Monday, April 10, 2017

Motherhood Musings: Diabetes and Pregnancy

I've written this post over several times. Each time it's scrapped because- well, it is a personal journey and it gets too easy to get bogged down in medical explanations and background knowledge. The thing of it is, is I have diabetes (You can read more here and here, if interested). Type 1, to be more exact, sometimes called Juvenile Diabetes though I contracted the disease as an adult. And the thing about diabetes is it makes everything more complicated. Including- and this should surprise no one- pregnancy. Pregnancy is already pretty complicated, despite the way movies on TV portray it, but, yeah, the disease instantly put me and our pregnancy into the "High Risk" category of pregnancies and that's what I wanted to talk about today.


Because you can't escape medical jargon completely when talking about diseases, here's what you need to know about Type 1 Diabetes. Your body makes this thing called insulin; it breaks down your food into a form of sugar or energy called glucose. This happens pretty instantaneously and you don't ever have to think about it. Anyone who is otherwise healthy who says they have low or high blood sugar levels (called hypoglycemia and hyperglycemia respectively) probably  (thankfully) has only the mildest forms of that, and their body can correct it typically pretty quickly. With Type 1 Diabetes, the body has stopped making insulin. So, we can eat food, but our body can't process it. We can literally starve to death, even while eating. Also- our blood sugar levels will soar really high. There is no cure for this disease, but it can be managed through medicinal insulin. It isn't as fast or as effective as the insulin made by the body, and it requires a lot of thought to manage, but it can help us. There is a danger that one can take too much insulin and get low blood sugar (low enough and it too can cause death). All of this is hard on the body, so there are a plethora of side effects.

Now, add pregnancy to the mix. That's when things get real interesting.

Needless to say, all this gets complicated. What it comes down to is management. I found out I was pregnant really early on (5 weeks, actually), and we were able to get in touch with doctors right away to get things locked down. Our regular doctor put us in touch with a specialist- A Maternal and Fetal Medicine doctor- who was in the nearest city to us. I also saw a diabetes educator who specialized in managing diabetes in pregnancies.

What they told us were the type of things that no soon-to-be-parents want to hear. The baby was at a higher risk for things like heart complications and spinal abnormalities. The baby's weight would also be a potential risk factor (because they get food from the mama, and it could have too much or not enough glucose in it. Meaning, the baby could grow too big too fast or alternatively be too small). After birth, the baby would also be at risk for several things immediately, the biggest of which was being at risk for hypoglycemia, because their bodies were producing enough insulin to deal with a high amount of glucose, but once the umbilical cord was cut, their bodies wouldn't be getting that much glucose and it could cause low blood sugar! Additionally, there were a lot of risks to me, mostly a heightened chance of getting preeclampsia, but we also found out my regular doctor had been mismanaging my diabetes, so my blood sugar levels were not where they ideally needed to be as a pregnant lady! Yikes!  Luckily, we had a great team of people. I saw them maybe twice a month throughout the first trimester and some of the second trimester. (Actually, frequent doctor visits will be a theme of this journey).

Being pregnant additionally had the strange effect of changing my sensitivity to insulin. Throughout the first trimester, even the smallest walk could sent my blood sugars plummeting, and I only needed a slight bit of medicine to process what I ate. As things continued, I became less and less sensitive and by the third trimester, was taking a unit of insulin for every 8 gms of carbs (this is roughly 4x the normal amount I would need to take!) Between the sensitivity and getting on different types of insulin though, my health was in the best place it had been since contracting the disease!

For us, the focus was really on the baby's health. We waited and didn't get the regular ultrasound at 20 weeks, because at 22 weeks, they needed an in-depth health screening that included both an ultrasound and a heart echo. This meant an hour and a half process first thing in the morning. We'd come up to Billings the night before, but I spent much of the night awake in the hotel, trying not to disturb my husband; I was that nervous about it. Once it became clear there weren't problems in the ultrasound, I had trouble keeping my eyes open, I was that tired!

Turns out, this would be one of many, many ultrasounds. Doctor visits for ultrasounds and stress tests increased until, for the last two months, I was in the doctor's office twice a week! I could have practically hooked myself up to the machine!

We had always planned on inducing at 38 weeks, on the assumption that the baby would be bigger (and that I was small). However, with the help of all these professionals, my pregnancy had seemed very much like a healthy person's, so our OBGYN was in favor of waiting until labor happened naturally. I'll be honest- I was very uncertain about this plan as our son had a HUGE head according to the ultrasounds (he still does) . As it turned out, what happened was what neither I nor the doctor expected. I did get some signs of preeclampsia and that necessitated the induction at 39 weeks.

I covered some of what happened during labor in Ellis Jerome's Birth Story, so won't retread that. However, I did want to touch on diabetes postpartum. First, it was really strange to go from so much medical support to almost none. I saw the OBGYN a few more times and that's it. I had to figure out how to manage insulin for a body that was flooding with hormones and whose insulin sensitivity was fluctuating wildly. Obviously, I know my body better than anyone, but it was a big change! Second was how the disease affected my body physically in postpartum. You see, I am one of those people who the weight just fell off of. And, yeah, I totally get how that could seem annoying to others who have had kids. Yet, this too was a result from the disease. Remember that part about starving up at the top? Well, what happens is, if your body can't process the food you are eating to make energy, it converts the fat. Since how much insulin I needed was changing so much, sometimes I missed the mark and my body couldn't get energy from what I ate, so it took it from the body fat. Silver linings, I guess, but trust me (since yes, someone once said they were jealous of this), I'd rather be healthy.

4 comments:

  1. I think that it is wonderful that you are sharing your story! Diabetes is a lot of extra stress to have to deal with when you're pregnant. I wonder why there isn't more medical care postpartum? I would think some extra guidance figuring out your insulin after baby would be just as important as during pregnancy...

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    1. You would think but... luckily, I am doing well despite that. Thank you for reading through this. It had a lot of medical components to it, so I wasn't sure anyone would.

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  2. Another really interesting story! That's sooo many doctors visits- but I'm so glad they did and good job and kept you both healthy. It's nice hearing the positive stories (but how frustrating about those negative parts! C'mon, doctors.)
    I enjoy how you seek out the good stuff in life- it's interesting how you got to be more healthy mid-pregnancy!

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    1. That is such a nice compliment, Ginger (I certainly don't always feel like I focus on the positive in my head....lol).

      Pregnancy in general- even if one is healthy- entails a lot of doctor visits. Luckily my doctor and most bill for taking care of you overall, not per visit!

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