# Mamas with type 1 diabetes



## ~pi (May 4, 2005)

This is a tribe for mamas with type 1 (a.k.a. juvenile) diabetes to discuss the issues surrounding T1 and pregnancy, birth and mothering, particularly within the AP/NFL paradigm.

As suggested by Colleen, this first post is a list of resources so that we can compile a list of information about ways to increase the chances of having a healthy, low-intervention T1 pregnancy and birth, issues with breastfeeding that have to do with T1, and issues to do with mothering that are affected by T1.

(Note: the way this is set up right now means that I will edit this post to add more resources. If we want to do it another way that doesn't require one person being the only one who can do that, that's totally fine with me, so if you would prefer that and have a suggestion, please bring it up.







)

*Resources*

*1. Pre-pregnancy/T1 in general*

*Insulin Pumps*

Pump Comparison

*Books on Pumping/Improving Glycemic Control*

John Walsh. Pumping Insulin, 4th ed.

*2. T1 and Pregnancy*

http://www.childrenwithdiabetes.com/..._pregnancy.htm
Colleen's note: The Children With Diabetes website has a pregancy Q and A page. I submitted a question to "Ask the Diabetes Team" recently. It's an easy way to get a second opinion...

*Research on additional risks and ways to lower risks*

Lauenborg et. al. Audit on Stillbirths in Women With Pregestational Type 1 Diabetes, 2003, full text
Maria's note: This is a multicentre chart review that suggests that the elevated risk of stillbirth *may* be linked to poor glycemic control.

Jansen et. al. Outcomes in Type 1 Diabetic Pregnancies: A nationwide, population-based study, 2004, full text
Maria's note: Large prospective study, but done during years before pumps were common.

Bernasko J. Contemporary management of type 1 diabetes mellitus in pregnancy, 2004, abstract only
Maria's note: I have the full text if anyone has questions.

*Research on changing insulin needs during pregnancy*

<looking for info>

*3. T1 and Birth*

Enkin et. al. A Guide to Effective Care in Pregnancy and Childbirth, 2000, full text
Maria's note: This is an *amazing* resource for anyone looking for evidence-based reviews of anything to do with pregnancy/birth. (It's sort of like Henci Goer's book, but more objective, and in my experience, tends to go over better with physicians.) There are some sections on diabetes. The book came out of the Cochrane Reviews and the authors made the full text available for free as a service to pregnant women. You may need to register to access the pdfs.

*Wearing a pump vs. IV drip during labour*

"During labor, insulin could be administered through intravenous drip of regular insulin or CSII."

Bernasko, J. Contemporary Management of Type 1 Diabetes in Pregnancy (CME Review Article). Obstetrical and Gynecological Review Survey, 2004: 59(9).

*Birth Stories*

A T1 diabetic homebirth (2nd baby, Britain, 2000)

Another T1 homebirth (3rd baby, Vermont, 1999, also 4th baby at home rather than birth center as planned due to fast labour)

my story - failed induction @ 40 weeks (1st baby, Canada, 2006)

<Please PM me if you're willing to provide a link to your story!>

*4. T1 and Breastfeeding*

*Breastfeeding to treat neonatal hypoglycemia*

La Leche League article 1997

A bfing-friendly protocol for the treatment of neonatal hypos (pdf, June 2006)

*5. T1 and Mothering*

<looking for info>


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## ~pi (May 4, 2005)

I'm Maria. I'm 30 years old and pregnant with my first babe due at the end of June/beginning of July. I am a Ph.D. student about halfway through my degree, have been married for almost 2 years, and I live in Canada.

I've been T1 for 23 years now (I remember life before home blood test meters!







) and have been pumping for almost 2 with my Cozmo pump.

I love my pump. I was reluctant to try it, but I cannot imagine going back to MDI now. It has made my life so much more flexible and my A1c's went from high 7's and low 8's (not terrible, but certainly not great) to consistently sub 6.

All of my pregnancy A1c's have been 5.6-5.8. Aside from a respiratory infection and way too many medical appointments, the pregnancy has been pretty uneventful.

I am planning a hospital NCB. I have a midwife (found here on MDC!) and a peri, as well as the usual team of endos. I'm really sad that homebirth is not an option for me, but I feel lucky to have a great team who are all on board with my preferences and also to have a hospital where most of the things that I want (e.g. no continuous EFM, no mom-baby separation, treatment of hypos via bfing, etc.) are standard procedure.

Some of the questions I have for the experienced mamas have to do with things like cosleeping safely (I sleep really hard when my sugars are anything but perfect and I've woken up more than once with my pump tubing wrapped around me and/or DH), breastfeeding, and how to balance my immediate needs (e.g. in the case of a hypo) with the equally immediate needs of a babe.

I'm really looking forward to getting to know you all.


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## MommyBear (Dec 19, 2001)

Hi, I'm Rachel. I'm 23 years old and have three sons (ages 4.5, 3 and 8mo). I just passed the 18th anniversary of my diagnosis and have been pumping for um... 7 years I think (with a brief period in there where I'd killed my pump and had to wait to get a new one). Right now I have a MiniMed Paradigm 512.

I've had quite a ride when it comes to pregnancy and childbirth. With my first I was young and stupid. I agreed to be induced at 38 weeks (because I HAD to be right? the doctor must know best...) and ended up with a very unnecessary c/s. My second was a VBAC that I had to fight to get. After 20 weeks I fired two practices of OBs and had two midwives turn me away. I ended up at the hospital (not knowing I was in labor) and my son was born less than an hour later. My third I was planning an UC (with the support of my OB) but had to give that up in the end because my son was swelling (later found out that was from Congenital Hypothyroidism) and had another c/s. I'm not upset about that c/s because I know it was needed. I learned from that and next time will get my homebirth.

I've been having a ton of thyroid problems since my youngest was born and I'm in terrible control of my bloodsugars. Not only is that not healthy, but it makes me grumpy with my kids. I need to get my butt kicked into taking care of myself.

I'm half asleep right now and can't see well, so I'll have to come back later with more details about me and my life with diabetes.


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## widemouthedfrog (Mar 9, 2006)

Hi there,

I'm Tricia in BC, Canada. I'm 29, I have a 9 month old dd, and I was diagnosed as diabetic during my 3rd trimester. It stuck. We're still trying to figure out exactly what I am (autoimmune-wise), but at the moment I am on an insulin pump. And I intend to stay that way.

April 18th is the 1st anniversary of my diagnosis





















- I am planning on celebrating by eating cheesecake. After all, never pass up a good excuse to eat cheesecake!

That said, I am pretty careful about what I eat, though I am currently battling night-time sugars that are higher than I'd like. I'm in my 5th month on the pump, so I'm still learning, though things are improving.

I've had quite a ride in the last year, learning about baby and diabetes at the same time. We cosleep and breastfeed. And yes, at times dd has to fuss while I treat a low - it is much better to have a mommy who is not passed out on the floor! My biggest concern was about night time, but I am actually the opposite of you, Maria: when I have BGs that are out of whack, I wake up again and again. This doesn't always help my dd, who is a light sleeper as it is. I am a tad grumpy this morning, can you tell?























Since I became diabetic during pregnancy, I was in panic mode for most of the last bit. Luckily, I wasn't induced, since babies come early and quickly in our family. In fact, if I'd listened to the hospital and stayed home a bit longer, we'd have had an unscheduled homebirth!





















One thing that I hadn't researched was the use of formula to bring up low BGs in newborns, and the use of formula to supplement when my dd was having serious problems eating at the start. Wish I'd known about milk donors then. However, she did learn how to bf just fine, though I still feel a bit guilty about the little bits of formula . I had wonderful bf-ing support, but some of the nurses at the hospital were pretty pro-formula.

Likely the worst part of the pregnancy was directly afterwards, when I still had some pancreas functioning...the endo thought the diabetes would go away and left me off insulin for 2 weeks until I got nice and sick...and clamoured to come in!

I also recently discovered I am somewhat hypothyroid. Yum.

Ok, I'm not usually this grumpy...but I think dd is teething again, so we had a bit of a bad night!

Looking forward to meeting all of you.

Tricia


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## hannahmom (Mar 5, 2004)

Oh my gosh I'm so happy that there are a bunch of us here! (well not happy about the circumstances obviously but you know what I mean)

I'm erica - 28 yrs old and pg with #2 (edd end of Aug). I was just dx'd T1 in October out of the clear blue sky. I had the GTT with #1 and passed with flying colors. Dd was 9lbs 1oz but I don't think I was diabetic at the time (although my mw suspects otherwise which is a whole other story).

We were ttc all last summer with no luck at all - dd was conceived very quickly - so I started to wonder what was up. Then towards the end of summer I started having those classic diabetes symptoms and got my diagnosis. I never even imagined I'd have T1, with the whole ttc thing, I thought I had PCOS or something. My endo didn't want us to continue ttc but I figured it hadn't happened in 6 months, it wasn't going to happen right now anyway. Well it did - about 6 wks after diagnosis. I guess my body just needed some stable blood sugar and I'm glad it waited because my a1c was 11.6! It was already at 7.3 when I conceived and I've gotten it down to 5.4 with the pump.

Like Tricia and Mommybear said - this pregnancy (even though my last ended in intervention hell) has been quite a ride. I feel like I'm fighting an uphill battle to get the birth I want and NEED. It took quite awhile to process my last birth which was a very difficult induction due to PIH. I was planning a homebirth until this all blew up in my face.

I'm with a mw group now but the back-up OB, while the most bfing friendly Ob I've ever met - is stuck in the dark ages when it comes to diabetes. He insists on doing an IV drip during labor and even made some comment about when I get insulin resistant he'd take me off the pump and put me on 2 shots/day. HELLO?! What did you just say? He obviously is clueless if he thinks a premix would give me better control.

So where I'm at now (gosh if you're still reading, can you tell I've been dying to let this out to people that get it?) is that I have to find out my peri's stance on the IV. My endo wrote my mw group a letter which had no impact. If my peri is okay and my mw's OB is still not - I think I will need to switch to an Ob that supports that. I don't want to but that is huge issue for me. I feel confident that I can advocate for myself in the other arenas but that one is tough.

Other than that I've just been talking to this baby and telling him/her to come just a little early so that I can go into labor on my own and stay home until I'm practically crowning to avoid potential disaster!


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## Think of Winter (Jun 10, 2004)

Hi, I'm Colleen. I'm 33 wks w/ 2nd pg. I'm happy to meet all of you and looking forward to helping each other have a healthy pregnancy and the birth of our choice.

I've been type 1 since I was 3, and pumping for about 5 1/2 years. So far my pg is uncomplicated. My bgs are not perfect, but my a1cs are great. No signs of any problems with the baby.

With my first pg, I really trusted my perinatology team and went along with most of their recommendations, including an early induction in spite of no complications. The induction was awful and resulted in a traumatic birth for my ds, a lot of regret for me, and a very long recovery period.

This time I'm doing all that I can to have a natural birth. You would think I was dangling my baby off a balcony from the responses I've gotten from just about everyone when I tell them I want to minimize interventions.

Homebirth and birth centers are not options for us. No one will take me. So we've been doing everything possible to make the best of a hospital birth. I'm trying to learn about what circumstances might lead my ob or neonatal folks to do unnecessary interventions so that we don't allow anything out of fear and ignorance.

We have a birth plan, are doing Bradley, and I've hired a doula to be another advocate for our choices while I'm in labor. Last week we met with one of the neonatologist at the hospital to discuss our choices with her re. care of baby. We'd heard that virtually all babies of diabetic mothers got to the NICU, and we're going to avoid that unless our baby is truly sick (and I don't consider slightly low bg to be sick.)

So far, my ob has (reluctantly) agreed to most of my birth plan. We don't exactly see eye to eye, but at least there won't be surprises while I'm in labor (knock on wood.)

Keeping my bgs normal is easy about 90% of the time, then I hit a growth spurt or something and my insulin resistance increases all at once, and I spend a day or two constantly bumping up my boluses and basals.

Anyone interested in sharing birth plans?

Take care!


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## Think of Winter (Jun 10, 2004)

The Children With Diabetes website has a pregancy Q and A page. I submitted a question to "Ask the Diabetes Team" recently. It's an easy way to get a second opinion...
http://www.childrenwithdiabetes.com/..._pregnancy.htm


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## widemouthedfrog (Mar 9, 2006)

Colleen - Welcome...
I was officially a gestational diabetic, so I guess I was lucky - most interventions didn't happen to me. Except formula feeding for a baby with low BGs - grrrrrrrrrr. Maybe you can ask your doula to fend off some of the interventions for you?

EJ - I can't believe that they'd want to put you on 2 shots. Silly, silly, silly. If I'd been on the pump during labour it would have been so great. As it was, had to worry about throwing up (sorry, TMI) and how my BGs might react. Luckily, I didn't throw up, but that was one of my big concerns.

Hey, baby tip for diabetics - the Ergo baby carrier has a nice pouch that fits a test kit, glucose tabs, and a few other items. I was just thinking today how convenient it was that they designed that just for diabetics!

Oh, and Colleen - I sometimes test in the middle of the night. Where do you keep your testing stuff for middle of night tests if you cosleep? My dd is just getting to the age when she might get into that kind of thing, but I still want it really handy.

Tricia


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## Think of Winter (Jun 10, 2004)

Quote:


Originally Posted by *widemouthedfrog*
Oh, and Colleen - I sometimes test in the middle of the night. Where do you keep your testing stuff for middle of night tests if you cosleep? My dd is just getting to the age when she might get into that kind of thing, but I still want it really handy.

Hi Tricia, I keep my kit on my bedside table, and my son's kit at the head of the bed next to his sippy cup. Ds also has type 1







Ds is free to open up the kit and "practice" doing little pokes, so it really doesn't hold a whole lot of interest for him. The only think that bugs me is when he wants to dump out the strips, and I just redirect him. He doesn't have the manual dexterity yet to open the strip vial. Keeping a quick glucose source next to the bed is more difficult. I keep meaning to put drawer latches on the bedside tables and haven't gotten around to it yet. Right now dh or I have to get out of bed to get something something to treat nighttime lows.

As for pump tubing, I worried about this a lot when he was tiny. Ds has always slept in the middle, so I try hard to keep my pump on the outside. We've never had a close call. We have had tangled tubing, though, usually from our morning cuddles!


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## widemouthedfrog (Mar 9, 2006)

Hi Colleen,

Yep, I do the same with my pump - it is in the pocket that is the farthest away from dd.

Is your husband diabetic too?

My endocrinologist won't confirm whether I'm autoimmune T1 or whether my pancreas was just toasted by a number of factors, so I am getting tested for antibodies. They might still be around, who knows. If so, I'm thinking of putting dd in the trialnet study to check for developing T1. Anyone else done that?

Actually, in a way it would be more convenient to cosleep with your diabetic child, and safer too. Hadn't thought of that. You'd certainly be more aware of how the child was doing.

Tricia


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## MommyBear (Dec 19, 2001)

I co-slept with my mama because of diabetes. She liked to have me near in case something might happen (even though she had alarms set to wake every 2 hours through the night to test my sugar). LOL I didn't object, I liked being in her bed


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## Think of Winter (Jun 10, 2004)

MommyBear,
Love your post about cosleeping with your mama!

Tricia,
No, my dh is not diabetic, and no diabetes in his family. We had ds in the TRIGR study to look at effect of bm vs cows milk on developing type 1, and his diagnosis was picked up at his 12 mo blood work. His cord blood tested +ve for the "at risk" gene. One thing I have regretted is that we did all of his vaxs on schedule up until 12 mo when he didn't get the chicken pox. But who knows...I think the TrialNet study is a great idea, and I need to look into enrolling new baby.

An update on me, today I was "fired" by my OB. It was pretty much a mutual decision, but still upsetting (How many times does she need to say "fetal death" in one visit?) She could not deal with my birthplan, specifically my wishes to avoid induction, IV, and continuous monitoring. I keep reminding myself that this is a good thing, since I haven't been comfortable with her or her partner since my first visit. And I do have several leads on OBs with more experience with natural birth. Wish me luck.


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## widemouthedfrog (Mar 9, 2006)

Colleen,

Sorry to hear about your OB's attitude - I actually had a very nice one who just told me to take it easy towards the end. However, I knew that baby would come early and quickly (or really hoped, anyway), so I wasn't too sticky about induction...I just nodded and smiled. As it was, dd came 2.5 weeks early, 1.5 weeks before they would have induced me. And they didn't have time to do anything towards the end, intervention-wise, except feed her formula afterwards argggg. Ah well, hopefully it is all for the best. My docs at the clinic where I visited (these were in addition to the OB - standard maternity docs) were the ones who kept on freaking out. They didn't really say "fetal death," they just kept on panicking at the slightest thing and sending me for emergency tests. It was really good for my stress level. For example, they decided one week that the baby wasn't growing, and I went in for an emergency ultrasound, after spending all night thinking babe was in distress...the ultrasound tech discovered that the doc had been looking at the wrong due date on the chart, and babe was growing just fine!

Yes, I deeply regret my choice to vax dd up to 6 months...I am thinking of delaying some of the future ones. At the time I wasn't aware of the possible connection between T1 and vaxing, or I would have waited. I am becoming crunchier by the minute, what can I say? Now she's visiting a naturopath - hopefully we'll be able to reconsitute some of that immune system....

I wanted to go into the TRIGR study, but as I said, dd was supplemented at birth, so I don't think I was eligible. Trialnet starts at 1 year, so if the antibody tests check out, I will start her on her 1st birthday!

We did cord blood too - is it possible to check that after the fact? Probably not.

I am really sorry to hear about your ds. That must be very hard to deal with. I know that if dd develops diabetes, I will be crushed...that said, at least I will know how to deal with it to a degree. And I'll be able to advocate for her right away.

Odd question - the docs told me that newborns have different blood sugar levels than adults. If this is true, when do kids fall into the range of normal Bgs? Ie: can I test my dd with my test kit? Not that she'd appreciate it, but I'd like to keep an eye on things.

Tricia


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## ~pi (May 4, 2005)

Tricia, I cannot imagine what it must have been like to deal with a diagnosis along with a new babe. Yikes!

Erica, how are things going with the whole pump/IV insulin thing?

Rachel, that's so sweet about your mom co-sleeping with you. How are you handling the thyroid issues? That's got to be tough on top of T1 and raising three small people.

Colleen, I'm sorry to hear about your OB. I hope you find someone more in line with your preferences. Thanks for the CWD reference, I will add it to the list! And yes, I'd be happy to share birth plans. Mine is currently under revision but I will post it when I have the next draft done.

I'm glad to hear about T1 mamas successfully co-sleeping. I think we may have some sort of safety barrier set up at first (like a snuggle-nest type thing) and then move to regular co-sleeping once s/he is older. We'll see how it goes.

We are participating in TRIGR, so I didn't really look into any of the other TrialNet studies, but I think they sound like a good idea. Besides any potential clinical benefits to participating, unfair as it is, it is definitely the case that people who participate in studies get better health care in general. (My PhD research is in a fringe area of medicine, so I see this a lot.)

We do plan to vax. According to my risk-benefit analysis, for us, vaxing is less risky than not vaxing, especially considering where we live and our travel habits. That risk-benefit analysis will obviously be different for different families.

FWIW, from a scientific perspective, the current consensus is that autoimmune T1 is caused by a complex interaction of environmental factors/triggers. I think that vaxes are definitely a factor to look at, since it is, after all, an autoimmune disease and there have been some potential links shown. I can totally understand why someone might choose not to vax. However, in considering the etiology of the disease, I doubt that vaxes are an independent factor, especially considering that the disease has been around a lot longer than any of the vaxes have.

By the way, I realized after I posted my "This pregnancy has been pretty uneventful," statement, that I forgot about when, around 14 weeks, I crashed overnight and woke up at 5 a.m. to paramedics standing around my bed and an IV in my hand. My DH woke up at 4 a.m. because, he explained, "I heard your breathing change." I love that man.







I was very low (1.4 mmol/L, or 25 mg/dL), nonresponsive, and we were out of glucagon at the time, so he decided to call EMS. They came, gave me IV dextrose (so much better than glucagon!) and I finally woke up, completely confused about what was happening.

Everything is going pretty well with the pregnancy these days. I'm at 29 weeks and am hitting some big insulin resistance, so I'm constantly adjusting my basals, insulin to carb ratio and correction factors. At this point, I'm just doing it all by feel. I tried to do it the usual formal testing way (e.g. fasting tests for basals, etc.) but by the time I had enough test results to see a pattern, the pattern had changed!









I really love almost everyone on my health care team. My MW is amazing. I actually found her here on MDC after having been rejected by a number of midwifery practices in my city. I am so, so grateful to have the chance to work with her and her group. She is the one who hooked me up with my peri, who I also really like, and recommended the woman from whom we took our prenatal class and with whom we will also be working for hypnobirthing.

I went over my birth plan this week with the peri and he was very open to all my preferences. I feel very respected when I talk to him, which, as I understand from other women - T1 or not - is not always the case, so I feel lucky. We talked about induction and I explained my analysis. He responded essentially, "Well, you're smart and you understand the risks. If you feel OK about it and everything looks good on the BPPs, I don't have a problem going to 41 weeks, although if you haven't gone into labour by then I'd like to talk about induction."

The only issue I've had at all is with one of the two endos responsible for my care. I *love* one of the endos; the other I just tolerate. Sadly, my last three appointments, she's been the one on clinic that day. She's fine, and she will go along with what I want, but she is somewhat narrow-minded. I was chatting with her about wearing the pump vs. having an IV drip and she said, a little confused as to why I might have a problem with IV insulin/dextrose (which is, admittedly, much faster than subcu and food): "Well, you're going to have an IV anyway." It took a little while for her to understand why I might not have an automatic IV/heplock in place. She also has *horrible* math skills, so whenever we're talking about pump adjustments, she makes wildly contradictory statements, which is a little alarming for me.

I hope everyone is doing well and enjoying the weekend!

Quote:


Originally Posted by *widemouthedfrog*
Odd question - the docs told me that newborns have different blood sugar levels than adults. If this is true, when do kids fall into the range of normal Bgs? Ie: can I test my dd with my test kit? Not that she'd appreciate it, but I'd like to keep an eye on things.

Colleen can probably answer this better than I can, but yes, newborns and children have a wider range of normal blood sugar. For example, depending on the individual protocol, newborns are considered to be low if they drop below 2.2-2.8 (40-50), whereas for adults, the limit is more like 3.3-3.8 (60-70).


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## Think of Winter (Jun 10, 2004)

Tricia,
I don't know at what age babies bgs are similar to ours. I would think pretty early. I wasn't worried about lows with my ds prior to his diagnosis, just highs, so I didn't think much about that. We tested him periodically in his first year. Any time it seemed like something just wasn't right. I don't know if we had an intuition about his subsequent diagnosis, or were just overly cautious. I can see testing for lows, too, though. Maybe if your dd is fussy and hasn't eaten in a while? My nephew gets lows that I think explain a lot of his behavior.

I don't think that there would be any value in checking your dd's stored cord blood. Save that for if you really need it. You could have her checked now.

Combo of Tests Predicts Type 1 Diabetes
Eighty percent accuracy found, could enhance future clinical trials on preventing the disease. http://www.healthfinder.gov/news/new...p?docID=528791
These tests are the basis for one of the TrialNet studies. If you did that, TrialNet would pay for the tests and arrange everything for you.

Maria,
I'm not totally anti-vax at this point, but after reading The Vaccine Guide by Randall Neustaedter, I got a better understanding of the potential negative effects of vaccinating according to the AAP schedule. One of the things I came away with is that multiple vaxs at such an early age are a stress on the immune system, and since type 1 is an auto-immune disease, it seems possible that there is a connection. Not assuming cause-effect, just that it may be another factor.

Gotta say I'm envious of your situations with your care providers. I'd love to have a midwife, or even an OB who can respect my ability to make informed decisions.

Catching up with the sudden, dramatic increases in insulin resistance is tough, isn't it? I always start by bumping up my basals by 0.025 or 0.05, but it takes a lot more than that to make a difference this late in my pg, and I end up with multiple high 100s and low 200s for a couple of days.

Take care all!


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## ~pi (May 4, 2005)

Quote:


Originally Posted by *colleen95*
Maria,
I'm not totally anti-vax at this point, but after reading The Vaccine Guide by Randall Neustaedter, I got a better understanding of the potential negative effects of vaccinating according to the AAP schedule. One of the things I came away with is that multiple vaxs at such an early age are a stress on the immune system, and since type 1 is an auto-immune disease, it seems possible that there is a connection. Not assuming cause-effect, just that it may be another factor.

Yeah, I hear you, and like I said above, I agree that it makes sense to look at vaxes as a factor in anything to do with the immune system. As for the schedule, I think what is frustrating for people who are active, informed participants in their children's health care is that, really, the vax schedule has a lot more to do with convenience than with immunology. The reasoning is, "Let's get everyone vaxed when they're coming in for appointments anyway and let's try to do it in as few appointments as possible." And while I do see the point of that from a policy perspective, I still get







: over the potential hazards of that approach.

Quote:


Originally Posted by *colleen95*
Gotta say I'm envious of your situations with your care providers. I'd love to have a midwife, or even an OB who can respect my ability to make informed decisions.

Yes, I'm very lucky. I think things tend to better in Canada to start with (i.e. most hospitals are bfing-friendly, keep baby with mom, etc.) and then I also have the added advantages of being in a major centre, giving me (a) a lot more options to start with and (b) access to teaching hospitals, which tend to be more evidence-based and open to patient preferences because of the research focus on evidence-based medicine (EBM) and patient-centred medicine (PCM), two of the biggest trends sweeping the medical research world!







It also helps that I am a researcher myself and work with physicians regularly, which means that I can more-or-less speak their language.

Quote:


Originally Posted by *colleen95*
Catching up with the sudden, dramatic increases in insulin resistance is tough, isn't it? I always start by bumping up my basals by 0.025 or 0.05, but it takes a lot more than that to make a difference this late in my pg, and I end up with multiple high 100s and low 200s for a couple of days.

Yeah, I'm starting to get pretty aggressive in my adjustments, which is not at all how I did things pre-pregnancy. It's a little odd to go from a TDD of about 40 units to so much higher! I'm averaging about 90-100 units these days, and I am told that I should expect to hit at least 150 if not 200.


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## widemouthedfrog (Mar 9, 2006)

Hi Maria and Colleen,

Thanks for the info about BGs in kids - I'm more curious about highs, obviously. Maybe I'll test her sometimes. Can't hurt (well, only a bit).

Yes, it was a lousy first 6 months with diabetes and baby. Kind of a crash course in "this is your new life".

Yeah, sadly I can't get her into the study until my endo confirms I am T1. Since I was diagnosed as gestational at first, he didn't test for antibodies, and assumed that I was T2. I'm not the "typical" T2 body type, but it does run in the family. However, the nurses all assume that I am actually LADA - slow-acting, later form of T1. It can act like T2 for a while until you become insulin-dependent. I stuck with insulin after pregnancy to avoid pills, and also because I wanted to go on the pump. I still have a wee bit of pancreas functioning left, but overall, I'm functionally T1 - we're just not sure if it's autoimmune or not. So I'm getting tested for GAD65 antibodies so that we can confirm. They may not still be around, but it's the best I can do.

Maria, where in Canada are you? I'm in Vancouver. Are you in Toronto?

Good to hear that you have a decent relationship with one endo. I really disliked my endo until recently - he treated me like I didn't have a brain, said "well, most people don't want to count carbs" when I lobbied to go on a pump. Arg! Perhaps I don't want to be most people! Anyway, during my last appt we finally had a good discussion about antibody testing, etc, and I think that he finally realized that a.) I have a brain b.) I am responsible and I'm working hard at this. I also have a background in science and research (not medical, but I have a scientific bent) - I think that he was kind of treating me as "youngish pregnant mom with no brain" rather than "intelligent youngish mom with background in science who happens to have diabetes." Not that it should matter.

Oh well, this all sounds rather snitty, and I don't mean to be. Rant, vent, rant.


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## ~pi (May 4, 2005)

Tricia, yes, I'm in TO. Sorry to hear about the endo - that attitude always bothers me. One of my proudest moments ever was with such a physician. I was OB-shopping for one who would work with my MW and who I liked. The first interview, the OB asked me who authorized adjustments to my basals, insulin:carb ratios, who authorized boluses







:, etc. I was pretty surprised by the question and told him that I did, of course. He replied in this appalled sort of tone, "You can't just be playing doctor with yourself!"

Proudest moment ever (I don't normally think on my feet this quickly) ... I responded innocently, "Oh. (pause) OK then, could you recommend an endocrinologist who would be willing to come live with me 24-7 and make all my decisions for me? Mine seems to be willing to treat it like the self-managed disease that it is, and is very happy with my control and A1c's, but she's obviously being too slack."









Anyway, Colleen, I just finished another draft of my birth plan, so here you go. It's very long (that's apparently OK here, though I've heard from people in the states that it should be kept as short as possible.) Names (mine, physicians, hospital) have been changed or removed.

*Birth plan for:* <my name>
*Partner:* <DH's name>
*Support Person:* <MW and backup MW>
*Physicians:* Dr. John Smith (perinatologist), Dr. Anne Thomson and Dr. Catherine Jones (endocrinologists)

_This birth plan was reviewed with Dr. John Smith on <date> and Dr. Anne Thomson or Dr. Catherine Jones on <date>. All sections of the birth plan pertaining to post-birth baby care were reviewed with Dr. Elizabeth Johnson_ (Maria's note: head of neonatology) _via phone on March 29, 2006.

Signatures:

________________________________________
Dr. John Smith

________________________________________
Dr. Anne Thomson or Dr. Catherine Jones_

------------------------------------------------------------------------------------------------------------
Dear Staff at My Favourite Hospital,

My husband and I are very pleased to be planning the birth of our child at My Favourite Hospital and are looking forward to working with you. The following is an outline of our preferences for the birth of our child.

I realize that many of our preferences are standard procedures at My Favourite Hospital, for which we feel very fortunate.

I also understand that emergency situations may arise and that in that case, these preferences may not be possible. If that should happen and if there is time, I would appreciate having a brief discussion about my available options.

The support people present at this birth will be my husband, DH LastName, and either MW1 LastName or her backup, MW2 LastName. MW1 and MW2 are midwives with My Favourite Midwives. They have clinical privileges at Hospital X and Hospital Y, but not at My Favourite, so they will be attending my birth in a support role. Dr. Smith has worked with MW1 in the past and agreed to participate in this somewhat unusual arrangement for concurrent care.

Sincerely,

<my name>

<page break>
*Summary (a.k.a my top 5 most important issues)*

*IV*: I do not want an IV or heplock. I have had numerous IVs in my lifetime and have always found the site to be very painful for 2-8 weeks afterwards. I would prefer not to have to deal with that while also recovering from childbirth. If an emergency IV is necessary, of course I am willing to have one inserted.

*My blood sugar*: I have been type 1 diabetic for 23 years, am on an insulin pump and have excellent control. My HbA1c readings have been 5.6% or lower throughout the pregnancy. While at the hospital, my husband and I would like to continue to manage my blood sugar by testing with my meter, using my insulin pump and having me eat and drink as necessary. If my blood sugars become unstable, I would be willing to have an IV insulin and dextrose drip. I understand that my nurses will need to monitor my blood sugar for my chart, and I am perfectly happy to provide blood samples as requested.

*Labour*: I would like to labour at my own pace, move around, change positions, have the option to use the shower, a birthing stool, birthing bar or birthing ball, and to push without coaching. I would especially appreciate no one counting during pushes.

*Birth*: Unless the baby is in distress and needs to exit urgently, I would rather tear than have an episiotomy. I would like to hold the baby skin to skin immediately, breastfeed as soon as possible, and deliver the placenta without artificial oxytocin (pitocin). I am willing to have prophylactic pitocin to prevent PPH after delivery of the placenta.

*Baby's blood sugar*: If the baby shows signs of neonatal hypoglycemia, I would like to try breastfeeding first to treat it. If s/he still needs more glucose, I would like to use colostrum that I will provide from a supply pumped ahead of time. If that does not work, I would like to use glucose solution or TRIGR formula administered via cup, dropper, syringe or SNS.

*Important Note*

We are participating in TRIGR.

<page break>
*Detailed Version*

*Environment*

I would like to make the environment as comfortable and relaxing as possible for me during labour and birth.

I would like to wear my own clothes, which have pockets for my insulin pump.

If possible, I would like to have the option of:
- dimming the lights
- playing music
- keeping unnecessary machines off

*Staff*

I understand that My Favourite Hospital is a teaching hospital and I am happy to have student nurses, medical students, and residents involved in my care. I would like students and residents to be identified as such to me and to my husband.

I would like the staff to know that I respond very well to supportive encouragement. (I would love the staff to tell me how fabulously I am doing as often as possible!)

*Induction/Augmentation*

Provided I am doing well and the baby is doing well as assessed via regular biophysical profiles, I would like to avoid an induction until at least 41 weeks gestation.

I would prefer to avoid any chemical augmentation during labour.

*Labour*

I would like to labour at my own pace as much as possible. This could include:
- eating and drinking when I wish to
- walking, moving around and showering
- bringing and using a birthing stool
- using a birthing ball or birthing bar
- pushing instinctively rather than being coached

I would like to avoid:
- continuous EFM (intermittent is fine)
- IV or heparin lock (emergency IV is fine)

I would like to avoid vaginal checks as much as possible.

Please don't offer me pain medication. I'll request it if I need it.

*Blood Sugar Management*

I would like me and my husband (who is trained in the use of my insulin pump and test meter) to manage my blood sugar so long as it remains sufficiently stable. This could include:
- eating and drinking as needed
- continuing to wear my insulin pump
- testing my blood sugar frequently (we will bring our own meter)

We are happy to also provide blood samples for the hospital's meter for my chart at whatever interval is deemed necessary.

During early labour, I would like to avoid an IV insulin drip unless my blood sugar readings are unstable, as judged by my husband and me, relative to my normal patterns.

During active labour, if I have two consecutive readings above 7.0 mmol/L, I would like to discuss the option of an IV insulin drip.

At any stage, if I am am hypoglycemic and unable to keep fluids or glucose tablets down due to vomiting, I would like to have an IV dextrose drip.

*Vaginal Delivery*

I would like:
- to risk a tear rather than have an episiotomy (If the baby is in distress and needs a quick exit then an episiotomy is fine.)
- me or my husband to catch (deliver) the baby if possible
- the person who is catching (delivering) the baby to announce the sex of the baby
- the baby to be placed on my abdomen/chest immediately
- my husband to cut the cord

*C-section*

Unless absolutely necessary, I would like to avoid a Cesarean delivery. If my primary care provider is not Dr. Smith, she or he determines that a Cesarean delivery is indicated, Dr. Smith can be reached, and there is time to do so, I would like Dr. Smith to be consulted for a second opinion.

If a Cesarean delivery is indicated, I would like to be fully informed and to participate in the decision-making process.

If a C-section is deemed necessary, I would prefer:
- my husband present at all times during the operation
- to see as much as possible of the procedure, especially the baby coming out
- spinal anesthesia rather than general or epidural

*After the birth*

I would prefer to have the baby with me as much as possible. If s/he needs medical attention, I would like my husband to be with him/her at all times.

I would like to:
- hold the baby skin to skin immediately after birth to help regulate his/her temperature
- breastfeed the baby as soon as possible
- have all heel prick tests performed while the baby is with me
- deliver the placenta without pitocin (prophylactic pitocin to prevent PPH is fine)
- take the placenta home with me

I understand that normal procedure for babies of diabetic mothers is to test the baby's blood sugars regularly for at least the first 24 hours after his or her birth. If I am feeling well and the baby has had two consecutive normal blood sugar readings, I would like to discuss the option of going home. My husband and I would check the baby's blood sugar ourselves during that time and return to the hospital immediately if s/he has two consecutive readings below 2.8 mmol/L.

*In the case of neonatal hypoglycemia*

If my baby becomes hypoglycemic, my preferences for treating it are, in order:
1.colostrum via breastfeeding
2.pumped colostrum (provided by me ahead of time) via dropper, syringe, cup, or supplemental nursing system
3.glucose solution via dropper, syringe, cup or supplemental nursing system
4.TRIGR formula via dropper, syringe, cup or supplemental nursing system


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## widemouthedfrog (Mar 9, 2006)

Hi Maria,
What a great birth plan! I wish I'd been half as organized.

Yes, up until last visit my endo was similar to the OB you mentioned - we had a lively debate about how much I could change things on my pump. And then last time, light bulbs came on. It was my first post-pump A1C (5.9), so I was still learning and having higher bgs sometimes, but I thought it was pretty good for such a steep learning curve. And many fewer lows than pre-pump, too. Suddenly he was congratulating me on decent control without a lot of lows, instead of flipping out about me changing basals by 0.05....

We'll see what happens next time!

Oh, a few things I forgot about last time:

Snuggle Nests - they're an in-bed cosleeper. My dd didn't like hers much, but if you're worried about lows or rolling, it might be a good option. They have a little top part that is kind of like a box, and then the bottom part is flat.

Nursing and lows - Once you're in a pattern, I think nursing generally lowers your bgs, not at specific times. However, it's good to monitor this at the beginning, because I did find that all of the night time nursing would drive me lower - be careful with basals. At the time I was on MDI, and it just wasn't working for me, so that was part of the problem too.

Wow, great to hear that your dh caught your low of 1.4...I hear that in early pregnancy lows can be particularly difficult (I wasn't diabetic then, or not diagnosed anyway, so that wasn't an issue for me).


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## MommyBear (Dec 19, 2001)

Quote:


Originally Posted by *~pi*
Rachel, that's so sweet about your mom co-sleeping with you. How are you handling the thyroid issues? That's got to be tough on top of T1 and raising three small people.

My thyroid is still nine kinds of screwed up. I'm jumping between hypo and hpyer with no noticible pattern. It's like one day I'm doing fine and the WHACK! I'm hyper and my BS won't stay up for anything. There have been times that I've disconnected my pump and (once) drank a two quarts of orange juice and my BS still stayed in the 60s. Then a few days later, when I can get in for bloodwork, it'll come back as "massively hypo." It's a mess. The first time they tested me and found me to be hyper, they put me on PTU. I was uneasy about taking it since it does pass through to breastmilk and DS3 was already hypo so I just didn't take it. Now I'm glad because I think it would have really screwed things up. They think I was hyper during my pregnancy and that caused DS's congenital hypothyroidism. He is 9 months old now and they're saying we can take him off Synthroid at 12 months because it seems his thyroid has started to work on its own.

LOL can you gell I'm up to my ear lobes in thyroid crap?


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## widemouthedfrog (Mar 9, 2006)

Hi Rachael,

Have you gotten checked out for autoimmune "stuff" going on with your thyroid? Apparently jumping hypo to hyper and back can indicate that your thyroid's being stimulated, then becoming more laid back again.

I ask because my thyroid is hypo now too...even though I'm skinny skinny...and someone mentioned this to me. But it's not too hypo, and I am hoping it stays sane for a while.

Those BGs sound AWFUL.

I understand about those meds...doc tried to insist I'd do well on diabetes meds after pregnancy, and even though some are considered ok, I wasn't all that keen.

Take care,
Tricia


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## hannahmom (Mar 5, 2004)

Boy was I behind on posts!









Things here are good - I had my Level II on friday and everything looked perfect. Baby is 14 oz and in the 83rd percentile for growth - I should not have asked about percentile because now I'm fixated on that! But I really think I just have big babies. Dd was 9lbs 1oz and I hadn't developed diabetes yet. I have to schedule a fetal echo four weeks from now to 'rule out the 30% of heart defects that can't be detected via the Level II'







Do/did you guys have to get a fetal echo? I'm not sure I feel it's necessary but I also don't think it's a battle I choose to fight. I'd rather piss off my healthcare team with other issues









I didn't get a chance to talk to the peri about the iv/insulin drip thing. He didn't bother to come in after my LII because it was so normal







But I think he does the echo so I will approach him about it then rather than scheduling a consult and paying for that. I've been trying not to think about it so much because I get so upset when I do. I'm trying to have faith in my mw's but I'm not so sure I do and I hope that doesn't put me in a bad frame of mind when I am laboring. But I have 20 more weeks to figure that all out - thankfully.

Colleen - good luck finding a new OB. I hope you find someone more supportive









Tricia and Rachel - That stinks about all the thyroid issues you girls are dealing with. I hope it all settles down soon.

Maria - thanks for posting the birth plan! I'm going to copy







That was a snappy comeback you had for that OB... I wish I had YOU to speak for me with this assinine OB who wants to IV me. Can you come to the States with your newborn and be my doula?









Re: the cosleeping/pump thing - we cosleep with my 2.5 yr old and she spins like a top in her sleep. I clip my pump to my pj pants and tuck the tubing into my underwear. Sometimes if I just let my pump roam free in bed it will wind up around her leg or something - but I've never had a site pulled out from that or anything. An infant doesn't move as much so i'd imagine it would be less of a worry.

Re the vax thing... I for one have racked my brain to figure out how, at my age I developed T1. I guess just part of the process of accepting diagnosis. My dr. asked if I had had any major viruses or anything - nope. The only thing I could come up with was that I had a rubella shot right after dd was born. So I really wonder if that sparked the autoimmune reaction... But I guess I'll never know... Re vaxes for dd - we selectively and delayed vax. I was more freaked out about reactions to the preservatives etc... than I was about diabetes from them. But now with #2 I'm not so sure...

I have a question though: If I wasn't dx'd until after dd was 2 yrs old, is she at the same risk for inheriting diabetes (and I know T1 has a much much lower risk of being passed on) than this baby? Or is this baby more at risk since I had T1 when he/she was conceived?


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## ~pi (May 4, 2005)

Hi Erica,

Yes, I had a fetal echo. As interventions go, I'm pretty comfortable with U/S. I would never have one for fun, but when there is a genuine medical indication, I think it's reasonable to use a very low-risk, non-intrusive screening/intervention. Plus the fact that fetal echos can catch issues that may require special treatment during pregnancy or shortly after birth was a factor in the decision for me.

I hear you about percentiles.







Sproglet was smack dab on the 50th at 24 weeks and then scored in the 64th at 29 weeks. I *know* the difference is within the error range, and yet it still freaks me out. I think I would do fine with a big babe (I am built exactly like my mom who had my 10 lb+ sister with no problems) but I just don't want to have to have the macrosomia discussion on top of all this other stuff.

Quote:


Originally Posted by *hannahmom*
I didn't get a chance to talk to the peri about the iv/insulin drip thing. He didn't bother to come in after my LII because it was so normal







But I think he does the echo so I will approach him about it then rather than scheduling a consult and paying for that. I've been trying not to think about it so much because I get so upset when I do. I'm trying to have faith in my mw's but I'm not so sure I do and I hope that doesn't put me in a bad frame of mind when I am laboring. But I have 20 more weeks to figure that all out - thankfully.

Good luck with that. If it helps, I think the thing that made the discussion go smoothly for me even with people who weren't very accepting of the no IV idea (e.g. the endo of whom I am not fond) was me presenting it as an if-then proposition. The fact that I have written in when I *would* like an IV seemed to calm them down and made them realize that I'm not going to be unreasonable about this and refuse an IV if it is clearly the way to go (e.g. unstable sugars, bad hypos combined with vomiting); I just want to try it my preferred way first and see how it goes.

Quote:


Originally Posted by *hannahmom*
Maria - thanks for posting the birth plan! I'm going to copy







That was a snappy comeback you had for that OB... I wish I had YOU to speak for me with this assinine OB who wants to IV me. Can you come to the States with your newborn and be my doula?









Glad the birth plan helped.







It's half copied to start with, so copy away! And like I said, I don't usually think on my feet that quickly, which is why I was so proud.







And I would totally come and help if I could. I'm sure you will be able to negotiate this, though.









Quote:


Originally Posted by *hannahmom*
Re the vax thing... I for one have racked my brain to figure out how, at my age I developed T1. I guess just part of the process of accepting diagnosis. My dr. asked if I had had any major viruses or anything - nope. The only thing I could come up with was that I had a rubella shot right after dd was born. So I really wonder if that sparked the autoimmune reaction... But I guess I'll never know...

Yeah, that's possible. Pregnancy can be a potential stressor, too. It usually takes a while for all the beta cells to get killed off, so it's always tough to know what triggered it. Like I said above, the general cause is more than likely a complex interaction of factors, which means that it's (a) tricky to figure out and (b) likely different for different people.

Quote:


Originally Posted by *hannahmom*
I have a question though: If I wasn't dx'd until after dd was 2 yrs old, is she at the same risk for inheriting diabetes (and I know T1 has a much much lower risk of being passed on) than this baby? Or is this baby more at risk since I had T1 when he/she was conceived?

As I understand it, if you have the genetic predisposition, you would have the same chances of passing along that genetic wackiness whether you had developed the disease or not. If you don't have the genetic predisposition, then no worries either way.


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## widemouthedfrog (Mar 9, 2006)

Hi EJ,

Ok, I don't THINK that being official T1 has anything to do with your child being at greater risk, though I may be wrong. Often am, actually. If it's a combo of genetic and environmental factors, I'd think that the genes would be around when you conceived #1 as well! You can have your children tested for antibodies through the Trialnet study, since you are T1.

I have heard that the age of the mother can have something to do with T1 risk, but I cannot remember where I heard this. And of course, it is more strongly inherited through the father's line. My dad's sister had it. I do recall something about kids being exposed to T1 antibodies while you are pregnant/bfing, but I don't recall this being a bad thing. I guess I should keep my references!

Yes, I am still (after 1 year) working on accepting the diagnosis. I've mostly got a handle on it, generally by getting some control of the diabetes itself. My most difficult part has been realizing that I am no longer self-sufficient. I depend on the medical system. That has been hard.

For me, I think that I actually developed diabetes due to a virus. I was plenty sick last Easter with a migraine/flu type of thing - it was so bad that since my husband was away, I moved in with the in-laws for a few days. 2 weeks later, diagnosis. Plus I was under major stress. All triggers.

Anyway, hope this helps! Maybe Maria can shed more light on the medical aspects of things (or at least provide better references than I can!)

Ok, back to all the work I need to do during nap time.









Oh, looks like Maria and I cross-posted....

Tricia


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## hannahmom (Mar 5, 2004)

I hear ya about being okay with u/s - and I don't have a huge problem with the fetal echo - I just hate to consent to some test 'just because' ya know? Now if they said there are markers for xyz or there is something we want to take a better look at, I would feel the test is more justified. I'm confident everything is okay and I will feel even better getting a clear result - but I want a definitive motive for the test.







Not that I'll get it... other than diabetes = greater risk (even though I was told the chances are so minimal with how newly dx'd and how good my a1c's have been). Ah whatever - like I said, not a battle I'm choosing to fight when there are more important things to worry about.

That's interesting that pregnancy can be a stressor in the progression of this too... I wish they could carbon date the dead betas to figure out time of death - so you could look back and piece together what may have been factors







I don't think in my case there is a genetic predisposition. I know T2 runs in the family, my uncle and great grandfather... But I definitely had the T1 antibodies.

Tricia - I couldn't agree more about accepting that you depend on the medical system and that totally sucking. Fortunately through dh I have great coverage on supplies but figuring out HOW to get all that covered was a nightmare. And omg the bills from diagnosis alone! We have to figure out some way to get my CDE appts covered - they were $200/visit and insurance denied coverage







:


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## ~pi (May 4, 2005)

Quote:


Originally Posted by *widemouthedfrog*
I have heard that the age of the mother can have something to do with T1 risk, but I cannot remember where I heard this. And of course, it is more strongly inherited through the father's line. My dad's sister had it. I do recall something about kids being exposed to T1 antibodies while you are pregnant/bfing, but I don't recall this being a bad thing. I guess I should keep my references!

I don't know anything about the T1 antibodies during pg/bfing.

Re: genetics, the basic stats are that if the father has T1, the chances are about 4-6%. If the mother has T1 and is younger than 25, it's about 2%, if she's over 25, it's less than 1%. I have no idea why age matters. Maybe it's a confounded relationship?







I haven't looked heavily into the genetics because I figure there isn't much I can do about it, you know?

Quote:


Originally Posted by *widemouthedfrog*
Yes, I am still (after 1 year) working on accepting the diagnosis. I've mostly got a handle on it, generally by getting some control of the diabetes itself. My most difficult part has been realizing that I am no longer self-sufficient. I depend on the medical system. That has been hard.

Yeah, that is hard. I still have trouble with that from time to time. When I decided to start the pump, I went through a little grief period. Although I knew it wasn't exactly the case, it felt like I was giving up on a cure and accepting that this is a long term thing. You'd think that after 21 years I would have figured that out already, but no.


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## hannahmom (Mar 5, 2004)

Quote:


Originally Posted by *~pi*
Although I knew it wasn't exactly the case, it felt like I was giving up on a cure and accepting that this is a long term thing. You'd think that after 21 years I would have figured that out already, but no.









It's funny you say that - because for some reason I'm decidedly pessimistic about a 'cure'. I don't ever really think about it... My mom gets all excited to tell me about the latest advances she hears about and I have a hard time not squashing her enthusiasm. Maybe it's just how I cope with the fact that this is a chronic illness and may not ever go away?

And I have a problem with calling it an illness - I kind of cringed typing that... We're not sick. More like a minor malfunction?


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## MommyBear (Dec 19, 2001)

Quote:


Originally Posted by *hannahmom*
It's funny you say that - because for some reason I'm decidedly pessimistic about a 'cure'. I don't ever really think about it... My mom gets all excited to tell me about the latest advances she hears about and I have a hard time not squashing her enthusiasm. Maybe it's just how I cope with the fact that this is a chronic illness and may not ever go away?

And I have a problem with calling it an illness - I kind of cringed typing that... We're not sick. More like a minor malfunction?









I feel the same way. I've told people that even if they do find a "cure" I don't know that I'll go for it. I don't want to be some test case and I'd want to make darn sure it was 100% before I'd even *think* about it. Diabetes isn't a big deal to me, its just life.

It also bugs the crap out of me when women find out they are gestational and totally freak out about it because they can't eat their precious Snickers (or whatever). And don't even get me started on the ones that *might* have to take insulin... because that is just the end of the world you know. I have a hard time not telling them "well, at least yours is likely to go away... mine is here forever and I deal just fine." I know that sounds so harsh of me, I'm really not a bitter person but for some reason, that just rubs me the wrong way.


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## widemouthedfrog (Mar 9, 2006)

Hi there,
Yes, it seems like a lot of the cures are worse than the disease itself, so far. And no, I don't like disease or chronic illness, either. Maybe "condition" works. Or my favourite personal phrases are "funky endocrine stuff" and "toasted pancreas". It seems obvious that I grew up in the 1980s, hmmm?























Quote:


Originally Posted by *MommyBear*
It also bugs the crap out of me when women find out they are gestational and totally freak out about it

Yeah, I was one of those people, but somehow I knew it wasn't gestational. Maybe because it was a lot worse than the other gestational diabetics. I wasn't upset about insulin, but I was afraid. I'm sure most people are when they start. But a friend of mine whose grandma was T1 says, "I just wouldn't be able to give myself needles (or insert pump stuff, or whatever)." Well, if you can't, you're not going to be around a long time if you're diabetic. Luckily, I was never too squeamish about that.

The other end of things are the people who are excited about the cure - and I think that's part of their grieving, perhaps? Trying to fix it? Or the ones who say, "Oh, it's ok, you just need to eat well, it's not that hard." Like my mother-in-law, who (bless her) just really, really wants another grandchild. So she says, "Lots of diabetics get pregnant, it shouldn't be a big issue." Well, I was already leaning towards having 1 child anyway. And having a kid is a big responsibility, and having diabetes is a big responsibility. Not sure I want to get pregnant again any time soon, on top of all that! Diabetic pregnancy is a lot of work.









Ok, ranting is over.






























Tricia


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## ~pi (May 4, 2005)

Quote:


Originally Posted by *hannahmom*
It's funny you say that - because for some reason I'm decidedly pessimistic about a 'cure'. I don't ever really think about it... My mom gets all excited to tell me about the latest advances she hears about and I have a hard time not squashing her enthusiasm. Maybe it's just how I cope with the fact that this is a chronic illness and may not ever go away?

And I have a problem with calling it an illness - I kind of cringed typing that... We're not sick. More like a minor malfunction?









Yeah, that makes sense. I don't think I ever consciously thought about the likelihood of a cure, but I really did go through a little grieving period when I decided to start the pump.

I don't have a problem calling it a chronic illness, although I do know what you mean. I certainly don't think of myself as _ill_.

Quote:


Originally Posted by *MommyBear*
It also bugs the crap out of me when women find out they are gestational and totally freak out about it because they can't eat their precious Snickers (or whatever). And don't even get me started on the ones that *might* have to take insulin... because that is just the end of the world you know. I have a hard time not telling them "well, at least yours is likely to go away... mine is here forever and I deal just fine." I know that sounds so harsh of me, I'm really not a bitter person but for some reason, that just rubs me the wrong way.

I hear you. I try to just remember that GD can be completely new and scary for women, because (a) it's a new diagnosis, which is always tough, and (b) it happens during pregnancy, when many women are already hypersensitive about things that can go wrong, and it's scary to think that something is happening that could affect your baby. But yes, hearing/reading someone whinging about having to test a few times a day for a couple of months bothers me, too!









One thing that helped me deal with the whole, "Oh, I could never take needles," and "Oh, how awful for you," attitude was when I got into some areas in my research about how people who are not living with a chronic condition tend to assume that it's much, much worse than it really is.

There have been experiments done with people's assessments of paraplegia, for example, where people assigned numerical values to describe how good/bad living with paraplegia is through a somewhat complicated exercise. People who were not paraplegic assigned much lower values than people who were. So really, it's just a matter of perspective.


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## MommyBear (Dec 19, 2001)

I learned something very important last night. Hospitals are not the friendliest place for an AP mama to be. I had to go in because my bloodsugars were crazy high (600) and they freaked out when I said I needed to keep DS3 with me so he could eat. Got some nasty comments from the day nurse today before I was discharged. So, in case you needed it, there is another reason to keep your sugars in check.


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## Think of Winter (Jun 10, 2004)

Hi Mamas,
I am 35 wks, and my high risk team are doing nsts including u/ss for fluid twice a week. This is making me really nervous. I am not concerned about the nsts, but it seems like an excessive number of u/ss. I had this many nsts with my 1st pg, but far fewer fluid level tests. Having recently been "fired" by my OB, I am anxious about saying no. Does anyone know where I can find a standard of care type document for high-risk pregnancies that would support my wish for fewer fluid scans? I know I have the right to say no to anything I'm not comfortable with, but I'm not feeling up to the looks I'm going to get, and the lecture, and the possibility that this group, too, will tell me that if I want to manage my pregnancy instead of them to find someone else. Any advice?


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## hannahmom (Mar 5, 2004)

Oh no! Mommybear that sucks







Do you know why you were so high? Or did it come out of nowhere? I'm so dreading the hospital experience when I deliver this baby - I feel like I have to fight for everything.

colleen - my mw does the twice a week NSTs and once a week BPP (fluid scan) starting around then. I think it is the standard of care for diabetic pregnancies. Hang on - do you mean they are doing fluid scans twice a week too? Perhaps you could mention how it was done with your first preg and request that they only do them once a week -- or even every other week? I'm sure ~pi will come up with some documentation for you







How do you like the new practice so far other than the nst/bpp thing? Good luck, I hope they are much more understanding than your first!


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## widemouthedfrog (Mar 9, 2006)

Ack, Rachael, I hope that you are feeling better now. 600 would be lousy. I've probably been there pre-diagnosis, hoping not to go there again, though. Ick, ick, ick.

When I was pregnant I had NSTs once per week and the occasional ultrasound. However, I wasn't official T1 at the time, so I am not sure about the standard of care for T1.

My daughter performed stupendously on the NSTs, by the way - she was a big kicker! It was rather amusing. Except this one time, when she fell asleep 1/2 way through, and I had to stay there for ages....





















I kept her last NST results for her baby book.

Oh, I just learned about a Yahoogroup called Positive Diabetic Pregnancies - you might want to check it out if you're not on it already. It might have the kind of info you're looking for.

Tricia


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## MommyBear (Dec 19, 2001)

I felt pretty gross with the 600 but sadly, that is by far not the first time I've gone that high. There was even one time when they had to dilute my blood before they could get a reading on it. When I go high, I go really high.

I really think I should have just stayed home Sunday night. They didn't do anything for me that I couldn't have done at home and at home I wouldn't have got nasty comments about nursing my baby. Live and learn. It'll take a lot to get me back to the hospital in the future, in fact I don't think I'll walk in under my own power.


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## widemouthedfrog (Mar 9, 2006)

Hi folks,

Rachel, I am so sorry to hear about your 600s....that is so lousy. I always find I can't eat too many carbs at night or I end up way high, but 600 would feel wretched. Sadly, I think it is true that we often know more than the docs about our treatment - but take care, watch that DKA....

Well, I'm still waiting for the endo to call me back, but it might be official - I may really, honestly be classified as T1. I don't know why I am so happy about this!























Since I was diagnosed during pregnancy, my endo always said that I was likely T2, and the nurses said I had 1.5 (LADA, slow-developing T1). I couldn't get him to confirm either way, though I was SURE it was 1.5, since I got really sick about 2 weeks before diagnosis. And I can't enrol Lauren in the Trialnet study without his confirmation.

So I finally talked him into an anti-GAD antibody test in March, and I just called (again





















) to see if the results were in, and anti-GAD was 88%, or high. So I suspect that confirms things! Hope it does in his mind.

I don't know why I am celebrating this. I knew all along, I guess, and it was driving me nuts to never be classified as anything. And now that it's definitely autoimmune, I know where I'm at.

Ok, enough excitement for one day.

Tricia


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## hannahmom (Mar 5, 2004)

I felt the same way when I had a definitive diagnosis... I guess part of it too is that there is a certain stigma attached to T2 because of some of the root factors that can lead to it.

Also I was 'happy' because, IMHO, T1 is much easier to manage. With every crumb I eat, I have a good amt of control over my bs. There is no diet or anything I need to avoid, except what my individual body does funky things with. I feel if I were T2 and someone said to me it could be controlled with diet and exercise, I'd never have the discipline. Even though I am a healthy eater and regular exerciser... I love my bagels and Rita's water ice









Tricia did your insurance cover the antibody test?? Mine rejected it and I had no clue until a $200 bill came in the mail... SURPRISE! It's considered investigative. Well wtf? I was sick, they ran a test to investigate. What is the problem? So we have to fight it.







:


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## ~pi (May 4, 2005)

So many posts!







I haven't been online as much lately because I've been away at a tiring, but productive, conference. I am now stopping at a city in between the conference city and my home for a weekend with my girlfriends from university, one of whom is due with *her* first three weeks after me.









Rachel, sorry to hear about the 600s.







You must have felt lousy and to have the staff fuss about keeping DS3 with you is just stupid.

Quote:


Originally Posted by *colleen95*
Hi Mamas,
I am 35 wks, and my high risk team are doing nsts including u/ss for fluid twice a week. This is making me really nervous. I am not concerned about the nsts, but it seems like an excessive number of u/ss. I had this many nsts with my 1st pg, but far fewer fluid level tests. Having recently been "fired" by my OB, I am anxious about saying no. Does anyone know where I can find a standard of care type document for high-risk pregnancies that would support my wish for fewer fluid scans? I know I have the right to say no to anything I'm not comfortable with, but I'm not feeling up to the looks I'm going to get, and the lecture, and the possibility that this group, too, will tell me that if I want to manage my pregnancy instead of them to find someone else. Any advice?

Sorry, Colleen, all the stuff I've seen on standard of care for T1 pregnancies suggests BPPs at least once -- and preferably twice -- a week.

I can understand being uncomfortable with it. Personally, I'm OK with u/s for medical reasons. I would never have an u/s for fun, but when there is a good reason, as interventions go, it's very low risk and noninvasive.

I am trading frequent BPPs/NSTs for a no-induction philosophy. My peri and I have agreed that we are both comfortable having me go to 41 weeks as long as everything looks good on the BPPs, and I am comfortable having them 1-3 times a week.

Quote:


Originally Posted by *widemouthedfrog*
Oh, I just learned about a Yahoogroup called Positive Diabetic Pregnancies - you might want to check it out if you're not on it already. It might have the kind of info you're looking for.

Some of us are there already. I was going to list it in the resources but I wasn't sure whether or not it is a violation of the UA to direct MDC members to other groups. I've found it a good resource for "is this blood sugar pattern normal?" but am occasionally frustrated by some attitudes about birth, which is why, when I noticed a few T1 mamas here, I thought it might be good to start a tribe.


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## zoe398 (Jul 8, 2005)

I'm jumping in a little late...I'm not T1, but my DH was diagnosed while undergoing chemotherapy for testicular cancer. Havig the cancer gone (for 2 years now), we're realizing that maybe the diabetes diagnosis wasn't taken as seriously then since we were already dealing with the cancer diagnosis. We're coming to this late, but we're coming to it. My DH needs to see someone and take better control of his life and health care. What are some good sites I could visit? What would you all suggest as the first step? He had very poor care when diagnosed and hasn't really followed up. He's taking a 70/30 insulin 3x a day. He recently had walking pneumonia and the doc at the clinic was very adamant about DH seeing a specialist, that he needed to be on a different care plan. Any suggestions?


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## hannahmom (Mar 5, 2004)

zoe - I can imagine it would be hard to focus on two things like cancer and diabetes at once!







I'd have him start by seeing an endocrinologist (I got a recommendation from my family doc) and getting a Hba1c test to get some sort of idea about where is he right now... From there, once the endo has a handle on where he is, and whether or not his insulin needs adjustment, it might be helpful to see a certified diabetes educator who can help with the more day to day stuff like carb-counting etc...

Have you checked out the American Diabetes Association site? http://www.diabetes.org/home.jsp It has a lot of useful articles, recipes and even a message board.

Good luck!


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## widemouthedfrog (Mar 9, 2006)

Hannahmom - yes, there is stigma with T2, though in my case, I know that I'd never feel like it was my "fault," since I tended to take fairly good care of myself. Though T2 is also a genetic disease. Mostly I am happy because for me it's some sort of direction for treatment - a definitive one. Though after speaking to my endo, he's decided that yes, I have scads of antibodies, and yes, I have diabetes, but that maybe I don't have T1. I think that it's time for him to give in and give up, or maybe it's time to change endos....

No, insurance didn't cover it. But I wanted it badly enough.

Maria - sorry if I did a bad thing with the cross reference!




























Hope that the big folks who watch these things are not lurking























Quote:


Originally Posted by *zoe398*
He had very poor care when diagnosed and hasn't really followed up. He's taking a 70/30 insulin 3x a day. He recently had walking pneumonia and the doc at the clinic was very adamant about DH seeing a specialist, that he needed to be on a different care plan. Any suggestions?

Mandy -
Sorry to hear that you've had such a rough time. Looks like you have a lovely family, though.

I'd definitely recommend that he see an endocrinologist and get an A1c. That's kind of similar to the average blood sugar over the last 3 months, though not quite. It'll tell you where you're at now, anyway.

A working pancreas puts out a constant, low-level stream of insulin plus big surges of insulin after meals. 70/30 is a mix of long-acting and short-acting insulin, I believe. It's a very rough way to approach diabetes management, kind of like using a hammer for your needlework project. A very skilled person who's very exact about timing of food and amounts of food can make it work.

However, people who want a bit more flexibility in how much they eat and who want - say - a chisel approach to management of their diabetes are on multiple daily injections. This means that you take 1-2 shots of long-acting insulin every day, plus a shot of faster-acting insulin every time you eat a meal or a large snack. This offers more flexibility and usually results in better blood sugar control.

Finally, there's the insulin pump. That's what I use. It would be the needle for the needlework project. Very fine control, if you use it right and work at it. It's also fairly expensive, unless you have insurance. On an insulin pump, you only use fast-acting insulin. This means that if your body needs a lot less of the low-level insulin at certain times of day, like night time, then you can program your pump (kind of like a little computer) to give you this. Pumps are attached to your body at one site for a few days, then you rotate - no injections. Meals are similar to the paragraph above, with the added bonus that you can stretch your mealtime insulin over a longer period of time - you don't need to take it all at once. This is useful for things like pasta and pizza. You can also turn the insulin off or make it lower when you're exercising.

The flip side of the insulin is blood sugar testing. Testing often and correcting if you're off is the other key to good control. And getting to know how your body reacts to certain foods, exercise, etc is key.

Please encourage him to find an endocrinologist, test frequently, and investigate other types of treatment regimes, particularly multiple daily injections. I am sure that he will feel so much better when he has better control. I certainly do!

Ok, this is a bit of a book, and we need to put dd to bed now....
Tricia


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## Think of Winter (Jun 10, 2004)

Quote:


Originally Posted by *zoe398*
I'm jumping in a little late...I'm not T1, but my DH was diagnosed while undergoing chemotherapy for testicular cancer. Havig the cancer gone (for 2 years now), we're realizing that maybe the diabetes diagnosis wasn't taken as seriously then since we were already dealing with the cancer diagnosis. We're coming to this late, but we're coming to it. My DH needs to see someone and take better control of his life and health care. What are some good sites I could visit? What would you all suggest as the first step? He had very poor care when diagnosed and hasn't really followed up. He's taking a 70/30 insulin 3x a day. He recently had walking pneumonia and the doc at the clinic was very adamant about DH seeing a specialist, that he needed to be on a different care plan. Any suggestions?

Hi Zoe,
I'm sorry to hear about your dh's diagnosis. The other suggestions you've gotten are great. Does your dh have a blood glucose meter? Is he checking pre and post meals? That will give him the best indication of how well he's managing on the regimen he's on now. We use Freestyle Flashes and really like them because they're fast, small, take the tiniest amount of blood, and the cable and software for downloading to your computer are free.

You can also get most meters for free, either from a drugstore promotion, by calling the manufacturer, or through your doctor or endo. You'll just need a scrip for strips (and if you don't have any luck getting a free meter, then a scrip for that, too.)


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## Think of Winter (Jun 10, 2004)

Thanks for your replies to my question about fluid level checks. I am stressing about everything, it seems like. Maria, I think you have a good point that more u/ss are a reasonable tradeoff for a later induction. I'm seeing my new OB today, so I hope to have a better idea of what I'm going to be facing at my delivery. I'm trying to prioritize my wishes for natural childbirth so I can have some room to negotiate.

I'm with you guys about being skeptical about cures. I've been hearing that a cure is just around the corner for over 30 years now, and it really irritates me to be given false hope. I'm resigned that there will be no easy, affordable, side-effect-free cure any time soon. We just try to make the best of the options we have.

Mommybear,
What a sad story that your hospital made it difficult for you to have your ds with you. Especially since you must have been feeling crummy already. Were you not responding to injections at home? I have learned some tricks for bringing bg down quickly if you are interested. I overbolus for the high (since I need a lot more insulin for high-highs), and test very frequently. I have also done intramuscular injections; that really speeds things up. But I usually do not get ketones unless I'm sick, and if you have ketones it can be riskier to bring it down really fast. Also lots of water, and if no ketones, mild exercise. I'm sure you know all this stuff already, but I wanted to pass along some things. Anything to stay out of the hospital. Hope you guys are getting back to normal at home and feeling bettter.


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## ~pi (May 4, 2005)

Quote:


Originally Posted by *hannahmom*
zoe - I can imagine it would be hard to focus on two things like cancer and diabetes at once!

















:

Ditto to the pp suggestions (and great analogy, Tricia!)

I would also check out some books. I've never read -- but have heard great things -- about Thinking Like A Pancreas. Your library likely has it; it's pretty popular.

---

Colleen, how are you doing? We're in your due date month now!


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## zoe398 (Jul 8, 2005)

Thank you all so much for your information. We do have an appointment with an endocrinologist now. DH is a landscaper, so he "exercises" all day. And it's especially hot here (SC). Last summer, he had great control with his blood sugar levels, but recently it's been more difficult to manage. When he had pneumonia, they did a 30 day test and his levels averaged 180. High, obviously. It's so scary to think of the long term damage that's being done to his body. I'm going to give this info to him, so THANK YOU all for your help. I'll bow out of this discussion now...I'm sure there's so much to discuss as mamas with diabetes. I'll keep reading, though!!!


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## Think of Winter (Jun 10, 2004)

We saw my new OB today. She was FABULOUS!!! She will support my going to 41 wks as long as my BPPs are normal, she is all for natural births (and recently did a water birth!), and we can have baby at the hospital I prefer, even though they don't have a nicu. All that, and she's got a wonderful bedside manner. When I gave her my birthplan and prefaced it with "everything here is negotiable, but these are our preferences", she said essentially, no no, this is your birth. Halleluia. What a load off my mind. OK, now I have the nerve to post my birthplan...


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## Think of Winter (Jun 10, 2004)

Birth Plan for , EDD:
Husband:
Doula:
Obstetrician:
Perinatologist:
Pediatrician:
Endocrinologist:

We know that we will receive excellent care and support for our personal decisions here at , and thank you sincerely for reading this plan and respecting our wishes. Having a natural, unmedicated birth is very important to us and we would appreciate any help you can give us. We are well-prepared and educated and have done everything we can to minimize risk during this pregnancy. Colleen has well-controlled Type 1 diabetes, and we are well-informed about the related risks to mother and baby in labor and birth.

We have researched each of the specific requests listed below and made informed decisions about them. Because many of these requests fall outside the normal practices at this hospital, we will be happy to sign any necessary waivers. Please do not perform any procedures, including routine procedures, on mother or baby without first receiving verbal informed consent. We will, of course, be flexible on all of these points if a complication arises. Nothing is more important to us than the health of our baby.

DIABETES MANAGEMENT

·My insulin pump will not be removed during labor or delivery. I will reduce basal insulin delivery as necessary to maintain blood sugar. I wish to decline IV insulin and dextrose.

·I will bring my own glucose monitoring kit and I will monitor my own blood sugars. I will treat highs or lows as necessary. I will bring my own supply of juice, glucose tablets, or food to maintain my blood sugar. Please do not interfere when I eat or drink as necessary.

LABOR

·I wish to decline an IV or a hep lock. I know the risks and am more comfortable waiting to see if one becomes necessary.

·I wish to walk, move, and change positions throughout labor and birth.

·I wish to have minimal vaginal/cervical exams. I find them uncomfortable and frightening, and not conducive to relaxing in labor. Please do VEs only when a decision needs to be made regarding my treatment (e.g. on admission, if pain medicine is requested, or if we are considering an intervention of some type such as pitocin, an instrumented delivery, etc.)

·I would prefer intermittent fetal monitoring only, and prefer that monitoring be done with a fetoscope or Doppler (1). We will consent to continuous monitoring if intermittent monitoring detects a problem or pitocin is used.

·I wish to avoid having my membranes stripped or my water broken.

·Please do not offer pain medications.

·I wish to avoid all drugs for inducing or enhancing labor. I have learned natural methods of strengthening labor, and have had a negative reaction to pitocin and cytotec in the past.

PUSHING & DELIVERY

·Please don't insist on when or how to push.

·I would prefer to give birth in the position that is most comfortable for me.

·I wish to avoid an episiotomy. Please do not touch or massage my perineum. I will request warm compresses or support if I feel I need it. If I do tear, I would like local anesthesia for repairs, please.

·Please do not use forceps or vacuum unless baby's life is at risk or it is the alternative to c/s.

·Either I or my husband would like to catch our baby, and I wish to hold my baby immediately after birth. Skin to skin contact is very important to us. Please perform the APGAR with baby on my chest.

·My husband plans on cutting the cord and will wait until it stops pulsing. Please do not clamp it until it stops pulsing.

·Please use pitocin after delivery only in case of severe hemorrhage, and then only with verbal consent. Please do not pull on my cord or the placenta.

INFANT CARE

·It is very important to us that breastfeeding begin immediately and without interference(i.e. removing baby to NICU or nursery.) Research indicates that this is the best way to avoid and treat hypoglycemia in a newborn, and our baby is at increased risk for hypoglycemia. Please do not offer sugar water, formula, or pacifiers.

·I will not consent to my baby going to the NICU unless absolutely necessary. I wish to be undisturbed for one hr following birth to bond with my baby and allow breastfeeding. Please perform any newborn procedures (weighing, measuring) afterward. We wish to be present for any baby examinations. If there is an immediate need for medical treatment, my husband wishes to accompany the baby at all times. We will be rooming in.

·I am aware that there is a risk for the baby to have hypoglycemia (glucose levels less than 40 mg/dl in the first 24 hours and 40-50 mg/dl thereafter) because I am diabetic. I will bring a glucose meter just for the baby, and either my husband or I will do her blood glucose tests (w/in 1 hr of birth or after first feeding, with increased frequency if hypoglycemia is present). We have extensive experience with doing heel sticks since my son was diagnosed with IDDM as an infant. Lows will be treated with breastfeeding. We will consider other options only if baby's blood sugar does not respond to breastfeeding.

·We respectfully decline erythromycin eye salve and hepatitis B immunization. We would prefer vitamin K drops to injection, if available.

·We look forward to giving our baby her first bath ourselves.

·We would appreciate it if the PKU blood draw/heel prick could be done during breastfeeding.

CESAREAN PREFERENCES
If a c/s is necessary, please use regional anesthesia. Do not remove my insulin pump. I wish to have my husband and doula present during the surgery. As soon as the baby is stable, my husband and I would like to hold and touch our baby. I want to breastfeed in the recovery room or as soon as possible.

IF THE BABY IS SICK
I will breastfeed if possible. If the baby cannot breastfeed directly, I would prefer the baby be fed my milk by syringe or tube. I would like to hold my baby as much as possible. If it becomes necessary to transfer the baby to another facility, my husband or I will accompany the baby immediately.


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## Darcy37 (Oct 25, 2004)

I found out I was type 2 when I was 4 weeks pregnant with my 4th child and Iam 38 yrs old Iam 35 weeks along and my baby is 5lbs 9 ounces so Iam doing great I take Glyburide and have since Dec 1 05 is there a thread for type 2 pregnant mommies?


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## hannahmom (Mar 5, 2004)

oh Colleen!!!!!!!







: I'm so happy for you!!! That rocks and it must be such a relief.









Now... if only I could find someone like that


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## ~pi (May 4, 2005)

Yay, Colleen!!























Erica, how is your IV/pump discussion going?

Darcy, I don't know of a tribe for type 2 mamas, but I haven't looked. I started this one after noticing a few T1 mamas here. I PM'd everyone to see if there was interest, and then just started the thread. You might want to try the same thing. Good luck with your pregnancy!


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## hannahmom (Mar 5, 2004)

Quote:


Originally Posted by *~pi*
Erica, how is your IV/pump discussion going?

Hasn't gone anywhere yet!







I'm still putting out feelers.

Normally I see an CNP at my endo's office but this month I'm seeing the actual endo. My CNP wrote a letter (which the one mw scoffed at) so I'm going to talk to the endo and see if she can also write a letter and provide specific guidelines for pump use - such as decreasing basal by x amt, correction ratios (which I already know







: ) etc... I'm also going to ask if she knows of any non-interventionist, pump friendly OBs - just something to keep in my back pocket if I feel this group is not going to respect my wishes and stop looking at me like a ticking time bomb.

I have my fetal echo on the 17th and I'm pretty sure they are done by the peri himself? I'll ask him about the pump then - otherwise I have to schedule a specific consult and I'll do that if I HAVE to but if I can catch him in the meantime...

Also I see mw #3 tomorrow. I got mw #2's opinion - she's the one that said she doesn't want to 'annoy' backup OB. So again we'll see.

I don't know what to do if I encounter opposition on all fronts. It seems like such a silly battle for them (more specifically Mr. sOB) to fight.

From day 1 I knew it would be an uphill battle in some regards and I knew that going into labor on my own was going to be the best shot at getting the birth I want - so I got the u/s tech to fudge my edd by 3 days. If they do get antsy to induce when everything is checking out a-okay - I refuse to allow that before 40 wks, and even then I will come up with an excuse that will buy me a few days (my edd is at the end of the week so I will push off until the following Monday). That gives me until 41 wks (unbeknownst to them







) to go into labor on my own - whereupon I am not planning to go to the hospital until the baby is practically crowning!







Then the IV thing is a non-issue









Isn't it sad when you'd actually really rather have your baby in the car?









collen - thanks for posting your birth plan too! You guys are doing all the work for me


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## widemouthedfrog (Mar 9, 2006)

Just a quick one before we get dd off to bed...

I am so sad looking at all of your birth plans. They are lovely. Makes me wish I had been "crunchier" at that time. And more organized - I was so panicked about diabetes, that I didn't really think a lot of this through. I think that getting diabetes and having a baby at the same time really made me rethink my approach to a lot of things, especially conventional medicine. If there is ever #2 baby, I will do things very, very differently. Ah well, we are learning...and to think, it has only been a year.

Tricia


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## ~pi (May 4, 2005)

Erica, I doubt the peri would do the fetal echo unless things are radically different in the states. Here, a tech and/or pediatric cardiologist does the echo. If it's the tech, the cardiologist looks at it afterwards and signs off on the report. Either way, the peri just receives a copy of the report.

Tricia, honestly, if I were diagnosed with something new and serious during the course of pregnancy, I'm fairly sure that all my plans would go out the window. I think most people have to get to a certain point in their disease experience first before they can look at balancing risks and bucking the system, and I really question whether I would have time to do that during pregnancy. Both Colleen and I have had our entire lives to get used to the disease and get really comfortable with all the different aspects of it, including all the self-management stuff. I'm not saying this to invalidate your feelings, because it totally makes sense to feel sad, I just wanted to point out that you became type 1 in probably the most stressful way possible, so it also really makes sense that you were a little panicked. I would have been a lot panicked!


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## Think of Winter (Jun 10, 2004)

Tricia,
I went along with everything my first time, too. We made the best choices we could with the information we had. Try not to doubt yourself. I'm trying to let my regrets about ds's birth go. xo, C


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## mady5 (Jun 18, 2004)

Hi everyone! I'm so glad I found you, it's such a relief to read about other people dealing with the same issues as I am and not freaking out about my crunchyness.

I was diagnosed with type 1 last june, but when I was pregnant I failed the gtt and my midwives thought I had GD. I remember being so depressed because I kept cutting carbs, even until I was only eating about 10 g of carbs a day a la Dr. Bernstein, and walking miles every day, but I just couldn't get my blood sugars below the 140s. I just felt like all of the advice to gestational diabetics was mocking me, because I was trying so hard to be so good and I just couldn't do it. I was the first time (but obviously not the last...) that I wasn't able to solve a medical problem that I was having by reading up about it on the internet and treating myself naturally. I had always been a big avoider of doctors, not being able to fix this was really humbleing, especially because there was a stigma associated with GD and I always had the impression that my midwives didn't really believe that I was towing the line. They put me on glyburide in the last couple of weeks, which obviously didn't really help, and in the end I wasn't able to have the birth center water birth that I wanted. Luckily I went into labor the day before my induction (I think I willed that baby right out, I remember walking 4 miles in the freezing cold trying to go into labor), but I was on continuous monitoring and IVs, which wasn't really what I had wanted for that birth. I did manage to avoid pain medication though, and I still remember the rush I felt when my daughter was born- it was amazing. She had a bg of 58 1 hour after she was born, and I tried to nurse her, but they really pushed for formula, and I was so exhausted (33 hour labor) that I let them do it. I wish now that I had tried expressing some colustrum, but next time, right? She was a bit macrosomic (9 lb 9 oz) with a bit of weight in her hips, but at the same time her dad is 6' 5" and was 9lb 3oz, and she is now above 97% for height, so I'm worried that my babies naturally being big may be an issue in my next pregnancy. After my birth I went back to eating normally, and never thought about diabetes again until June, when I had lost all of my pregnancy weight and then some, and was waking up 5 times in the middle of the night to pee. I finally dug out my meter from when I was pregnant, and the reading was 400 something, so I went to the ER and you know the rest of the story. She had stopped gaining weight for about a month before my dx, and when I was hospitalized and my blood sugars were evened out, I suddenly had much more milk, so I'll always feel sad about that month when she was so young and didn't get enough to eat. My blood sugars were great for the honeymoon period, but now they are pretty lousy. I'm fighting to get my insurance to cover the pump, my big problem is waking up really high (300-250) and going low in the afternoon (60-40). I feel sorry for dd because she doesn't understand what's going on, she'll be crying to nurse and I'll be sitting on the floor waiting for my blood sugars to go up feeling like my face is melting off. But I have a lot of hope, I was just with my new endo today (at the Joslin clinic, lucky me!) and she had a lot of ideas as far as switching my bolus from lantus to levemin or trying symlin or breaking up my bolus into multiple injections. I really want to get this under control so that I don't have to be terrified of getting pregnant. (Isn't it funny how it can be easier to want to take care of your health for someone else's sake rather than your own?)

As far as cosleeping goes, I cosleep with my daughter and have never had any problems, I had never thought of the impact of nighttime lows on safety, but I also tend to wake up if I start going low at night. (Although I have hypoglycemic unawareness during the day, go figure.)

I love reading all of your birth plans, it's so inspiring to see other diabetic moms having low intervention births.

My experience with nursing and lows is that my bg isn't affected unless she has a 2 hour nurse-a-thon at night.

Quote:

Originally Posted by widemouthedfrog
Yes, I am still (after 1 year) working on accepting the diagnosis. I've mostly got a handle on it, generally by getting some control of the diabetes itself. My most difficult part has been realizing that I am no longer self-sufficient. I depend on the medical system. That has been hard.
My husband and I had wanted to live off the grid in the woods. Learning to go to doctors regularly at all has been a big adjustment for me, and I get scared sometimes realizing that if there was some catastrophe that restricted my access to insulin, I'd be up a creek without a paddle.

Well, thank you so much for reading this far. Sorry about such a long post, but it feels so good to talk about this with people who really get it.


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## Darcy37 (Oct 25, 2004)

I have been on Glyburide since December 1st they put me on 2.5 mg I didnt have to up it to 5 mg till I was 7.5 months pregnant Iam inducing in 3.5 weeks at 39 weeks unless I go on my own which is what happened with my 20 month old.Iam going off the glyburide on the 15th so it can be out of my system before I deliver so the baby doesnt have a sugar drop I just hope I can keep my sugars low once I go off it.Monday they did ultra sound said she is 5 lbs 9 ounces so good so far it has been hard being diagnosed with type 2 at 4 weeks pregnant was devastating and sometimes I resent it but Iam doing what is best for Athena and she is my 4th and last baby Iam 38 will be 39 in October.


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## widemouthedfrog (Mar 9, 2006)

Oh Mady,
I think that I just read the story of my pregnancy...except that it was yours. As you may have read in my introduction, I was diagnosed last year in April with gestational diabetes. Luckily for me, one of the nurses told me immediately that I'd be going on insulin, and she suspected that I was type 1.5 (slow-acting type 1). I had similar interventions during pregnancy and labour. I also had major issues with milk supply, especially during the first weeks. Finally, a wonderful health nurse told me I had to go back on insulin - I was monitoring my blood sugar and it wasn't pretty. I finally argued my endo into taking a look before 6 weeks were up, and argued him into going onto insulin again, then spent the next 6 months begging for a letter saying I could get a pump. This was because he insisted that I was type 2 and didn't need one. Finally, I paid for antibody testing to show that I had the antibodies for type 1.5 - which I did, in spades. So my endo still won't confirm anything, but I have my pump and I know where I am at. But boy, what a hard, hard time it was. And I feel for anyone else who has had to go through that.

I find that things are so much easier to manage on the pump. My night time basals were way too much for me on Lantus...but daytime ones were too small. So I kept on waking up low after nurse-a-thons. Just what you need with a wee one.

Yes, it is not pleasant to go low with babe around - I have always been able to function ok when low, so I can kind of "fake it" with my daughter - keep her entertained enough even though I feel lousy. But boy, I feel it afterwards in the energy department. And it's funny, I can tell that a low is starting when I keep on repeating the same silly phrases to her (generally, I think up new silly phrases to say




























).

Thanks for the encouragement about birth plans, everyone. Yes, I know, if there is a next time I will be more prepared. I didn't really know how much I'd missed until I started reading about others' natural childbirths...

Ok, off to put the wee one to bed.


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## ~pi (May 4, 2005)

Welcome, Mady!









That's a tough diagnosis story. It must have been such a stressful thing to go through while pregnant and then adjusting to parenthood. Yikes.

Good luck with your pump quest. I don't know if it works like this where you are, but here, the pump companies have special departments that deal with insurance companies for you. They were able to get me partial coverage even though technically I had no coverage for durable medical equipment. So if you haven't done so already, you might want to choose a pump, contact the pump company and trying attacking it from that angle.

I have variable basal needs, too, and it made a world of difference when I got my pump and got all my basals adjusted. I remember having so much energy and thinking, "If this is what non-diabetics feel like all the time, they should be _doing_ more!"


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## hannahmom (Mar 5, 2004)

Quote:


Originally Posted by *~pi*
I remember having so much energy and thinking, "If this is what non-diabetics feel like all the time, they should be _doing_ more!"









Omigosh I soooo remember this feeling! I had no idea how sick I felt until I felt better!
















mady - Joslin has such an awesome reputation I'm sure you are in great hands and will be back to 'normal' in no time









So now there is a new wrench in my situation... Last night I saw mw #3 - and I LOVE her! She seemed to think that we could work on Dr. sOB about the pump. She mentioned nothing about annoying him like the last mw. BUT! She proceeds to tell me that he will probably want them to put me on the monitor - so I say "yes intermittently, right?" - Nope. I ask "you mean tied down in bed with the belts?" - Yup. She said it's not definite but she has a strong feeling.



















































I just cannot win! I told her that I'd prefer to have the baby in the car at this point and she felt bad but basically told me to do what I already planned - to labor at home as long as possible.

Now I don't know what to do. I almost want to find an OB that actually has a lot of experience with T1 women - that is off the bat okay with the pump , will let me go to 41 wks if my nsts/bpps are okay, etc... But then do I have even more battles ahead trying to have a low-tech birth? I'm so used to the laid back mw approach. My mw mentioned last night that I'm a physician's dream because there is something TO manage.









In the meantime I'm getting my hands on Birthing from Within and the hypnobabies cds. From what I understand of hypnobirthing, if I have to be strapped down during labor, it might be the best way to cope.

*sigh*


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## MommyBear (Dec 19, 2001)

Quote:


Originally Posted by *hannahmom*
Now I don't know what to do. I almost want to find an OB that actually has a lot of experience with T1 women - that is off the bat okay with the pump , will let me go to 41 wks if my nsts/bpps are okay, etc... But then do I have even more battles ahead trying to have a low-tech birth? I'm so used to the laid back mw approach. My mw mentioned last night that I'm a physician's dream because there is something TO manage.









You should move here and use my OB. He was totally supportive of me homebirthing and didn't even balk when I wanted to UC. When I ended up needing a c/s he almost cried when he told me. He managed to make it a good experience, even though it was the exact oposite of what I'd planned. I really can't say enough good things about him.


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## hannahmom (Mar 5, 2004)

Can I come live with you in august?


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## MommyBear (Dec 19, 2001)

You bet! I think everybody should have an OB as good as mine. Heck, he delivered twins with the mama squatting, he's just that wonderful!


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## Think of Winter (Jun 10, 2004)

Welcome Mady,

Wow, you have had a tough year. I remember so well those afternoon crashes, and waking up way too high. Seems to me that your endo has every reason to prescribe a pump. I know that they make you jump through some hoops at the Joslin to get one, though (my cousin did it last year.) But it will be worth it.

I also recognized feeling awful because your baby wanted you, and you just couldn't do anything. But I think that's part of motherhood, too. Now that I'm hugely pregnant, I have to say no to my ds a lot more than I would like, especially when he wants to be carried. And in spite of the fact that my ds was diagnosed at 12 mos, I believe that having diabetes has not detracted from my mothering abilities.

Best wishes to you getting your blood sugars more evened out. Since you are relatively newly diagnosed, it may be disappointing to you that they will never be "normal." All of the diabetic training materials still say that as long as you do everything right, you should be able to get stable blood sugars. I think for the vast majority of us, that just isn't true. There are so many factors, many of which are a complete mystery, that affect blood sugar. I do think the pump is the best tool available, though, and one would certainly solve your dawn phenomenon problem and your afternoon drops.

Welcome again!

Colleen


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## Think of Winter (Jun 10, 2004)

EJ,
Have you thought about just following your own birth plan? Just smile and say "no thank you" to everything, or go hide in the bathroom? That will get you off the monitor. I so sympathize with what you are going through. My first OB was very opposed to no IV and no continuous monitoring. I figured worst case, I would labor as long as possible at home, then just say no to everything when I got there. How will your dh be about getting between you and a pushy nurse? Is there someone else who could be there with you? I know they're all going to want a strip when we first arrive at L&D, but they really cannot force you to keep it on, right? I know you don't want to plan on fighting while you are in labor, but that may be the only way to get the birth you want.


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## Think of Winter (Jun 10, 2004)

Just wondering what you mamas thought about this. I have had more than one crying sessions over not banking my ds's cord blood (since he was diagnosed with d), but now that I'm pg again, I'm still not sure. I know that there is a study going on now that's looking at using a child's own banked cord blood to treat type 1.

Obviously if money weren't an issue, we'd just do it. But putting nearly $2000 on a credit card makes me nervous.


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## widemouthedfrog (Mar 9, 2006)

Hi Colleen,

We did it, and my diagnosis was the main reason. Do you know the particular study? I am curious. I thought that I had read something about a study, but I didn't know that it was actually successful at all.

That said, I think that for many disorders, the problem may be in the blood as well, so it's not too useful. And it is a new technology.

At the time, we had just sold our apartment and had a little extra money around, so we did it. If it were today, I don't think we'd be able to afford it...although we'd probably feel guilty.

Anyway, I wouldn't beat yourself up about it one way or the other.

And there are always public cord blood banks, too, if you want to donate it. That goes to research, too. Usually, I am all for the charitable, public good thing to do, but this time I did cave and decided to do what I thought might be good for us, and only us.

If you do it, make sure you bring the kit to the hospital - in our haste to go in, we forgot it in the car, and dh had to make a mad dash after dd was born....

Tricia


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## Darcy37 (Oct 25, 2004)

If you donate it will they let you use it if your child ever needs it?


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## ~pi (May 4, 2005)

We aren't banking. We are looking into donating whatever cord blood is left over after the collection for TRIGR, though.

Besides the fact that we can't afford private banking, I would be willing to bet heavily (and I guess in a way we are) that should there ever be something that can be done with stem cells to create islets, the technology for other sources of stem cells will be there anyway. There is so much work being done in that area. I could be wrong, but that's the way I see the science heading.

Quote:


Originally Posted by *colleen95*
I know that there is a study going on now that's looking at using a child's own banked cord blood to treat type 1.

Really? This is news to me. Who is running it?


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## ~pi (May 4, 2005)

Quote:


Originally Posted by *Darcy37*
If you donate it will they let you use it if your child ever needs it?

Generally yes, if there is any left.


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## Think of Winter (Jun 10, 2004)

I got this from someone on Parents of Pumpers:

Quote:

New Study Aims to Treat Type I Diabetes with Banked Cord Blood

Dear CBR Client:

If you have a child who has been diagnosed with type 1 diabetes and you
banked his or her cord blood, you may be eligible to participate in an
exciting study that offers new hope to these young patients. Researchers at
the University of Florida believe that a child's own banked newborn stem
cells may be ideally suited for regenerating insulin producing cells within
his or her body. To learn more about the trial, or to see if your child may
be eligible to participate, please click here. Please note that a sibling's
cord blood unit cannot yet be used in this trial.
This is from the CBR website:
http://www.childrenwithdiabetes.com/...lood200503.htm


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## widemouthedfrog (Mar 9, 2006)

Hi Colleen,

Many thanks...I think ours is accredited, even though it's in Canada. That sounds great! I'll keep my fingers and toes crossed that Lauren doesn't have d, though, but we're going to put her into Trialnet after mid-June.

Tricia


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## ~pi (May 4, 2005)

Thanks, Colleen! I will check it out.


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## ~pi (May 4, 2005)

So I'm very lucky with my health care team in general, but I'm having trouble with one of the endos. I







the one I usually see, but she has been away the past month and so my last four appointments have been with the one I dislike.

She's head of the department. Why, I do not know ... she has a pathetic publication record and IMHO is not a great clinician, either. I never feel like she is listening to me, and her math skills are atrocious, which means that whenever we're talking about pump adjustments I have to correct her to make sure I understand what she means.

She actually complained at my last appointment that pumps make things harder for her because of the flexibility they afford patients.








I mean, I understand that yes, it would be easier for her to understand changing insulin usage if I were on a strict MDI regimen, but come on, let's weigh her slight inconvenience in working with pump ratios against my considerable inconvenience in using MDI.







I think she wants robots for patients, honestly.

However, my main issue with her is the doom and gloom attitude she brings to clinical encounters. Every time I see her she starts talking about all the possible reasons I could get admitted to the hospital any moment now. I think she's a bit of a power-tripper, too, since she told me proudly that, "We are usually the ones who tell the OBs when it's time to admit you."

At my last appointment, she told me that about a third of women who have had type 1 for 20+ years will deliver before 35 weeks. I asked what that stat was based on, she told me there were a few cohort studies and it was also borne out by her clinical experience. So after having a good cry in the washroom on my way out of the clinic







: I went and did a lit search to find said cohort studies. I came up with nothing; in fact, I found that the stat is generally much lower than that and that almost all cases of preterm delivery in type 1 pregnancies are associated with complications of type 1 that I. DO. NOT. HAVE.









I'm going to try to find out if there is some way that I can not see her any more, because she is really driving me insane.


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## widemouthedfrog (Mar 9, 2006)

Maria,

Honestly, specialists (or anyone) like that make me so frustrated! We have brains too, people....

It has been a rough 2 days. I think that my pancreas goes downhill in episodes. For the last 48 hours I've been high - not DKA high, but uncomfortable peeing all the time, grumpy and feeling nasty high. Anyway, I've switched some basals in the wee hours and I am hoping to gradually make improvements. This has happened to me once before, and hopefully this is the last time I have such a huge jump in basals/ratios. I am almost at the "usual" total daily dose of 30 units, so I suspect the old pancreas has almost given up. Coming after my GAD antibody test, I think it just decided that it was time. For those of you who know The Importance of Being Ernest, it's kind of like his friend Bunbury, the imaginary invalid - Bunbury was told he could not live, so Bunbury died. Hence goes my pancreas... (gosh, I'm a little odd)

So this morning I had a temper-tantrumy morning (me having the tantrum) because try as I might (hot shower, run around the block), I felt awful and NOTHING would bring the BG down. Finally I plummeted downwards. Growl. Happy Mother's Day!

Hope that others had a better one!

On the good side, I now have enough data to officially enrol Lauren in Trialnet. The package is coming this week!

Oh, Maria, I am sure you know how to do this, but I have 2 things that I would get organized pre-baby.

1. Access to a good lactation consultant/post-partum doula/health nurse/LLL leader.... I had uncontrolled diabetes in the first few weeks, which caused some breastfeeding issues. You won't, so hopefully it will not be a problem, but it's good to have a support system in place.

2. Figure out how to deal with unplanned exercise after a meal. My daughter isn't much of a napper, and many a time I have gone for an unplanned walk after breakfast to put her to sleep. And many a time (until I figured out how to deal with it) I went low, despite eating lots of sweet things during the walk.

Lauren was due July 9th, by the way (actually, a little earlier according to my estimation). She was 2.5 weeks early, not 5. And I haven't read a lot about T1 and pregnancy (since I was officially gestational), but from what I've read, I didn't see a lot about 5+ weeks pre-term birth. Maybe a little early due to all of the inductions, though. And early babies run in my family, anyway (along with fast labours, but that is another story).

Ok, enough pontificating. I hope that everyone else had a wonderful Mother's Day.

Tricia


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## HotMama (Oct 26, 2002)

Sneaking in here for a question...I'm doing research for a friend whose 7 yr old daughter was just diagnosed. They already are way beyond the diet recommendations and are looking at the carb thing, but this is their first time dealing with the allopathic world after homebirths and not vaxingso they're blown away to say the least. I've shared the two websites already mentioned in this thread and now they're wondering about how to best support her immune system, and her general health. If you all experienced women have any advice, or places to send me to research for them, I'd appreciate it. I'm NAK a lot with a new babe, but books are also good. Also, any thoughts on the support we, their community, can provide to support them would also be lovely.


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## widemouthedfrog (Mar 9, 2006)

Hi hotmama,
How nice of you! Hope that they are doing ok.

You just inspired me to go through my list of links and make a file.

Here are some books and some links. Hope these help.

Tricia

insulin-pumpers.org (Insulin pumps, an excellent method of delivery)
Good email lists.

http://www.collinscreations.ca/ Pump pouches, homemade

www.trialnet.com (Clinical Trials)

www.diabetesforums.com (General information)

http://www.jdrf.org/ (will connect you with a mentor)

http://www.glycemicindex.com/ (A step beyond carb counting. I eat primarily low-glycemic foods, since they make my blood sugar easier to control)

www.quinoa.com (For the best non-wheat, low-glycemic grains around. Free shipping!)

http://www.childrenwithdiabetes.com/ Products and info

http://www.immuneweb.org/lowcarb/ For people looking for vegetarian, lower-carb recipes

http://www.westonaprice.org/moderndiseases/index.html (Weston Price on diabetes, mostly Type 2, but somewhat helpful)

Books
How to prevent and treat diabetes with natural medicine - Michael Murray, Michael Lyon
Think like a pancreas - Gary Scheiner
Pumping Insulin (for those with pumps)


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## HotMama (Oct 26, 2002)

Wow! That's what I was hoping for...I'll dig through and pass it on. Thanks so much


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## ~pi (May 4, 2005)

Hotmama, a couple more resources:

http://diabetesmall.net/ One of my favourites. Tons of info, links, products, books, etc.

http://uniaccs.com/categories.asp?id=2 Pump accessories.

Quote:


Originally Posted by *HotMama*
They already are way beyond the diet recommendations and are looking at the carb thing, but this is their first time dealing with the allopathic world after homebirths and not vaxing so they're blown away to say the least. <snip> Also, any thoughts on the support we, their community, can provide to support them would also be lovely.









My 2 cents:

That's really nice of you to be looking into how to support them. As for specifics, this really depends on your friend, but I think it can be especially hard for people who are used to being firmly outside the medical establishment to be all of a sudden thrust into it, so it's nice if the people around them can be sensitive of that.

For me, it can be really hard to hear or see eye-rolling about Western medicine because while I definitely think that over-reliance on it is a bad thing, complete dismissal of it, particularly in the context of a diagnosed, treatable disease, can be equally narrow-minded. I find it personally difficult to hear statements that ignore the possibility that there are times when allopathic methods are useful. So depending on how your friend feels about that, you might want to keep an eye on how the community discusses her dd's issues.


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## ~pi (May 4, 2005)

Thanks for the tips, Tricia!


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## Think of Winter (Jun 10, 2004)

Hi Maria,

Sorry your endo is such a [email protected]#ch. I know it's stressful looking for a new dr at this point, but you need someone who will be supportive and encouraging. Trust me. I was so upset having to find a new OB at 35 wks, but it has made such a big difference and was very much worth it. Did you say you're in Toronto? You could try checking the insulin pumpers endo recommendations list. She actually sounds like someone I used to see there at U of T.

I have never heard that preterm labor is a complication of Type 1. Try to put it out of your mind. I suspect the reason many type 1's deliver premies is because they are induced.

Hugs to you. You are doing great, and growing a perfect, healthy baby.


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## Think of Winter (Jun 10, 2004)

Turns out this referral won't help Maria, so I deleted it.


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## ~pi (May 4, 2005)

Thanks so much, Colleen.

There are two endos in the clinic. I *love* the other one and it was just my bad luck that I happened to see the one I disliked for my last four appointments. Through some good luck and careful suggestion, I was able to arrange it so that I will only see the one I like from now on.









I'm so glad that you got a better OB!! I hope all is going well with you!


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## txtarheel (May 27, 2006)

I was busy browsing the site looking for the legal ramifications of refusing the eye drops/ointment and HepB vax in my state and stumbled on this thread. I'm in a couple other groups with pregnant Type 1's, but crunchy they are not! I usually get rude or "dead babies" comments when I mention things like avoiding earlyinduction and breastfeeding to treat newborn hypos. You guys all seem so well informed and proactive. I was starting to think I was the only one out there making my own adjustments to my regimen and who questioned the "wisdom of the experts."

A little background on me - I'm 32, I've been Type 1 for 22 years and pumping for nearly 13 years. I'm 35 weeks pregnant with my first tomorrow. So far this pregnancy has been pretty uneventful. My A1c was 6.5 when I conceived and it's been 5.5 or lower ever since. I've just smoothed out the most recent (and I'm hoping LAST) past of resistance in the past couple of days. It's scary how much insulin I'm on - nearly quadruple my prepregnancy dose but at least I know that means that my placenta is still working well!

I have been quite lucky to have a really supportive medical team. My endo and CDE usually just tell me how well I'm doing and that they'd be out of a job if all their patients were as proactive. They don't freak out over a lone high reading or even several since they have a clear grasp of how resistance works and that it takes a couple/few days to work out. My OB is supportive of letting me go to 40 weeks as long as everything looks good, I think I'll be able to convince her of close to 41 since my due date is July 1 and I've got that whole holiday weekend to my advantage. My only concern at this point is the baby's size. His last u/s suggested he was in the 90th percentile for weight. It's frustrating since my sugars have been in such good control. But I'm just writing it off to my husband's height!

I'll stop with my novel now, but I look forward to hearing more from this group!

Katherine


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## MommyBear (Dec 19, 2001)

I just got my latest A1c back and its horrible. I knew it would be bad, but I didn't think it would be this horrible. I'm embarrassed to even post what it was but lets just say it represents an average bloodsugar of over 300







:

Can anybody give me some good ways to get back into shape?


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## ~pi (May 4, 2005)

Welcome, Katherine!!







(And come join the July DDC!) Sounds like we're at almost exactly the same place!

My insulin needs have just started dropping slightly from about 100-120 TDD (2.5 - 3 times normal) to more like 100, which has me mildly concerned, but it isn't totally unexpected at this point, plus I've been a lot more active lately. I'm keeping a close eye on it, watching for big drops, and using healthy placental thoughts for my hypnobirthing mantras!









Quote:


Originally Posted by *MommyBear*
I just got my latest A1c back and its horrible. I knew it would be bad, but I didn't think it would be this horrible. I'm embarrassed to even post what it was but lets just say it represents an average bloodsugar of over 300







:

Can anybody give me some good ways to get back into shape?









Rachel.

Does the 512 have an alarm you can set for post-bolus testing? When I've had trouble in the past, one of the big things that helped me was setting my pump to alarm first at two hours, and then one hour anytime after I bolused.

I'd also check your basals and do some basal testing. (Do you have Pumping Insulin by John Walsh?) If your A1c is that high, I'm guessing you're probably having overnight trouble? I've always found that if my overnight basals are fine, everything else just kind of falls into place. And it makes a huge difference to my A1c to have 8 hours of nice, level sugars every day.


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## MommyBear (Dec 19, 2001)

I have no clue how to figure out what my basals should be. Other than trial and error that is and I'd really like to avoid going low while I'm alone with the kiddos. I haven't been checking my sugars because I just can't remember to do it. Even when my pump alarms, I rarely hear it (I've learned to tune it out). I know I've got some depression issues going on that I'm sure are playing into this but I don't have anybody to talk to about that. Life just seems so screwed up right now. When my endo did the guilt trip thing saying "If you don't take care of yourself you may not be around to see your boys grow up" I didn't even blink. I know that. And sometimes I feel like that might happen and somebody else would raise my boys. It scares me that that isn't enough to whip me into shape.

Boy, I've shared way more than I planned to.


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## widemouthedfrog (Mar 9, 2006)

Aw, Rachel







It's so easy to get depressed with all of this, I know. And an AIc like that must make you feel extra nasty. I know that when my Bgs go above - say - 180, I get really grumpy and depressed.

Oh, and did you have thyroid issues as well? I think that those can lead to depression too. If you haven't had your levels checked, it might be a good idea. I have a bit of hypo-thyroid, and my aunt has it in spades, and I know it's really affected her.

I've flipped through pumping insulin. It's somewhat helpful. Have you been to the insulin pumpers web site? Google it and it'll come up. They have a great email list for pump tips, tricks, and just support. Everyone there is going through the same sorts of things....

I test a lot. For me, a relative beginner, that's the only way to get to know my body. From that, I've learned that a normal bolus just won't do for lunch or dinner - I go low at 1 hour. I also test in the middle of the night (dd kindly wakes me for that one







) to check basals, since I used to go low then. Maybe one day I will feel ok not checking, but for now, I do.

The only way I can feel sure about my basals is by fasting. When I first started on the pump, I fasted all morning into the afternoon. You don't need to go that crazy, but skipping a meal is necessary to check them. If your BGs stay within ~20 (1 point in Canada), then you're stable. Then you know that any problems are in the meal time ratios. If your BGs rise and fall a lot while you're fasting, you'd change the basal rate a couple of hours before. For example, if you're around 100 at 9 am and at 11 am you're at 180 (without eating), you'd edge up your basal rate between 9 am and 11 am. Then you'd try again the next day to check the impact.

I hope that makes sense. Pumping Insulin likely explains it more clearly. Do you have a supportive diabetes or pump educator around who could talk you through it?

I agree with Maria -night time is key. I try to fine tune my dinner ratios and eat lower-carb for dinner so that any errors aren't as large. I check before bed to see where I'm at. If I find that I am consistently waking up high or low for a week or so, I check my basals in the middle of the night.

Katherine, welcome! Great to hear that your insulin needs are still going up. Mine dropped a little earlier than they should have, which was a tip-off that babe was going to be born a little early. As per usual in my family, though with d I was concerned about lung development, etc. Although none of us chose to be in this tribe (d-wise, that is), it's great to have folks to hang out with once we're here.

Ok, talk about novels!


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## ~pi (May 4, 2005)

Rachel, I'm so sorry you're having such a hard time.







If it helps to know this, I've definitely been there (depression, poor control, etc.) It's a tough, tough place. Depression is actually more common in diabetics, and it's a hard cycle to get out of, because when your sugars are wacky, you don't feel good, and then you're less motivated to take care of yourself, etc.

I would really recommend Pumping Insulin as a resource on basal testing. If you can afford it, order a copy from amazon (here is the link) and if not, your library should have it. It has a great section on how to test and set your basals. Honestly, I would bet money that if you got your overnight basals set properly, things would really start to look up. If you can't find a copy, PM me and I'll see if I can scan and send you the relevant section.

As for the testing, maybe you can make yourself a rule that works with your kiddos, e.g. every time you feed them, you do a quick sugar check before or afterwards, whichever works best for you.


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## Think of Winter (Jun 10, 2004)

Hello Everyone,

Welcome Katherine! Glad you found us. Sounds like you have a great team for your pregnancy, so congratulations. That seems to be a big challenge for most of us. Wow, pumping for 13 years! I bet you've learned a few tricks and seen a lot of progress. About your baby's size, try to put it out of your head if you can. Everything I've read says that growth scans are "wildly inaccurate." You're nearly there now, too. Are you worried that your docs will want to induce for size, or about birthing a big baby? If it's the latter, I've read some great stories lately about 9+ lbers just sliding right out! Have you read Ina May's Guide to Childbirth? She's included some really inspirational birth stories. My last scan, at 38 wks put my baby girl in the 80th percentile or 8 lb 2 oz, but I'll be absolutely shocked if she's that size even at birth.

Rachel,
Wish I had some magic words to help you. I have just one child now, and I know it can be really tough to focus on yourself. But that's what you need, I think. Is there any way you can get some time on your own to relax? I have so been there with my bgs being completely out of control. In fact, I was completely out of control for the first 24 yrs of my life. I just felt like I couldn't do it and was afraid of the number I'd see if I did check. Your dr using scare tactics probably won't help. I'm sure you're feeling fear already. For me, the only way to get back in control was to feel like I had the ability and strength to do it. And I for one believe in you and know you can do it. Can you talk to your dh about helping you? Maybe start with testing before meals at least so you can bring down those highs and not feel so yucky? Constant highs will leave you feeling awful and defeated. Let go of feeling guilt about high numbers. They are just a number, not your fault. Getting past my fear of lows has helped get my a1c down, too. Do you have glucose tabs around, or smarties? If your a1c suggests an average of 300, I would guess you could up all of your basals by 10-20% right off the bat. And it might be relatively easy to get your insulin:carb ratio by checking pre and post meal a few times. If there's anything we can do to help, let us know. I'd be happy to pm you my phone number, too, if you ever feel like talking or venting.

Maria,
It's funny that you mentioned that your insulin requirements are dropping and it's got you concerned a bit. Same here. With my first, my perinat said something like it was good that my resistance kept going up because it meant my placenta was healthy, so now I've got that in my head. But my current team doesn't seem at all worried that my resistance is going down. I'm trying not to worry about it. Baby seems very healthy based on all my nsts and her movement.

As for me, my due date is Monday. I'm halfheartedly trying natl inducution (dh is doing his part if you know what i mean, brought on lots of ctx! And took some evening primrose today.) By Monday I'll probably get more serious about it. But I'm not quite ready! I really want my house a bit tidier, baby girl's clothes put away, etc. But my midwife said last week, "don't go past due and make us worry about you." so I'd really like for baby to come by the middle of next week. And I am so excited about the birth. I'm feeling very empowered and supported, which is a wonderful change from where I was a month ago.

Take care everyone!

xo,
Colleen


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## widemouthedfrog (Mar 9, 2006)

Have a wonderful birth, Colleen!
I think that insulin requirements are _supposed_ to drop before birth, aren't they? Or am I wrong about this?

I agree wholeheartedly about not beating yourself up for highs. I used to be such a perfectionist, before d and before baby. Now, I get by, I correct, I know I'm as perfect as I am going to be. Which isn't very perfect at all.


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## MommyBear (Dec 19, 2001)

That's the thing. Most of the time I just don't care. I use every scrap of caring I have for my kids and I just don't care about myself or my health anymore. I don't beat myself up over highs. I know I'm high and sometimes don't even care enough to bolus for it. That is how bad it is. I'm just empty.


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## mady5 (Jun 18, 2004)

Hi everyone! I was in the hospital with the stomach flu and my routine got so out of whack that I haven't been able to post until now. It was my first time throwing up uncontrollably with diabetes- kinda scary, but now that I've done it I feel like I have more of a plan for what to do when it happens again. I'm so grateful for nursing antibodies though, I don't know what I would have done if my little girl had gotten it at the same time.

Rachel- I just wanted to say that I know where you're coming from about how hard it is to controll diabetes when you're feeling depressed. The crummy blood sugars make you feel rotten to start with, and at least in my case bring on this total apathy. For the past few months, up until a couple days ago, my fastings were all 250, 337, or something else awful. Then in the afternoon, I would end up going low, and half the time binge eat after my correction, screwing up my bg even more. Seeing those numbers can be so discouraging that I think that it's natural to just start becoming numb to them, it's a mental defense mechanism. Alot of the time when I'm tallying carbs for a complicated recipe with no portion sizes while my daughter and husband are almost done with their dinner, or having my bg skyrocket during exercise and then plummet a few hours later, I have this feeling that other diabetics must not do all of this, that it can't be this complicated for everyone. I know that's not true, but sometimes I feel consumed by tallying and pinching up and writing things up in a little book. I don't know why it's so much harder for moms to take care of themselves than it is for them to take care of everyone else. My endo adjusted my basals again a few days ago, and my fastings have been in the 80s, but I'm afraid to believe that they will stay there, because I've had intitial good results to basal changes in the past and then they get messed up again. I think that it must be changes in night nursing, or the death throes of my pancreas, or who knows?

Katherine- My daughter was 9 lb 9 oz- half of it was that she was and is a big girl, but the other half was macrosomic due to my misdiagnosed diabetes. I had a long labor, but the pushing was quick, only one hour, and the miwives made me lie on my back and didn't even let me move around (!?!). I think that the key with a big baby is to just give yourself plenty of time to open up, I didn't even tear or need an epistomy.

Baby woke up, gotta run, best wishes on the upcoming births


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## widemouthedfrog (Mar 9, 2006)

Oops


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## widemouthedfrog (Mar 9, 2006)

Rachel - sounds like you need a holiday. Or at least some time to refresh yourself, even some regular time to do that during the week. Having 3 young kids is not easy - my mom says that she can't remember 2 years of her life. And she doesn't have diabetes, either. Do you have any kind of support system - grannies, church, friends who could come over and babysit for a bit? Not to be nosy or prescriptive (I can't stand it when people do that to me). I've been really burned out by things in the past, so much so that I couldn't even _think_ about how to make things better. Sounds like that might be where you're at. Having some reflection time generally helped me, as long as there was a good support system to turn to when I was ready to take action.

We're going away for a few days - Lauren and mommy's first trip together. Crossing my fingers that all goes well....


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## MommyBear (Dec 19, 2001)

I think that is part of my problem. Right now I have zero support system. I can't even find childcare for when I do my volunteer work once a week. I need to just bite the bullet and ask. I just always feel so guilty about doing that because I feel so selfish. I feel like everybody else can manage, why can't I? My fasting was 307 today. I don't even know how much to give to correct. It's all a crap shoot. I have no clue what my basals should bee, how much to bolus... nothing. My doc doesn't like counting carbs so he encourages the use of the point system. I remember when I lived in PA there was a diabetes educator that used some math formula to figure out where to start me for my insulin rates. I wish I knew how she did that, it seemed to work pretty well. I think I have some insulin resistance going on though. The one thing I don't like about the Paradigm 512 is that the max bolus you can give is 25 units. I often need more than that but forget to give a second bolus once the first is finished. While I was pg there was mention of putting me on a more concentrated insulin (U500?). I might ask about that again.

My thyroid is also super screwed up. My TSH was 11. Go figure I forget to take my Synthroid too. Again its the "me on the back burner" thing. I never forgot to give my youngest his synthroid when he needed it. I was just taking mine at the same time but now that he doesn't need it anymore, well nobody takes it now.

Blerg, another novel. I feel like I'm sounding very "poor me" and that really isn't what I'm trying to do. There is just so much going on and this is my *only* place to talk about it.


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## ~pi (May 4, 2005)

Quote:


Originally Posted by *MommyBear*
I remember when I lived in PA there was a diabetes educator that used some math formula to figure out where to start me for my insulin rates. I wish I knew how she did that, it seemed to work pretty well.









Rachel. It sounds like your endo isn't as helpful as he could be. Again, I recommend Pumping Insulin (I found it really helpful in figuring out all my rates and ratios ... it really helped me get and keep my A1c down) but in the meantime here are some links that describe how to figure out your carb ratio and your correction factor. These are probably the formulae the CDE used.


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## Think of Winter (Jun 10, 2004)

Hi Mamas,

Today is my due date. I've been doing a few natl induction things (acupressure, bd w/ dh, epo), and I've had lots of signs that labor is approaching, but it has not started yet. Now I'm starting to get scared of placental degradation and stillbirth. Baby girl seems to be moving a little less today. But I've been nesting, so very busy and may not have noticed.

I've been so adamant with my care providers about not getting induced (at least before my due date), but now I'm a little scared. What do you all think? My last two a1cs were 4.7 and 4.6. Am I just getting the late-term fears that all mothers get, or should I really rethink this? What do you guys think about the risks of induction (my first induction was awful) vs the risk of late-term fetal death? Is going to 41 wks before medical induction a little crazy?


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## ~pi (May 4, 2005)

Hi Colleen,

Wow! Happy due date!

I would make a decision based on data and gut feeling. What is the data saying? How have your insulin needs been changing? How are the BPPs going? How do you feel about it all?

The biggest thing I would look at is insulin usage. At 36 weeks, mine is starting to decrease slightly, so that's a concern. If my needs start to decrease too quickly or too much, that's a sign that the placenta is not holding up and hence a medical indication for induction IMHO. But if they hold more or less steady, I am comfortable going on because that means the placenta is most likely doing well.

Here is a chart I made a couple of weeks ago that shows my overall trends:

http://i23.photobucket.com/albums/b3...insulinuse.jpg

I made it by hacking into the pump database (I have a Cozmo, the password is deltec, so they obviously expect people with some computer knowledge to do this) and pulling the data I wanted.

As for movement, what happens when you have something cold and sweet and then lie down for a bit? My MW told me that's the acid test ... almost every baby will have a dance party if you give them a little sugar, something cold, and you stop moving.

On a less technical side, do you ever "check in" with the babe? I do that from time to time and have actually been trying to convey the idea that as much as I'd like to give him/her all the time in the world, it would really be better if s/he came by such-and-such a time. My mom swears that she was able to talk to me and my sister in the womb ... she's so crunchy she's flaky







but I think she may have had something in that you can connect with the babe if you need to.


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## txtarheel (May 27, 2006)

Thanks for the welcome all! I'm glad to know we're all trying to avoid induction, I felt so alone in that.

Colleen, I have read Ina May's book and am not worried about my personal ability to birth a big baby. Frankly, I'm just assuming he's gonna be shaped like his father - long and lean. Daddy is 6'7" and under 200 lbs. My OBs (it's a 2 doc practice) claim they don't believe in inducing for size. However, I haven't seen the more experienced one (and the one I really trust) except for a brief approval of an NST strip since my last ultrasound. The new and inexperienced one keeps throwing things out about worrying about size with increasing frequency. Tomorrow is my next BPP and growth estimate and I'm supposed to see my preferred OB. I'm hoping we can get some of this out in the open then. I also have a doula and have read pretty extensively, so I'm feeling pretty prepared for a natural childbirth as long as the inexperienced doc doesn't interfere too much! I'm guessing in a few weeks I'm going to feel just the same as you. I'd really like to push it to 41 weeks, then I wonder if I'm being irresponsible. I've already bought my EPO and plan on starting it next weekend at 36 weeks. Maybe I'll take Maria's mom's advice and start talking with him about a timely appearance.

Mady, 9lb9oz on your back? Wow! That's my fear. That I won't be able to talk the hospital out of all the restrictive monitoring and such and I'll be stuck in an uncomfortable, unproductive position. I don't know why I'm so paranoid. One of the L&D nurses is also Type 1 with a pump. Plus the hospital supplies birthing balls and squatting bars in each and every room. I've really heard good things about them, but I just like to worry about all the possiblities before hand.

I'll check back in tomorrow after my appointment. We really do have a group due all at the same time!

Katherine


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## Think of Winter (Jun 10, 2004)

Thanks, Maria. My insulin sensitivity seems to have changed in the last 24 hrs. My basals are good, but my insulin:carb has changed significantly. I have an NST this morning, then I see the OB, so we'll see. Wish us luck. I'm hoping the insulin thing is another sign of early labor + being much more active than usual. I'd still love to let her come in her own time (with a little nudging from me.)


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## Think of Winter (Jun 10, 2004)

I saw my Ob this morning, and he thinks everything looks fine. He told us that all babies have to experience some degree of stress to begin the process of birth. He didn't think that my insulin needs dropping, which he agreed was a sign that the placenta is degrading, is a bad sign, just a sign that baby is getting closer. My nst was good, as was my fluid level. So I'm going to try to stay calm! Thank you for your prayers and good wishes.


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## ~pi (May 4, 2005)

Colleen, that's fantastic! Keep us posted ... I'm looking forward to reading your birth story.









I'm at 36 weeks today and had a BPP and growth estimate this morning and everything looks great. BPP was 8/8, no problems, and growth estimate is 78th percentile, which makes me very happy. I would absolutely argue with anyone who wanted to induce for size, but if I don't have to, that's much easier on me!

My insulin usage has stabilized again. I think I was just seeing a bit of a drop on days when I was especially active. I had a couple of less active days in a row and my TDD went most of the way back up, which is making everyone (including me!) relax a little.


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## txtarheel (May 27, 2006)

Colleen, I'm glad your OB will let you keep going past your due date. I tried to have that discussion with my yesterday and was pretty unsuccessful. I know I picked her because she was one of the few that would let me go that long, but I was hoping I could get a few more days out of her since things were going so well. I can't wait to read your birth story!

Maria, I'm glad things are going well for you as well. It's always a bit reassuring to have good test results.

I had my latest BPP and growth estimate yesterday as well (at 35w3d). The BPP was an 8/8 and I was glad to hear my fluid levels had evened out a bit. They had been on the high end of normal, but yesterday were smack in the middle of average. He's still estimated to be a big boy (about a month ahead of schedule) but must have dropped in the percentiles since last time. He'd put on less than a pound in three weeks according to the latest estimate. He'll still likely be a 9lb baby but I'm OK with that.

I also saw my preferred OB and she was not at all worried about size. She talked about scheduling my induction for the week before my due date and I tried to push it back some but wasn't very successful. I guess I'll let her know next time that she can schedule it whenever she wants, but I won't be showing up until June 30 at the earliest.

He hasn't started to drop yet and my cervix has done squat at this point. So I'll start taking evening primrose oil this weekend. Hopefully that a few weeks of that plus a lot of walking will make an induction more likely to succeed if it comes to that. Plus, the midwife that teaches our childbirth class taught us several good accupressure points that can bring on labor with good success. I'm thinking I'll be using those once I hit 39 weeks.

That's all for now,
Katherine


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## Think of Winter (Jun 10, 2004)

Maria,
I'm glad you're not as concerned about your insulin needs. Funny, our baby was 80th %ile for wt at my last growth scan, too. Not that I believe those things...

Katherine,
I think that's great that you're going to try to get things going a bit before a medical induction. How far along are you? Have you also looked into the gentlest approaches to a hospital induction? Could you share your accupressure pts? I've been doing the between-my-thumb-and-pointer for a few days, but I can't find the one on the outside of my ankle.

Take care all.


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## txtarheel (May 27, 2006)

Colleen,

I know my OB's preferred method of starting an induction is amniotomy and then see how things progress. I'm not the biggest fan, but I'd rather that than starting out with a hard course of pitocin. I know if things don't progress fast enough with an amniotomy then the hospital will rush to intervene further due to the risk of infection. Past that as far as I know my OB will move on to pitocin to speed things along. Are there other medical options (besides cervadil (or cytotec which I will refuse)) to be aware of?

I looked at my handouts and they only mentioned the hand point. I know the MW demonstrated the ankle one last night. I'll ask again at our next class since I would like to know it as well. There was also a point between a couple of toes that she said would help.

Katerine


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## Think of Winter (Jun 10, 2004)

Katherine,
I have not done much research on induction beyond learning that mine could've gone a bit slower and gentler. I had cytotec, then rapidly increasing doses of pit, then a foley to manually open my cervix. But my cervix had no signs of being ready, and I don't think baby had even dropped. I guess if I had it to do again, I'd hope for a promising Bishop's score and start with low, repeated doses of pit. But I'd want to talk w/ my ob about it. In fact, I probably should have done that at my last appt.


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## hannahmom (Mar 5, 2004)

Hi Everyone!
Wow I can't believe how close some of you are to delivery! I cannot wait to read your birth stories and I wish you all peaceful, smooth, low-intervention births. Keep us (or me? Am I the last one due?) posted









I'm just about 27 weeks and have just hit the wacky insulin resistance stage. For the past week or so, it was just my AM numbers that were crazy. Now my 1 hr post meals have been slightly high. So I'm fiddling with insulin:carb ratios. My fasting seems to be holding steady so I haven't had to do anything to my basal rate which I'm so surprised about. However, I'm so newly diagnosed that I think I still have a few betas alive and kicking.

Can I just tell you that a big fat 60 carb bagel with cream cheese will be my first breakfast after I have this baby??









I'm in the middle of 24 hr urine test #2... FUN AND GAMES, right?! Especially at work... when I commute via train







I have a mw appt tomorrow and I think I start bi-weekly NSTs next week.

I haven't yet sorted out the pump v. drip issue yet. The peri who was supposed to do my fetal echo was out of town so a regular tech did it. So I didn't have a chance to talk to him. I know I have to get on the ball to sort this out - I'm passively agressively hoping I'll just go into labor before my edd and not have to worry about it.


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## Think of Winter (Jun 10, 2004)

Hi Mamas,

Just wanted to let you know that baby Clara was born Friday morning at 1:39, perfectly healthy! We were even able to leave the hospital a day early. I'm a bit tired and a bit sore, but really content with how things went and thrilled to have a happy, healthy baby girl. She was bigger than I'd expected, 8 lb 5 oz! Everything went great, and my doula, midwife, and the hospital were really wonderful about supporting our wishes for a natural birth.

I knew I was in labor by about 3:30 Thursday afternoon. Ctx got painful by about 7 pm, so I got in the tub for a while. That felt wonderful. We went to the hospital around 11:30, then I only had about 2 hrs there before baby was born. I'm glad I labored at home as long as possible, but the ride to the hospital wasn't much fun. We had efm for about a half hour when I first arrived at the hospital, but that was it. No iv or hep lock! No drugs except for lidocaine to repair my tears and some motrin and one dose of darvocet the next day. Second stage was harder than I'd hoped it would be. Somehow, I had another posterior baby, hence the tears. My midwife said that if I'd allowed her access to my perineum, they'd have been much less severe, but I felt like I couldn't control my response at that point and jumped away from her touch. I found it tough to change positions once I started pushing, so I wasn't able to use gravity to my advantage. But once she started to crown, she just came shooting out. No bruising, and minimal molding. Clara's bg just after birth was 72, and was in the 40s for the next 2 tests, but she never left me and did great with bfing. I don't think anyone even asked me what my bg was, except after I nearly passed out a couple of times from low iron. I'd been a bit anemic, and the birth made it worse.

We did collect cord blood. The cord stopped pulsing almost immediately, so she had to clamp and cut it within a couple of minutes of birth. Hope we made the right decision. But I figure if I'm going to have regrets, I'd prefer regretting spending the money rather than regretting not getting the stem cells. By the way, when I looked into donating, all the places I found listed maternal iddm as a reason why they wouldn't accept it.

One thing that surprised me was that my bg during labor and delivery, and for the next 24 hrs, was very different from my first birth. Last time, my total daily dose didn't go down prior to my induction, but then I needed no insulin once the induction was underway. I was low from about when the ctx started until days after the birth. This time, my tdd was around 70 u/d for my last trimester, and dropped to about 50 u/d during the last 4-5 days of my pregnancy and the day baby was born. The next day it was 40, then 30. My pre-preg tdd was about 20-25, so I'm nearly back to normal. And I was on the high side during labor, birth, and recovery. My bg got as high as 180 during labor, and climbed to nearly 300 within a few hours of birth. Stress hormones, maybe? Funny though, I didn't feel high at all. And this is after months of being so tight that 120 sometimes felt high.

Well, better get back to baby and ds1. Hope you are all well. Thank you for all your support, information, and well wishes. This board has been a godsend. Take care all.


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## hannahmom (Mar 5, 2004)

Congratulations Colleen!! And welcome baby Clara









It sounds like you had a much more peaceful experience than last time! I'm so glad to hear that you got the birth you wanted. I'm so envious and I hope that I'm able to pull together a team that is as respectful of my wishes. Thanks so much for sharing your birth plan and story.

Btw - I assume you pump, right? (since you mentioned no IV/heplock) Did you suspend it during labor? Or did your endo give you a temp basal to use? I'm sure my endo will give me more guidance shortly since I'm much further along but I'm curious as to what other people did or plan to do. I've heard a lot of people suspending their pumps - but then if the stress of delivery raises bs, then are they just giving corrections for that? Do any of you know what the range of bs was that your team was comfortable with before intervening with IV insulin?

Now I seem to be flat out hitting a resistance wall. I'm so paranoid about these highs (which aren't soooooo terrible but I've hit 145-180 at least once/day for the past week or so). I feel like I can't eat ANYTHING







: I have no more wiggle room if I miscalculate my carbs. I think pre-pg my ratio was 1:22, then it went to 1:10 in AM, 1:15 rest of the day, now I think I'm 1:10 all day and I have to be reeeeaaallly careful about what I eat for breakfast because if I eat anything over 30 grams of carb in the AM I spike. Of course this is a stage where I have the appetite of a teenage boy







so I have to eat two breakfasts. I think I have it all worked out but do you think it will effect my a1c a lot?

Want to hear something funny/gross? I had to do my 24 hr urine at work last week. Preggo-brain struck and I accidentally left my jug in the work fridge over the weekend!! ewwwwwwwwwwwwwwwwww It sucks that I have to do the test all over again - but the upside is that they gave me one of those hat things so now I don't have to 'hover'









I start bi-weekly nsts on monday... One is at my mw office and the other is at the sOB's office. It doesn't sound like I'll even be seeing him at all since my mw wants me to make a separate 'consultation' appt to discuss using my pump during labor/delivery. Makes it so easy (on my part) to continue to ignore the issue - I hate confrontation, even when it doesn't have to be negative!

Maria - are you next? How are you doing?


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## widemouthedfrog (Mar 9, 2006)

Yeah Clara and Colleen!














:









Hannahmom, I work p/t at a nature centre...you should see what we have in OUR fridge. I laugh when people ask me if they can store food for birthdays there....

Mommybear, how are you doing?


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## Think of Winter (Jun 10, 2004)

Quote:


Originally Posted by *hannahmom*
Btw - I assume you pump, right? (since you mentioned no IV/heplock) Did you suspend it during labor? Or did your endo give you a temp basal to use? I'm sure my endo will give me more guidance shortly since I'm much further along but I'm curious as to what other people did or plan to do. I've heard a lot of people suspending their pumps - but then if the stress of delivery raises bs, then are they just giving corrections for that? Do any of you know what the range of bs was that your team was comfortable with before intervening with IV insulin?

When I was induced, I started out dropping my basals, then ended up suspending, because my bg kept dropping. But I didn't even have to drop my basals with this birth. My guess is your endo will have to either be in contact with you, or you'll be doing your own adjustments during labor. My pump does basal adjustments as percentages, which is nice. As I start dropping (or rising), I can adjust by 10, 20, 30%, etc., until I level off. I was never given any kind of cutoffs for when hospital personel would take over my diabetes management. I made it pretty clear I'd be doing it myself, and they were so thrilled w/ how I managed during pg that they didn't question me. Sounds like you are doing equally well.


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## MommyBear (Dec 19, 2001)

Bleh.


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## ~pi (May 4, 2005)

Congratulations, Colleen!!!







: What a gorgeous name!

No time to update now, but everything is mostly OK. I'm getting some backpedaling from my endos and the neonatology team, which is annoying but manageable. Feeling great -- if somewhat huge! -- and the babe is squirming around as I type.

Rachel, I'm thinking about you.


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## ~pi (May 4, 2005)

My TDD is really looking like it's tanking. I'm pretty unhappy about it.

Cross-posting from my DDC:

Quote:


Originally Posted by *~pi*
I had a pre-e scare yesterday that meant some time in the hospital. Fortunately all the labwork came back normal, so I came home, but the symptoms (splitting headache, spiking BP) were a concern so I'm having regular checks now.

I'm also having some issues with my insulin needs. They are increasingly trending down, which is a pretty reliable sign that the placenta is not holding out. Not unexpected for me since I have had type 1 diabetes for 23 years, but not what I was hoping for. I'm giving it the weekend to collect more data, but if it's still looking like this when I hit 38 weeks on Tuesday, I will consent to an induction. It isn't at all what I want, but I know it would be the best, most rational decision according to the risk-benefit analysis.

I'm feeling a little bummed that it isn't looking too good for me on the letting-nature-takes-its-course front. I knew that I was at higher risk of all this stuff, but I was really hoping I would luck out and not have to deal with it!

Anyway, there has been a lot of







over the past couple of days, but I'm trying to get over myself and not be a suck about this, since I know there are lots of mamas who go through way more than this. (All our DDC moms on bedrest, for example!)

And who knows ... I've been sending vibes to the babe that s/he may need to come out soon, my MW has been doing some stretch & sweep, I'm on the EPO bandwagon, etc. so maybe I can still avoid a chemical induction. (Where did the fingers crossed smiley go?)


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## hannahmom (Mar 5, 2004)

Maria, have you seen this thread?

http://www.mothering.com/discussions...d.php?t=464575

Do I remember correctly that you are planning on hypnobirthing? I hope that helps too should it come to a chemical induction.

Keep us posted and take care of you


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## ~pi (May 4, 2005)

Thank you, Erica!! I hadn't seen it and it looks extremely useful. As much as I like to think I'm rational and informed, I have to admit I've kind of been doing the hands-over-ears, "La la la, I can't hear you," about induction. So I don't actually know that much about what might be involved.

Quote:


Originally Posted by *hannahmom*
Do I remember correctly that you are planning on hypnobirthing? I hope that helps too should it come to a chemical induction.

Yes, and it has come in handy lately! Obviously I have no idea how it will go in labour, but it's been very useful so far to help me relax and calm down when I'm upset and/or stressed.


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## widemouthedfrog (Mar 9, 2006)

Hi Maria,

The same thing happened to me - a downward trend for a couple of weeks, actually, which then partially resolved itself. But dd was born 2.5 weeks early, naturally. Perhaps it is an indication that babe is simply ready to be born a little early? Fingers crossed for you. In my case, I was on bed rest from week 35 on, since my job involved a lot of walking (hiking, actually) and I was - ahem - dilated rather more than the OB wanted to see.

My fingers crossed that you're able to skip the induction bit, or if it does happen, that you work through it with minimal interference...


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## Think of Winter (Jun 10, 2004)

Hi Maria,
I'm sorry to hear that you may be facing an induction. But I'm sure that you'll make the right decision as to whether to go the medical induction route or wait. Go with your instincts on this. I'm praying for you that baby is ready and that's why your body's doing what it's doing. I'd been having early labor signs for about a week before Clara was born, and the day before I kinda just went with it instead of lying down, resting, and hoping it wasn't really time yet. I did a lot of walking, I used the accupressure points on my hands, and I told baby over and over that we're ready and want to see her. Try to keep relaxing as much as possible. We'll all be thinking of you and wishing you a safe, beautiful birth.
Colleen


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## ~pi (May 4, 2005)

Thanks for the encouragement, everyone! I have a happy update.









My TDD started to creep back up over the weekend and my BP went back down to normal. Babe got 8/8 on the BPP this morning and then I saw my peri, who was not too concerned about the BP scare and is still happy to go to term (two more weeks.) The endo may still freak out tomorrow over the insulin/BP combo, but I feel a lot better about pushing back given the latest data. So it looks like I may have a little breathing room!







:

I did a bunch of work over the weekend on either crossing things off the To Do list or letting them go, so now I actually feel ready for the babe to come anytime. A woman on my DDC graciously gave me a Hypnobabies script, "Come Out, Baby," which DH has been reading to me.

I met with the midwifery clinic's N.D., who set me up with some homeopathics and did a few sessions of acupuncture. Between that, the stretch & sweep, and my own susceptibility to suggestion, I am pretty sure I lost my mucous plug over the weekend, and I have been having very mild, regular-ish contractions yesterday and today.

So the clock is still ticking, but I am more and more hopeful that the babe and I can beat it.


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## Think of Winter (Jun 10, 2004)

Hey Maria, How are things?


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## ~pi (May 4, 2005)

Things are OK, thanks. Still no babe, but still 11 days on the clock, too. I have a good feeling about Tuesday/Wednesday for some reason. (Although possibly because those are the dates I picked on the calendar way at the beginning of the pregnancy.)

I'm continuing to do a bunch of encouraging of the babe in various ways. S/he had another 8/8 BPP this morning, and my insulin needs seem pretty stable. My cervix is apparently quite soft, and I'm about 50% effaced, so that's a good sign, I think. I am planning to spend the weekend not stressing about it at all.









How is everything going with your new little one?


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## hannahmom (Mar 5, 2004)

~pi glad to hear things have calmed down and that your body is getting prepared. Sending you relaxing, come out soon baby vibes









I have a happy update also - the backup sOB agreed to let me use my pump during labor!!! The mw I love did end up talking to him about it - I think she felt bad because I was crying at my last appt. I just get really overwhelmed with the medical intensity of this pregnancy sometimes - the bi-weekly nst + afi, monthly growth scan, monthly endo appt... and so on.


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## ~pi (May 4, 2005)

Quote:


Originally Posted by *hannahmom*
I have a happy update also - the backup sOB agreed to let me use my pump during labor!!! The mw I love did end up talking to him about it - I think she felt bad because I was crying at my last appt.

EJ, that's fantastic!! Way to go for continuing to go for something that's important to you!









Quote:


Originally Posted by *hannahmom*
I just get really overwhelmed with the medical intensity of this pregnancy sometimes - the bi-weekly nst + afi, monthly growth scan, monthly endo appt... and so on.

Oh, I so hear you. (And I'm jealous ... you only have monthly endo appointments? Mine started out at twice a week and are now once a week. Ugh.)


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## ~pi (May 4, 2005)

Well, the Tuesday/Wednesday didn't happen, obviously. I am somewhere between 50-70% effaced (depending on which MW I ask), 1-2 cm dilated and the babe was at station -1 although s/he seems to have moved up a little again, judging by how little breathing space I have.

I'm really feeling the pressure right now, and it's really getting to me that I feel great, I'm happy to be pregnant, and if it weren't for the







type 1, I'd be more than happy to carry the babe for as long as s/he wants. I'm doing so much stuff to try to nudge my body into labour, and I just feel so badly about it.


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## widemouthedfrog (Mar 9, 2006)

Maria,
Wow, I must have missed a reminder around here.
Glad to hear that you're still goin' - I guess!
Sending you














:







: for the


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## hannahmom (Mar 5, 2004)

Maria - how frustrating to be 'on the clock' with a first baby since they often do take their precious time coming









Are you past your edd now? How much longer will they wait?

I know it's probably the last thing you want to hear, but it's very encouraging that you are effaced and dilated - should it come to a chemical induction perhaps something less harsh like cervadil will do the trick just fine without further, harsher intervention.








Sending you 'come out baby' and peaceful birthing vibes. Keep us posted...


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## Think of Winter (Jun 10, 2004)

Hi Maria,

Hang in there. You are doing so great keeping yourself and your baby healthy. Try not to worry, and don't feel bad. Remind yourself that you've done everything you can, you have a great medical team, and that baby is doing just fine. Whatever your birth experience, it will be the best one possible for you and baby. Sending prayers for a gentle birth.

By the way, I can't remember where I read this recently (maybe here), but in case you haven't heard about this...Bathing newborns can lower their blood sugar since it takes a lot of energy for them to warm up again. Another good reason to postpone it.

xo, Colleen


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## widemouthedfrog (Mar 9, 2006)

A cheer for Maria:
Go baby,







go baby,







go, go, go baby







!













































:







:































































:







:


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## ~pi (May 4, 2005)

Thanks, all, I will definitely keep you posted.

Tricia, that made me smile. Thanks!







.


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## Think of Winter (Jun 10, 2004)

So how is everyone doing? Anything new, Maria? How are you feeling Rachel? Katherine?

Life with baby is wonderful. So far, I've only had a couple of rough nights. Last night was the first time we had a lot of unexplained crying, but then when she finally settled around 11, she slept through til 4:30. Dd is such a different baby than ds was. Actually, she's been sleeping so much that I'm tempted to weigh her again. But on the other hand, I think I did best with ds when I relaxed and let him set his own schedule, and trusted that he'd eat when he was hungry and sleep when he was tired.

I had been hoping not to worry about dd getting diabetes, but I've already tested her blood sugar (after a day of lots of sleeping and not much eating). I'd sure love to just forget that there's a chance that she'll get it, too, and not reach for the meter every time she sleeps, eats, pees, or cries a little more than it seems like she should.

Take care everyone.


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## MommyBear (Dec 19, 2001)

I've been battling strep throat and feeling horrible. Sugars still screwed up, as is my thyroid. No money so we can't pay bills but that isn't diabetes or health related. Met with the superintendent of DS1's school today, it didn't go as planned. Blerg.


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## julie128 (Jan 9, 2003)

I hope I'm not diabetic. I never noticed this thread before, but it's very apt today.

My mother is diabetic, and she was here watching the kids today. Before she left, she took her blood sugar to see if she should eat before she left. On a whim, I test mine, too. It was 79. This was a few hours after a lunch of turkey sandwich and a nectarine. Should I be worried? We just started ttc, should we wait until after I talk with my doctor?


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## txtarheel (May 27, 2006)

I think I read too many different boards!

I'm still around and preggo. I've got an induction scheduled for Monday of next week. I'm excited that I managed to get a couple extra days (that puts me at 40w2d). It was cool of my OB to do that. Her reasoning was that my Bishop's score was so crappy that my chance of an induction failing earlier was too great. Since the practice really doesn't like to induce or perform C-sections she felt giving me a few extra days was the best choice. Even given that Batboy is estimated to be in the >90th% range. But my BP, NSTs, fluid levels and placenta all seem to be doing well, so there doesn't seem to be much extra risk.

I've been having what I assumed is pre-labor or early labor for a couple of weeks. I've been having a lot of frequent contractions that don't quit from either water or changing my activity. But, they only managed to dilate me to about 1 cm and my cervix is still high and not at all effaced. I've had two days of acupuncture treatment. Tonight I've been having some sit up and take notice contractions, so I'm hoping that's helping. I've got one more acupuncture adventure tomorrow and I'm thinking I'll spend a lot of time walking the mall. We're gonna go and try to get the logistics of sex worked out shortly and see if that moves things along.

I feel like an induction would work well at this point, but I really want the chance to labor at home for as long as possible, off the hospital's time clock. I'm sure you guys understand!

I'll take all the labor vibes you want to send me!


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## Think of Winter (Jun 10, 2004)

Quote:


Originally Posted by *julie128*
I hope I'm not diabetic. I never noticed this thread before, but it's very apt today.

My mother is diabetic, and she was here watching the kids today. Before she left, she took her blood sugar to see if she should eat before she left. On a whim, I test mine, too. It was 79. This was a few hours after a lunch of turkey sandwich and a nectarine. Should I be worried? We just started ttc, should we wait until after I talk with my doctor?

79 is well w/in the normal range.


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## julie128 (Jan 9, 2003)

Quote:


Originally Posted by *colleen95*
79 is well w/in the normal range.

My mother said the normal range is 95 to 130. What's a good website where I can research this? Thanks.


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## widemouthedfrog (Mar 9, 2006)

Hi there,

If you're concerned about your blood sugar being too low, look up hypoglycemia. But that number is fine, honest: I'd feel great with it! You can look at the Diabetes association - they might have range info. Don't have it on hand at the moment.

Your mom might be referring to "normal for diabetics". We have to work to keep our blood sugar within a certain target range. Usually our target is a bit higher than the average person, so that we don't accidentally give ourselves too much insulin and then end up with seriously low blood sugar (like, 30s or 40s).

Colleen: I hear you with the worry. We tried to do dd's blood sample for Trialnet, and she has small veins, so it didn't work. How did you manage it? I check her blood sugar too. Do you know what is normal for a small child - the same as an adult? Hard to find a time when she is "fasting" since she is an all night nurser...

On a lighter note, does anyone know if there are toy meters and lancing devices out there? Dd loves mine and likes to play with the lancing device. Odd kid. Maybe I will just get her one. Hopefully she will never need a real one. I guess she is fascinated with anything mommy has. She likes the pump, too, but I don't let her play with that!

Rachel, sorry to hear of your strep - ick!


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## MommyBear (Dec 19, 2001)

Quote:


Originally Posted by *widemouthedfrog*
On a lighter note, does anyone know if there are toy meters and lancing devices out there? Dd loves mine and likes to play with the lancing device. Odd kid. Maybe I will just get her one. Hopefully she will never need a real one. I guess she is fascinated with anything mommy has. She likes the pump, too, but I don't let her play with that!

My oldest son used to beg me to test his bloodsugar. DS2 has never liked it much because I test him fairly frequently (he dehydrates easily and when he's making up for it I always get worried about him drinking a ton). DS3 likest to play with my pump and I sometimes let him since there isn't much he can do without me knowing.


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## Think of Winter (Jun 10, 2004)

Quote:


Originally Posted by *widemouthedfrog*
Colleen: I hear you with the worry. We tried to do dd's blood sample for Trialnet, and she has small veins, so it didn't work. How did you manage it? I check her blood sugar too. Do you know what is normal for a small child - the same as an adult? Hard to find a time when she is "fasting" since she is an all night nurser...

When ds was in the trigr study, our coordinator called around to find a lab and phlebotomist who was especially good with babies. And she is great. We all go to her now. She could draw ds's blood at 3 mos. Is your dd drinking water yet? It helps to get them well hydrated first. The only time we couldn't get a sample from ds was when he was dehydrated. We also use a topical anaesthetic on his arm first, and that helps with pain. Your ped could prescribe one for you. As far as I know, children's bg is similar to ours. I guess it would get my attention if it ran over 125-130 more than once.

Quote:


Originally Posted by *widemouthedfrog*
On a lighter note, does anyone know if there are toy meters and lancing devices out there? Dd loves mine and likes to play with the lancing device. Odd kid. Maybe I will just get her one. Hopefully she will never need a real one. I guess she is fascinated with anything mommy has. She likes the pump, too, but I don't let her play with that!

Do you have an old one that could be all hers? I let ds play with our meters and pumps. He likes to pretend to give himself insulin and check his bg.


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## hannahmom (Mar 5, 2004)

Tricia what about this guy? http://www.fifty50pharmacy.com/index...r/PUMPERNICKEL

He doesn't have a meter or lancing device but he's got a pump and a 'nifty' fanny pack


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## widemouthedfrog (Mar 9, 2006)

Awww, that's a cute little monkey. Maybe next year, when she's more into dolls, I will get her one. She currently enjoys pushing buttons, so I figure hands off the pump for now. However, perhaps I will find an old lancing device and sacrifice an old meter to the cause....

Yeah, dd's blood sugar has been in the 100-115 range. I don't test it often, and I know breastmilk is likely higher glycemic, though I guess it is fairly fatty too. And she always has some of that in her.

We now have that numbing stuff. She drinks some water, but I will also nurse first. I hadn't looked at her veins before, but she really doesn't have obvious veins, so I think that is a bit of an issue! I, on the other hand, have lovely ones, just right for blood tests...


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## ~pi (May 4, 2005)

Life has been a little crazy, but I have a minute now so wanted to let you all know that I had a boy, 9 lbs 4 oz., on June 29 via emergency C-section. I was induced on June 27 at 40w.

The birth experience had pretty much everything that I didn't want, but I really feel like I gave it my absolute level best and just had a few too many things not go my way. Everyone at the hospital was very respectful of my wishes and preferences, but after all my hopes that my body was ready to go, it just wasn't. I ended up with a raging infection and fever of 104, never got past 6 cm, and then finally after a lot of DS not looking too good but holding off from doing anything because the tests were conflicting, he had a very obvious decel following a contraction, and we were off for an emergency C.

My sugars were great throughout the labour, controlled by me and DH. When it came time for the C-section, the endocrinologist on call, who I previously disliked and now actively loathe, ordered an IV drip instead, turned the insulin up too high, I crashed, and then they brought me up way too high. When the baby was born, he was covered in meconium, so I got to hold him for about 30 seconds and then he went off the NICU right away, where they tested his sugar and found that it was 25. It was stable after they treated that, but he still spent the first 1.5 days of his life in the NICU. I wasn't allowed to go down for the first 12 hours, although I did get to see him briefly when the nurses wheeling me from surgery to recovery very kindly took me to the NICU for a few minutes first.

DH was with him from birth and they fed him the colostrum that I had been pumping ahead of time, which makes me cry every time I think about it. (They were so careful about that -- labeled the container, made sure it went with him, etc.) Unfortunately for us, after that, they plied him with formula like there was no tomorrow, so we struggled a lot to get breastfeeding going, but thanks to my MWs and the hospital breastfeeding clinic, I think we have really turned the corner (touch wood). We just had our first 24 hour period with no supplementation at all. Especially since the birth was so hard on him, it means so much to me to be able to nurse him.









He is gorgeous, and I am tired, but happy.


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## Think of Winter (Jun 10, 2004)

Congratulations on the birth of your beautiful son! We've been waiting to hear from you. I'm sorry you had a difficult birth, but you're so right that you did your best, and not everything can be in our control. Best wishes with breastfeeding. I'm sure things will get easier every day. Take care and enjoy your baby. xoxo, Colleen


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## widemouthedfrog (Mar 9, 2006)

Congratulations, Maria! What a beautiful boy....

We also had trouble breastfeeding at the beginning, for the same reason - after a number of difficult weeks, it did get better. Remember that you're both learning!

I am sorry to hear that the birth didn't work out as planned, but I'm glad to hear that your son is healthy. Since Lauren was born, I've been so glad that the majority of my parenting decisions are no longer influenced by the fact that I have diabetes. It's a factor, but not the deciding one.


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## ~pi (May 4, 2005)

Thanks, Colleen and Tricia. Bfing is definitely going well now ... little man loves to nurse! Last time we checked, he was gaining an average of 31 g (about 1 oz) a day, which makes me feel really good. I've been adjusting my basals lower and lower because lactating is taking so much energy! It's slightly weird to be back down to pre-pg TDD or lower.

Katherine, how are things?

Erica, how is the home stretch going?

Rachel, how are you?


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## hannahmom (Mar 5, 2004)

Maria congratulations!!! He _*is*_ gorgeous!! (Ya know I replied to this thread a few days ago and it's missing - and my post count is different too - verrrrrry strange) Anyway I'm so sorry things didn't go the way you had hoped. Take care of yourself - I had a traumatic birth with #1 (not a c-sec but a really tough induction) and it took a long time for me to get past it. I'm glad to hear that he is nursing like a champ now too.

Things here are good - I'm 33 weeks and have those good ol' biweekly nsts. But baby is head down (yay) and likely to stay that way. AF level is good. I'm still needing to adjust my insulin almost daily which is frustrating but just part of the deal I suppose... Not much excitement yet - which is good!


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## ~pi (May 4, 2005)

Just checking in ... how are things, EJ? Everyone else? Katherine, did you have your babe?

Life is good here ... I seem to have finally got my basals and ratios set properly for bfing and am no longer having so many lows.

I'm finding it challenging to keep on top of testing, changing my set, etc. while caring for DS. I was absentminded enough before he arrived!









Hope everyone is well!


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## kpt (Aug 6, 2006)

Hello my name is nick and i am a DH. my wife has type 1 diabetes and i am doing a major "screening" of info reguarding birth and how we can have a natural homebirth. there is so much negative nfo out there that neither one of us want her filled with that energy. any information would be great at this point. we are due somewhere in march and obviously are only about a month and a half in. i have spent the last few hours reading all your posts and i truly appreciate everything that you all are doing. rachel and i are very excited to be bringing in a ball of light into this world and now is just the how that is the process. we are currently in cali and will be moving to michigan soon for a better and more stable birthing environment.


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## Think of Winter (Jun 10, 2004)

Welcome Nick!
What a wonderfully supportive dh you are! Welcome, and best wishes for finding the path to the birth you choose.


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## widemouthedfrog (Mar 9, 2006)

Hi Nick, welcome!
Unfortunately I don't have too much to say on the topic of starting out a pregnancy with diabetes, since I was diagnosed on week 28.

However, from the sounds of it, finding a good health care team who is responsive to your needs and willing to discuss options is key - isn't it always!

And I do have tips for dealing with newborns /babywearing/cosleeping and being diabetic!

You might check out the TRIGR study for formula, should it come to that at the hospital. And I think that Maria pumped prior to birth for her little one.


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## palmgal (Mar 7, 2004)

Hi everyone








I am so glad to find you guys. My name is Courtney and I have 2 little kiddos a little girl who is 3 and a little boy who is 5 months. I was recently diagnosed with type 1 diabetes. I have been in the diabetes prevention trial, now trialnet and have been high risk with 3 positive antibodies for almost 5 years now.

DD was born at the hospital via a drug-free fairly unintrusive labor. She had a pretty severe shoulder dystocia and so her head was delivered and the emergency lights were blaring and drs running in. My OB reached in, broke her collar bone and pulled her out. She had an APGAR of 1, and 8 so she was in distress, but recovered nicely. I was not diabetic for this pregnancy.

I was diagnosed with gestational diabetes at 9 weeks with DS. Since it looked more like preexisting diabetes I was placed with the high-risk group. This pregnancy and birth were very different than the first. I was on glyburide for a while, and then switched to insulin. Drs sort of bullied me into a planned section, due to diabetes, previous dystocia, and u/s reports that the baby was large. DS was born by section at 38 weeks and was 8 lbs 7 oz.

Right after delivery my sugars were normal for almost 4 weeks. It was heaven







then, they started to creep back up. 7 weeks pp I failed 2 oral glucose tests and was positive for 3 auto-antibodies. I went back on insulin a few weeks later.

DS is genetically high risk as discovered in the TEDDY study. DD was never tested but now will be enrolled in TrialNet and PANDA at DS's next TEDDY appointment.

I see an endo for the first time in a few weeks, hopefully will get me back on track, my sugars have been pretty crappy for the last few weeks.

I am so glad to "meet" you all!
-Courtney


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## widemouthedfrog (Mar 9, 2006)

Hi Courteney,
Your experience sounds similar to my own, except that I was dxd at 28 weeks, and my sugars never did go down afterwards (drat!).

I'm curious about those other 2 studies. Dd has teeny veins, so we're still waiting to do the trialnet blood sample. Do you have links to the others?

Thanks!
Tricia


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## palmgal (Mar 7, 2004)

http://www.ufdiabetes.org/research_TEDDY.asp
this is the link to the TEDDY study, but baby has to be enrolled before his or her 4th month.
http://www.ufdiabetes.org/research_PANDA.asp
here is the PANDA study

I know what you mean about tiny veins, I had to leave the room when they were trying to get a vein from my 2 month old.

I am sorry your sugars never went back after pregnancy. I did have a few weeks where blessidly I was not worried everytime I put anything in my mouth. One of my good friends baked me a chocolate cake I had my section 3 days before my 30th birthday) and delivered it to me when I was in recovery







They wouldn't let me eat it for the 1st 24 hours but I pigged out after that









Speaking of sweets she threw a baby shower for me and ordered this low carb no sugar cheesecake only 3.2 carbs per serving:
http://www.juniorscheesecake.com/store/index.asp
it was soooooo good.

-Courtney


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## ~pi (May 4, 2005)

Hi Courtney,

Nice to "meet" you. Sorry about your dx. It must be challenging to deal with the diagnosis and getting your sugars level while caring for a toddler and baby!







: Good luck with the endo appointment ... are you looking into pumps or do you plan to stay on shots for a while?


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## palmgal (Mar 7, 2004)

It is difficult to deal with learning with kids, because they want to snack or eat and then so do I







, or more commonly I forget to eat because I am so busy with them.

I want to go on the pump, but not until I have "real" insurance. I am still a student so I have crappy student insurance. I pay for all my meds and tests strips out of pocket








-Courtney


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## ~pi (May 4, 2005)

So how's everyone doing?

I'm adjusting to motherhood. Every so often I have a low and it's a little tricky to deal with with DS. I'm trying to stay much more on top of my BGs, but my fear of lows is leaving me with more highs than usual.

Erica, what's up? How did the birth go?


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## hannahmom (Mar 5, 2004)

Hi everyone,

We had a baby girl on 8/30! 8 lbs 13 oz (smaller than dd #1 who was 9lbs 1 oz BEFORE I even had diabetes), 20.5 inches

The birth was really amazing. Unfortunately I was induced on my due date because the backup OB for my mw's would NOT let me go overdue. I tried to have my membranes stripped ahead of time but I was barely dialated (although 80% effaced) so nothing really happened except some cramping and spotting.

I went to the hospital at 7 am and was started on pitocin around 8:15. My mw was really gentle and gradual with it. I wasn't really needing to work through my contrax until around 1 pm. I sat on the birth ball the whole time since I was strapped to an IV pole and monitors







But I think that really helped me get through everything. Dh held a hot pack to my back during each ctrx and I was able to work through them.

Around 4:30 I was in a LOT of pain so my mw checked me. I was only 6 cm - so I asked for an epidural thinking I had so much work ahead and if I was having that much trouble coping already... I had a total of 2 more contrax, the anesthesiologist was looking at my back and I had a MAJOR contraction. The nurse asked if I was pushing (I didn't know!) so they checked me and I was complete! So I never had the epi - whoo hoo! I only pushed 3 times and baby was born









I nursed right away - baby's bs was 43 and never dropped







She's nursing like a champ.

It's amazing how little insulin I need now though. My insulin:carb ratio went from 1:5 to 1:30









How is everyone else?


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## palmgal (Mar 7, 2004)

I guess I am doing ok. Things seem to be going well and then bam I get an unexpected low, or worse I get high and can't seem to get it down. my ratio is 1:30 and I don't adjust yet for snacks so if I get high I stay that way until my next shot, unless I can get out and walk. I get really cranky when I am high or low, I totally pick fights with my DH, it is awful. Often times I get midway through an angry rant and realize it might be my sugar and go check. Couple that with lack of sleep since DS nurses all night and I am a very pleasant combo of hormones and wacky sugars.

-Courtney


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## widemouthedfrog (Mar 9, 2006)

*hannahmom* - congrats! It sounds like things went well, considering the circumstances.

*Courtney*, I get the same way when I'm high. Even modestly high will put me in a cranky, cranky mood. I only realized it after I would blow up when I was trying to put dd down for a nap early on...and when it wasn't going well, I'd flip out. If dh was around, he'd try to calm me down and I'd end up telling him where to go.

Now, I am generally a very calm person - a tad dramatic at times, but nothing like the above. So blood sugar really does impact my mood. I "cured" myself by eating REALLY low-glycemic foods for breakfast, so that I wouldn't go high at 2 hours. And when I get snappish, I check my blood sugar.

On another note, I just got a new endo - the old one was stuck on the idea that I could get along fine w/o insulin. Not. So I go to the new one, he looks at my antibody test results, and says - "So you're Type 1". Yay. I like him already!

Although he did ask why I eat so much - my answer was that I am really active (hike/bike every day) and that I'm nursing. He was floored, and said, "That's weird". Dd's only 15 months, come on! Anyway, I informed him that the WHO recommends nursing until at least 2. I think that it is my mission in life to educate health professionals.









We can't really afford it, but I am considering a CGMS (continuous glucose monitoring system). Apparently the sensors can be used a lot longer than they say, with no ill effects. We'll see.


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## g.r.i.t.s (May 19, 2006)

Hey gals I have a quick question..When I went to the doc this last week...he told me that I had crossed the boderline of diab. He said with my sugar level I could control with diet and exercise...any helpful hints?


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## palmgal (Mar 7, 2004)

Hannamom I am so jealous that you had a vaginal birth. My first was vaginal, and medication free but DD had a pretty severe shoulder dystocia, and the cord wa caught by her shoulder. I delivered her head and her heartrate dropped with every contraction. The Dr. had to reach in and break her collarbone and pull her out. Even with that intervention her APGAR was only 1. No lasting damage thank goodness, but scary nonetheless. I did not have diabetes with her. This pregnancy I felt pressured into the c-section, I was with the high risk practice and they felt with the diabetes, with the history of dystocia and the fact this baby was a boy (they said boys often have wider shoulders) that a section was the way to go. I am still sad, and wished I was more proactive









widemouthedfrog, the anger I feel when high or low surprises me. My sister is also a type 1, although she has had it for 10 yrs. She is really often out of control, she also has an eating disorder (diabulemia) where she will stop taking her insulin for periods of time. She is often very difficult to be around, moody angry. Now I know why. I feel like I am turning into her (when she is not in control, she is a great person when she feels well) and that I am pushing people away with my anger and crankyness. Regarding the nursing, when I was first diagnosed they asked me to enter a research study of the use of general T-cell immunosuppressants to prolong the honeymoon phase. They would have covered all treatment, all supplies and a pump if I wanted it (which would have been great since my insurance maxes out at 600 dollars per year for prescriptions), plus travel. However, the drug is not approved for nursing and I refused to stop nursing (DS was only 3 months at the time) I was getting all sorts of guilt to do what was best for me and stop nursing. They kept asking how long I was planning on nursing and I keep repeating that I nursed DD past 2 years. They seem absolutly shocked to hear this.

g.r.i.t.s Hmm during pregnancy I was on a very strict diet even on insulin. Some of my favorite foods were light Thomas' english muffins an egg and a piece of cheese. The light muffins have a lot of fiber and didn't effect my sugars as rapidly. I ate a lot of almonds, drank a lot of water and walked everywhere I could. I hope that you are able to regulate you sugars!

-Courtney


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## widemouthedfrog (Mar 9, 2006)

Courtney - yes, I know - I wanted to go into some of those studies too, but couldn't. I got the same reaction from the previous endo - "you're not going to be nursing that long, are you?"

grits - I find that low-glycemic foods (look up low-GI) work well for me. And lots of green veggies, of course. And a more low-carb protein. In some ways, it's easier to deal with the "hard" foods when you're on insulin - things like potatoes, corn, and wheat all are higher glycemic and all make my blood sugar spike. So I tend to avoid them. And I am VERY sensitive to things in the morning, so I have a pretty rigid morning meal regime (for the reasons I mentioned above). Steel cut oats, buckwheat, soy dogs, yogurt.

Low glycemic foods may have the same amount of carbohydrates as high glycemic foods (like yam is the same as potato), but they have a greater immediate impact on your blood sugar. For example, potato makes my blood sugar go WAY up at 1 hour, while yam does not. It's slow and steady. Low GI foods may also have a lower overall impact on your blood sugar - for example, when I eat steel cut oats I only need 1/2 as much insulin as I would normally take for that # of carbs.

My dad just got diagnosed with pre-diabetes/diabetes (onthe threashold) 6 weeks ago. He's switched to a lower-carb and low-GI diet and has lost weight, his fasting blood sugar has gone down, and he says he feels great. Of course, he is also active. He also takes a walk after dinner (this helps fasting blood sugar).

Hope that helps.


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## g.r.i.t.s (May 19, 2006)

thanks for the help ladies.


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## ~pi (May 4, 2005)

Erica, congratulations!!!







: Sounds like a great birth!







What ended up happening with the pump wearing argument?

Courtney, I get cranky when I'm high sometimes, too. If you don't mind my asking, why are you not correcting for highs with a shot? And sorry to hear about your insurance. I'm a grad student and was in a similar position; fortunately after a lot of arguing I managed to get my insurance to cover $4000 of the $6000 for a pump.

Tricia, way to go with your new endo!









ETA: I just realized that I never mentioned it here ... we were happy to find out soon after DS' birth that he does not qualify for TRIGR.


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## palmgal (Mar 7, 2004)

pi, I have no idea now why I am not correcting with a shot, the endo just never mentioned it. I am not adding on corrective units before a meal either if I am high. They caught this REALLY early though, so I am still in my honeymoon and have pretty high residual insulin function. I have a real job lines up in March, with good benefits. I will think about switching to a pump then, and I am excited about it. Which study is TRIGER? DS (6 mo.) is in TEDDY (testing environmental determinants for those high risk) and found to be high risk and DD (3) was just tested for entrance into PANDA (Genetic test done for newborns and infants) and the Natural history study (she could enroll since I have type 1).

-Courtney


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## ~pi (May 4, 2005)

Oh, that makes sense if you're still in your honeymoon.

As an aside, I hate that term. It's actually one of the toughest times in terms of glycemic control -- that doesn't say "happy vacation" to me.







: I think it's easier when you have no more insulin production and everything becomes more predictable.

Great to hear about the coverage starting in March!


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## ~pi (May 4, 2005)

We were unsure about cosleeping prior to DS' birth, but are big fans now that he's here. He naps in a sling or the Amby and occasionally starts the night in the Amby if he's really sleeping hard, but most of the time he's snuggled between me and DH.

I've had a few unusual nighttime highs and lows recently, which make me sleep harder than normal. A couple of times, I woke up with DS snuggled in the crook of my arm, nursing away, and I have no recollection of putting him there. (DH didn't put him there either, and he isn't getting there on his own.)

Once, I awoke and couldn't find DS ... I had fallen asleep nursing him and I guess once he was done, I moved out aside, put him down on his back on the other side and placed a firm body pillow as a barrier at the edge of the bed just in case.

I'm a little freaked out by all this. I'm starting to come around to the idea that I pretty much know where he is and am taking care of him in my sleep, but it's unsettling that I can't remember doing this. Anyone else have similar experiences, or are you always conscious of your actions regardless of sugars?

(I may x-post this in the Family Bed forum)


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## widemouthedfrog (Mar 9, 2006)

Maria,
One of the reasons I am thinking of getting a CGMS is that I woke at 2.2 (40s) the other night. That scared the @!*% out of me. I've retested my basals and cut back on them, but when Lauren does an all-night nurse-a-thon, I have the feeling that impacts me. And also the phases of the moon, of course. I don't want to NOT wake up - let's put it that way. I was totally conscious of what I was doing, but inwardly I was just quaking and thinking "what if".

Ok, that isn't exactly encouraging. I know I had a lot of lows initially when dd was nursing a lot at night. Now it's just sometimes. I don't sleep better or worse when low or high - I just get sweaty.

I think that your not remembering may also just be exhaustion. I get sleepy and I nurse reflexively and barely wake. A friend of mine (non-diabetic) accidentally placed her baby under the bed, and woke to a "lost" baby. The baby was fine.


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## ~pi (May 4, 2005)

Hey all, long time no chat! I'm just bumping this to say hello and because I'm going to send a link to someone. I'm also adding a couple of new links to the resources post.

How is everyone doing?

DS is nearly 7 months and is a total blast. These days, he loves to sit, grab at things around him, and put them in his mouth. He is a nursing monster and co-sleeping is going great, although he's been nursing a lot at night so I keep having to lower my nighttime basals. I'm at less than half of my pre-pg rates right now.

DS started showing all the signs of solids readiness about a month ago, so after some procrastinating, we finally started with some avocado last week. It was a huge hit, although he may have been more excited about the fact that we handed him a spoon than the fact that there was some mushy green stuff on it.









I continued to have a really hard time dealing with his birth for a while, but did a lot of work on that and came to terms with a lot of things. I feel much more at peace now. I finally wrote and posted his birth story last month and am continuing to work on getting some answers, apologies, and changes implemented at the hospital.

How are you and your small one(s)?


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## widemouthedfrog (Mar 9, 2006)

Hi Maria,
We're all doing fine here!

I read your birth story - my goodness.
The feeling of "brokenness" is one of the reasons I'm considering only having one biological child. I am not fond of thinking of my body as something that does not work.

I got the minimed CGMS in November, using it part time now. I enjoy seeing the numbers, but it's pretty expensive and for me, it takes ~24 hours to become accurate. Also, it is hard to find new real estate when looking for both pump and sensor sites. I find that having a toddler jumping all over me, slinging, and nursing makes it hard to find an area of my body that is not being constantly knocked around.

Have fun with the solids! Dd didn't eat much until ~9 months, but she sure loved that spoon - ramming it in and out of her mouth, that is. She loves avocado too.


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## JanB (Mar 4, 2004)

Hi everybody,

I'm not type 1, but can I play here too? I'm a type 2 diabetic who is controlling with an insulin pump by choice -- and boy, if you don't think that raised some eyebrows over at my endocrinologist's office... During my last pregnancy, my OB/GYN in Seattle recommended me as a good candidate for pump therapy, so I went ahead and started it, and loved it. Since I had the pump anyway and was familiar with insulin therapy, I went back on it when I started TTC'ing this one. Everyone at the endo's office was almost in shock. I remember being gently told several times, "You know there are oral medications... right?"

But my feeling was that while the oral meds, particularly metformin, are widely used now, there's still not been a major study indicating their safety, and why go with the unknown when I can go with the known? Pregnant women have been using insulin since 1922. And the only known side effect is hypoglycemia. So, here I am on the pump.

For those of you who may have seen my post in Birth & Beyond, I'm currently dealing with a situation where my peri. has privileges at a hospital that is not particularly baby-friendly, and I'm considering my options re how to refuse the observation nursery and a few other things. My primary plan is just to stay at home as long as humanly possible to avoid a lot of the pre-birth intervention. That actually worked out pretty well for me last time. I got to the hospital already 6 cm dilated and had the baby 7 hours later (this is a quick labor for me







). So we'll see how it goes this time. Mostly I'm just happy that even as an extremely insulin-resistant type 2 diabetic -- and I'm not even that overweight, for cripes' sake! But I do have a family history of diabetes on both sides of my family so I guess I got double whammied -- I've managed to have two, and what looks soon to be a third, very healthy baby. So I count my blessings.


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## ~pi (May 4, 2005)

Quote:


Originally Posted by *widemouthedfrog* 
I got the minimed CGMS in November, using it part time now. I enjoy seeing the numbers, but it's pretty expensive and for me, it takes ~24 hours to become accurate. Also, it is hard to find new real estate when looking for both pump and sensor sites. I find that having a toddler jumping all over me, slinging, and nursing makes it hard to find an area of my body that is not being constantly knocked around.

Hi, Tricia! That's interesting about the CGMS. My pump is up for renewal next summer and I have been pondering switching to Minimed for the CGMS. I am concerned about the expense, though, and I have heard conflicting reports about how long the sensors actually last. And I can imagine the difficulty in finding "real estate"!







I've already had a few too many incidents of DS tugging on my tubing.

Thanks for the comments on the birth story. I still don't really know why I had such a hard time with everything -- my story is not that uncommon, and certainly, many women have much worse ones. In any case, I'm continuing to work on it, both on a personal and institutional level.

Quote:


Originally Posted by *JanB* 
I'm not type 1, but can I play here too? I'm a type 2 diabetic who is controlling with an insulin pump by choice -- and boy, if you don't think that raised some eyebrows over at my endocrinologist's office... During my last pregnancy, my OB/GYN in Seattle recommended me as a good candidate for pump therapy, so I went ahead and started it, and loved it. Since I had the pump anyway and was familiar with insulin therapy, I went back on it when I started TTC'ing this one. Everyone at the endo's office was almost in shock. I remember being gently told several times, "You know there are oral medications... right?"

Welcome, Jan! This is a very small group and we're pretty off-and-on in our activity level, but I think we have all had pregnancies on a pump, so we can relate.

I don't really understand the opposition to pumps for type 2's. If you're going to prescribe insulin, why not give the option of various delivery methods? Hopefully your new clinic will consider it as a legitimate option for future type 2's after seeing how well it works for you.


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## JanB (Mar 4, 2004)

Hi everybody, I don't know how often people are checking in here, but I'm approaching my due date and had a question about glucose management during labor. I'm on an insulin pump, as I was with my last pregnancy (my first pregnancy I was managing with multiple daily injections) -- last time around, the protocol was for me to take off the pump and for the hospital staff to manage my blood glucose via IV -- insulin if too high, dextrose if too low, etc. I was not informed what their cutoff ranges were for administering treatments, nor was I informed when they were giving insulin or dextrose. My glucose was okay during labor and my baby didn't have hypoglycemia, so the outcome was good, but I didn't really care for the lack of info given to me.

How outrageous would it be for me to ask/demand to manage my own blood glucose during labor? I'd like to avoid an IV if possible (I will consent to a heplock) partially because I don't really appreciate seeing my blood sugar go up and then finding out two hours later, oh, they gave me dextrose via IV, that's why. I at least want to put in my birth plan that I want to be informed of all blood sugar management treatments.

How have the rest of you handled this?


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## widemouthedfrog (Mar 9, 2006)

I wasn't on a pump during labour, but if I ever did it again I would NOT want to let go of it! I laboured at home for the majority of the time, and I was just fine checking my blood sugars. I would have needed dh to check (or assist) during ~30 minutes of transition and pushing. Dd's birth was fast, though!

I tend to tread a fairly fine line in glucose control, and IV just seems pretty hit-or-miss to me. But I would likely try to run higher so that I wouldn't be going low too much during labour.


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## Tilia (Nov 18, 2006)

I found my tribe! I read the first few pages and WOW I don't know anything about diabetes yet.

I am Anne, 27 yrs old and I was diagnosed with Type I about a month ago. Before that, my doctor thought it was Type II and was treating me with metformin and actos. I was on oral meds for 2 months with blood sugars in the 400s all day. When I woke up it was never under 250, usually 380. I originally went to the doctor for dizzy spells and blurred vision. Anyway, I go to a family practice doctor and he just assumed it was Type II after the blood work and didn't order the labs to check for autoimmune until 2 months of no reaction to the meds.

Oh, and I had gestational diabetes with DD. She was induced 3 weeks early after an ultrasound revealed that she was pretty big. I picked induction over a planned C, I know not the best discussion for this website. Anyway, the birth went great, less than 24 hours. Her blood sugars were fine after, but she was jaundiced and wouldn't nurse for 24 hours. So we stayed in the hospital for a week for her to get light therapy and fluids (with the help of a LC she finally latched on and was a strong nurser). Evidently the diabetes went away for over a year, but I really don't know how long I was living with it.

So, now I am on insulin and giving myself 4 shots a day. Right now I am dealing with a honeymoon, I guess they call it. I was taking 30 units of Lantus every night, and 1 unit of Humalog for 10 grams of carbs. Now I am on 15 units of Lantus and 1 unit per 20 grams. It is so irritating. For a while I was getting low 6 times a day and testing about 10. Now I am back to only 1 low, testing 6 times.

Anyway, this is long. I am so very depressed about this disease and I really don't want to deal with it. I have a toddler and my DH is in Germany for the next 2 months (we are in Iowa). It is just a huge life change for me to plan out my meals, eat at certain times, etc. Plus I was on low-carb to try to lose weight, now they want me to eat carbs. Bleh. Plus I hate working out, and I am a little overweight.


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## ~pi (May 4, 2005)

Quote:


Originally Posted by *JanB* 
How outrageous would it be for me to ask/demand to manage my own blood glucose during labor? I'd like to avoid an IV if possible (I will consent to a heplock) partially because I don't really appreciate seeing my blood sugar go up and then finding out two hours later, oh, they gave me dextrose via IV, that's why. I at least want to put in my birth plan that I want to be informed of all blood sugar management treatments.

How have the rest of you handled this?

Hi, Jan! Congrats on hitting the home stretch!

I managed my own sugars during labour for the most part. I had a very old-school endo who -- even though my sugars were stable -- kept pushing and pushing me to consent to IV insulin and dextrose. My labour was not going well and I finally gave in just before I ended up with an unplanned c/s. Big mistake -- suddenly my lovely control was gone, I went way low (2.4, or about 40) and then way high (around 10, i.e. 180) and DS was very hypoglycemic after birth.

From what I understand from talking to other women on pumps, it's about half and half self-controlled vs. IV-controlled. It depends mainly on the hospital and physicians -- it's pretty arbitrary and there is no good evidence that supports one way or the other. (Which means to me that it really should be the mother's choice.)

Welcome, Anne! Sorry to hear about your diagnosis. Honeymooning sucks! It's so unpredictable. Just so you know, later on, you should be able to move to a much more flexible eating style. (Insulin pumps are very helpful with that.)

oops ... babe crying, must run


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## widemouthedfrog (Mar 9, 2006)

Quote:


Originally Posted by *mom2005* 
I found my tribe! I read the first few pages and WOW I don't know anything about diabetes yet.

Hi Anne! My dd is 22 months now (how time flies). As you probably read from my introductions, I was dxd at 6.5 months pregnant with dd - assumed to be Type 2 as well, though I had a kind nurse who refused to let them put me on medication. So I have been on insulin since then.

Your control sounds very much like my own at the beginning. It is a totally overwhelming life change and learning curve. Honest, after a while it will be second nature!

A few weeks ago I turned to dh after changing my pump site before dinner and poking my finger (he and dd had started eating) and said, "You know, some people don't have to change a site before eating!" He said, "Yes, they're on injections..." I said, "No, people - well, like you." I can't imagine NOT having to test my blood sugar before a meal now.

I hope that you have some support out there. I really needed mine. Even (especially) online diabetes support groups!


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## txtarheel (May 27, 2006)

_How outrageous would it be for me to ask/demand to manage my own blood glucose during labor? I'd like to avoid an IV if possible (I will consent to a heplock) partially because I don't really appreciate seeing my blood sugar go up and then finding out two hours later, oh, they gave me dextrose via IV, that's why. I at least want to put in my birth plan that I want to be informed of all blood sugar management treatments._

I would talk with your OB and/or endo. My endo was very hands off and didn't have privledges at the hospital where I had my son. I have been comfortable making changes in my insulin doses for several years and my endo has confidence in me doing so and my OB was thrilled he didn't have to worry about it. I kept my pump on throughout my labor and delivery. The nurses seemed relieved that they didn't have to deal with it and I was much more comfortable that way.

My husband also knew how to check my sugars as well and he ended up needed too after several hours of pitocin with no epidural. My doula and nurse also were helpful in reminding us to make sure my sugars got checked. It will also be important to make sure that you will be allowed to eat or drink something if you're going to do that. It is against the rules in many hospitals, but I had permission to have hard candy and gatorade as needed to keep my blood sugar up. And, my OB was so accomodating that when I ended up having a c-section, he even let me keep my pump on then. At that point I did need my husband to help manage my blood sugars a bit, so you'll want to make sure you've got someone else around who can help and understands things.

So, no, I don't think it's outrageous, the worst that can happen is that they will say no. I also just made a second page of my birth plan with my current basal rates, proposed rates during L&D, target range for my blood sugar, actions when out of the target range and starting range for my basal rates after delivery. That was helpful to both the nursing staff and my personal support people.


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## widemouthedfrog (Mar 9, 2006)

JanB, this might be an odd thing to say, but good on you managing d through 3 pregnancies! I can't imagine managing diabetes during pregnancy with 1, let alone 3.

So


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## Tilia (Nov 18, 2006)

:

I wanted to have a bunch of kids, all close together. I am just so nervous now. Can a baby develop diabetes because of me??


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## ~pi (May 4, 2005)

Quote:


Originally Posted by *mom2005* 
Can a baby develop diabetes because of me??

Anne, type 1 is weakly genetic. the last stats I saw suggested that children of T1 mothers have a 1-2% chance of developing T1 themselves. Interestingly, the risk appeared to be lower if the mom was over 25.

Your genetics have not changed since you have been diagnosed, so the risk for your children has not changed either.


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## Tilia (Nov 18, 2006)

OK, thank you! I am 27, but had DD when I was 25, so hmm. I am just going to watch her for signs.

Before I found out I had diabetes, I didn't think there was any family history. Upon my diagnosis, I found out my paternal grandfather and paternal uncle have or had it. I am not sure which type. My grandpa had it before he died of a heart attack when my dad was 13. That was in the 60s. I haven't talked to my uncle in a few years, so I had no idea! Now I am making sure all my family members watch for warning signs. I have a horrible feeling that my brother will get it too.


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## ALittleBitCrunchy (Jan 8, 2005)

Excuse me for barging in, but I just wanted to say that reading through your posts have made my day! My 3yo daughter is T1 (diagnosed almost a year ago) and we are out of the honeymoon (thank goodness!), on MDI (with Novolog and Lantus) and in the process of switching to a pump (Minimed, with CGMS). It's in insurance's hands right now, but hopefully within a month... I don't have anyone IRL with T1 and it's so overwhelming. I worry about her day-to-day health, as well as some of the long-term effects. She's 3 and I have already read enough about T1 and pregnancy to be scared for her. Reading this thread has given me so much peace. Thank you for sharing your stories!


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## widemouthedfrog (Mar 9, 2006)

Sorry, Anne, I didn't mean to scare you!

Type 1 diabetes is more strongly inherited through the father's line. I was 28 when I had dd, and it only comes from the female line (me), so apparently dd has a similar chance to any member of the general public - almost.

I would work on getting a handle on your own diabetes first, then register for Trialnet. Trialnet is a study that looks at the family members of Type 1 diabetics and checks them for diabetes antibodies - one indicator of the likelihood of type 1. I am awaiting the results for my daughter.

As for pregnancy, I am just a rather neurotic being who would prefer the hassles of adoption to the challenges of managing blood sugar during pregnancy. Pregnancy is absolutely possible - check out Diabetic Mommy if you are curious. I also became diabetic during pregnancy, so that um - puts a damper on future pregnancies for me. Kind of not-so-good memories.

Welcome ALittleBitCrunchy! Not that you wanted to be part of our club







: .Check out the Diabetes CGMS listserves out there (continuous glucose monitoring) - there are some folks with little ones on there. Insulin Pumpers is also good - there is a Parents of Pumpers list.


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## JanB (Mar 4, 2004)

Quote:


Originally Posted by *widemouthedfrog* 
JanB, this might be an odd thing to say, but good on you managing d through 3 pregnancies! I can't imagine managing diabetes during pregnancy with 1, let alone 3.


Aw, shucks.









It's funny, but these days it seriously seems like not a big deal to me. I'm just so used to it. It's just one more pregnancy thing to have to deal with -- you know, take your prenatals, do squats, check your blood sugar, adjust your pump settings...







It all falls into a routine after a while. I'll admit that the first months before the level 2 ultrasound are pretty scary for me, but after we pass that hurdle, it's not that bad. My OB keeps telling me that with an A1C under 6 or so (actually it might be even higher) your risk for developing complications from diabetes is essentially that of a normal woman's.

Although, yes, when you tell people that you are pregnant and also an insulin-dependent diabetic, they tend to react.... badly. I sometimes want to shake people by the collar and yell, "I am not Julia Roberts in Steel Magnolias! This is the 2000s! I AM JUST FINE!!!!"


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## widemouthedfrog (Mar 9, 2006)

Quote:


Originally Posted by *JanB* 
Although, yes, when you tell people that you are pregnant and also an insulin-dependent diabetic, they tend to react.... badly. I sometimes want to shake people by the collar and yell, "I am not Julia Roberts in Steel Magnolias! This is the 2000s! I AM JUST FINE!!!!"









That's what someone I know said, when I'd already had the baby








Bah on Steel Magnolias.


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## ~pi (May 4, 2005)

Quote:


Originally Posted by *JanB* 
It's just one more pregnancy thing to have to deal with -- you know, take your prenatals, do squats, check your blood sugar, adjust your pump settings...









<snip>

I sometimes want to shake people by the collar and yell, "I am not Julia Roberts in Steel Magnolias! This is the 2000s! I AM JUST FINE!!!!"

















:

Welcome, ALittleBitCrunchy.







Sorry to hear about your daughter's diagnosis, but on the bright side, it sounds like you are doing great things for helping her to maintain great health. I second the groups already suggested, and you might also want to check out childrenwithdiabetes.com.


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## vbactivist (Oct 4, 2006)

Hi. Subbing. I will be back with an intor later. But I am sooo glad to have found you.


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## Tilia (Nov 18, 2006)

To any of you diagnosed in adulthood: How long does this so-called honeymoon last? I think mine has been a month so far. Right now I am decreasing my insulin AGAIN. I had three lows today. And three yesterday.

Also, does exercise affect blood sugar more during the honeymoon? If I have a blood sugar below 140 and go for a half hour walk I drop into the 60s. Then I have to eat sugar so what was the point of walking?

Is it just me or does low or high blood sugar make other people cranky and impatient with their children?


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## widemouthedfrog (Mar 9, 2006)

Quote:


Originally Posted by *mom2005* 
To any of you diagnosed in adulthood: How long does this so-called honeymoon last? I think mine has been a month so far. Right now I am decreasing my insulin AGAIN. I had three lows today. And three yesterday.

I'm not sure. I have gradually increased my basal and bolus ratios over the 2 years since diagnosis. They vary month to month, though.

Quote:


Originally Posted by *mom2005* 
Also, does exercise affect blood sugar more during the honeymoon? If I have a blood sugar below 140 and go for a half hour walk I drop into the 60s. Then I have to eat sugar so what was the point of walking?

I am on an insulin pump. This gives me a steady basal rate of insulin, so if I am sitting on my "bottom" all day and not eating, in theory my blood sugar stays stable. If I DON'T eat and I do light-moderate exercise, I turn down my basal rate and my blood sugar doesn't drop too much.

However, if I have had a meal any time in the last few hours, I MUST snack (sometimes a lot) before walking. Even jumping up and down with dd at library story time can send me low - I'm really sensitive to exercise. Yesterday, I started ~200, went for a run, checked after 5 minutes and I was 80.

The other way I deal with exercise after a meal is to bolus less for the meal (I have learned how much less over time), then exercise soon after and let the exercise control my blood sugar. I have many, many different tweaks for different kinds of exercise and different amounts of time after the meal.

This is just one of the many Random Acts of Blood Sugar Fun.







:

Quote:


Originally Posted by *mom2005* 
Is it just me or does low or high blood sugar make other people cranky and impatient with their children?









Oh, yes. Very much so. A mild low makes me feel overwhelmed, too much to handle, get away from me kid! A high makes me cranky, why are you all out to get me and make me mad?! When dd was ~10 months she had a hard time going down for her morning nap, and I would get really mad and storm out. It took me months to realize that the start of the nap coincided with the blood sugar peak from breakfast, hence the extreme crankiness.


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## ~pi (May 4, 2005)

Quote:


Originally Posted by *mom2005* 
To any of you diagnosed in adulthood: How long does this so-called honeymoon last? I think mine has been a month so far. Right now I am decreasing my insulin AGAIN. I had three lows today. And three yesterday.

I was diagnosed as a kid, but I'm pretty sure honeymoon lasted several months.







It does get easier once the honeymoon is over. Things get more predictable.

Quote:


Originally Posted by *mom2005* 
Also, does exercise affect blood sugar more during the honeymoon? If I have a blood sugar below 140 and go for a half hour walk I drop into the 60s. Then I have to eat sugar so what was the point of walking?

I'm not sure if honeymoon affects it more, but FWIW, I find low impact activity drops me faster than anything else. I drop faster just walking than I do playing soccer, for example.

Like Tricia, I make adjustments on my pump to deal with exercise and have learned through trial and error how to deal with it.

Quote:


Originally Posted by *mom2005* 
Is it just me or does low or high blood sugar make other people cranky and impatient with their children?









Not just you!! It's very normal.









I get anxious when I'm low and irritable and spacey when I'm high.

Have you checked out the very first post on this thread? It's a list of resources that you might find useful.


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## ~pi (May 4, 2005)

Hey, all! Jan had her baby! Here is the thread:

http://mothering.com/discussions/sho...d.php?t=680690


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## JanB (Mar 4, 2004)

Hi, everybody!

Well, we are still recuperating -- physically I am feeling okay but emotionally I am on a real roller-coaster. Am thinking about seeing my GP about PPD.

But, the real reason I am posting here... my OB/GYN had me turn down all my basal rates to 1/3 of what they were pre-birth, plus my bolus ratio is about 1/3 of what it was previously. He said to use that as a starting point and then walk it up to where it needs to be. I'm having some trouble stabilizing, though. My fasting blood sugar has been running around 125-130 and I'd prefer it to be closer to 100. I keep creeping my overnight basals up but it doesn't seem to be doing much... but then again yesterday I had a severe low (30) after lunch so I guess I'm scared to ramp the settings up too much. I'm trying not to sweat it much for now, because 125-130 isn't that bad in the grand scheme of things, just wondered if anyone has some advice.


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## widemouthedfrog (Mar 9, 2006)

30 - ouch! For some reason, I had the HUGEST reaction to a 70 today, so bad I had to sit down because of the sweating (and ate bad things, bad bad me







: ).

I had the biggest issues postpartum with nursing and lows. Sorry to hear that things are tough right now. Take care. Lack of sleep, wonky blood sugar, and yeah...2 other kids...that's a lot to handle. Sending some postpartum doula juice your way.

Have you set up a nursing station or fanny pack with juice, etc, so that it's easier to work on those potential nursing lows?

I'd prefer 100 too, but it doesn't always happen. Allergies are making things tough right now. I like to wait until I've been higher in the morning for a week or two before I make any basal changes, then I test like a fiend overnight and in the morning. And hey, having a newborn makes it really easy to do those overnight tests (looking on the bright side?







).

Do you have insurance? Any chance they would help with a CGMS, even for a little while?









*Oh yes...forgot, a big congratulations on little Gus, too!*


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## ~pi (May 4, 2005)

Jan, I let my BGs run higher for a few months after DS' birth. At first I kept keeping on with the tight control, but then I had a couple of scary lows while home alone caring for him. Almost dropping your baby is a good way to get you to change what you're doing! I personally would not sweat 120-130 fasting at all. IME, it took a few months until my hormones settled down and I got into a good nursing rhythm. Things calmed down then.


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## Tilia (Nov 18, 2006)

Help! Should I really be living alone with my 18 mo? I am very worried about getting a low and passing out while caring for my daughter. I thought I was going to get some help soon, but then my husband announced that he is divorcing me. Total blow but thats a different thread.

I live alone with DD and sometimes no one comes over to visit until 6 p.m. It terrifies me that I won't wake up and my DD will be crying in her crib all day until my sister or mom come over after work. I am a SAHM.

I was diagnosed only a few months ago and am honeymooning, so I have little control over the disease. I also don't understand a lot of it yet, and am being seen by the endo tomorrow for the first time.


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## widemouthedfrog (Mar 9, 2006)

Quote:


Originally Posted by *mom2005* 
Help! Should I really be living alone with my 18 mo? I am very worried about getting a low and passing out while caring for my daughter.

So sorry to hear that things aren't going so well. When dd was smaller, I got someone to call me twice a day. If I didn't reply within 30 minutes, they were to come to my house.

Sometimes you can get buttons on a wristband to press and they call a home care person for you. They use them for seniors. I carried a cell phone with dh's and mom's number on speed dial, dextrosol, and a meter and kept them on me at all times in a fanny pack.

Hope that helps! HUGE hugs.


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## GeorgieGirlsMom (Jul 27, 2006)

: I am so glad I found this thread!

I was dx with T1 about three years ago during my pregnancy with my daughter.

I read the diabetes.org boards daily but this is more of my cup of tea.

I am so excited.

I am pumping with minimed 722 and love it most of the time; if you could love anything about diabetes.









It's late, but I'm glad this is here. I was starting to think that I was the only one on Mothering with t1 d.

Annie


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## ~pi (May 4, 2005)

Hi Annie! Welcome!! Sorry for the delayed response -- this can be a slow-moving thread, as there are just a handful of us.

Wow, there are a lot of women who were dxd during pregnancy. That must be such a whirlwind.

Great to hear about th 722. I'm up for a new pump next year and am considering switching to Minimed for the CGMS. (I currently have a Cozmo.)

Speaking of pumps, is anyone else's dc obsessed with their pump? DS (now one year old!) desperately wants to play with it. He loves the tubing and grabs it at every opportunity. I don't know how best to deal with this -- it can be really painful and I don't want him to pull the set out. Gah. Any tips welcome.

Anne,







. I hope things are going OK for you.


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## widemouthedfrog (Mar 9, 2006)

Quote:


Originally Posted by *~pi* 
Hi Annie! Welcome!! Sorry for the delayed response --

Speaking of pumps, is anyone else's dc obsessed with their pump?


Yes, is she ever. But it's old hat now, I think. She is getting an Angel Bear Pump Stuff toy pump for her teddy this Christmas.

She used to ask if she could have a pump (well, she'd say "I that!") and I told her she had one inside her. She's fine with that for the moment.

She went through a grabby-while-nursing phase for pump sites. I mostly use my "bottom" for sites, so it's not so much of an issue. Ahem. When they are on my tummy I often use a pregnancy belly band (tube of material) to cover them. It goes under my t-shirt. I am far more concerned that she will pull the tubing and site during nursing acrobatics. Sometimes the Ergo pushes on them a bit too when I have the sites in certain places.

She also likes to sleep ON my pump, and then I have to extract it when I get up before her. But the back light is VERY useful for looking at her sleeping position when I'm getting into bed, so that I don't have to feel around in the dark.


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## GeorgieGirlsMom (Jul 27, 2006)

Oh my gosh, I love the back light on my pump! It is perfect for checking on sleeping babes.

Annie


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## vbactivist (Oct 4, 2006)

Hello,

I said I would be back to introduce myself so here I am.

I am currently 27 weeks pregnant. I was diagnosed with diabetes at 5 weeks pregnant. It turns out after the endo did the antibodies test (the one with the titers) it is Type 1. I have had a crazy roller coaster of a time these last 5 months. I was pm-ing JanB for a while and she has been an enourmous support and wealth of information.

I started on the pump about a week ago. It is okay. There has been so much going on and I get exhausted thinking about it. My baby does have a moderate sized whole in the lower chamber of his/her heart.

What I am really looking for right this minute, though, is info on th ACOG's guidelines for delivering diabetic mothers. I have had 2 prior c/s (pre-eclampsia and PIH). THe OB today said that they would do an amnio at 37 weeks and depending on the results deliver then or 1 week from then. I do NOT want to schedule a cs. Even if a vbac is out of the question, I still would rather wait until at least 39 weeks. She said that the ACOG guidelines are to deliver diabetic mothers as soon as the baby's lungs are mature. I tried googling info on that, but am having no luck. Where you all delivered before term? If so, how early? Does anyone have any insight for me?

There is so much more, but right now, I am just completely overwhelmed. I just got back from the doctors and cried the whole way home.

Do diabetcs ever have homebirths?

Thank you so much for any info!


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## widemouthedfrog (Mar 9, 2006)

Well, my dd just came 3 weeks early on her own, so she solved that problem for me.







My doctors wanted to induce 2 weeks early. I was not amused.

Children of diabetics tend to take a longer time to reach lung maturity (or they can, I think). So I don't know why going any farther than 2 weeks prior to the due date would be ok. Also, dd had a weak suck, and I think that the sucking reflex improves in those last few weeks. I'd go through online journals and argue it a bit with the docs. If babe is not looking too big and the placenta appears to be healthy, then shouldn't things be ok? Or am I fooling myself here?

Sorry to hear about the hole, but good that you know beforehand.

The pump takes some getting used to, but it is fabulous for an active, difficult-to-plan lifestyle - aka "having small children".

I think that a few T1 diabetics have had homebirths, but I don't think most midwives would touch me. I doubt that I will ever have a second, but if I did I would fight for a vaginal birth in a low-key hospital setting, with my pump on and dh and I managing it.

Feel free to PM me if you ever have any questions!


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## vbactivist (Oct 4, 2006)

Quote:


Originally Posted by *widemouthedfrog* 
Well, my dd just came 3 weeks early on her own, so she solved that problem for me.







My doctors wanted to induce 2 weeks early. I was not amused.

Children of diabetics tend to take a longer time to reach lung maturity (or they can, I think). So I don't know why going any farther than 2 weeks prior to the due date would be ok. Also, dd had a weak suck, and I think that the sucking reflex improves in those last few weeks. I'd go through online journals and argue it a bit with the docs. If babe is not looking too big and the placenta appears to be healthy, then shouldn't things be ok? Or am I fooling myself here?

Sorry to hear about the hole, but good that you know beforehand.

The pump takes some getting used to, but it is fabulous for an active, difficult-to-plan lifestyle - aka "having small children".

I think that a few T1 diabetics have had homebirths, but I don't think most midwives would touch me. I doubt that I will ever have a second, but if I did I would fight for a vaginal birth in a low-key hospital setting, with my pump on and dh and I managing it.

Feel free to PM me if you ever have any questions!

Okay, I would feel fine if the baby came early on his.her won. Wha I want to avoid is a 37 week baby with a weak suck like you mention or a stay in the nicu that could be avoided. I have looked online but the journals are really hard to find exactly what I need. Thanks for your response widemouthed







I am glad to know about the lung development being slower. I wil definintely bring that up.


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## GeorgieGirlsMom (Jul 27, 2006)

The reason behind the induction is that the placenta is at risk for breaking down causing fetal demise. A few years ago a former L&D nurse (a grandmother now) told me stories about woman with t1 diabetes that would give birth to still borns because the placenta had started breaking down. She wasn't trying to scare me but remember what it was like years ago when there was only two different insulins. They were truly the dark ages then.

With my daughter, I was induced at 38.5 weeks but I also had tight control. She was a champ at nursing from the start.

I also visit the diabetes.org board and there are several women there that didn't get their first home glucose monitor until they were half way through their pregnancies in the 80's. They have had children with no complications.

I was put off by the thought of an induction but having t1 diabetes is truly a high risk situation. This isn't so I can pop this baby out so I can attend a party but rather, "let's err on the side of caution." KWIM?

I have worked out more NST's with my OBGYN at the end to make sure everyone is doing ok. Then we will induce at 39 weeks if necessary.


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## vbactivist (Oct 4, 2006)

GGM _ Thanks for the info. I totally understand that this is somewhat high risk. ANd I would be more than fine with the scenario you suggest - inducing at 39 weeks if all is well. What I am not interested in is 37 weeks, for no reason. I am willing to have nst's to check that everything is okay, but an amnio and then delivery at 37 weeks to me seems uneccessary. Thats why I am glad to hear of different peoples experiences.

Also, does anyone have any experience with wearing their pump during a cs?


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## ~pi (May 4, 2005)

Quote:


Originally Posted by *vbactivist* 
She said that the ACOG guidelines are to deliver diabetic mothers as soon as the baby's lungs are mature. I tried googling info on that, but am having no luck. Where you all delivered before term? If so, how early? Does anyone have any insight for me?

I was pushed to induce at 38 weeks. I refused until 40 weeks. If I could do it again, I would refuse outright until 42 weeks at least (barring any complications.)

Basically what it comes down to is that at a certain point, it is thought that the baby of a diabetic mother is safer out than in, and that therefore, you should get them out as soon as the lungs are mature. However, that POV does not give a lot of weight to the mother's feelings in the matter, nor does it (IMHO) appropriately consider the risks to the baby and the mother of getting the baby out before s/he is ready.

Stillbirths do happen in T1 women more often than in non-diabetic women. This is a very real risk. Most literature quotes rates of about 2% (vs. non-diabetic rates of about 0.4%.) It is not just about the placenta, either. There are some new theories about hypos in late pregnancy potentially leading to problems for the baby in utero.

However, the research that led to these estimates was done in a time when tight control was very, very difficult to achieve. My personal suspicion is that maintaining tight control significantly reduces the risk of stillbirth. This was supported by my peri, who was quite impressed with my glycemic control and didn't even blink an eye at the idea of me going to 41 weeks, though he later revised that to 40 weeks after discussions with the very old-school endocrinologist.

Colleen, who has posted on this thread, had an induction with her first child. She went to 41 weeks before going into labour spontaneously with her second child.

Something to consider is that inductions carry extra risk for a VBAC. (They increase the risk of uterine rupture.) It is a very personal choice, though.

Quote:


Originally Posted by *vbactivist* 
There is so much more, but right now, I am just completely overwhelmed. I just got back from the doctors and cried the whole way home.









I have so been there. Hang in there.

Quote:


Originally Posted by *vbactivist* 
Do diabetcs ever have homebirths?

Very rarely. See the first post on this thread -- I posted some links to birth stories.

Quote:


Originally Posted by *widemouthedfrog* 
The pump takes some getting used to, but it is fabulous for an active, difficult-to-plan lifestyle - aka "having small children".









:

Quote:


Originally Posted by *vbactivist* 
Also, does anyone have any experience with wearing their pump during a cs?

I consented to IV insulin for the surgery, but I know of several people who have worn their pumps during their c/s.


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## vbactivist (Oct 4, 2006)

oh, Pi, thanks so much for all your insight. I will check out your links in the beginning of this thread. I wouldn't be induced because of the prior cs, but I don't want to schedule a section so early. /your argument about the tight control makes sense. I will definitely bring that up at the nex appointment. Also, I saw the nurse who sells the pump today and she said that the hospital i wil be at does have a policy in place for pump use for patients and that she has heard of quite a few people (not necessarily at this hospital) wearing their pumps during surgery. She said it usually comes down to the anestesiologist. She suggestes I reall get my endo on board and that will help. I was reading a yahoo group opost about someone who had surgery and they wanted to take her pump away and she said, do you remove non diabetic's pancreases before surgery? And they said no, she told them then sh'ell use her pump, and they let her! Sometimes its just a matter of getting people to think outside the box.

Also, does everyone nurse their babies ebfore the glucose est (for the baby I mean)? Do most of your babies receive glucose water? I would like to avoid that if at all possible as well.

Thanks so much everyone for all your help!


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## ~pi (May 4, 2005)

Quote:


Originally Posted by *vbactivist* 
your argument about the tight control makes sense. I will definitely bring that up at the nex appointment.

Just FYI, it would be very unusual for a health care provider to support the idea of waiting beyond 40 weeks. Many are still in the mindset of 37-38 weeks. From their perspective, waiting adds lots of risk for little benefit.

The trick is to decide whether or not you share that perspective. Many type 1 women do, and IMHO there is nothing wrong with that. If you don't, though, you're going to have to be very clear with them about your preferences and decisions, because it could be hard for them to accept.


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## widemouthedfrog (Mar 9, 2006)

VBACtivist, I think we're on the same pumper's list









I had VERY poor control through the majority of the pregnancy, due to T1 diagnosed when I was 6 months pregnant.

In my mind, if I had a do-over I would weigh the lung maturity issue and the placental deterioration issue, and likely be ok with being induced at 39 weeks.

I recall that my docs were VERY concerned about dropping insulin requirements about 5-6 weeks before my due date. The placenta makes you resistant to insulin, and dropping insulin requirements could mean that the placenta was breaking down. I had lots of ultrasounds towards the end - and nonstress tests - to make sure baby was ok.

I was not very well educated at the time of dd's birth. They tested her glucose and gave her formula before I nursed her. Grrrrr. At least I remembered to ask them to do it in a cup, not a bottle. ~Pi, you expressed milk and they had it waiting for your son, right?


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## vbactivist (Oct 4, 2006)

Quote:


Originally Posted by *widemouthedfrog* 
VBACtivist, I think we're on the same pumper's list









I had VERY poor control through the majority of the pregnancy, due to T1 diagnosed when I was 6 months pregnant.

In my mind, if I had a do-over I would weigh the lung maturity issue and the placental deterioration issue, and likely be ok with being induced at 39 weeks.

I recall that my docs were VERY concerned about dropping insulin requirements about 5-6 weeks before my due date. The placenta makes you resistant to insulin, and dropping insulin requirements could mean that the placenta was breaking down. I had lots of ultrasounds towards the end - and nonstress tests - to make sure baby was ok.

I was not very well educated at the time of dd's birth. They tested her glucose and gave her formula before I nursed her. Grrrrr. At least I remembered to ask them to do it in a cup, not a bottle. ~Pi, you expressed milk and they had it waiting for your son, right?


Hi Tricia,

I would be more okay with waiting until 39 weeks. Its just so hard to know what is a real medical concern and what is just an arbitrary protocol they are used to following, you know?

Pi - did you express milk after the baby was born? I doubt I would get anything but colostrum before birth and in the first few days following.


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## ~pi (May 4, 2005)

Quote:


Originally Posted by *widemouthedfrog* 
~Pi, you expressed milk and they had it waiting for your son, right?

Not milk, colostrum. It wasn't much, and it didn't prevent him getting IV dextrose and formula (by cup) shortly afterwards, but it made me feel slightly better when he was in the NICU.

Quote:


Originally Posted by *vbactivist* 
Its just so hard to know what is a real medical concern and what is just an arbitrary protocol they are used to following, you know?

It's extremely hard.


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## vbactivist (Oct 4, 2006)

Thanks for the hugs pi. did your son need the dextrose because of being early or from your diabetes? Was that why he was in the NICU? Were your blood sugars under sontrol close to when you had him? I am sorry to bombard you with so many wquestions, but I am wondering what 'usually' happens to babies of diabetic mothers. Is it unreasonable to expect that _no_ supplements be given? Thanks so much for any info.


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## ~pi (May 4, 2005)

Quote:


Originally Posted by *vbactivist* 
Thanks for the hugs pi. did your son need the dextrose because of being early or from your diabetes? Was that why he was in the NICU? Were your blood sugars under sontrol close to when you had him?

Well, as it turns out, he never needed the dextrose at all. His blood sugar was extremely low on the heel prick, but the lab reading (from a venous sample taken
at the same time) came back well within normal range.

I had a very difficult labour with an infection, so he was in the NICU for a septic workup and because of the low BG reading on the meter.

I had great control right up until I consented to go onto IV insulin about an hour before he was born. It all went to heck at that point.


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## Staceyy (Jul 21, 2006)

Helpful sites:

www.diabetesforums.com

www.diabetes.org

www.diabeticpastrychef.com


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## vbactivist (Oct 4, 2006)

Hi agian! Stacey, thanks for the links.

I have a question about pumping and babies. Where do you all have your sites? I am concerned about where the pump site will go once I have the baby. My older children know not to knock into me (it helps being pregnant as well). But have you found good places for the site that doesn't get bumped into when babywearing or just holding a baby? I was up a lot last night trying to think of a good place. I am a little depressed about this. Thanks for any info.


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## hannahmom (Mar 5, 2004)

I never found a great place... The best place was as far back on a love handle as I could reach. If I but it on my lower abdomen my pants rubbed and when I put it on my belly it was always in the way.

This is just my experience but I found that after dd #2 (I wasn't dx'd yet with dd 1) my sites got yanked/sore, dd 2 was always grabbing my tubing, I couldn't find a good place to clip my pump and it was just plain problematic. By the time summer was rolling around, I was really frustrated. So in June I went back on MDI - especially having to deal with 2 kids, being in and out of the pool etc... I was going for hours w/out my pump because it was it was just really difficult to juggle and keep track of time. Since I'm nursing my bs has been great and I haven't needed the pump to keep relatively tight control.

I was finding it really difficult to take good care of myself after dd 2. I would forget to bolus for meals for hours afterwards. I wasn't testing regularly - and I STILL struggle with that very much. I was making really poor food choices and getting frustrated that I wasn't losing baby weight. I think I needed MDI to kind of force me to concentrate on taking better care of myself.

Sorry if that wasn't what you were looking to hear - just letting you know what worked for me


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## ~pi (May 4, 2005)

My sites are definitely more of a problem now. Tubing gets yanked, sites get kicked, etc. And DS is fascinated by the pump, which doesn't help.

It hasn't been unmanageable, though. Pre-DS, I played a lot of sports with the pump, and that was way more of a hassle.

I put most of my sites on my hips or belly. Sometimes they're right on the Ergo waist strap line, so I either suck it up or use a different carrier. Unless I get a direct kick to the site (which does happen occasionally at night, and it hurts) it doesn't bother me.


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## vbactivist (Oct 4, 2006)

oh, EJ and Pi - thanks so much for replying. I was 'really' hoping you would come on and sa, oph, no, its not a problem at all! Thanks for your honesty. I can't decide which would be more of a hassle - giving injections and then _having_ to eat right away or dealing with the pump. I am mostly worried about it getting knowcked out all the time and the cost and inconvienence of replcing the site more than every three days. I wore my second ds pretty much non-stop the first year.

I find that the 'fattier' the site location, the less likely it is to stay on, almost like the fat gets bunched up or something.

Does anyone else _hate_ diabetes? Or are most of you at a point where you just feel like its part of life and not really a big deal anymore? BEcause I pretty much hate it. I call it stupid diabetes whenever I talk about it for any reason. I feel like it has totally put a damper on my life. I am worried about insulin always being available/affordable to me. I am really worried about how I am going to manage once the baby is here. I know that there are lots of other people with Diabetes out there, but in my head I figure they just don't parent the same way I do and so its not as mucha s a hassle (babywearing, nursing, cosleeping - with the pump).

Do any of you think a real cure is likely soon? I know I am all over the place iwth this post - sorry. I am just feeling overwhelmed today.


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## ~pi (May 4, 2005)

Quote:


Originally Posted by *vbactivist* 
I am mostly worried about it getting knowcked out all the time

FWIW, my site has been knocked out twice: once playing sports, and once when my tubing got snagged on a branch as I biked past a shrub. DS is pretty rough, but has never managed to remove a set.

Quote:


Originally Posted by *vbactivist* 
Does anyone else _hate_ diabetes? Or are most of you at a point where you just feel like its part of life and not really a big deal anymore?

I think pregnancy is a huge stressor. I hated it during my pregnancy, and it was the first time in 23 years that I had truly felt like that. I hated how it restricted my options for birth.

I hear you on your concerns about affording insulin, etc. We are less flexible in our lives because we need to make sure that one of us has extended health coverage.

In general, though, I would say that now, I'm back at the point of acceptance. It isn't "no big deal" but since I can't do anything about it, I just deal with it as best as I can.

Quote:


Originally Posted by *vbactivist* 
Do any of you think a real cure is likely soon?

I am not holding my breath for a cure. Maybe in ten or twenty years.

Quote:


Originally Posted by *vbactivist* 
I know I am all over the place iwth this post - sorry. I am just feeling overwhelmed today.


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## widemouthedfrog (Mar 9, 2006)

Just back from vacation.

Actually, dd used to LOVE to tug on sites on my tummy, and the ones on my lower back/upper bum and sides would get caught in the ERGO. Or the tubing would get caught in a soft hip sling.

Currently, I often use my bum for sites. I find that this works best with carriers and nursing. The tubing goes right up and I put the pump in my pocket, so it rarely gets caught on anything or fiddled with. I can't stand it when DD fiddles with my pump sites. I did teach her to leave them alone when they are on my front- similar to teaching her NOT to twiddle my other nipple while nursing. I do put sites on my tummy to rotate them, and I dislike them when they are there.

I dislike diabetes when I am high and low. When I'm neither, I'm generally pretty happy. It chugs away in the back of my mind constantly, though. You've got to get used to that bit. I figure that I can either spend all of my time and energy hating it, or I can manage it the best I can, not obsess about it, and be happier during the time that I have.


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## vbactivist (Oct 4, 2006)

Quote:


Originally Posted by *widemouthedfrog* 
Just back from vacation.

Actually, dd used to LOVE to tug on sites on my tummy, and the ones on my lower back/upper bum and sides would get caught in the ERGO. Or the tubing would get caught in a soft hip sling.

Currently, I often use my bum for sites. I find that this works best with carriers and nursing. The tubing goes right up and I put the pump in my pocket, so it rarely gets caught on anything or fiddled with. I can't stand it when DD fiddles with my pump sites. I did teach her to leave them alone when they are on my front- similar to teaching her NOT to twiddle my other nipple while nursing. I do put sites on my tummy to rotate them, and I dislike them when they are there.

I dislike diabetes when I am high and low. When I'm neither, I'm generally pretty happy. It chugs away in the back of my mind constantly, though. You've got to get used to that bit. I figure that I can either spend all of my time and energy hating it, or I can manage it the best I can, not obsess about it, and be happier during the time that I have.

Pi - thanks for the info and the hugs.

Widemouthed - when you say bum, where exactly do you mean? Do you actually 'sit' on the site or are you talking higher up like more on your hip?
I just looked at your blog. I feel like crying, just because you seem to get it. I have good days and bad days. Every high is soooo stressful. And then it takes forever to correct. and I hate when I have ahigh after dinner, because then I feel like I have to stay up and correct it for hours. or risk sleeping all night with a high, or going really low from over correcting. And it seems like every week I find another food that messes with my blood sugar. So far the foods I feel I really must avoid due to late highs are pizza - beans rice - corn - potatoes









Thanks again to everyone who has responded. It helps to be able to talk to people who get it. Do any on you like any of the yahoo groups? I mostly would want one with mothers of yong children I think.


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## widemouthedfrog (Mar 9, 2006)

Quote:


Originally Posted by *vbactivist* 
I just looked at your blog.

Awww, thanks. I am a very inactive blogger, I must say! It's funny, but ever though I have it in my signature, I'm always surprised when people say they've been reading it. I guess it's a way to share things that I would never say.

When I say bum sites - no, you don't sit on them. That isn't good for the site. But there is a part between the fleshy bit of the lower back and the part you sit on. Let's call it the "upper bottom," shall we?







: I go from the fleshy part of the hip into the middle of my bum, but not too close to the - ahem - crack - because absorption isn't great for me there. I can get 2-3 sites in a line downwards from my lower back to where I sit.

Oy, I think that is WAYYYYY too much information!


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## vbactivist (Oct 4, 2006)

Quote:


Originally Posted by *widemouthedfrog* 
Awww, thanks. I am a very inactive blogger, I must say! It's funny, but ever though I have it in my signature, I'm always surprised when people say they've been reading it. I guess it's a way to share things that I would never say.

When I say bum sites - no, you don't sit on them. That isn't good for the site. But there is a part between the fleshy bit of the lower back and the part you sit on. Let's call it the "upper bottom," shall we?







: I go from the fleshy part of the hip into the middle of my bum, but not too close to the - ahem - crack - because absorption isn't great for me there. I can get 2-3 sites in a line downwards from my lower back to where I sit.

Oy, I think that is WAYYYYY too much information!
















Thank you for this information! Its not Too much







Its actually really helpful. I am worried about how this is all going to play out. But I really don't want to go back on injections. THat was also really inconvienent and I had a lot of lows that were scary then.


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## txtarheel (May 27, 2006)

Hi all,

It's nice to see this thread is still active and has some new folks around. I came by briefly about a month or so before my son was born in July of '06. I never came back and posted or discussed by birth because I was so disheartened by it. It had many similarities to Pi's as a failed induction leading to a c-section. But, I'm pregnant again and trying to see if I can manage to have a better experience this time.

Right now I'm struggling with finding a care provider. I've got a great endo, but past that I'm just searching. The OB who delivered my son had no problem with me having a VBAC next time around. But at the time, he was the jr. doc at a two doc clinic. He ended up being the one in charge of my induction at 40 weeks that neither of us really agreed with in retrospect. He was so apologetic about my section. I would use him again, but he's now the jr doc at a different practice with six others. That just seems like an awful lot of opinions to have to deal with when I have so many strong feelings about diabetes and birth.

I've seen a lot of questions about pumps in L&D and surgery. I kept my pump on and stayed in control of my sugars the entire time I was in the hospital. We just reported my sugars to the nurses and they were happy with that. I had made an addendum to my birth plan that included the frequency that I would check them, the range I wanted them to be in and suggested courses of action if they were out of range. I was lucky that the nurses in my particular situation were really happy about that plan. My husband did help. I had trained him on checking my sugars, changing my basal rate and giving boluses well before the hospital. He managed to keep checking and maintaining things when I had my epidural nap after six hours of pit. It was hard doing it all ourselves, but I wouldn't trade it in. I do recommend a well trained support person to help make it work though!

Anyway, I'm glad to be back, and I'll try and stick around a bit more this time around!


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## txtarheel (May 27, 2006)

I know I just posted earlier, but the woman who seems to be the most respected CNM doing homebirths in my area just wrote me back. I told her in my initial contact that I was Type 1 and had a c-section. She told me she would like to meet with me and thought I sounded like a great candidate for her practice.

It was really just a fantasy when I wrote her that she might take me as a client, but I feel really hopeful about this. Especially after I've read the few homebirth stories out there for T1's.

Katherine


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## widemouthedfrog (Mar 9, 2006)

Wow, Katherine. That's fabulous! Do they have a protocol for low BGs of the babe after birth - nursing?

If we ever had another, I'd love to have a homebirth. However, since dh wasn't ok with it even in a "normal" pregnancy, I doubt that I'd be able to convince him. Lack of good medical care is one reason I'd be hesitant about the whole pregnancy thing, actually. I like my endo but I'd have to find some sort of maternity doctor who wouldn't immediately schedule me for an induction 3-4 weeks early.


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## txtarheel (May 27, 2006)

I haven't talked with her in person yet. I just sent out emails to some recommended CNMs in the area figuring I'd get the standard, "high-risk, need an OB, go to a hospital" crap. The low BG after birth is really my only concern. If it weren't for that I'd have no hesitation. However, since she's a CNM instead of a CPM, she should have IV equipment for emergencies (I know some do in this area). IMO, my son's BG was only low because it was so long before he got to nurse and once he started, they "had" to take him away before he was done for an exam. Of course he flailed and screamed and used up lots of energy during that time. His BG was normal at birth and only a couple points below the cut-off after the screaming, flailing non-nursing ordeal.

So, yeah, nursing would be my first choice. I'm also pumping now to have some stored milk for later. Once I've converted to producing colostrum near the end I'll pump some of that as well.

Happily, my husband was as upset by our hospital experience as I was so it took zero convincing on my part. He's all for homebirth!


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## ~pi (May 4, 2005)

Katherine, it's so nice to see you here again.







I'm sorry about the circumstances about your son's birth, but it's good to hear that you may have more and better options this time.









Keep us posted -- if we ever decide to have a second, I'll be following in your footsteps.


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## ~pi (May 4, 2005)

txtarheel and vbactivist, how is everything going? How was the meeting with the CNM, Katherine?


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## txtarheel (May 27, 2006)

So far, so good here. We were supposed to meet with the CNM yesterday but she had to attend a labor. Since DH will be out of town next week, we're meeting with her the first week in November. We've emailed quite a few times back and forth and I've got a good feeling about her so far. She's been researching pregnancies and labors with T1's with a pump and hasn't run away screaming yet! She's done tons of VBACs in the area so I know that won't be a stumbling block.

I'm just dealing with crappy ol' insulin resistance thus far. Much like last time, it hit me hard and fast and unrelenting. I was hoping it wouldn't be quite as severe this time. When we discovered my son's milk allergy, I gave up dairy as well and cut my total daily insulin by 30%. Not only did I reduce my basals, but my insulin:carb ratio changed and my correction factor did as well. But, I think the rate of increase is just as big this time around so far...


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## txtarheel (May 27, 2006)

I just thought I'd post an update on me and my situation. It looks like as long as all goes well during my pregnancy, I'll get my HBAC! At least I know that we'll have done everything in our power possible for it to happen. If I end up in the hospital, I believe it will have been truly necessary.

I've got a HB CNM on board. We've met at great length. She's really great and completely on board with having me as a client. Her only caveat was that I have a back-up doc that was also aware of and on board with the plan. I was scared to talk to my doc about it, but from what I'd heard, if anyone was going to be OK with it in my area, it would be him. I finally got up my nerve today and he was fine with it. No scare tactics, nothing. He just made sure I was aware (which I was) that I did have a higher than average risk of needing a hospital. But he, I and MW all agree that we'd know before labor that was true. Once labor begins, we all feel my risks are no more than average.

I don't think I'm planning on telling my endo though. She knows my doc and thinks he's great. I was surprised she didn't have a problem with me seeing him since he's family practice and not high-risk OB, but she was completely on board. I think we'll leave it at that as far as she's concerned.

Other than that, things are going great during this pregnancy. If it weren't for insulin resistance, I don't think I'd even feel pregnant. I've had barely any nausea, none of the terrible exhaustion that I had last time around and generally feel really good. We even checked at my endo appointment last week and I'm at about 50% less insulin than I was at this same point last time around. Proof that my new and improved diet/eating habits really are paying off.

I'd love to hear from the rest of you guys that are preggo too and hear how it's going!


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## ~pi (May 4, 2005)

Oh, that is such fantastic news!!!







: Please, please, please keep us posted! I am so thrilled for you!


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## txtarheel (May 27, 2006)

Let's see - it's been a while since I've updated here. I'm currently 34-ish weeks and things are still on track for my HBAC!

I've switched to a CPM. My original MW and I had some communication issues and she ended up dropping me because I never signed a contract that she never asked for. I can't decide if she decided she really didn't want me as a client or she was just a flake. But I feel really good about MW #2. My only issue is that CPMs can't legally attend births in my state, so it's all a bit under the radar. My parallel care doc does know I'm planning an HBAC and is at least superficially on board with it. At least I haven't heard any crap from him about it.

He did get a little freaky about my blood pressure which was quite annoying. I've had borderline BP (never over 140/90) for as long as I can remember - at least since high school. It's been the same throughout my pregnancy and was during my last. It doesn't go up, I don't spill protein, my kidney function is great, I don't even have much in the way of swelling. But, he decided to blow a gasket over it about a month ago. Luckily I managed to bring it down to barely even borderline high with some serious magnesium supplementation.

Then, we had a growth ultrasound about three weeks ago. It suggested that baby boy has an enlarged kidney. The u/s report suggested that both were enlarged, but my research seemed to indicate that only one was enlarged if you took into account that I'm in my third trimester. However, that one is pretty significantly enlarged. I keep getting mixed responses about how severe it is or what the treatments issues will be. If another Dr. suggests it's not a big deal, just "daily antibiotics from day 1 and probably surgery in a few years" I'm gonna completely give up on the medical community. I was told we'd have a series of u/s every 2-3 weeks to track the enlargement (and make sure the first one wasn't a fluke) but I can't get anyone to schedule another one. My parallel care doc hasn't sent over any paperwork and the freaky woman in charge of the u/s facility doesn't see a need for another scan until 38 weeks. My MW, however, thinks it would be good to scan again. It would be nice to know and I'm planning on calling my son's ped to see if I can get a better opinion from her.

I did realize today how lucky I've been with my care providers in the past. With my first pregnancy, I went to their office for all my NSTs/BPPs, so I didn't have to deal with outside opinions and I didn't have to fight them to carry until 40 weeks. But, since I'm going to a family practice guy for my backup, I have to go to the hospital for my NSTs/BPPs. Today was my first and I had an actual Dr. come and do the u/s portion of it. She seemed dumbfounded that I could possibly have normal fluid levels at this point. She refused to schedule NSTs past 38 weeks since I'd have my "induction date" set by then. Then she discovered I'd had a c/s with Johnson so figured I'd need to go ahead and get my c/s on the books. I know she's not my caregiver, but unfortunately, she's in charge of the facility and I'm gonna have to hear from her whenever I go in at 40+ weeks and am sure she'll flip out. Plus, they were way more sensitive about what constituted a "reassuring NST" than my previous caregivers. I'm a bit concerned about what the protocol is when an NST is "non-reassuring." Am I going to need to be prepared to leave the hospital AMA because they are going to want me to wander upstairs for an induction? I know the only reason I'd want to be at this hospital for my birth is because it is an extreme emergency and my son's life or mine is in danger. It's the closest to me - hence why I'm going there for testing, but they don't believe that diabetics should be allowed to wear their pumps at all - it's immediate IV drip for insulin/glucose.

I suppose that's enough rambling by me for now, I'll update more as the days grow closer...


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## txtarheel (May 27, 2006)

Gah...just when it was going so well.

I woke up this morning with ctxs. I usually have them in the evening and they don't concern me. This morning seemed a bit different. They were definitely crampier than my usual. I knew I wasn't dehydrated, I'd been eating well. Then my blood sugar was 55. It's usually in the 80's when I get up in the morning.

I drank a lot of water anyway. I took my usual liquid magnesium supplement but upped the dose a bit. I sat and told my husband I needed to rest. Nothing was helping. I was having them every 5-6 minutes, but they were only a few seconds each. I ate lots of eggs with my one slice of toast (since I'm at the point that I can't do much in the way of carbs in the AM). I lay on my side for a bit and drank more water. Nothing was seeming to work. I decided to try walking since some claim it works for them. Not so much for me. I tried a warm shower and a bath - again, it didn't seem to help. And my after breakfast blood sugar was far lower than it should have been when I hadn't eaten anything different.

After about three hours of this, I decided to call my MW. She didn't have any further suggestions for me to try and suggested strongly I head to the hospital. I called my Dr. and let him know what was going on. He suggested I meet him at his office since they'd be way more interventive than necessary if I showed up at L&D (more bonus points for him!). So we finally got our schedules worked out about 5 hours into my ctx festival to get seen. Luckily we learned that my cervix is still high, hard and closed. I also apparently had the beginnings of a BV infection. He felt the BV could cause the ctxs whether actual labor or not. But was worried that letting them go on unchecked could lead to actual labor. And being barely 35 weeks he wanted to stop that due to the whole lung development/steroids/blood sugar issue (more points for him!).

So he sent me home with some abx and terbutaline pills. I'm alternating the abx with probiotics, especially since reading a lot of threads here, it was suggested that BV in late pregnancy is nothing to be messed with and doesn't respond well to natural treatments. I took one dose of the terb. I'm not really sure how I feel about it. It shot my blood sugar up pretty quickly. It hadn't been over 100 all day - after one pill it was nearly 250. It did respond well to insulin and head back down, but I'm a bit concerned about taking another and going to bed.

The ctx have definitely slowed down - definitely further apart than they've been all day and shortening in duration, but they aren't gone. The suggestion was just to take the terb today and tomorrow and see how things are on Sunday. We're just trying to keep things from turning productive until the abx start to knock out the infection. He wanted me to double up the doses of terb until the ctx were gone, but I think I'm going to go with fluids, rest and single doses.


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## ~pi (May 4, 2005)

Ack! Sorry to hear about that, K! How are you doing now?


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## txtarheel (May 27, 2006)

Thanks! Things seem to be going better now. After a long weekend and Monday of doing absolutely nothing, I'm getting a bit done with frequent rests today. I think the infection was definitely causing the problems and it must be on its way out at this point. Plus I'm feeling better by the research I did about T1 and fetal lung development. It looks like there aren't any problems different from non-diabetic women as long as my A1c is below 8. Since I don't even know how many years it's been since my A1c was that high, I'm gonna toss the lung development issue out the window of things to worry about!

Just 1.5 more weeks and my MW can attend me at home!


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## txtarheel (May 27, 2006)

I'm thinking things might really work out for my HBAC plans. I'm currently 37+6, we've had our MW home visit, I had an open conversation with my backup Dr. about my HBAC plans last week, his only request was to call him when I'm in labor so he knows there might be a possibility of transfer. It sat funny with me when he asked, but as T1's we all know there isn't much else to do but transfer if we can't keep anything down to keep our BG up, so I'm OK with it.

I managed to pump 2 oz of colostrum in 20 minutes this afternoon from just one side. I'm gonna pump the other side shortly. That should be enough if we've got minor infant BG/latching issues for a couple of syringe feedings, then I can pump more if needed. Dr. is also in family practice, so we'd head in to see him if Baby Boy needs IV glucose. He's all into telling me how dumb formula is for treating low BG - if he'd deliver at home, I'd take him, but I just don't want to be at a hospital if I can help it! We've also got some glucose for backup as well if we need it.

But, I think I'll be lucky if I make it out the week without delivering. Since my BV cleared up a few weeks ago, I'd been pretty contraction free. Just random BH tightening and nothing more. Friday morning at my NST I registered a couple of minor contractions. One I didn't feel, one I definitely did. Happily, Baby Boy responded well and had a beautiful strip in less than five minutes. I took advantage of my sitter's schedule and spent several hours running errands. Definitely more contractions going on, but hey, I was busy getting stuff done and they weren't too much in the way. Friday in the late afternoon and evening, they definitely picked up in intensity and frequency. They weren't lasting too long, but were definitely every 4-6 minutes, crampy and stretching around into my back. I tried relaxing, hydrating, a bit of wine, nothing did anything to change their intensity and I was definitely feeling them down in my cervix as well. I headed off to bed assuming they'd be gone by morning. I'd had about 10 days of this (though less intense) with Johnson and still was induced and ended up with a c/s, so I was figuring this was just the beginning.

Well, a couple of the contractions woke me up Friday night, and they were still going strong Saturday morning. They hadn't really gotten more intense or closer together, so I just hung out trying to get stuff done. I had energy and nesting desire, so I chose to go with it. I was definitely feeling things down below and several of them I had to breathe through. I started noticing a reduced need for insulin Saturday morning as well - a good sign of activity going on. By afternoon, things were slowing down, but never completely stopped. I noticed my babe was definitely much lower - no possibility of sitting with my legs together any longer and he'd also shifted from his pretty persistent ROA position to an almost perfect OA for the first time. So, even if they weren't doing anything else, the contractions were definitely working to improve position. I also noticed that my insulin sensitivity was decreasing again, so I decided not to call my MW and see how things went. Nothing woke me up Saturday night.

But, today, they're still there. Not too frequent this morning, but the ones that I did have were much more intense. I didn't much feel them in my back, but they definitely took my breath away. After we got home from church I was wiped out and had to lie on the sofa for a while. Thank goodness it was a weekend and DH could feed Johnson and get him down for his nap. After naptime I went upstairs to try and work on fixing Johnson's new room a bit. I was pretty useless - zero energy. Just moving a few armloads of clothes from his old room to his new room was enough to make me go lie down again. And the contractions still haven't stopped. DH had a meeting tonight and it was all I could do to get Johnson to bed. Things seem to be picking up again in intensity, the wraparound backache seems here to stay and I'm thinking I'm back at every 5-6 minutes again. So, Johnson's asleep, DH is gone for a couple hours, I'm gonna find something easy for dinner and call my MW and give her a heads up on the situation.

I thought prodromal labor usually gave you a break for a while - it definitely did for me last time. Days/weeks of this with no break and I'm gonna be beyond exhausted. I think I'm going to request DH take the day off tomorrow because I have no clue how to deal with this and a 22 month old at the same time!


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## ~pi (May 4, 2005)

Thinking about you and wishing you nothing but good things: as much good rest as you can get right now, level BGs, and a smooth and easy HBAC when the time comes!









Keep us (or maybe just me? no idea where everyone else has gone) posted when you can. I am looking forward to hearing about it later!


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## widemouthedfrog (Mar 9, 2006)

txtar, that sounds wonderful! I don't think we'll be having a second child, but if we did that would be my wildest dream. Think that it would need to remain wild around here, though....

Good luck juggling your other little one during all of that! I also had contractions for many weeks leading to dd's birth, and it made for a quick labour. Hopefully the same is true for you!


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## ~pi (May 4, 2005)

Just posting to let you know I'm thinking about you, K.









Many happy labour and healthy baby vibes coming your way.


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## txtarheel (May 27, 2006)

Here's what I posted on my personal blog...

Our new little one - Casey Howard B. joined us at 1:11 AM on May 2. He weighed in at a whopping 10lbs, 8.5oz, 24 1/2" long with a 39cm head and even wider shoulders.

Despite all of our best efforts, 2 weeks of mostly non-stop prodromal labor and over 25 hours of labor, he proved to be related to his brother, unable to enter my pelvis and born via c-section at the recommendation of two different care providers who wanted to avoid that outcome as much as we did. But he's happy, healthy and content with a head full of red hair and nurses like a champ.

My experience was orders of magnitude better than last time - partly because we knew what we were going to the hospital for and partly because the staff was so amazing to us. They even let me walk to the OR and climb on the table by myself. The little bit of time he was away from me once he was born, Monty got to stay with him the whole time. Once his blood sugar dropped to 39, the nursery staff immediately brought him to me to nurse while we were in recovery - never a mention was made of feeding him formula or giving him pacifiers or bottles while we were in the hospital. He's been so much easier to nurse than Johnson - partly I credit to the fact that I know a bit more about what I'm doing as far as positioning, but we didn't even have to try to teach him to latch. The hospital was not only amazing about not mentioning/pushing formula, they didn't even care if we co-slept. When the nurses came in and we were sleeping together in the bed, all they did was raise the rails on the side of the bed and tiptoe back out.

My recovery has been much smoother than last time as well. I've managed without taking anything but high doses of ibuprofen once the 24-hours morphine from my spinal wore off. I have very little pain and can walk, even up and down stairs without too much trouble. The hardest part for me was leaving Johnson at home for so long and not being able to pick him up at all now that we are home. But, he's warming back up to me - he wasn't too sure at first. And he's starting to show some interest in his brother. Hopefully we'll have a good settling in period in the next few days.

[Addendum for this thread]
No one feels any of this has to do with my diabetes. That's one nice thing. Apparently, I have some quite odd anatomy at the top of my pelvis as to how my pelvis, uterus and cervix relate to each other. I was managing to dilate, but without the help of Casey's head to do so. The shape just doesn't seem to allow a baby's head to enter my pelvis to help dilation and help the head mold to an appropriate shape. My MW's feeling was that if I managed a vaginal birth, I'd have been in hard labor for 3-4 days, pushed for hours and likely had a baby who had to have his collarbone broken and likely nerve damage to get out as well as leaving me with a 3rd or 4th degree tear for which I'd have to go to the hospital and have surgery to repair anyway. We decided that the risks for a c/s were lower at that point. We also knew that since I'd been in labor for quite sometime, the problems associated with an "early" baby were unlikely since he was working hard to get the job done on his own.

It seems unfortunately that I'm in the small minority for which c/s are likey a good thing and no one thinks I have much of a chance of a vaginal birth even if I had a smaller baby in the future. Luckily, my Dr. is more that happy to take the same course we did this time - let the baby initiate labor, labor at home for the benefit to the baby and his respiratory development, assess the situation and see if there's a chance of a vaginal delivery and then worry about the section. I'm just grateful that the experience was so much better than last time and think I could manage doing it all again, even if the outcome was the same.


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## widemouthedfrog (Mar 9, 2006)

Welcome, Casey!

I am so glad that (almost) everything worked so well.
It sounds like all of your organization and discussion paid off.

Congratulations! Enjoy your little ones.....


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## ~pi (May 4, 2005)

Welcome, Casey!







: What a great name.









I'm sorry to hear that the HBAC/VBAC did not work out.







I'm so glad to hear that it was a significantly better experience for you this time, though. Wishing you smooth and easy healing.







:


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## DentedHalo (May 27, 2008)

New one checking in. I'm not a mom yet, but hubby and I began talking about having kids lately. I'm still wading through the posts here, and learning more and more by the minute.


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## txtarheel (May 27, 2006)

Welcome! We're glad to answer questions too. It'll take a while to read through all the posts here, but there is a lot of good info.


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## widemouthedfrog (Mar 9, 2006)

welcome from me, too! feel free to respond here or PM with any questions, though I didn't start my pregnancy with type 1 - so I don't think I am as qualified as some of the others in early pregnancy and type 1 management.


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## vbactivist (Oct 4, 2006)

Hello again!

I have posted here in the past - I was diagnosed with Type 1 when 5 weeks pregnant. I had a baby girl Nov. 1 2007 - she was born with a congenital heart defect. The cardiologist said it had nothing to do with the diabetes, but the genetecist said it probably was because of the diabetes









Anyhow - you all were so helpful last time when I asked about pump sites. I have been inserting on my back hip where I think Tricia suggested since my daughter was born. But now it is swim suit season. I am frustrated (actually had a mini tantrum this afternoon). It is hard enough to find a suit that fits. Now I have to find one that works with nurising and the pump. Actually I am really depressed today about the diabetes. I hate it. I feel like I don't want to live sometimes if it means living with it forever. I'm sorry. I'm sure this sounds ungrateful. Please don't quote this post, as AI plan to take it down at some point. I guess this turned into a vent when I really just wanted to know what everyone does for swimwear. Last summer when I was pregnant, I inserted at the top of my abdomen, and kept the pump in my"bra". But this year with nursing, that won't work. I guess I am thinking a two piece and weraing the pump on the band of the "shorts". But I don't want anyoen to see it. I especially hate the way the tubing looks. Even if only a little bit is visible. I feel like a freak hooked up to a machine. I'm sorry.


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## DentedHalo (May 27, 2008)

I am sorry to hear that your babe ended up with with the defect. I'm pretty sure that even the most recent studies on T1 and congenital heart defects show more confusion as to how those really happen than actual answers. I'm not trying to trash any particular group here, just stating that a study that provides "mights" and "maybes" is generally totally useless in the great scheme of things.

As to your outlook on diabetes - you don't sound ungrateful at all. You have been diagnosed very recently, and T1 can be quite a horror to deal with until you get used to it and start treating it as a somewhat tamed evil twin. I think everyone goes through this phase, and the phase tends to come back occasionally when once in a while you just get fed up with pumps\testing\counting carbs and all that jazz.

I'm not sure if this will work for you, but I can tell you what I did when I was fed up and hating my diabetes. I found a few friendly ears and I whined like nobody's business. I think it helped me because I eventually got tired of whining and went back to scheduled programming.

Trust me, you are not alone in your feelings. I bet you there are more people here who have at some point in time felt the same way you do now. It really, truly eventually goes away - I think at a time when you make a conscious peace with your new lifestyle.

Can't help you with your pump problem though. I'm on insulin pens.


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## widemouthedfrog (Mar 9, 2006)

vbactivist, you mean you don't like wearing the COOLEST mp3 player ever?







(Actually, I did use my pump the other day when I was asking a kid to turn off his tamagotchi during our nature programs. i whipped out my pump and told him i'd stop beeping if he did)

I heartily recommend online forums (insulin pump forums, email group for insulin-pumpers.org) for whining and complaining. And this one, of course. I don't go to Diabetic Mommy too often, but it seems like a good venting place too. My dh and my mom are both serious worriers, so while I vented with them in the first 6 months, I often go online to b$%ch now.

Honestly, the "I hate this" does start to go away. At least it did for me. Took about 1-1.5 years, though. I've now had diabetes for three years, and there are some days and weeks when I go through my routines so smoothly that I forget it is there. I put in a lot of effort at the beginning to create good routines and to understand how my body reacts to different things, though.

There are other days and weeks - like allergy season - when I can't go a moment without remembering it, and it brings me to tears. I find that it can be hard to talk to those who do not have this - even though they understand to a degree, it is difficult to understand that you need to be on top of this EVERY MINUTE. That is what online discussion is good for. Or real-life support groups, if you have them in your area.

For example, about a month ago I was having serious allergies to tree pollen AND my site failed right after dinner, which meant that my blood sugar was flying into the stratosphere. And my mother-in-law needed me there RIGHT NOW for a family photo. Everyone was grumbling about how difficult I was being by opting out of the photo, while I was silently working on putting in a new pump site in the bathroom, trying not to disturb the party. See! I grumbled here. Now I feel better. Maybe.







:

Two positive things I have done in the last year:

Went on CGMS sensors full time. I use them for a lot longer than recommended, so they are not actually that expensive. I like to know what my blood sugar is doing at any particular time, and for me the certainty is worth a lot. Even though I have another device on me and I look a little bit more "BORG".

I have also started running in the last year, and I am training for a marathon for the Canadian Diabetes Association. I found that getting type 1 really crushed my sense of my body as a good, whole body. Running is helping me get that back. It is hard to manage with the insulin and exercise, though.

*Back to the pump site and where to put the pump bit:
*

We are lucky enough to have a pool in our complex, so I just leave my pump at my house and head over to the outdoor pool in the summer. I wear a minimed, so I need to take it off for swimming in the public pool and I have to put it in a special locker, and that makes going to the public pool a bit too much stress.

However, I am thinking of starting triathalon this fall, and I plan to bring out my old solution: swim shorts. I got them when I started the sensors, because I put the sensors in my thighs and I didn't want everyone to see them. Shorts also have pockets, they come in cool colours, and you don't have to shave you know where. Not that I said that.














: And you might start a new pool trend. Or you could just pretend to be really, really modest. The pockets sometimes come with little snaps, so you can snap your pump inside.

So get a great bikini top - or whatever - and pair it with a funky pair of shorts.

Of course, my qualifier - I have absolutely no fashion sense, so this might not work for you.

Take care!


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## ~pi (May 4, 2005)

vbactivist,







Sometimes it just sucks, doesn't it? How long are you going swimming for? Can you bolus for the missed basal and just take the pump right off? I take mine off to play sports, to swim in the ocean, etc. FWIW, I don't really try to hide mine, and the vast majority of people think it's an mp3 player.

Also, as the mother of a toddler who is really not happy with any outing or activity unless there are highly regular instances of







: (side note, until I nursed an active toddler, I did not appreciate how truly perfect that smilie is) I still tuck the pump in my bra when wearing certain outfits. It does take a little more deft handwork, but it is not out of the question.

Longer term: have you thought about the OmniPod? Or even MDI?

DentedHalo, welcome, welcome, welcome!









Tricia, hi! Inspiring news about the marathon and CGMS.









I am *buried* with work at the moment, so have to scoot, but I wanted to say







I will post my own update when life calms down a little.


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## widemouthedfrog (Mar 9, 2006)

I agree with ~pi, most people think it is a fancy mp3 player. Only other people who wear a pump know it is a pump. And they are always overjoyed to find someone else who wears a pump.

If you're bothered with having others see it, why not make up a 1-liner about what it is - and be done with it? I work with kids, and since my sensor/pump sometimes goes off during a program, the kids see the pump when I check it and turn off the beep (it is in my pocket otherwise). When they ask what it is, I say - it's an insulin pump, I have diabetes. It gives me medicine. You can leave out the medicine part, but I find that the first part sounds a bit abbreviated and they end up asking what it does, anyway. I don't really like referring to it as medicine, but the kids tend to get it, anyway.

If they press further, like the kids in our complex have - or my daughter has - I just say that everyone needs something called insulin so that their body can use their food. They have something inside them that makes insulin, and I use a pump. I tell my daughter that she has a pump inside her. That is ALWAYS the end of the story. Well, except if you are my daughter, and then you have to ask annoying questions like, "What colour is MY pump, mommy!?"
















Adults rarely ask - unless they know what it is. Adults are like that.


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## widemouthedfrog (Mar 9, 2006)

Oh, and I don't go into autoimmune issues or anything like that with little kids. I just present the pump as an alternative to a pancreas. I know it isn't, of course.

If parents ask, I do talk about type 1 if they press the issue a bit. I just say that yes, it can be challenging to manage and that it is a balancing act with insulin, exercise...and that I find that the pump and sensors help me with this. Because I am often doing a public education program at the time - about nature, not about diabetes







- I tend to keep things lighter. If they seem interested, though, I will talk about it in depth after my teaching is over.

The major questions they ask:

* Does the pump test your blood sugar and give you insulin for that?
No, I still have to use my brain to figure out how to balance insulin, food, and exercise, and that can be hard...because as the mom of a three-year-old, my brain is already taxed.

* Oh wow, you got diabetes when you were pregnant. You're lucky, that goes away.
Well, gestational diabetes is what most people get if they get diabetes when they are pregnant. It does go away (often), but it can be a sign you're at risk for type 2 diabetes later. I happened to get type 1 diabetes when I was pregnant, which is the autoimmune one (like MS) that people often get as a child. It doesn't go away. It means that my pancreas doesn't make insulin anymore. A quarter of all type 1 diabetes actually happens when people are over age 25.

I know y'all know all these things, these are just my responses to common questions about the pump and diabetes. I find that having a ready answer helps me feel better about explaining.

And the last one is only applicable to people in the situation that vbactivist and a couple others on this list have - type 1 started when you were pregnant.

So, I don't really have an issue with people asking me questions when they see my pump.

However, I still dislike the "OMG, you're really terribly sick and I feel sorry for you" looks that I get sometimes. Then I whup all of them climbing 150 stairs, and I feel better.


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## Asarum (Aug 27, 2007)

hi Im new here also, ive been looking for a forum where i would fit in. i think i may have found it here. i have type 1 and ttc, we would love to have a homebirth and i was wondering if anyone here has or know of diabetics that have. we are meeting with some midwives open to the idea this month. any advice on what to ask them.
thanks looking foward to getting to know you all.


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## DentedHalo (May 27, 2008)

Howdy Asarum!

I have type 1 as well and I have about given up on kids for the time being. I am having real difficulty in finding providers who are willing to accommodate me - my town is not diabetic friendly all around, never mind a diabetic pregnancy.

I would be really interested in hearing about your experience with the midwives.

I know I read at least two stories of diabetics having fully blown home birth. Here's one:

http://www.aims.org.uk/Journal/Vol12No4/diabetes.htm

As you can see from the story, the biggest battle is often finding understanding providers and banging your head against the system.

Welcome to our little tribe. I hope you stick around, the ladies here are positively great.


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## widemouthedfrog (Mar 9, 2006)

Hi asarum, welcome! I didn't start out my pregnancy with type 1, so not a lot of experience there.

dented halo, if I had acquired type 1 before I got pregnant, I know that I would certainly have looked into adoption. But I lean that way anyway. My dh, with his worrying tendencies...he might have been convinced to adopt too, even though he also has concerns about adoption.

Now, even having had a wretched pregnancy (during which I was diagnosed with type 1), I would be ok getting pregnant again. However, I don't think that I would want to do it without a glucose sensor. If you have insurance, they should generally cover you during TTC and pregnancy. That is one of their few exceptions to the "we never cover CGMS" rule.

Getting pregnant with type 1 would seem to me to be a matter of careful planning and a leap of faith, since we all know that this is not the easiest thing to control at all times.

I think that the hardest thing for me to practice during pregnancy would be self-forgiveness. I am now fine with the occasional "bad" blood sugar readings. I don't berate myself, I just deal with them. However, I would have a harder time if I was also carrying another little human.

Good luck with your decision!


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## ~pi (May 4, 2005)

Welcome, Asarum!

In addition to the 2000 story DentedHalo posted (it's also posted on the first post in this thread, along with another such story that took place in Vermont in 1999), I know two women with type 1 who planned homebirths in the past few months. One (on this tribe - txtarheel) transferred to hospital for reasons unrelated to her diabetes. The other (not on this tribe) had a homebirth for her second baby.

I had MWs who were willing to do an 'oops!' homebirth with me in 2006, though I ultimately ended up going to the hospital for an induction.

It really depends where you live, what the regulations are there, and whether or not you can find midwives open to the idea. I do think the options are slowly expanding. I'm trying to get some of these cases written up so that they are at least out there in appropriate journals.

The questions I would ask would include:

- What do you see as some of the issues specific to my diabetes that might present additional challenges during pregnancy/labour and how would you prefer to approach them?


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## DentedHalo (May 27, 2008)

*widemouthedfrog* - My insurance covers CGMS, I kid you not, only for those whose diabetes is mismanaged. I'm out of luck on that, although I am certainly not bothered by it, considering. But $$$ is not an issue, I am going to buy my own anyway because I'm one of those very geeky people who like to try new gadgets out.









I think you are a damn strong person, too. I can yak all I want about diabetes, but I've lived with this thing for nearly my entire life. I can only imagine how awfully difficult and stressful it was to be given the diagnosis during pregnancy. There's so much information to absorb and process at the beginning, mind boggles.

Quote:


Originally Posted by *~pi* 
The questions I would ask would include:

- What do you see as some of the issues specific to my diabetes that might present additional challenges during pregnancy/labour and how would you prefer to approach them?

Brilliant question, that. Further questions:

- What is your knowledge of Diabetes Type I? (I'd rather educate a midwife than deal with someone who thinks they know stuff about diabetes and are wrong. In my opinion, each diabetes is different and each one of us has different circumstances. You probably don't want to end up with someone who applies the same set of rules to every diabetic client they see.)

- What is your approach to management of diabetes during labor? (This can be a killer question. I have already spoken with providers who, despite being shown materials pointing to the fact that self or spouse-aided management in labor works perfectly fine, were still dead set on the hospital\IV with insulin and dextrose approach.)

*Asarum* - Is your significant other on board with your diabetes? Does he know about as much about it as you do? I think having a fully educated partner can be the make or break in any circumstances, not only in pregnancy and labor. My hubby was nothing short of a life saver for me twice already - once when I got really ill and had no chance in hell of getting medical assistance, and another time when I had all the medical assistance in the world, but the assistance was clueless about diabetes. Having someone who knows all the ins and outs, and who can properly assess your situation is priceless under such circumstances. In my case, it saved my life twice.


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## Asarum (Aug 27, 2007)

thanks for the support. i have a couple appointments this month with some midwives. im trying to put together some questions, so if anyone has any advice on that please let me know. i will keep you updated on how it goes. your support means a lot it hard to find good support, most people are just scared for me.
thanks again,
dorene


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## DentedHalo (May 27, 2008)

Gang, first I'm gonna gloat (because I'm happy like a pig in s**t), then a question.

Our poor *~pi* was subject to a few frustrated PMs from me when I joined MDC, due to the fact that I was having difficulty with finding a good endocrinologist and I was out of my mind angry. Well, those times are over.

There was a staff rotation at the practice I go to, and I got to see a completely new doc. He's fabulous! He's also from Europe - totally different diabetes mindset. No freaking out about my job (no schedule whatsoever, often working nights, what diet?), no insistence on seeing a nutritionist, no pushing of anything etc. Told me to call him if there's a problem, if I have questions or want any tests done.

My A1c runs squarely at 6.4 (my comfort level), no health issues, no complications - with the earlier docs it was a battle because although everything was fine, I didn't fit their management plan. I was told to change jobs so that they could manage me better (!), constant pushing of an insulin pump (nothing against, I just don't want one right now), one doc wanted to change me from Humalog\Lantus to a pre-mix because all of her patients were on pre-mix and she wasn't comfortable with me being on something else...

I told my new endo all of the above, and his reaction was rather priceless - "Why tinker with something that works perfectly fine?"

Yah, no, really....

Gloat over, now a question.

I'm on the thinner side (5'8", ~115-120 lbs). I've been like that pretty much all of my adult life, it's what's normal for me. When I was at the endo's office, a new nurse there remarked that I must be getting hell from doctors about my weight. I used to and I've certainly been accused of anorexia before, but then the nurse explained what he meant. To wit:

"There are young girls with diabetes who basically do anorexia by insulin." He explained that apparently it's a fairly new trend, but some folks out there simply lower their dosages of insulin to nothing, eat much less and maintain very low weight that way.

I can see how that could work, but holy cow...

Is anyone familiar with this?


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## widemouthedfrog (Mar 9, 2006)

dentedhalo, congratulations on finding a new endo! Isn't it lovely to have someone who treats you like you're the manager of your own diabetes? That's why I switched, too. I know that so many people struggle with understanding diabetes and/or try to ignore it, so I do understand the health care provider's perspective. However, it is refreshing when they're able to break out of the "must do it my way" mode into "wow, you're managing ok, here's some leeway to do it your way" mode.

The weight thing you're talking about is diabulimia. I struggled with close-to-anorexia as a young teen, but I like food a lot now. However, I have met people at our clinic who've had it, and boy, it sounds awful. Anorexia is inherently a struggle to exert some control over your life, and I guess people with diabetes find it even more necessary to feel in control of something...since so much of this disease makes you feel like things are beyond your control.

On a side note, have you ever been checked for hyperthyroid? I believe that this can manifest due to an autoimmune disorder too. I am mildly hypothyroid, though not enough that any endo (including my new fab one) will do anything about it. However, the marathon training I am doing at the moment has made me really lean - I'm the same weight as I was, but a lot of muscle.


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## DentedHalo (May 27, 2008)

Quote:


Originally Posted by *widemouthedfrog* 
I know that so many people struggle with understanding diabetes and/or try to ignore it, so I do understand the health care provider's perspective. However, it is refreshing when they're able to break out of the "must do it my way" mode into "wow, you're managing ok, here's some leeway to do it your way" mode.

Yup. I unfortunately live in a border town, where the docs often see more DT2 patients than DT1. Poverty is horrendous here, so is lack of even the most basic education - the docs don't have a choice but to force everything on their patients, and "because that's the way we do it" is basically the simplest concept that allows them to keep their patients reasonably healthy. DT1 patients are not that much different, and with all of the above you have the added "bonus" of poverty making for horrible nutrition.

However, there's something to be said for weighing the facts and seeing what's in front of you. If I applied the same lack of flexibility to my own job that my previous endos applied to theirs, I would have been kicked out of my guild a long time ago.

Quote:

The weight thing you're talking about is diabulimia. I struggled with close-to-anorexia as a young teen, but I like food a lot now. However, I have met people at our clinic who've had it, and boy, it sounds awful. Anorexia is inherently a struggle to exert some control over your life, and I guess people with diabetes find it even more necessary to feel in control of something...since so much of this disease makes you feel like things are beyond your control.
Dang, it even has a name. I was just surprised to hear about this, because I know that diabetes alone can be a royal pain in the a** at times and I didn't think that anyone would want to add anything extra to that. Now that I think of it, it could go both ways - someone with anorexic tendencies would have the perfect tools (diabetes\insulin) at their disposal, and a diabetic could easily get into the mindset of "the less, the better" with the added "bonus" of less injections\controls with the very low levels of carb intake. Thanks for the info, much appreciated!

Quote:

On a side note, have you ever been checked for hyperthyroid? I believe that this can manifest due to an autoimmune disorder too.
Yup, had thyroid checked - nothing out of line. Being lean is an inheritance form my dad's side of the family - they're all tall and thin. At 5'8" I'm the shortest one in I think 3 generations.







I also run and exercise, mostly because of my work. After all the hours of having my rear end glued to my chair, my backbone would crack in half if I didn't get some movement.

How is your marathon training going? I think it's fantastic that you're doing it, and I sorta wish I was able to make that kind of a commitment to something. I bet you're going to ace it!


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## widemouthedfrog (Mar 9, 2006)

Quote:


Originally Posted by *DentedHalo* 
How is your marathon training going? I think it's fantastic that you're doing it, and I sorta wish I was able to make that kind of a commitment to something. I bet you're going to ace it!









Marathon training is going pretty well, though I've been tired the last week. Dd is not napping any more. I don't know about acing it, but finishing would be good. That's the kind of running category I'm in.


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## emmabird (Aug 28, 2008)

hi ladies~
my name is emily.
i was just diagnosed with T1 this march, but am now under control. my first post-dx a1c [now] was 5.6. of course, i'm probably honeymooning a bit, but due to my interests in natural medicine and food therapy, i keep my sugars tightly controlled.
i am not pregnant and have not been ever, but within the next year, my partner and i would like to start our family.
i joined this forum b/c of my concerns with [perhaps] being bullied into induction, c-sxn or iv glucose drips, etc. while i understand that out-of-hospital birth is not really an option for t1 gals, i want to have as natural birth as possible. my internist said something great: "it's not the t1 that puts a woman at risk, it's a t1 woman who doesn't have tight control." this gave me hope that i will be able to plan and have a healthy pregnancy, but also a healthy birth.
i am hoping to just learn and listen from all of you, and hopefully get my questions answered as i move into this next phase of my life over the next year. thank you sisters!
my first question then, is induction always necessary? i've read some articles that said t1's are always induced [slightly] early b/c of the 'placenta maturing a bit fast' due to something about our sugar fluctuations....? i wouldn't want to be!


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## fullofgrace (Nov 26, 2002)

Hello!

In the interest of limiting FYT to subjects not hosted elsewhere on the board, we have moved your tribe here. *You're still a tribe, which means you're still support-only.*









If you have any questions about the move, please do not discuss it on the boards. Rather, contact an administrator (in green) via Private Message or start a thread in Questions and Suggestions where one of the administrators will answer you.

Thanks, and happy posting!


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## ~pi (May 4, 2005)

Welcome, Emily!









Quote:


Originally Posted by *emmabird* 
my first question then, is induction always necessary? i've read some articles that said t1's are always induced [slightly] early b/c of the 'placenta maturing a bit fast' due to something about our sugar fluctuations....? i wouldn't want to be!

It depends a little bit on where you are, what sort of HCPs you have, and your relationship with them.

In general, yes, T1's are induced earlier than non-diabetics, mostly due to concerns about stillbirth. For a long time, 'early' meant 37-38 weeks. It was seen as a tricky balance because T1 is associated with both an increased risk of stillbirth and an increased risk of delayed lung maturity.

I have noticed a slow shift in attitudes going on as more and more women are maintaining very tight control throughout pregnancy. Tight control generally means less chance of complications. It is becoming more common now to delay induction until 39 or 40 weeks or, in rare cases, beyond. It used to be that people got freaked out as insulin needs fell towards the end of pregnancy, thinking that it was a sign of placental deterioration. There seems to be somewhat less panic about it now.

It would be pretty unusual to find medical practitioners who would support going beyond 40 weeks (though a few do) but it is, ultimately, your decision. My opinion is that it is a highly personal thing. You really have to decide what is important to you.

I struggled a lot with the induction issue. I had 'negotiated' to go to 40 weeks assuming all looked good, but I started getting pressure at 35 weeks despite having really gorgeous control. I had originally thought to perhaps push the 40 weeks if I had to, but in the end, I gave in to the pressure and was induced the day I hit 40 weeks.

I had no caregivers who were explicitly supportive of going beyond 40 weeks, and I was not prepared to take what I saw as complete responsibility for any negative outcomes. I realized some time afterwards that I already shouldered that responsibility whether I realized it or not, and that I needn't have looked externally for approval of my decisions. If I were in the same situation today, I don't know if I would make quite the same decision, but on the bright side, I really learned a lot about myself through the whole experience.


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## widemouthedfrog (Mar 9, 2006)

welcome, Emily!
I developed type 1 during pregnancy, so needless to say...my control wasn't the best during pregnancy. My HCPs had a policy of inducing any people with diabetes around 38 weeks. Luckily for dd, she came at 37.5 weeks. And really quickly, too, so I basically arrived at the hospital and out she came.







No need for any drips or anything.

I was really torn between the options. Knowing that my control hadn't been great, and knowing that lung maturity could be an issue vs wanting to make sure that the placenta wasn't deteriorating.....

My insulin needs started dropping quite early and quite rapidly. I recall that this happened ~7 weeks prior to my due date, ~4 weeks before dd was born. The placenta causes insulin resistance, which is why they are concerned that dropping insulin needs may = declining placenta.

As far as I know, they can't check the placenta's health. They did do two late-term ultrasounds on me to make sure that dd was still growing well, plus lots of kick counts and non-stress tests. I was ok with all of these at the time because I was quite overwhelmed with all of the new diabetes stuff.

I think that they can check lung maturity, can't they? Though this might have involved an amnio sort of procedure, and I don't think that I was willing to go there.

Good luck with all of your choices! I am not sure what I would do if I had to do it over again. Most likely I would once again count on our family history of having babies three weeks early.

ETA: If I did do it again, I would be picky about my choice in care providers. The people I had for dd's birth were the only ones around here would would take me...because my doctor at the time did not deliver babies. They knew very little about type 1 and pregnancy, because they didn't deal with a lot of high risk pregnancies. If I did it again, I would make sure that I had an endo I trusted and a doctor I trusted, and I would work on educating them and discussing things with them before I even became pregnant.


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## iamlsh (Oct 24, 2008)

Hey all







I have recently found this site, and then subsequently this thread. I am a type 1 diabetic of 17 years, pregnant with my third. My husband and I are considering home birth. Does anyone here have any experience with this?


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## J&B (6 mo ago)

Hello all,

I am a type one diabetic looking to have a natural home birth but can't find any midwives to help me. Does anyone have experience with this? We are located in Louisiana, USA. 
I have an A1C of 5.7 and our goal is 5.2 for the third trimester. I had a 5.2-5.4 A1C before I was pregnant.


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