This is the third entry in a series of four posts by Shelly Jensen.
Carbs, Carbs,Carbs (or not). Let’s get this out the way: when we are pregnant, we often crave food or can’t stand the sight of it. If you are like me, you crave carbohydrates. Even when I was going through morning sickness, the only thing that would help me feel better was carbs! I am talking about serious carbs – macaroni and cheese, banana muffins, bagels. This is normal pregnancy stuff but can make you feel terribly guilty if you succumb to it. The important thing to remember is to plan for these episodes. Also, talk to your doctor or nurse about it. Tell him or her, “Look, I am craving carbs, I’m hormonal and I cannot help myself!” The important thing is to be honest with your team. Do not hold back and do not feel ashamed.
Like every other pregnant woman, you have strange new cravings as well as strange aversions. If you have morning sickness you might have a hard time eating. This also needs to be discussed with your team. They will work out a plan for you so that you can prepare for these cravings as well as times that you just can’t eat (unfortunately, that never happened to me). Insulin dosages can be adjusted very precisely throughout the day to accommodate these moments.
The same goes for an exercise program. If you are a pregnant woman who would like to continue your exercise regime throughout your pregnancy you need to discuss a plan with your team. As you already know, exercise affects your blood sugar and when you add pregnancy to that equation, you need to pay even closer attention. If you are not already in the habit, please keep glucose tablets in your pocket during exercise. Your temporary basal settings on your pump will come in very handy for planned exercise. As your doctor tweaks your insulin settings very precisely and meticulously, you will start to realize what an important tool it will be throughout your entire pregnancy.
First Trimester Dips. I had morning sickness during each of my pregnancies in the first trimester. Actually, it was more like all-day sickness for me. Although I was eating muffins and macaroni and cheese, I noticed a drop in my insulin needs. This is very common in the first trimester and is due to your new fetus confiscating the glucose from your body. If you are one to despise the thought of food during the first trimester you may notice an even lower dip in your insulin requirements.
As you may know from previous experiences, sudden and extreme hypoglycemia can be very frightening. When you are under tighter control, you are more prone to these episodes. During the first trimester of pregnancy, you may be even more susceptible to an occurrence. This happened to me a few times in each of my pregnancies. I am fortunate that I can feel it coming on right away and so was able to correct it quickly. However, one day I was visiting a friend out of town and I happened to be alone in her house on Sunday morning. Before I even knew what was happening I felt as though I was going to faint right there in her living room. My body started shaking and I was seeing black spots. I knew what it was but I had never felt it so badly. I could barely make it to the pantry where I ransacked a package of cookies. I did recover but it scared me to death. The only thought that went through my mind was “what if this happens when I am home alone with my newborn?” This is a very real concern and I vowed to keep glucose tablets in every room of the house, in my pockets and purse at all times. To this day, I stockpile glucose tablets. Next, I had to explain to my friend why her pantry looked like an animal had attacked it.
I have always been a bit embarrassed about my diabetes and some of the side effects. However, the episode at my friend’s house made me realize that I now had another human being to consider. Of course my husband and family were very well informed of these types of side effects but I could no longer let my awkwardness prevent me from letting my friends, neighbors and coworkers know about my condition and what to do if I had symptoms of low blood sugar.
I wound up announcing my pregnancy earlier than most women do. When I took this step it felt very empowering and it also felt like an act of love for my baby. Just be warned – many of your well-meaning friends will nod with empathy as they tell you about their uncle who was just diagnosed with diabetes and their cousin who had borderline diabetes while she was pregnant. Most of the general public does not understand the differences between the various types of diabetes. So, I suggest you just nod back with a smile and if the moment permits, clarify your condition. They will then realize that the “pager” you have been wearing is actually an insulin pump.
Second Trimester Bliss. I truly enjoyed the second trimester of both of my pregnancies. As is common, my blood sugar levels and insulin requirements evened out and I felt great. Morning sickness was over and I was craving healthy foods and taking walks. My readings were near perfect. My “bump” was showing but I was not uncomfortable (yet). I started telling the whole world that I was pregnant. These glory days inspired me to pay even closer attention to my food intake and patterns throughout the day.
Lots of tests were conducted in this trimester. Due to my “advanced maternal age”, not because of my diabetes, we decided to have an amniocentesis to detect disorders and defects such as Down’s Syndrome. We were thrilled that the results came back with no red flags. Next, my doctor ordered a level 2 ultra sound to be sure the baby was developing properly (translation: no deformities in the lungs or heart and other organs). My husband and I were much more apprehensive about this test than the amniocentesis. Everything was measured as precisely as possible. So, when the specialist who read the measurements brought us into his office we were a bit nervous. I will never forget the words he used: “your baby is developing normally, thank God.” The words “thank God” really hit me with how “high risk” this pregnancy really was. My husband and I celebrated that evening by calling our family members to let them know the news.
Third Trimester Panic. The only good thing about my third trimester was that I did not have to take the glucose tolerance test for gestational diabetes! I had a terrible time keeping up with how rapidly my insulin needs were increasing. During both pregnancies, there were some scary and unexplained high readings. My wonderful nurse was always there for me. I called her crying on more than one occasion. I was so worried for my unborn child. By my 38th week my total daily insulin dosage had doubled from pre-pregnancy. My belly was so big that I could not see my infusion sites and I wound up with some sores that I never knew were there until my doctor saw them. So, I had to get experimental with my sites so that I could see them. The only good thing was that my breasts became so large that I was able to conceal my pump in my bra very easily, something I continued to do after giving birth.
Towards the end of the third trimester of my first pregnancy, I developed edema (severe swelling in my ankles). This is a higher risk when pregnant with Type 1 Diabetes. I am not exaggerating when I say that my ankles looked like those of an elephant. I frequently looked at them saying out loud, “these are not my legs!”
The edema quickly developed into a case of preeclampsia (high blood pressure and protein in my urine). This is also a higher risk when pregnant with Type 1 Diabetes and the only cure is giving birth. While edema is uncomfortable, preeclampsia is very dangerous to the mother as well as the fetus. Incidentally, I did not develop either of these conditions in my second pregnancy. When preeclampsia was discovered at a routine visit with my Obstetrician on a Friday afternoon, I was swiftly sent home on bed rest with medical jugs that I was to fill with my urine. Picture my devoted husband carrying these samples to my doctor’s office on his way to work! I just kept saying, “For better or worse!” Well, the bed rest did not last long because I simply could not remain in bed. When I visited my doctor again with no signs of improvement, I was sent to the maternity triage. I was then admitted to the hospital and waited for five days until I had an emergency cesarean section. To be continued.
Post Script
Share your stories with me. As I continue to say, every pregnancy and every person with diabetes is different. These were my experiences but you will have your own unique experiences. Please write to me and let me know your own story. I would love to hear from you. Also, if you have Type 1 Diabetes and are hoping to become a mother, please contact me. My goal is to reach out other expectant mothers with Type 1 Diabetes. My wish is that the next woman who feels as frightened and alone as I did may be comforted by our stories.
This is the third entry in a series of four posts by Shelly Jensen.
