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.

Victory!

Less than six months after diagnosis, I had another appointment with my endocrinologist yesterday…  And it was full of awesome!

It addressed a lot of things that have been frustrating me since my diagnosis.  The most obvious issue is wanting to be healthy and have my blood glucose under good control, and I found out that my A1c has come down to 6.1!!!  That’s down from 13.4 when I was diagnosed!!!

*happy A1c dance*

Another huge issue for me is being in control of my own health... and I don’t necessarily mean “in control of my health despite diabetes.”  I mean something more along the lines of, “In control despite the fact that my life now contains a menagerie of medical professionals telling me what to do.”  I am so glad those medical professionals are there, and I know I could not have gotten so under control so quickly as I did if I hadn’t followed their instructions to the letter, but I couldn’t help but feel that they were in control of my health... and sometimes, I was waiting and waiting for confirmation on a change that I already knew I needed.  So I thought, once and for all, that I was going to ask my endo for official sanction to make adjustments to my treatment myself.  I went armed with a bookmarked copy of Pumping Insulin and lots of explanation as to why I could safely and effectively make my own decisions.  When she asked if I was still working with my CDE, this gave me the opportunity to explain that I was still working with her, but I wanted some more freedom to make my own changes.

“Oh yes, absolutely!”

Oh.  OK.  That was easy!

She gave me some guidelines for making decisions, told me I can fax her numbers anytime I need help, and said she was completely comfortable with me making these decisions.

*happy victory dance*

And another biggie…  Something I was sure I wouldn’t hear her say considering the numbers I was showing her included two highs over 200 and one bad low of 43 this past week…  She told me that it’s safe enough for me to go ahead and start trying for a baby whenever my husband and I decide to!!!  (She understood that last week was a weird one for me, and said, "With type 1, it's never going to be perfect.")

*happy baby dance*

I feel like I’ve reached important goals and blown hurdles right out of my path.  Life is good, and I believe I have the ability to shape my future the way I see fit instead of around my disease.

Better Pace than Expected

While talking to my diabetes educator on the phone yesterday, she said she felt my insulin ratios and doses don't need any changes yet.  I was disappointed, and told her I was eager to really get things down... and she pointed out that the last couple of days had been great.  And it's true.  And after thinking about it for a while, I realized a few things:

1. My recent numbers aren't that far from what she said will be my eventual goal range.  I occasionally rise above it, but not by that much.
2. I'll learn to adjust my own ratios and doses for specific situations.
3. I want "normal blood sugar," but I don't have a normal body.  I don't have a working pancreas, which would normally create both insulin when my blood sugar starts to rise, and glucagon when my blood sugar gets too low.  Until things are a little more predictable and I've recognized a few more lows, staying on the higher side of normal is probably safest.
4. I hadn't been exercising, and exercise tends to lower blood sugar!

So I went for a brisk, 20 minute walk yesterday evening.  Afterward, my blood sugar read as about 25 points lower than I started... and this morning, my fasting (morning) blood sugar was 20 or 30 points lower than it normally is.  If I have the same results for another day or two, I'll check with my educator to make sure the new trend is safe.  (One of my my fears is having a low blood sugar in the middle of the night!)

In other news:

I'm meeting with an Animas pump rep tomorrow morning.  At Panera bread... I'd better check their nutritional info!

My left arm is randomly sore, like I strained or twisted it.  I know I tend to try and carry too much with that arm, in order to free my right hand for things like unlocking the door, but everything seems like a symptom of doom and gloom diseases these days!

Numbers and a trip to the endocrinologist

My blood sugar numbers have gotten pretty good, and I really hope my Diabetes Educator lowers my target numbers.  They're currently 130 (before meal) and 180 (after meal), but the general range I'll be shooting for eventually will be between 70 and 140... or 70 and 120 when I get pregnant.  Most of my numbers are generally between 100 and 150 right now, which isn't too far off from that long-term goal range!

I went to the endocrinologist yesterday, which I'll talk more about later.  But she told me three things that make me very happy:

1. I should go ahead and start the paperwork necessary to get an insulin pump.  I may not be able to get it until I've met some time requirements set by my insurance (6 months), but starting now means less waiting when I get to that point.
2. She doesn't see any reason why I shouldn't be healthy enough to start trying to get pregnancy again by the end of the year, maybe even by fall.  (Also, planning a pregnancy makes getting a pump approved much more likely!)
3. She thinks we should see how much my improving blood sugar lowers my cholesterol before starting cholesterol medication.  She seems to think there's a chance I won't have to take any at all until I'm older.  *This is quite different from my GP's statement that she's never even known a diabetic who had their cholesterol sufficiently under control without medication.  If my cholesterol improves enough that my endo doesn't think I need meds, I may take the middle road:  Wait until I'm done having babies, then take the meds if my GP still thinks it's warranted.)

So far, I'm leaning toward an Animas Ping insulin pump.  (Medtronic's Paradigm is a close 2nd choice.)  I'm already looking forward to the greater precision of a pump!