Diaversary: Celebrating the Best Bad News of My Life

Yesterday was my one-year diaversary, and how did I celebrate?  With cake!  Yummy, sugary, properly-bolused cake!

Chad was awesome.  I was feeling crumby from an earlier low BG and I tried extra hard to look all pathetic and tired and pregnant on the couch while I said I should eat cake for my diaversary.  So Chad went to the nearest market with a bakery and brought back both red velvet and carrot cake!

They're individual slices of cake, but still just huge!  I bolused (generously!), made marks in the icing to indicate how much I would eat so I wouldn't get carried away, and thoroughly enjoyed my treat.  Chad had some of what I didn't eat and we still had plenty of cake leftover.  That's how big these stupid (but tasty) slices of cake were!  Supposedly two servings, but really more like 4.

And this was a little celebration, as far as I'm concerned.  We weren't celebrating diabetes, we were celebrating the diagnosis and the fact that the disease is about as under control now as it could possibly be.  (But let's not fool ourselves. There's no such thing as 100% control when it comes the the big D.)  One year ago, I got the best bad news of my entire life.

My blood sugar behaved with the cake, and I went to bed feeling pretty much OK about life.  Yeah.  Life is pretty good.

Tantrum

I was wandering the supermarket, which means that I was thinking about carbs.  By the time I wandered onto the "lunchbox" aisle, my thoughts had begun to turn sour.  All of those adorably portioned carby goodies stared at me.  Cookies, crackers, little crunchy bread sticks that come with their own suspiciously shelf-stable fake cheese dip, boxes containing cute little 100-calorie pack snacks.

A friend's old criticism bubbled to the surface of my memory...  People think those 100 calorie packs are a good idea, but they're not.  They're still not healthy, and you can just take a portion out of a regular sized box.

I (and she) did not know that I was diabetic at the time (I'm fairly sure it was already developing then), but now I realize that individually packaged snacks make it easier to eat snacky stuff with diabetes.  No counting crackers necessary, just grab a pack and punch the listed carbs into the insulin pump.

But my slightly sour thoughts didn't lead me to find this fact interesting.  Instead, I found it infuriating.  Other people eat straight from the box of crackers, no counting, no calculating.  That's how almost everyone else does it.  Why do I have to do it?  Why do I?  Why me?!?!

The words rang in my head with the sort of angry, distraught tone I used as a child, the one that I felt certain would illustrate to my parents just how grave an injustice it was that I couldn't do what I wanted to do, the one intended to pull at heart strings, infuse guilt, and drive home just how incredibly strong my emotions on this subject were.

Whoa.

I was so taken aback by this inner tantrum that I stopped right there in the aisle.  Where had that come from?  I normally don't ask "why me?" when it comes to diabetes, because I don't think there's any kind of answer other than genetics.  It occasionally strikes me as very strange to think of myself as diabetic, because I spent so much of my life without serious health concerns, but it usually ends there.

And all because I miss eating out of a full box of crackers?  I'll admit that I am readily frustrated by anything that makes simple tasks like eating more complicated, but was it really this that inspired the strongest emotional reaction I've had to diabetes in quite some time?

It's no secret that I'm under a lot more stress than usual and that my mood swings more easily, because I'm pregnant.  Maybe it was this added volatility.  Maybe I was really throwing an inner tantrum over my pregnancy being 100 times more complicated due to diabetes (as in "oh my gosh this is complicated," not "this pregnancy is full of complications").  Or maybe this tantrum was buried deep beneath the conscious logic and practicality I've held to since diagnosis.  Maybe that was my inner child finally shouting loud enough for me to hear her, finally striking that exact tone that would make the adult me stop, pay attention to her, and reconsider.

Only, dear Inner Child, I cannot reconsider diabetes.  I'd gladly change this for you if I could, because I agree, diabetes isn't fair.  It does suck.  And that big box of crackers?  I do want to blindly eat fistfulls of them on the couch without even thinking.

*tantrum*

Better Than Therapy

Going to the endocrinologist is good for me. I don’t just mean it helps me stay healthy, I also mean that it helps me stay sane.


I’d gotten reasonably zen about diabetes management, especially since I was doing really well. Then I got pregnant, and zen immediately slipped from my grasp. My control on my blood sugar suffered, not due to any lack of effort or education, and my stress went through the roof in response.

In a zen state, I’d have said, “OK, my blood sugar is going higher than it should. All I can do is what I can do. Crying and feeling guilty just wastes energy.” But I was not in a zen state. You see, not only was I hormonal and dealing with life changes, but I was also reading blogs, forums, websites, and books on pregnancy with diabetes.  Everywhere I turned I read about all the horrible things that can happen if your blood sugar is high, and a high blood sugar seemed to pretty much be anything out of that super tight range for pregnancy.  I seemed to absorb other women's obsession or anxiety over this, as if I didn't have enough of my own. Though my endo’s office had called me back right away with my new blood glucose goals (under 100 before eating, under 120 two hours after), it was the internet that made me scared of higher numbers. Not even counting the occasional and mysterious 200+ number that happened even when I did everything by the book, I felt like a horrible mother who was actively mutating my own baby whenever I decided to indulge in a treat (say, a small ice cream?) and came in somewhere closer to 150 two hours later.

*cue internal freak-out and self-guilt-trip*

But visits to my endocrinologist have put things in perspective every time, so far. Never once has she criticized me, never once has she told me that a number is dangerous, never once did she suggest I need to try harder. No. She even told me the first time I came in with numbers that upset me, “I’m not worried.” She doesn’t worry, she deals. “Numbers like these will happen, but we need to figure out how to keep them from happening too often.” Then we’d discuss a game plan.

Yesterday’s visit with her was fabulous. I handed her a sheet with numbers that were much improved, but definitely not even close to perfect. We were both on the exact same page about how to fix them, and she made some adjustments to my morning basal and evening I:C. She said that I was really doing well overall, and I walked out feeling not like I had failed with those less-than-perfect numbers, but that I had done a great job of improving them and was leaving with a plan to make them even better, maybe even get them in line once and for all… Well, once and until my insulin needs change again! Damn hormones!

Will there ever be a cure?

Will there ever be a cure?


It's a hot topic on D forums and blogs.  I think I most often see people say something like, "Probably, but not in my lifetime."

I'm not a naive and wishful thinker, but I'm not as jaded as a lot of veteran PWDs yet.  I haven't heard the repeated "just 5 more years" from multiple doctors.  In fact, I haven't heard that even once from a doctor (and I'm glad, because I don't think there's any way they can promise something like that right now).

My point is, I think it'll happen.  I don't actually know when, but I wouldn't be shocked at all if it happens in my lifetime.  (Not shocked, but ecstatic!)  If an actual cure doesn't happen, I am confident that diabetes care will be improved so significantly that it will almost be as good as a cure.  Maybe we won't get our beta cells back, but maybe we'll only have to give ourselves one or two injections a day to achieve healthy, steady blood sugar levels.  (I'm looking at you, SmartCells Inc.)  Or maybe someone will figure out how we can be given new beta cells that our immune systems won't attack on sight. (Russia, bravo for fearlessly exploring that frontier!  And you scientists at Washington School of Medicine, keep it up!!!)  Or maybe after the artificial pancreas becomes a reality that can be continually improved upon, someone will also develop an even faster acting insulin to pair with it, and that artificial pancreas will be developed to the point where it can function real-time based entirely on the rise and fall of blood glucose (with no need to enter carb values or temporary basal rates).

I just see so many promising ideas.  Any of these could be the development to change the lives of PWDs forever.  Maybe no one is going to hand me a pill that will cure my diabetes next year, but I do think I'll be given some life-changing treatment options in my lifetime.

Life's Never How You Picture It.

I haven't been to either of my doctors yet, but I've made appointments with both (already well over a dozen with my endo!) and spoken to my endo's nurse.  My blood glucose goals are now below 100 before meals, and below 120 two hours after meals.

I'm actually very close to those goals even when I don't quite meet them (and I've just made a change to my insulin pump's "target" that should finally nudge the less than perfect numbers under), and I've managed to get my spiking blood sugar to chill the hell out.  Primarily, I'm figuring out that I need to have a little more protein and healthy fat with my breakfast (when things are most likely to spike), and the same true to a lesser degree with lunch.  Dinner is never a problem.  If I eat pretty well, my evening numbers are always fabulous.

I can totally do this.

For the most part, I feel pretty good about things.  I had one night where I felt very sorry for myself...  I was realizing that this pregnancy isn't going to be "what I always wanted."  Not that I've ever been the "daydream about pregnancy and babies" type, but I always had a basic picture of how things would be:

I'd enjoy my pregnancy, dealing with whatever minor inconveniences (like morning sickness) come my way and feeling a little like an earth goddess as I bask in the miracle of creating life and letting my body do what it was designed to do.  Then when delivery came around, I'd labor at home for as long as I could, go to my hospital, and labor naturally until my doctor said, "It's now or never for the epidural."  (You see, though I fully believe the female body knows how to do this stuff on it's own, I'm way too much of a wimp to accept the level of pain that comes with pushing!!!  :p )

That's not the picture I see before me now.  I'll probably have something like 20 or 30 doctor appointments between now and then, tests that aren't normally done on "healthy" mothers, there's probably no way any OB will let me carry to full term and labor when my body decides to do it naturally, and there's likely to be much more monitoring and a higher chance of a C-section.  It's like my body is a liability instead of a miraculous tool for creating life.

Sounds crappy, doesn't it?  But it's the most bleak view (short of imagining all the things that could go wrong will go wrong).  I totally let it get to me the other night and I cried all over Chad.  (He's so sweet.)

But now, I'm realizing that everything's been pretty normal so far, so and I don't have a reason to believe that everything will be horrible the second I set foot in a doctor's office.  Yes, things are likely to be more medicalized than I want.  I accept, grudgingly.  But I can't focus on that; I have to keep it all a part of what supports me and a healthy baby.  Just like diabetes management isn't the focus of my life, but part of what supports it.

I'm also looking into having a doula, a trained professional who is there to support mom, dad, and baby through pregnancy and delivery (and sometimes for a while postpartum).  I think it would both help me focus on the wonderful things that are happening, and stay more informed and in charge during delivery.

As everyone says, the thing that counts most is having a healthy baby in the end.  I agree with that, but I also believe that is most likely to happen if the pregnancy and delivery are no more medicalized than actually necessary.  (Thank god we have OBs and the interventions that are sometimes necessary, but the US has both incredibly medicalized births and some of the worst birth statistics of the industrialized countries.)

I'm saying all this like I'm afraid I'll be swept into an O.R. the second I arrive at the hospital, but the truth is that I'm going to do everything humanly possible to keep my blood sugar normal and my OB has never given me the impression that she's big on intervention for intervention's sake.  For all I know, she'll support me in my desire for normalcy to every extent she is able.  I meet with her nurse practitioner on the 5th of January, so I'll have a better idea then of what is in store.

T1 vs. T2

I've noticed something, ever since I was diagnosed as a type 1 diabetic: We T1s tend to be defensive.

We don't want to be confused with type 2 diabetics, we don't want people to think we could get better "just by eating right and exercising," we don't want people to think we take insulin because we don't take care of ourselves. All understandable. I remember, in particular, seeing a mother on a message board say something like, "some people think my child got diabetes because I gave him too much candy." The very thought makes me so angry for her!

But let me flip this around... When I first knew I was probably diabetic but was still assuming (before further tests) that I was type 2, I was kind of embarrassed. Even though I lead a healthier lifestyle than what usually triggers T2, I felt I had done this to myself. I'm a little overweight (actually more than a little, according to height/weight charts), I lovvvve carbs, and I don't exercise as regularly as I should... and I suddenly felt like these were sins for which I was being punished. Then once I knew I was T1, I didn't want people to confuse it with T2.

So, here's that flip (finally): What does all of this T1 defensiveness say about people with T2? It says, "They do it to themselves. They could prevent it. They are being punished for their gluttony and sloth."

And that's not true.

"Hold on!" you cry. "All the experts say it's caused by poor diet, lifestyle, and obesity!" But actually, those are some of the triggers (sort of like T1 is "triggered" by an illness that throws the immune system into overdrive). T2 is hereditary, and far more common than T1. There are even athletes who develop and live with type 2 diabetes, and I'm not about to tell them they did it to themselves. (I have no doubt they could totally pound me!)

And what if someone's poor choices moved them further down the path toward T2 diabetes? Are we going to judge them for it, when their habits may not be any different from those of someone more fortunate in their genetics?

Yes, poor diet and lifestyle can trigger or worsen T2 (those things can also worsen T1). Yes, some T2s can (and some do!) control their diabetes through exercise and diet (this also helps T1s manage diabetes). Yes, some T2s are non-compliant and allow their condition to get worse and worse (there are also T1s who do this). But that doesn't change the fact that they have a disease, and one very closely tied to our own.

We are on the same team. The diseases, triggers, and treatments may not be identical, but we're all facing many of the same challenges and dangers.

When I encounter someone who makes assumptions about me based on T2 information (which is, understandably, much more commonly distributed than info about T1), I will strive to educate them without pointing fingers at people with type 2 diabetes. It will be, "Actually, I have to use insulin no matter what because being type 1 means my immune system killed all of my insulin-making cells." It will not be, "It has nothing to do with how I eat! That's type 2!"

Because I'm not going to talk smack about my teammates.

Things can't be all doom and gloom!

I have in my hands a wonderful, wonderful thing.


Lab results... Showing my cholesterol significantly improved!

You can't imagine the relief this brings... And the motivation to start taking an active roll in improving my cholesterol!  When my results were so terrible and my GP doctor was telling me that she's never known a diabetic who could get their cholesterol to the levels where they really needed to be on their own, I felt helpless.  Fine, nothing I can do will fix this.  Just give me more medicine, and then more medicine (hormonal birth control) because of that medicine, and then I'll take more insulin because of that medicine!!!  Just whip up a medical cocktail in my bloodstream and kill every delusion I have about control over my body and fate...

But not now!  Bringing down my blood sugar alone brought me to an "OK" level, according to my endo: 170 (down from 238) overall.  My lab results say that below 100 is desirable for diabetics.  I don't know a whole lot about cholesterol, but it doesn't seem unreasonable that I might be able to achieve that through improved diet and exercise.  My GP also said that she wants my HDL ("good" cholesterol) up to at least 70, and it's already improved from 36 to 60.  Again, by replacing bad fats with good fats and getting my self-pitying butt off the couch?  I think I might be able to get to 70!!!

Maybe I'll need cholesterol meds some day, but I don't think today is that day.  Now that my numbers are "OK," I don't feel like my heart is a ticking time bomb anymore.  I just feel like someone who needs to eat better and exercise... which was true before any of this ever came to light.

My current plan:

• Exercise at least 2 times a week, preferably 3... Even if it's just a walk around the block, DO IT!
• Do a better job of avoiding trans fats and excess saturated fat. (Please ignore the Burger King chicken sandwich wrapper on the coffee table!  That... that was for my cat!  I swear!)
• Lose 10 pounds.  Not only does weight loss improve cholesterol, but 10 pounds would put me back into the range where I just feel better!

Now, I'm going to go get dressed for yoga class!!!