I had a visit with my endocrinologist today and, as usual, she made me feel like I'm moving forward on the right path.  We made a slight adjustment to my early morning basal insulin to get my fasting BG down a tad, but she didn't feel any other changes were warranted yet.  I had some "highs here and there," yes, but they didn't follow a pattern and I never let them last long.

But the best part is that she made me feel about a million times better about not gaining weight.  I think I managed to gain a couple pounds if her scale is the same as my OB's, but she (and her nurse) seemed slightly confused about there being any concern.  Aside from only being 14 weeks (tomorrow) into my pregnancy, she commented that much weight gain isn't really necessary as long as you're eating enough and eating well (and taking prenatals).  She also agreed that it's not relevant to my diabetes management since we know what my blood sugar is (and it's nowhere near high enough to prevent me from gaining).  Maybe that was just an off-handed comment on my OB's part, but if she expresses that concern again I'll ask her to please confer with my endo.

I also went ahead and mentioned that the hormones have been a nightmare for me emotionally, because my counselor felt that both of my doctors should know that that's going on.  She wasn't at all surprised considering my history of depression and commented that some women feel the best of their entire life, and others just ride an emotional roller coaster.  She confirmed that I'm doing everything to take care of myself (including staying on my Wellbutrin), but it honestly just makes me feel better when someone acknowledges my depression with understanding and acceptance.  I definitely feel pressure to be happy for everyone, because that's what people expect from a pregnant woman, and I've already had one person I'm close to insist that this "isn't normal," that this is a "wonderful time" and I should be happy.  I'm certain she said this in an attempt to get me to step up my attempts at treating depression, but the last thing I want is to feel abnormal (and guilty) for not being deliriously happy.  Happy about having a baby?  Yes, I am.  But happy, as in mood and attitude?  No, I am not.  And I feel like I have to apologize for it at every turn.

That said, at least my anxiety over my weight has been alleviated.  Really, I'm just not going to stress about it unless it actually looks like it's becoming problematic.

In Which I Lament the Loss of My Turkey Sandwiches

Pregnancy food restrictions make me realize, sheesh, simply eating with diabetes is nothing.  Yeah, you have to figure out carbs and either avoid or account for high fat, and you may find certain foods that don't work well for you individually, but you can still more or less eat anything.

Let's count out anything diabetes related first and take a look only at the four pregnancy related food restrictions that bug the hell out of me:

• No deli meat.  At least, not unless you heat it up to the point of "steaming" first.  It's more likely to have listeria, a bacteria (that causes food poisoning) that's pretty deadly to an unborn baby.  (From what I've read, the chances of it happening are incredibly low, but the consequences are so dire that the risk isn't recommended).  By extension, cold meats that you wouldn't think of as "deli meat" are similarly restricted.  No more turkey pepperonis as my mindless, carb-free snack on the couch.  I tried microwaving them first, as I have tried with cold cuts for sandwiches, but the texture becomes way gross.
• Big or predatory fish, including tuna, is to be avoided or limited due to higher levels of mercury (recommendations from different sources vary, but one serving a month seems common).
• Anything with raw eggs, including Caesar salad (traditionally, the dressing will have raw egg).  The chances of salmonella is the problem here.  I still eat Caesar salad on occasion though, because I love it so very much, because I think salmonella is a crap shoot (I've heard about more outbreaks from vegetables, like spinach, than from pre-made products like dressing!), and because raw egg is in more foods than you're likely to expect.  Ever had a really high-end frosted cake, like at weddings?  You may have eaten raw egg in the frosting.  Good mayo or aioli?  Raw egg.  Eggnog?  Raw!  Eggs Benedict?  Raw egg in the Hollandaise sauce.  I won't even go into the many desserts.  Unless you're allergic to egg (or are a vegan), you probably have no clue how to completely avoid raw egg.  In the grand scheme of things, I doubt a Caesar salad with properly handled dressing is more dangerous than simply not being vegan.
• Soda.  I'll also include caffeine in general here, but aspartame (ick!) in diet soda is also a general concern for women who didn't avoid it before pregnancy.  These are not on the universal "don't" list, and my own OB says that having one or two a day is fine (though some OBs recommend against it entirely, and any visibly pregnant woman drinking soda or coffee is probably going to get some uninvited advice!).  My biggest issue with this one is iced tea... I love the stuff!  It's my drink of choice when dining out, and I've started carrying Splenda in my pocket since not all places offer it (neither the pink or blue packets are recommended during pregnancy).  But since I start my day with a cup of tea or coffee, no refills for me.  (On the soda front, Diet Rite is a sanity saver.  It has neither aspartame or caffeine.  I keep some in the house at all times, if I can.)

There are a million other little restrictions.  Soft cheeses that aren't pasteurized (unpasteurized cheeses don't seem as common as the APA seems to think, though), unwashed produce, sushi with raw fish (understandable, though Japanese women continue to eat it!), undercooked or rare meats, etc. etc. etc...  Add to this anything that causes my blood sugar to spike (which is somewhat unpredictable these days), like pizza or white rice.  Eating "not good for your blood sugar" foods on rare occasion isn't so horrible... until you're pregnant.  (Then it's both bad for your baby and filled with guilt and stress.)

Those don't sound so terrible, right?  I didn't think so either... until I realized it counted out most of my convenient lunch options.  No deli meat sandwiches has been the biggest issue, for my lunches.  Also, the little pre-made salads you can buy in stores usually have deli meat in them.  We don't have a break room here at work, and I probably wouldn't stay if we did (psychologically, I just need to get away from work for an hour), so this leaves very few no-cooking options for me.  Combine this with the fact that I've had like, zero energy or motivation (due both to typical pregnancy fatigue and to some depression), and that results in lots of fast food lunches.  Not nutritious, but at least it means getting out for a little while, almost no effort, and not consuming something on the kill-your-baby list.

Diabetes?  It's not easy to live with, but it's not so bad on the diet front.  It didn't eliminate my convenience foods at all.  Convenience foods come packaged with a nutrition label, and I just opted for the versions that helped avoid blood sugar spikes (like whole grain Lean Pockets instead of the non-whole grain ones).  But pregnancy?  It's thrown a major wrench in my lunchtime convenience.  I have to figure out a super-low-effort solution.  Maybe zap a Lean Pocket before I leave for lunch?  Use bagged salad and veggies on Sunday to make a week's worth of little salads to eat along with my lunches?  Keep chicken salad around for sandwiches?  I have to figure it out, because I do think fast food makes me feel more like crap.

It's just awful timing.  Depression has been a major issue for me lately, and this makes me lethargic and supremely unmotivated.  I need a new game plan until I'm able to pull myself out of this emotional mess.

Not the Only Villain

Sometimes I forget that I struggle with more than just diabetes. There's also chronic depression. And, honestly, I forget it largely because I'm so much happier than I was about six months ago. I have a job I like more, I have a career goal and am working toward it, I no longer feel crappy because of undiagnosed diabetes, and getting diagnosed with diabetes has honestly given me a lot of perspective and direction in life.

But chronic depression isn't a direct result of the state of your life, it's a direct result of your brain chemistry. (Though it's admittedly also affected by the state of your life).

So when I started feeling almost weak on my feet, unsteady, and almost unwilling to take the next step and then another, I kept repeatedly checking Dexcom and my meter to see what my blood sugar was doing. I really felt that it must me low or plummeting, but how could two separate meters and a CGM be wrong? I did eventually sink to the 70s at one point and, still feeling awful, I opted to go ahead and drink a juice box since I was slowly moving downward...

But that juice box and my rising blood sugar did not help the way I felt. Searching for my stupid devil horns in boxes we still haven't unpacked since the move was an effort in that my hand barely wanted to move items aside, and my knees wanted to let me sink to the ground. I should have known what was going on when I finally lay in the middle of the floor because I didn't even want to drag myself to the bedroom or couch to lie down... That's something I used to do all too often, when things were much worse in life.

And when friends arrived to pick Chad and me up for Ghouls Gone Wild, I found myself almost in tears over wanting to go enjoy the parade yet knowing that I would not enjoy it and quietly blaming myself for letting some sort of mysterious diabetes symptom keep me from having fun. Walking three or four blocks? How would I put one foot in front of another so many times if I barely had the energy to move from one room to another in my own home? Standing there for an hour watching floats and costumes, many of which are very cool and impressive, how could I focus on anything like that while trying not to freak out about the crowd and the noise? I'd have to stay home... but maybe I shouldn't stay home alone--because what if something was really wrong with me--but how could I ask my husband to also stay home because of my disease?

That irrational argument against asking Chad to help keep me safe is what caused my confusion to lift. This was not some mystery symptom of diabetes, this was a far more familiar companion: depression.

Oh yes, hi, I know you all too well. I had not thought to look for you, because you are not the greatest villain in my life anymore, but I recognize you. You are sneaky, conniving, and cunning. You caught me off guard, but I am much better equipped to deal with you now. You know what I've learned from my diabetes? Management, and the acceptance of What My Life Is. I'm always diabetic, but I keep my blood sugar under control without despair at the thought of having to do test after test, bolus after bolus... and the thought that diabetes will still throw me a curve ball every now and then. Likewise, I am always dysthymic but will keep my depression under control without despair at the thought of having to manage it for the rest of my life... and that you will still throw me a curve ball every now and then.

But neither will get the better of me ever again. Period.

This is one of the many positive ways that diabetes has impacted my life; it's made me better equipped to face long-lasting struggles and not feel like I'm struggling. It also caused me to go to counseling to help adjust to the changes in my life, which has taught me how to look at my thoughts from the outside and recognize that I am not my thoughts. (An odd concept, I know, but it made perfect sense as I recognized that totally irrational thought.)

So hi, depression. I acknowledge you. Now I'm going to manage you, and this time, I am going to get the better of you.