglycemic and will need to be put in the NICU until her sugars stabilize.  Which I, obviously, want to avoid to the best of my ability.

I'm planning to keep my sugars on lock down until she's out, but even during delivery I am planning to run my own diabetes management.  Typically most hospitals want to take over checking a diabetic's sugars and administering insulin via an IV drip for the patient, but I am not comfortable with anyone's standards but my own - so I'm going to do it.  Either HB or I will check my bg every 30 minutes and we'll keep my pump on so that we can fine tune as necessary to keep me at 120 mg/dl or under throughout labor.  If I have to have an emergency c-section, obviously that goes out the window, but in all other scenarios I'll fight anyone tooth and nail to maintain as much control over my body and my pancreas as I possibly can.  It's my responsibility, after all, to grow this baby and raise her once she's out, so while I am willing to accept outside help I reject anyone's suggestion that I hand over the responsibility for my baby daughter while she is encountering the world for the first time.

Yes, I am stubborn, but you probably noticed that already.  Ah well, this stubbornness is why my HgA1C rocks the socks off of my endocrinologist... pardon me while I keep it up!

Agh!

So there are points in each of our lives when we all have one of those moments/days/weeks/whatever that just aren't going in our favor.  You know what I am talking about - the day you wake up already late for work, get a speeding ticket on the drive in, have a fight with a friend over lunch and manage to drop a meatball down the front of your white dress right before an important briefing and then you get home to discover your pooch ate the heel off the left shoe of your favorite pair of heels - you know, those days.  I've felt like things have been going pretty well lately - nothing new to report with the pregnancy, grades came back from Middlebury and were where I wanted them, and HB and GW are well all things considered - and I have been fighting the good fight to good effect.  But then, out of the blue, diabetes struck again!

I don't know what it is about the last couple days, yesterday in particular, but my sugars have been all over the map.  One minute I am slightly low and my body is exhibiting major hypoglycemia symptoms (seriously, last night I could have been running a marathon in 150 degree weather given how fast my heart was pounding and how hot I felt) and the next my sugars are soaring higher than I've seen in I don't know how long. All I can figure is that one of the following has to be true:  A)  I've been off on my carb counting; B)  my insulin resistence is ramping up; or, C) my body just plain does not know what to do about the specific carbs I've been eating. 

It's probably a combination of all of the above at any given point, but it is frustrating none the less.  I mean to vasilate between correcting a low with my three (yes, repeat that, three) starburst and then rage bolusing (this means injecting extra "unnecessary" insulin to correct for a high faster than waiting for active insulin to work) to correct the unexpected high is simply obnoxious.  I'm sure there are those out there thinking some extremely useful thought like "well, just eat two starbursts, dummy" and while you might have a point, it's times like this that I'm sooooooooo not interested in commentary about what I should or could do better with my diet or diabetes management. No offense meant, but let it be known I beat myself up enough over abnormal blood glucose numbers for all of us thank you very much.

The cherry on top of my bad diabetes day yesterday was in the middle of the Sound of Music Sing-A-Long HB, GW and I went to (oh so much fun!!) my pump freaks the heck out and reads the stop-you-dead-in-your-tracks, armagedon-is-upon-us, you've-got-to-be-kidding-me error code: "motor error." AGH!!  So while the thousands of people around me were belting The Hills Are Alive while Maria is twirling on the big screen, I go into pre-panic mode and have to reset my pump all the while hoping to God that the mechanics of my pump really aren't failing.  Exposing my huge belly to the crowd to disconnect the infusion site, I removed the resevoir from the pump and held my breath as I watched the piston rewind back into the gear box.  It beeped - rewind successful.  I reinserted my old, still full resevoir into the pump and went through the key stoke commands to reset it and watched it intently for additional problems.  And - thank God - it worked fine.  I exposed my belly again to hook it back up and promptly joined in the chorus of nuns and would-be-nuns in "hallelujahs!" (Thank you to the male-mother superior sitting in front of us for the extra blessing, ha.)

Okay, so maybe that wasn't an actual cherry on top of that particularly bad bg day, but those heart-racing moments of concern that my plastic, artificial insulin life line had been cut off scared the boohockey out of me.  Granted, I have back up insulin in the pen form back at the house and I'm not completely in over my head if my pump does actually fail, but seeing as I'm not always home, I don't carry my insulin pens with me (they need to be refrigerated) and time without active basal insulin in my system is not healthy time for the baby, I would really rather not need to go there.  Further more, I've fine tuned my diabetes care to the point that my bolus doses are within 0.05 units of exactly where I need them to be at any given moment... with an insulin pen, you can only dose in whole numbers thus requiring too little or too much insulin.  Let it be sufficient to say that without the pump, I am pretty sure my diabetes management and my sanity would be out the window.

I know that Medtronic has a 24 hour emergency hotline for full on pancreas crisises like that and that they would have either fixed my pump or gotten a new one to me as fast as FedEx can move it, so it's not the end of the world to have it break.  But given the cost of replacing it, the efficacy of treatment on the pump and the necessity - at this point in the pregnancy in particular - to be as close to non-diabetic as a type 1 can get, I'd really just rather not go there. 

Needless to say I said several many more diabetes related prayers this morning at mass and increased my morning bolus ratio and my afternoon basal ratio to hopefully combat any resistance issues I'm starting to face.  From the other pregnancy and diabetes blogs that I follow, it seems to be pretty typical that things get a bit out of hand right about now and continue to deteriorate as the third trimester approaches and wears on.  Hopefully I'll get to expereince the frustration of third-trimester insulin woes for several many weeks and Baby will be delivered after wk 36, but we'll just have to see how all of this unfolds. 

I head into the endocrinologist tomorrow morning for my first A1C check up since early this summer and I anticipate that it will be a good number.  I've only had issues the last several days and the past three months have been solid, so we'll see where that officially puts me in the rankings...

Holy OW.

So I had a feeling that this might happen sometime soon since I'm not putting on too much weight and the baby bump is getting bigger and harder, but alas inserting my infusion site has become a ridiculously painful experience.  I went to reinsert the site at a new place on the left side of my abdomen and instead of only going into the subcutaneous fat like it usually does, the needle bounced off my abs or uterus or something and seriously hurt like all get out.

Don't get me wrong, I have a really high pain tolerance and I am used to the pinch of a two inch needle jabbing my stomach every few days, but having a needle hit muscle or something more tender than fat is SO uncomfortable.  I've had to switch my infusion sites from the parallel lines next to my belly button to my sides since Baby has oh so lovingly deposited extra cushion for Mama there... So far the swap seems to be working out, but it makes lying on my side uncomfortable and carrying a purse is a bit painful when it bounces on the site.  Oh the joys of being a diabetic!

In other news, I've been completely on the ball with checking my blood pressure twice a day, weighing in daily and checking my urine for protein to make sure preeclampsia isn't setting in.  So far things are all within normal levels and that is great.  I'm going to be talking with my perinatologist at my next appointment about whether his concerns are for "IF" preeclampsia sets in or "WHEN" it sets in.  I'm not sure what to make of this high risk pre-preeclampsia routine since preeclampsia is frankly much more intimidating to me than any of the other complications we're having with this pregnancy.

The Preexisting Diabetes and Pregnancy book I've been reading has several many stories of women who had similar combinations of complications that had their babies as early as week 30 (which, by the way, is only six weeks from now)... scary. But face it, week 30 is better than week 24 -- and week 36 is even better than week 30!!  I registered for delivery this morning with the Fairfax INOVA Women's Center and I am glad that is ready to go just in case.  I've pretty much resigned myself to the expectation that we'll likely deliver earlier than optimal and that the use of a NICU may actually be required, but that is all in God's hands and I can only hope for the best.

Week 23: Less pressure is good pressure

THANK GOD FOR PERINATAL ASSOCIATES OF NORTHERN VIRGINIA!! I am so glad to be back in NOVA for the quality medical care these doctors provide that I cannot even begin to articulate how relieved I am.  No offense meant to the people in Vermont that want to go to Fletcher Allen, but sign me up for comprehensive, careful prenatal care for this and all future pregnancies please!

So, as it is probably obvious, I had my first prenatal appointment back in VA yesterday afternoon.  They ran a second level-II ultrasound to double check what results were found in VT and were able to confirm with greater clarity that the baby is in fact a girl and that she is healthy.  They looked at my blood sugar logs and used the word "impressive!" to describe my self-care - GO ME.  Unfortunately, amazing diabetes control aside, the doc confirmed that there are several complications on top of my insulin dependence that makes the remainder of this pregnancy risky:  elevated Alpha Fetoprotein (AFP) levels, a partial Placenta Previa and very high risk of preeclampsia.  Let me explain:

1)  Each fetus creates a protein called Alpha Fetoprotein that is present in the fetal serum and amniotic fluid.  As a standard test between weeks 14-22, docs check the level of AFP in the maternal bloodstream to ensure that it is within normal levels (no higher than 2.0). Simply by being diabetic, the range for normal levels of AFP are lower and therefore more sensitive (no higher than 1.9) than non-diabetics; my level is 3.25.  Fortunately this abnormal number is not directly correlated with my diabetes and there was nothing I could have done to prevent it, but unfortunately it does present issues that need to be addressed on top of my diabetic-pregnancy care.

So what does this mean?  Well the initial assumption with elevated AFP levels is the presence of neural tube defects (such as Spina Bifida), which we have thoroughly ruled out through the comprehensive level-II ultrasounds.  Great right? Heck yeah... but we don't know what is causing the elevation now and that creates concerns about the structure of the placenta.  I'll be going into the doctor's office every three weeks for the time being so that they can check fetal growth and if she isn't growing at the appropriate rate for her gestational age (which she currently is) that means she isn't getting enough nutrients through the placenta and we may need to deliver her early.

2) Well the doctors in Vermont were wrong - I am not previa free.  The great news is that my Placenta Previa is in fact a partial and does have a possibility of sorting itself out between now and delivery, however the doctors here in VA are unwilling to say that it "will" move because it is much lower and closer to the cervix than it ought to be.   There is nothing that I can do to fix it and ultimately it is a wait and see what happens situation, so all I can do is hope for the best and work on damage mitigation. Between now and delivery I need to do everything in my power to make sure that I am not making the situation worse: no heavy lifting (anything over 10 lbs; btw GW weighs 36 lbs now), no exercise and increasing amounts of rest.

Keep your fingers crossed for me that the placenta continues to move up and reduces complications with delivery!

3) The new concern as a result of my diabetes mixed with both the placenta previa and elevated AFP is a higher risk for preeclampsia.  Preeclampsia is pregnancy hypertension or elevated blood pressure that results in extremely dangerous situations for both mom and baby.  If I am actually diagnosed with preeclampsia I will likely need to deliver Baby early, but for the time being I am in pre-preeclampsia mode.  So while my blood pressure is currently fantastic (yesterday it was 105/62) it can go up almost instantaneously and whatever great number I had before wont matter.  Unfortunately there isn't anything I can do to ward off preeclampsia, but I can keep an eye out for the symptoms of it and be able to respond quickly if and when it does set in.



So... the long and short of it is that my diabetes is under tight control, but that does not affect the presence or treatment of the other complications.  Worst case scenario, each individual complication is solved by emergency, early delivery so any hopes I had to make it all the way to week 38 are pretty much shot.  I'm taking things one day and one week at a time right now and trying to keep my blood pressure and stress as far down as possible.  I anticipate with HB's ACL reconstruction surgery on Friday, GW's upgrade to a real bed (buh-bye crib!) and my anticipated insulin resistance that it'll be a difficult task to keep my anxiety down, but I'm doing everything I can and the certainty of that at least makes me feel better.

Update amid chaos...

Sorry for the hiatus everyone - between final papers for class and getting back home to Virginia it has been a crazy week and a half.  I am hoping to sit down and have some time on Sunday to answer a couple questions people have sent in... so bear with me.  I will also be posting a new Baby update after I head to the perinatologist on Tuesday to actually get answers that I've been missing for the last six weeks.  At the end of the month I check in with my endocrinologist in person and should have an updated HgA1C at that point.

I have time for one quick funny story now though...  Last week, I was talking with my endocrinologist over the phone about my blood sugars and she asked me if I was having any trouble with resistance.  After week twenty in a pregnancy - I am almost to week 23 - insulin requirements go up and up and up because of the sponge like nature of the placenta, so her question is logical and will be increasingly more common until November.  Well, at that point, I was able to articulately answer that "no, things are just fine" and that "no fine tuning is necessary."  Knowing full well that God and my pancreas have a funny and sometimes sick sense of humor, the next day my sugars were all sorts of out of whack... a day early and a dose short, eh?

Let the reindeer games begin!

To my partner in crime

Do you know what the worst part of being a diabetic is?  Standing like a marooned, blubbering idiot watching your husband drive away.

Wait... that has nothing to do with diabetes... oh well, I'll write about it anyway.  

After two weeks of "vacation" in Vermont, HB left today to drive back to Virginia and get back to the working grind of our daily reality back home.  It was wonderful to have him up here - to share this new aspect of my life with him and to hold his hand through the last few weeks of medical appointments.  Admittedly I'm beginning to mentally check out of my classes for my own reasons and I am glad that school ends in just under two weeks, but watching him go today made me very sad.  I'm going to miss him with professional precision from now until then, from that second his car disappeared around the bend and down the hill to the moment I anxiously open the front door back home in August...

Your nose is blue.

I know many don't understand why or how our relationship works, but for whatever reason it does and for that I'm eternally grateful.  Especially over the last few months, I've found myself awe struck by the immense luck I've had in not only finding a partner I want to work at marriage with, but an honest to God best friend that makes my world better.  Between the care he's helped provide medically, the support he's offered emotionally and the encouragement he's given freely, I feel like any number of the hurdles I individually face in life are less high and more attainable than they ever were on my own...

I can't tell you exactly what it is or how he does it that makes my everyday life, even with diabetes, everything I could have hoped for.  Perhaps some HB-centric inversion of Maya Angelou's poem "Phenomenal Woman" would be appropriate here, but I've never been known for a mastery of rhyme schemes or appropriate use of couplets.  All I can say is that it is in the little things, like:

*  when he's standing over my shoulder watching the processing line go around on my BG meter, waiting with me to see how my sugars are doing.  And when the tight-number finally appears on the screen, I love how he cheers for me as if his favorite football team just won the super bowl. 

* how he measures out pancake batter on Sunday mornings to ensure that each pancake is the same equivalent size so that I can easily calculate what number of carbs I'm eating.  Of course he rolls his eyes at me when I ask him to tell me how many carbs are in the maple syrup he gushingly poured over his pancakes, but still... :)

* when he talks with me in riddles and puns, making a game out of the English language.  Just this morning he turned that horrid song "who let the dogs out?" into a sing-along about dairy cows for GW and made us all laugh with his "moo, moo, moo" interpretation.   

Sure, sure I know this is a post off topic (and sappy), but sometimes I just have to say exactly what is on my mind and HB deserves the shout out.  Many spouses of diabetics struggle with the impact disease has on their relationship - either as a result of their own apathy for it or, more commonly, with the diabetic's apathy for it.  Fortunately this isn't the case in our house and I am very grateful for his continued support, increasing love and invaluable friendship.  Diseased or not, I feel like a million bucks around him and nothing can beat that. 

That said, I miss you and love you very much HB.  See you not soon enough. 

Carb counting challenge reminder :)

Don't forget to post your carb counting challenge answers!  Only have a couple guesses so far, but nothing correct as of yet... the prize is still up for grabs, so take the challenge and it could be yours!

:)

Echo Results

Halfway through the drive back from Burlington tonight, we stopped at this mom-pop type bakery on Route 7 called "The Love Shack."  Having spent a good portion of the day whining about wanting a cookie, HB graciously stopped to pacify my craving and we scoured the baked goods for the perfect selection...  Ultimately purchasing a bakers dozen of cookies out of sheer indecision, we taste tested a few on the drive home and - ironically - determined that the "Motherly Love" cookie is better than either the "Puppy Love" or "Summer's Love" cookies.

Why, you might ask, is this cookie better than the others? Made with dried cranberries and white chocolate morsels, this "Motherly Love" had the right blend of sweetness and acidity to make the perfect cookie bite (not to mention a valid parenting suggestion).  So flavor wise, the cookie was more complex and more foodie-palate-satisfying than either the chocolate and peanut butter chip cookie or the chocolate chip oatmeal cookie.  But that's not all... the "Motherly Love" cookie was better than the others because of the name and the outcome of my day.

The fetal echocardiogram went beautifully.  After spelling out the likely complications that diabetes can cause for fetal heart development, the neonatal cardiologist said that Baby's heart couldn't look more normal and that based on what he saw there is no need to do additional testing to confirm his findings.  In other words, Baby's heart is developing in the best case non-diabetic pregnancy kind of way - thanks be to God!  He was also very pleased with my weight gain thus far and the simplicity that my body-type creates for diagnosing complications in the baby - thanks be to Sean T for helping get me in the best pre-pregnancy shape possible!  

So what does this mean? It means that my BG control has rocked and that any of the complications my diabetes could cause for the baby thus far aren't an issue.  Granted, it's a bit early to straight out celebrate as BG control directly correlates to baby size/weight (that will only be determined in the final weeks of pregnancy through ultrasounds), but I'm feeling pretty good about things and we're very relieved that diabetes:Baby::baseball:daisies - completely irrelevant!

Obviously there are other issues that we still need to keep an eye on - where the placenta is, any possible issues with fetal growth and how my blood pressure is doing for preclampsia purposes (98/50 today btw) - but all of that is fortunately non-diabetes related and out of my hands.  I know and so do my doctors that I am doing everything I possibly can for a healthy baby and, at the end of the day, that helps me sleep at night.

Thanks for the support. I'll let you know how the next prenatal appointment goes when I get back to VA and can touch base thoroughly with my MFM down there. :)

Fetal Echocardiogram Today in Burlington

As I mentioned in one of my last pregnancy related posts, the fetal echocardiogram is the next big hurdle for me to clear in the pregnancy.  In all pregnancies the doctors will look at the development of the baby's heart to make sure that it is healthy and not showing malformations or irregular operations. With insulin-dependent pregnancies, they do a higher resolution more careful screening of the baby's heart because problems with heart development are more likely to happen with diabetics because of the impact abnormal blood sugar ranges have on fetal formation.

So with non-diabetic people in general, typical blood glucose ranges are between 70 and 100 mg/dl.  With diabetics, this range is very difficult to achieve and requires full attention to get even close to such "tight" control, which is why our optimal range is slightly higher between 70 and 120 mg/dl to account for this difficulty. Now, consistent blood sugars above 120 mg/dl prior to conception and during the first trimester of pregnancy can cause birth defects - specifically in the cardiac system - because of the delicacy of the fetus' system development.  Obviously this means it is completely on the mother (aka me) to give the baby a healthy heart from the get-go.  No pressure.

Wanting to give baby the best shot possible at a healthy life, I worked very hard to have tight sugar control before conception and I've had my sugars on lock down since the beginning of the pregnancy for fear that I might do something to Baby.  Today is kind of the culmination of that... whatever happens in the coming months with my placenta previa, my higher risk for preclampsia and issues with fetal growth are all irrelevant to my diabetes control and out of my hands.  But today, the fetal echo, is a direct measure of my blood sugar control and its impact on the pregnancy.  Again, no pressure.

I'll report back how it goes as soon as I get a chance...  until then, please keep your fingers crossed and us in your prayers.  We'll take whatever help and positive vibes we can get!

Carb Counting

Thanks to Cousin Lisa, I have yet another awesome topic to write about that I wouldn't have otherwise thought to cover if she hadn't asked a great question:  how do I know how many carbs are in everything I eat?  Yeah, a completely integral part of being a diabetic, but something I haven't necessarily thought conscientiously about in ages...  great question!

Breaking things down to the absolute basics for those unfamiliar with nutritional components: the food we eat is primarily divided into three categories - protein, fat and carbs.  Protein comes from things like meats, seafood and eggs. Fats come from things like nuts, ice cream and non-lean meats.  Carbohydrates are in foods that contain fruits, vegetables, grains and sugars.   It is important to note here that these categories are not mutually exclusive and that they often blend together in each of the meals we eat every day...  taking a cheeseburger as an example you've got protein, fat and carbs in several combinations like so:

So when "carb counting" you are looking to identify how many grams of foods from this third category are in whatever food you eat and, based on the hamburger example above, you can see that carbs come from more than just bread.  As a diabetic, I have to sit down at every meal and put a number to the plate of food in front of me... does it have rice? does it have potatoes? what hidden carbs are there? what kind of bread is used? is there milk in it? is the protein breaded? what is in the sauce?  And don't forget about drinks! I've found that most drinks have more carbohydrates than one might imagine...  1 cup of milk has 13 grams of carbs; a cup of coffee only has carbs if you add sugar and milk, but you have to account for the effect caffeine may take on BG; soda - don't even get me started; and juice, talk about straight sugar in a glass!

When I first was diagnosed and had to meet with a dietary nutritionalist to learn how to carb count, I was completely overwhelmed by the prospect of knowing what was in everything.  Fortunately I was previously acquainted with reading nutrition labels and that made things much, much easier - all I had to do was grab a measuring cup and do some basic math.  But when I don't have access to nutrition labels (like at restaurants, when other people cook for me or when making things from scratch) it got much more difficult.

I remember a conversation I had with a long time family friend back in Colorado who is also T1 about how he knows what carbs are in what.  Having been diabetic since he was just a kid his response was simply that "at some point, you just know."  Now a year and a half in, I get what he means and I "sight read" my food, but it has taken much practice and research to get to this point.

So what resources did/do I use?

Not being a terribly big fan of technology (face it, I'm anti-facebook and twitter), my absolute favorite go to nutrition guide of choice is the Prevention Magazine Nutrition Adviser book (ISBN-10: 0875962254).  It breaks down most foods (not complete meals, but specific components of meals) into a standard nutrition label - so for foods that might not have a label (ie apples and bananas) it is a great way to learn the necessary stats.    I'd definitely recommend this book!

If you're an internet searching type, the website of choice that I use most often is calorieking.com (I believe it is also in the form of an iPhone app).  It is a gigantic online database that you can sift through for basic ingredients or for comprehensive meal choices at specific restaurants.   It mainly covers chain restaurant, fast food or ready-made grocery store meals, so it does leave a gap of information for local Mom-Pop type places, but it can give you an estimate of what the stats are of a certain dish to guess off of.  So for example, the lasagna bolognese at the Macaroni Grill has 720 calories, 41.3 grams of fat, 46 grams of carbs and 41 grams of protein.  Assuming that the lasagna you make at home contains similar ingredients and is a comparable portion size, it like has 40-50 grams of carbs as well.

Another phone app resource that some of my diabetic friends use is called "Track3". From what I understand it is a comprehensive diabetes app that provides nutrition information and an exercise/meal/BG journal.  I don't personally use this so I cannot speak to it from experience, but from what others have said it is a great resource for carb content searches and data collection.  It seems to be geared toward diabetics, but I'm sure there is a way to make it work for non-diabetics as well if interested.

At the end of the day, carb counting is about being as close as possible to the right number of carbs (within 5-10 grams is usually okay), but mistakes are inevitable.  You can miscount and under bolus sending sugars sky rocketing or you can over count/under eat and send sugars into hypoglycemic ranges. Obviously it is ideal to know what you're getting exactly and to avoid such miscalculations, so understanding how to read nutrition labels and researching restaurant nutrition information is a great first line of defense.  But once you know some basics by memory - like most rice and pasta is about 40 grams per cup, an apple is 20 grams give or take a few and bread is typically between 15-20 grams a slice - it gets easier to eyeball meals you can't measure exactly and roll on with life.

I will admit that I still struggle with foods I am unfamiliar with and I do find myself in situations that are outside of my carb counting comfort zone.  Like when going to ethnic restaurants that use ingredients that I can't pronounce, let alone identify or when someone else cooks something I've never eaten before, I'm often left to take a wild guess or to ask the awkward question of "um, what is this?"  So heads up, when serving dinner to me or any other diabetic, you might be asked to show the recipe card  for the dish or the cans/boxes your ingredients came from just so a better, more accurate guesstimate can be made. Ultimately it's the responsibility of the diabetic to read what is in front of them, but don't be surprised or offended if they ask for more information or opt out of a certain dish for health reasons.

Well I hope that this post begins to answer your question to at least some degree, Lisa!  There are other ways to watch what you eat as a diabetic - such as no-carb/low carb diets or using the glycemic index - but I'll skip that for now since they're a bit more complicated than carb counting.  If any reader would like more info on those options/what they mean, I'd be happy to go into more detail about them in a future post - just let me know.

Until then, I have two challenges for all of you:

1) Check out the nutrition labels on your food and to track how many carbs you eat during the day.  Measure your food, conscientiously note when you snack and what is in your drinks.  It's a very different perspective of your plate than you might be used to, so please feel free to share your experience in a comment :)

2) Take a look at the following pictures and descriptions of common breakfast meals.  Whoever can give me the total number of carbs (including decimals... silly engineers) in a post comment first will get a prize! (And it is a sweeeeeeeeeeet prize!)

1) Thomas' brand Cinnamon raisin bagel with 3 oz regular cream cheese.  2) A Starbucks blueberry scone and grande iced coffee with milk and two sugar packets.  3) Two scrambled eggs, two medium slices of bacon, two pieces of white-bread toast and 1 cup of home-made hash browns.  4)  1 cup multi-grain Cheerios with one medium banana and 1 cup 2% milk.  5)  Seven 4" homemade buttermilk pancakes with 1/2 cup real maple syrup and 1 Tbsp of butter.  6) 12 oz fresh orange juice. 

As soon as someone guesses correctly, I'll post the answer for all to see :)

Good luck!

Juvenile Diabetes Research Foundation - aka JDRF

While we were in Burlington last week, I ran into a very nice man named Tony who was wearing an awesome shirt that read "F DIABETES".   Unable to resist asking him about the shirt, it turns out that he is also a T1 diabetic and that he and an entire team from NJ had driven up to Vermont for the JDRF Ride for the Cure - a 100 mike bike race to increase awareness of the autoimmune disease and to raise money for diabetes research.   In the short conversation I had with Tony I learned that his team alone had raised nearly one million dollars... amazing, right?!

I'd never heard of "JDRF" before - remember I'm still newly diagnosed with only 1.5 years of insulin dependence under (on?) my belt - so I began to do some online research.  Holy Cow is this organization an amazing source of information and a solid support community!  From my initial reading, JDRF is the leading global organization focused on type 1 diabetes research with the admirable  mission of treatment, prevention and cure of insulin dependence.   It has more information about type 1 specifics than even the American Diabetes Association and what an easy site to navigate - props to those web designers!

Now, I could boil down what the website has to say here, but I'm not going to.  The purpose of this blog is for me to share my experiences and bridge the gap between incomprehensible medical mumbo-jumbo and the vernacular for those who may find my writing style agreeable... But if there are readers out there who are interested in learning more about the Foundation, what it does and/or how to get involved, check out their wonderful website at: www.jdrf.org!

And for the record... Tony made the Tshirt he was wearing and very graciously shared with me the url for where I can get one of my own.  I ordered mine in Gray - the type 1 diabetes awareness color.  So if you'd like to get an "F Diabetes" tshirt as well (and in doing so put a smile on the face of some random insulin-dependent who sees you wearing it) go to: www.premierthreads.com

Rock on. 

Our prayers go out to the Aurora shooting victims, wounded and their families.

Water.

So I got an excellent question the other day (thanks Bun) that hadn't even crossed my mind to write about:  how do I go swimming or take showers with my insulin pump?

Well, I don't. I don't swim or bathe while wearing the pump.  The pump is like any other non-waterproof electronic that runs off of a battery - it mechanically fails when it gets wet.  Given that I am fully dependent on it functioning... water and the pump just don't mix.

To work around this, the designers of insulin pumps understand that diabetics need to bathe and that some of the weird ones (obviously does not include me) even like this strange concept of swimming, so they created a quick release at the infusion site to disconnect the pump and tubing from the cannula.   This leaves the port in the skin until an infusion change is medically required (every two to three days), but allows the diabetic to remove the pump as necessary.

My current infusion site with the "male plug" inserted in
it; the red spots above the site are from previous cannulas -
the sites take a quite while to heal.

I can't speak to the exact set up of all insulin pumps, but what Medtronic does is provide a male and female "plug" for the pump tubing.  The female part of the plug attaches to the tubing and covers the needle while it is disconnected from the infusion site.  The male plug is inserted into the infusion site to cover the exposed end of the cannula - this prevents water, soap, whatever really from getting into the cannula and therefore your system.

The disconnected tubbing and the "female cover"

So that should cover the logistics of taking it off to be in water, now on to the consequences... well as I have explained else where, the pump delivers both a basal insulin (background insulin) and a programmed bolus of insulin to cover food.  With it disconnected, the body doesn't receive any insulin and the longer this goes on the higher a diabetic's blood sugar will go.  Without ingesting more carbs, blood sugars shouldn't go up quickly, but if the pump is left off for more than say 30 minutes BGs will progressively go up with the body's natural hormone production cycle.  It's not the end of the world to let your sugars go up temporarily in order to have fun and swim (did I just use "fun" and "swim" in the same sentence?), but if you're pregnant or sick, it's generally not worth the risk.

One additional interesting thing to point out about the use of artificial insulin and water is that a diabetic should not take a shower or bath in hot water until all of the active insulin in their system is depleted.  The reason for this is that hot water, like exercise, increases the efficiency of insulin and can cause hypoglycemia.  Since this should be avoided whenever possible, I guess that old rule of "no swimming after eating" actually has a bit of credibility.


Fair enough? Make sense? ... Marco?

Thank you so so much for the question!! And, please, if any reader has a question go ahead and shoot it my way in an email or just post a response/comment.  I'm more than happy to tailor future posts to people's interests or curiosities!

3:04 AM

I don't know if it is because of my growing baby bump that my back is bothering me as much as it is or if it is the manifestation of my stress knotting itself into reasons to lay awake tonight, but it's 3 o'clock in the morning and I've been wide awake for almost an hour.  The power light of our macbook was flashing like light house beckoning me safely home in the turbulence of my thoughts, so we'll see what this pitch-dark post makes itself out to be...

I almost dropped my pump again today when it got caught on GW's foot as I helped him step out of the truck.  Fortunately I had a free hand and was able to grab the cord before it fell too far from my infusion site and rip itself from my skin.  We were in a pretty remote part of VT at the time away from our rental place, so I didn't have a solution ready at hand were that to have happened.  I typically have an emergency SureT set up in the center console for times like this, but this wasn't my car and I don't carry around the necessary equipment to handle more than a hypoglycemic episode.  Before being a diabetic I didn't even carry a purse, I just threw my phone and wallet in the back pockets of my jeans and rolled out.  But now that I am out of college, need to carry glucagon and a requested matchbox truck or two for my son, I have no interest whatsoever in further conceding defeat by needing a full on diaper-bag, over-sized purse to replace the one I already lug around along with my book bag.

While I was surprisingly coordinated today in my pump saving reflexes, I unfortunately haven't been quite so quick or quite so lucky at other times.  One time, I turned around to reach for GW in his car seat and the infusion site I had placed on my oblique caught on the seat belt buckle and tore out... Another time, walking down the hallway of our home while carrying a bin of clean laundry I failed to notice my pump tubing loop the door nob to the bedroom and riiiiiiiiip there it went... While lying on the floor playing with one of our dogs, Gracie, she snagged a loose end of cable with her nails and spastically tugged it out in a playful bounce.  And there was this other time when snuggly-sleeping with HB that the cord somehow got wrapped around his arm and my site went with him when he rolled to his other side.  Let me tell you... between the shock of having a cannula pulled out of you unexpectedly and the pain of the tape detaching itself from your skin, it is not a fun experience to go through!!

I don't know if any of you have had an IV administered to you before, but for those of you who have, do you remember the extra caution that went into your every movement so as to prevent the tubing from becoming snagged on anything that might require the nurse to reinsert the IV?  Perhaps I simply have a more innate distrust of that tape stuff they use than other people do, but each time I've have an IV my motions are far fewer in number and much more deliberate in purpose than they are normally.  Well, wearing an infusion set is to one degree or another similar to this - but because it is always there, it's easy to forget about it or to not notice when the tubbing is hanging out farther than it really ought to.    So while I am extremely attentive to the perceived inability to flex my elbow while wearing an IV, I am sometimes blissfully unaware of my diabetes to my own detriment... blissful ignorance replaced with an instantaneous reminder of reality. Oh joy.

That reminds me of those random moments when sitting down to a meal that I absentmindedly go to pick up my sandwich and enjoy the food in front of me without remembering the loaded sentence "I'm a diabetic" first.  It's absolutely wonderful to take that bite and enjoy the quality bread and other ingredients without concern, but when the thought hits that I am savoring unaccounted for carbs, I have to put my contentment in normalcy aside, lay down my food and be the disease again.  In a lot of ways I am envious of the other type 1s who were diagnosed as kids and don't remember what it was like to not be diabetic... I spent 24 years becoming accustomed to life and eating as a healthy person and it's sometimes very surreal to realize my life has been divided into a before and after shot.

So while you're sitting there enjoying your bowl of Cheerios tomorrow morning (that is 20 grams per cup of regular - non-honey nut - Cheerios and 13 grams per 8 oz of milk), take a moment to realize how nice it is to be healthy... I didn't appreciate it enough before I got sick and hind sight being what it is, it would have been nice to make the connection of how good I had it before sugar became a problem.

Okay... so...

Today was a strange day and I'm not entirely sure how to digest it.  We had yet another prenatal appointment where the docs simply wanted to check on my blood sugars - and, duh, they're still phenomenal.  We then had our level II ultrasound to check on the baby and learn more about what is going on...

The good news is I do not have complete placenta previa like they initially thought. The bad news is that the first half of the sonogram showed a partial previa and the second have showed none, so there still remains a possibility that a partial previa exists and we'll just have to continue watching its placement as the pregnancy continues.  I guess there is some concern about potential fetal-growth issues as a result of the location of the placenta, but we won't know anything more about that until closer to the third trimester.   

I am (and HB is too) somewhat reluctant to be hopeful at this point about the prospects of being "complication free" (minus the diabetes of course) because the emotional yo-yoing of the past couple weeks has taken a lot out of me (us).  It's definitely a different kind of care we receive here in VT than in VA and, to be completely honest, I find it a bit unnerving.  Another doctor today asked me why I consider myself to have juvenile diabetes... he then followed that up by mockingly dismissing the "uptight" (aka comprehensive) doctors of NOVA and established that "well, this is Vermont... we do things at a much lower level."  Um, not too confidence building here people.  For the sake of my sanity and the copious amounts of school work I must focus on in the next couple of weeks, I'll just nod my head, say thank you very much for the exam and please mail comprehensive reports to my docs in Virginia... and then once we're back we can get into the details of what may or may not be happening and what exactly needs to be done about it.  It's out of my hands and in God's, so we'll just let him handle it between now and then. 

There was some bad news at the appointment, though, that I feel compelled to share...   we found out we're having a girl... A G-I-R-L.. meaning pink and bows, dresses and curls, sugar and spice...  I honestly don't think there is an appropriate word or sequence of words that I can put here to thoroughly express the bewilderment that HB and I are currently feeling... Don't get me wrong, we're excited about Baby and we're thrilled that things seem to be developing as normally as they possibly can, but we've just become so comfortable with our son and the idea of little boys that the idea of a daughter (that word does not roll off of my tongue naturally) is just completely foreign.

Ironically, when we found out we were pregnant with GW back in 2009 I went through several weeks of wishing wishing wishing for a daughter before we had the 20 week ultrasound.  I had this picture in my head of the Gilmore Girl's mother-daughter relationship and I found solace amidst the shock of it all in the closeness such a relationship could bring to my life.   Disappointed when we learned that we were having a boy, I promptly spent the next couple months sulking about it and slowly coming to grips with this concept of raising a son (a word that did not roll off of my tongue naturally).  But once he was born and placed within the embrace of my arms it was complete love at first sight... I couldn't remember why I wanted a girl instead of this beautiful little boy.  

GW's heart string...  3 days old.

And so it turns out that God has a sense of humor about these things... this time hoping for another little XY we're given an XX.  My prayers for a healthy baby and a healthy pregnancy have been answered, but in exchange for another little life twist.  If history is destined to repeat itself as they say so often it does, I'm sure that my current feelings of perplexity will disappear when Baby is handed to me and she grasps that heart string I've reserved just for her.   

I don't have anything else to report at this point and will touch back with you all when I do, but the next thing we have in a couple weeks  is the fetal echocardiogram to look at Baby's heart development more closely.  Based on what we saw today, it looks like we can expect that appointment to go very smoothly, but it's definitely the biggest mile-marker for how my diabetes is affecting the baby's physical development.  So we'll see how it goes.

** Thank you to everyone who sent up prayers for us 

and shared warm fuzzy positive vibes with the universe!! 

Your support and love is very much appreciated! **

Level II Ultrasound in Burlington today...

My 20 week ultrasound had to be moved to 18 weeks because of a need to watch complications more carefully.  Unfortunately I was all excited to learn the sex of the baby at the 20 wk appointment, but today I am just an anxious wreck (didn't sleep at all last night) with far too many worries about what the doctors have to say and what the next five months will entail.  I will let you know what we come up with, but please keep fingers crossed for us (and send some prayers upstairs if you believe in that sort of thing) that complications remain minor and minimal!

Here goes...

Miracle of Modern Medicine

I've been thinking a lot the past couple days about the immense fortune I've had in living my life in the 20th and 21st centuries.  There are many things to be said about the comforts of modern life and the wondrous convenience of living with air conditioning, streaming movies, cellular telephones and electric toothbrushes.  But in spite of my sincere appreciation for bubble wrap and some what comical interest in writing an ode to heated car seats, the thing that deserves a blog post tribute all of it's own is nothing less than modern medicine.

It occurred to me when I was moping the other day about my placenta previa that conditions like this typically killed women in the past... Unable to identify the root of the problem without such technology as ultrasounds or to preform survivable surgical techniques to remove the baby, it's no wonder that the mortality rates of women in child birth were so high in pervious centuries.  I mean the modern technique for caesarean sections has only been preformed since 1881 and one historical account I read said that sixteen years prior to this standardization similar surgeries in the UK resulted in an 85% mortality rate... EIGHTY FIVE PERCENT!

Given that in the year 2000, the mortality rates in the United States for c-sections were 20 in 1,000,000 I can't believe the incredible stroke of luck I have to be in my particular predicament in the era that I am dealing with it.  Perhaps it goes a bit far to say that having placenta previa is a "stroke of luck," because let's face it any pregnancy complication is an unwelcome complication, but the reality check that in any other century (or might I many other countries) this would likely be the last five months of my life is quite the wake up call...  whoa.

Once I made the mental leap from placenta previa to smelling the roses it hit me that this isn't the first time that I've "cheated death" because of advances in modern medicine.  Like I said in my first post, when I was diagnosed with diabetes back in January 2011 the doctors were seriously concerned by my diabetic ketoacidosis (DKA).  Not even identified as a sickness until 1886, DKA was considered universally fatal until the introduction of reliable insulin therapy in the 1920s.   It's my understanding that today the mortality rate caused by DKA is less than 1% when caught early enough and treated appropriately...  So when the doctors at Georgetown University Hospital said that I was a couple weeks away from multi-system organ failure and plausibly could have died if I hadn't been diagnosed with diabetes when I was, they truly weren't kidding... thank God for IV potassium and artificial insulin!

In my romanticized, literary perspective of the world (thank you Jane Austen), I've often been quite nostalgic about centuries past and the simplicity of life that people faced in the uncomplicated, proper societies of yore.  Longing for the world of pre-facebook and basic arithmetic, I've talked about this ideal picture in my head with HB regularly and he often laughs at my boiled down, Hollywoodized version of yester-year... okay fine, perhaps there were more disease epidemics, the "middle class" didn't really exist and literacy was a privilege of those who didn't have to work hard labor... I blame it on that game Oregon Trail, the sister that always got bitten by the snake recovered when I crossed the prairie...

But all jokes and day dreams aside, I've got to admit he has a point.  In light of the realization that my life would have ended at age 24 because of my diabetes or at age 26 because of child birth, I am extremely grateful for whatever grace of God that has me alive today rather than in the 19th century or earlier.

So here is to you, modern medicine! Thank you for extending my life expectancy and giving me the opportunity to work on my optimism.

Cheers!

New layers of complication...

So I need to take a step back from my discussion of diabetes for one post and talk about something else significant that is going on with me medically.  In exchanging phone calls with my pregnancy doctors down in Virginia, they informed me that I have "complete placenta previa"and that this condition elevates my theoretically high risk pregnancy because of diabetes to a new level of high risk due to an actual complication.

For those who are not familiar with the condition, here's the general gist:  placenta previa is caused when the fertilized egg embeds itself near or on the cervix rather than anywhere else on the uterine wall.  This creates a problem as the baby grows because the placenta can partially or completely cover the cervix which prevents the mother from a having safe vaginal delivery.  In some cases of partial placenta previa, as the uterus grows the placenta will be pulled upward away from the cervix and gradually reduce the complications caused by it's early low placement.   In complete placenta previa - apparently which I have - this is not the case and the issues caused by this unfortunate implantation site only increase in concern and severity as the pregnancy wears on...

What this means:

• There is no possibility whatsoever of a vaginal delivery and I will require a c-section.
• There is risk of fetal and maternal hemorrhaging that will, at some point shortly, require I be placed on bed rest.  What degree of bed rest is yet to be determined. 
• If/when hemorrhaging occurs, heavy or excessive bleeding may result in an emergency c-section (regardless of gestational age) for life saving (both maternal and fetal) purposes.
• If hemorrhaging is uncontrollable, blood transfusions may be necessary.
• Expected delivery will be moved up to somewhere between week 36 and 38 rather than in between weeks 38 and 39 because of diabetes or week 40 for normal pregnancies.  Earlier delivery than week 36 is possible if there are life threatening complications. 

There are of course other issues that go into this condition, but I am trying very hard to remain as positive as possible at this point so as to not go into the downward spiral of "what ifs..." unless they become personally relevant to this pregnancy.  It is definitely very concerning to me that there is an additional level of issues that we need to keep in mind and that my diabetes isn't the only medical problem to be tracked...  I mean the fact that these conditions aren't even remotely correlated and that this second layer of complication is a completely out of the blue, new issue is enough to throw my mind for a complete loop.  Certainly makes the idea of "just" a diabetic pregnancy sound good right about now...

I will admit that I'm definitely disappointed that I won't be allowed a vaginal delivery since that was - no kidding - the part of this pregnancy I was most looking forward to.  I logically understand that a c-section is required to keep me and the baby alive, but I am emotionally struggling with the fact that an experience I so treasured with physically giving birth to GW is medically out of the question for Baby.  Don't get me wrong, I am completely on board with everything the doctors tell me to do to take care of this little one - heck I've been taking care of this baby since November and I wasn't even pregnant until March! - but the emotional and mental toll of diabetes and placenta previa is exhausting.

Here is a link to the Mayo Clinic page on placenta previa for those of you who are curious to know more - http://www.mayoclinic.com/health/placenta-previa/DS00588/.  I've got another appointment later in this week with the docs here in VT (oh joy...) that I plan to ask more detailed questions about what this means and how we're going to handle it, so I'll keep you posted as more information becomes available.   In the mean time, keep Baby and me in your prayers - I'm doing everything I physically can, the rest is up to God.