Well, let me tell you, I stopped reading any medical information very early on with my first pregnancy. Ultimately, I realized that I needed to be in complete control of my medical treatment since I am responsible for managing both my Diabetes and my pregnancy. What I realized is that my medical team is there to guide me through my journey, but as you either know, or will soon find out: I'm in charge up in here!
All of that being said: This post is my opinion and my experience ONLY! You should follow all medical advice and recommendations provided by your treatment team. My experience should NOT take the place of or be used in place of any medical treatment. Bottom line, listen to your doctor; I probably don't know you and every woman and pregnancy is different!
Here's my deets: I have Type 2 Diabetes. In case you're unaware, there are three types of Diabetes, here are my terribly over simplified definitions: Type 1, usually develops early and frequently people use and insulin pump to manage their sugars, Type 2, which usually develops later in life and Gestational, which is isolated to women who are pregnant. (For more details, do like everyone else does and Google it.) I was diagnosed with Type 2 about five years ago. While I am pregnant, I take injectible insulin and oral insulin; when I am not, I only take oral insulin.
The first few weeks of any pregnancy are scary for all women, or at least I think they are... right? (I don't want to generalize, but I'm pretty sure that most women feel this way.) There are lots of unknowns until you hear that heartbeat; suddenly, or at least for me, most of the worries melt away... but then I remember that I have Diabetes and that the beginning of the pregnancy is the easiest part of managing my sugars. As soon as I find out I'm pregnant, I call my Endocrinologist and schedule an emergency appointment. I'm typically seen that day and start injectible insulin within 24 hours. (To clarify, I am an "uncomplicated Diabetic," meaning that I have good control while on oral insulin, but good isn't good enough; while I'm pregnant, I want to have excellent control, hence starting the insulin right away.) I continue with my oral insulin as well. That's probably not that helpful, so here's what all of that means within the context of typical day:
I wake up test my urine for ketones, take my fasting sugar, give myself two different shots of insulin, take my oral insulin, eat breakfast, test my sugar two hours to the minute after the first bite of my breakfast, eat lunch, test my sugar two hours to the minute after the first bite of my lunch, eat a snack, test my sugar before dinner, give myself two different shots of insulin, take my oral insulin, test my sugar two hours to minute after the first bite of my dinner, eat a snack, give myself one shot of insulin, go to bed.
As my pregnancy continues, this regimen changes a little bit. I add more snacks and with my third pregnancy, there were more shots, but this is pretty much the blue print that I follow for 36 weeks. I go for blood work to determine my overall Diabetes management every 12 weeks. My Endocrinologist also tests me for a whole bunch of other Endocrinology related issues; for the record, I can't even bring myself to worry about whatever these things may be, so unless the levels come back outside of a normal range, I make it a point to not focus on these results. After the initial appointment, I meet with my Endocrinologist every 4-6 weeks, this schedule is dictated by my comfort level and need to see him.
Let's talk about the OBGYN, shall we? I have seen the same doctor for about 4 years, he delivered Arden and Jameslyn; Cullen was delivered by another doctor in the same practice whom I really like, but not as much as "My Guy" (that's what I call him behind his back). This pregnancy, the practice changed things up a little bit. With the boys, I had my first appointment at 9 weeks, with Jameslyn I saw "My Guy" at 5 weeks. With the boys, I had my first ultrasound at 11 weeks, with Jameslyn my first ultrasound happened at 6 weeks. I see "My Guy" on the regular, initially I go about every 3 weeks, eventually it's every 2 weeks and by 6 or 7 months I see him every week. He and I have grown pretty close over the last 4 years, sharing lots of stories about our families and I also update him on things that are going on that affect my pregnancy and well being. He listens patiently. He is proactive when necessary, he is confident in me and my abilities and talks frequently about how numbers are relevant but there's more to medicine than whats documented in the chart.
And finally there's the high risk OBGYN; I've gotta be honest, they are the least involved with my treatment, but the most "heavy handed" with their direction... wanna take a guess how that goes over with me? I start seeing them between 11 and 12 weeks. I then go every 4 weeks for ultrasounds to monitor the baby's development and growth. Around 22 weeks, I am seen by a Pediatric Cardiologist, who performs an EKG on the baby to determine what, if any effect the Diabetes has had on the baby's heart; thankfully, there has been no effect on any of my kids' hearts. Starting at 32 weeks, in addition to the growth ultrasounds, I start getting two non-stress tests every week. A non-stress test is where the baby's heart rate is monitored by straps that are put over my stomach. In a 20 minute period there have to be a certain number of accelerations in the heart rate, this indicates that the baby is healthy and not in distress. After the test is complete I get an ultrasound to measure the amniotic fluid around the baby. If the baby doesn't have enough accelerations in their heart rate, I then have to get a longer, more involved ultrasound where they look for specific movements and actions like fetal breathing and movement, etc. I hardly ever see any doctors from this practice, the ultrasounds are performed by ultrasound techs and the non-stress tests are performed by registered nurses; the doctors only "pop" in at the end of growth ultrasounds to warm me about various things and scare me. No, for real though. I remember at my 20 week ultrasound, I was all excited when I found out that I was having a little girl (hooray!), but that quickly ended when a Doctor, whom I met once 4 years ago came in to look at the ultrasound results. She made sure to scare the hell out of me by letting me know that there's always a possibility that my bladder and bowels will need to be cut open during my c-section. So, I think it's understandable that my reaction to the doctors in this practice is usually blank stares or a healthy dose of "my reality." Regarding the bladder and bowel concerns, I told the doctor straight up that if that happened, I'd deal with it at the moment, until then I wasn't going to worry about it, nor did I want her to talk about it... thanks, but no thanks.
So that's my Diabetes treatment in a really simplified version. Here's what I want everyone to understand, having Diabetes while you're pregnant is scary and can be overwhelming. Women with Diabetes need to be supported, not judged. Women need to hear that they're doing a good job and that even though their children may never understand the day-to-day work that their Mother's did, that those children will appreciate all of the time and effort that goes into maintaining healthy blood sugars. And while I'm going on about what is support, I'd like to discuss some Diabetes etiquette. Here are some fundamentals, which again represent my personal experience and opinion only:
Please be mindful of what you say. Statements or questions like, "I thought that you only got Diabetes if you were overweight?" (which is an actual statement that I overheard someone making) are rude and quite frankly ignorant. People get Diabetes for all types of reasons, which include: genetics, excess weight, medications that increase blood sugar levels, and some women get Gestational Diabetes have no underlying issues that would put them at greater risk... When statements like this are made, it makes me think that you are judging me for being overweight. Here's a tip, don't say things like this to anyone with Diabetes; you can think it all day long, but have some sort of a filter and don't say it.
My medical treatment is my business. I love it when people are supportive. Let me define support- care with restrained concern. This type of support is appreciated, but invasive questions are not. Here's what you can ask me, "how are you feeling?", "how's everything going?", "where did you get that totally awesome purse?" Here's what you cannot ask me, "what was your sugar? good or bad?", "what did you have for lunch?", "why are you eating that?" Here's what, none of these questions are your business, nor are they your concern. Diabetes is pretty misunderstood. Women need to be maintaining their blood sugars, not having swings in sugar, so frequent small meals are not only needed, but pretty healthy. My sugars are my business only. I'm solely responsible for what I put into my mouth and therefore, if you don't have the worry of maintaining my sugars, you also don't have the right to know what they are; if I need or want you to know, I will inform you. Also, this isn't my first time at the rodeo ladies and gentlemen, I'm the expert here, I don't need your opinion and unless you have a medical degree, I'm not listening to you.
"I could never do that!" "That sounds awful!" Oh really? Well tell me how you really feel. Here's the thing, I don't have a choice about testing my sugars and taking insulin; so if I don't have a choice and you don't have a different option for me, I really don't care what you think. When people make comments like this it makes me feel a little helpless and the last thing that I need to feel is any amount of helplessness. I get it, when people hear everything that I do on the daily, it can seem overwhelming, but here's what I'm not going to do: complain. I am able to get pregnant and I have had three healthy children, so I consider myself incredibly lucky and blessed beyond anything I could have ever imagined. There are plenty of women who would be willing to do what I am doing in order to have children, so the last thing that I'm going to feel bad for myself. However, I will not deny that it is a lot. There are times that I think, wow I just checked my blood sugar 1,260 times and gave myself 1,260 shots of insulin- give or take a hundred tests and shots; but never, ever, ever will I think I couldn't do it or that it was awful.
Doctors, listen up! I really like most of the doctors that I see; quite frankly if I have to see them 50+ times in 36 weeks, I'm not going to see someone I don't like. Here's what's incredibly frustrating: three doctors telling me three different things. Here's an actual scenario: the Endocrinologist recommends staying on oral insulin the entire pregnancy, he told me that he would put his wife on it if she were in my position- I trust him, so I'm fine with this. The OBGYN has no opinion about this medication, Diabetes management is up to the Endocrinologist. At my first consultation with the High Risk OBGYN, they let me know that they don't approve of oral insulin while women are pregnant, because of the class of drug that it is in. Well thanks everyone, you're almost no help. Here's what I did, I went with my instinct and continued with the oral insulin. I thanked everyone for their opinions and let them know that I was going to do what I was comfortable with; I also let the High Risk OBGYN know that I didn't take oral insulin with one of my children and I did take it with the other one and that they're both handfuls at times, but I can't point to either one of them and say, "Oh that's my oral insulin kid that's actin' a fool." Also, since I'm 12 weeks along, isn't a little late to be letting me know that this isn't something you'd recommend? And sometimes I get mixed messages from people within the same practice, one doctor says it's safe to breastfeed while on oral insulin, another says it's not. Over the last 4 years, I've come to realize that it can be incredibly scary, but also empowering when you are willing to take a lead role in your medical treatment; after all, you know your body and baby the best.
I've wanted to do this post for a long time. I wanted to let everyone know what it's really like to have Diabetes while being pregnant. It's a long, hard 36 weeks and at times I'm not very nice, in my defense, it's most often because I'm feeling overwhelmed, but I don't want anyone to know about it. I don't want to be a "whiny" pregnant lady, who is emotional and weak. If there's one thing I never want people to think is that I can't handle it. Considering every, I think that my "not nice moments" are few and far between, but I'm not sure that Jim would agree...
If you are reading this and you have Diabetes and are pregnant, trust me, you will be fine. I am here to tell you that I've done it before and that you shouldn't worry about everything that you read- in fact, I would recommend that you not read very much. There are some things that you can control, for example what you eat; this has a direct impact on your sugars and I recommend being very aware and conscious of what you're putting into your body and how it reacts. For example, I may be able to have an ice cream bar and not have an elevated fasting sugar, whereas you may have an ice cream bar and 12 hours later, you're reading a number that's way off the charts for you; everyone is different. I believe in being informed and educated so that you can take part in your medical treatment, that's what I've tried to do with all of my pregnancies and what I feel has worked the best for me. I also recommend that you find doctors with whom you're comfortable; you're going to need to trust them with your life and your baby's life, so if your team isn't working out, find a new one. Most of all, relax and enjoy yourself, it's hard work, but in the end you will have this amazing little person who will make all 2,500+ finger sticks and shots worth it.
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