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Archive for June, 2011

Jun 30 / Caro

Wheels

We’ve got new wheels! That is, a new car.

At the grand ages of 31, it’s actually the first car Ian or I have ever owned as “our own”. We both learned to drive as soon as it was legal at the age of 17, and then drove cars that belonged to our families rather than us. I lost my license at the age of 21 as a result of being diagnosed with epilepsy. Ian moved to London and, like most young people in London, had no need for a car. It takes longer to drive yourself almost anywhere in London than it does to use public transport. For the few occasions when a car would be useful, justifying its ongoing cost would be difficult.

When we moved out of London last year, a car was on our “to-do” list. But we were very fortunate to still not really “need” one. I live within ten minutes walk of work. We live five minutes walk from the train station from which Ian commutes to work. The same train line takes us to the two local towns we have most reason to visit and the train service is both quick and frequent. We even live within walking distance of two supermarkets, one of which will deliver your shopping after you’ve bought it. And with all the expense of buying a new house and doing it up, the car slipped down the list.

Then, suddenly, I was pregnant. And just as suddenly, a car seemed a whole lot more important. The idea of visiting friends and family travelling by train with a baby doesn’t seem appealing. Just nipping to the shops with a baby will be easier in the car. (Not to mention the whole “getting to hospital when I’m in labour” thing that I don’t want to think about at the moment and I’m going la-la-la-la-la-la because I can’t hear you saying it.)

I hope this baby is grateful that we’ve bought it a car. Honestly, I used to think friends were pretty spoiled if their parents bought them a car for their 18th birthday. This kid isn’t even born yet!

Jun 29 / Caro

Increasing Insulin, Increasing Appetite

Over the last couple of weeks, I’ve seem some consistent increases in the amount of insulin that I’m using each day.

Whilst the first trimester saw some of the lowest insulin doses of my adult life, less than half way through the second trimester things are starting to head skyward, with my basal rates creeping up almost every other day and – even more significantly – my total daily doses of insulin up by a good 15%.

I’m not normally one to get overly hung up about how much insulin I’m using, preferring to adopt the understanding that I need to take what my body needs in order to keep my blood glucose levels under control. But I can’t help little worries rising to the surface, because from everything I’ve read twenty weeks is pretty early to be meeting with insulin resistance.

I’m not sure why I’m worried really. Insulin resistance is caused by the hormones being spat out by the placenta. A good healthy placenta presumably spits out plenty of hormones, so the ever increasing insulin needs are presumably a sign that everything is growing and progressing as it should.

But of course, along with rapid changes in insulin doses come less stable blood sugars, which the nagging voice of worry at the back of my head reminds me isn’t good for Flangelina. And there is more than a tiny bit of guilt in the mix when I look at some of the things I’m doing that could be contributing to those increasing insulin needs. Like not being so fastidious about minimising the number of carbs in each meal, which leads to bigger bolus doses. Bolus doses that might not, however, be enough, because I’m not very good at altering bolus ratios. I’m eating more at similar times each day so I’m using increased basals to compensate for these carbs, which makes it appear that my basal need has gone up even more than it should.

At the root of both these things is: ravenous hunger. After spending the first trimester with perma-nausea and a very restricted palate, it seems my body is making up for it. I probably wouldn’t stop stuffing my face if it weren’t for these insulin doses spelling out in black and white exactly how much I must be eating.

And as for those bolus doses needing to be bigger still – well that’s a problem that’s a result of years of bad habits. I know how to carb count. I really do. But I was on multiple daily injections for years, and then my first insulin pump came before the advent of so-called “smart pumps”. Neither of these methods had fancy bolus calculators that allowed me to enter the number of carbs I was eating and then gave me a resulting bolus dose based my insulin-to-carb ratio. So I learned to think in units of insulin rather than grams of carbs. I can look at a lot of plates of food and know how many units of insulin are required to cover them.

But now that everything has changed so much, I’ve come unstuck. The number of units of insulin that used to cover a plate of pasta or a bowl of cereal doesn’t even come close anymore. But psychologically it’s hard to take so much more insulin. When I’m used to a meal needing 4 units and suddenly it needs 10, it’s hard not freak out and think “I can’t take that much insulin, I’ll be on the floor”. Basals are comparatively easier to alter, because once they’re done, the tick along in the background without constantly screaming in your face “Look how high I am. Look how much insulin you’re using”.

It’s as much a psychological battle as simply a numbers game. I’m still struggling, but I’m getting there. I know that I have to, each time I feel Flangelina kick. And if Flangelina’s presence means I need to use 120 units a day, then I‘ll do it. I’ll do anything.

Jun 28 / Caro

Twenty

Twenty weeks. The official half-way point in the forty weeks of pregnancy.

Part of me thinks “Wow, that’s gone quick”.

Another part thinks “Really? Only halfway?”

I’m very thankful that things are going well so far in this pregnancy. But I can’t lie. I can’t honestly claim to be enjoying it. I’m really desperate to meet this kid inside me, and to know that they’re really OK. I can’t shut off the worry that although I’m doing my best, it may not be good enough.

Although I’ve managed to move past the constant freaking out about every number that is slightly out of range – I’m adept at testing, correcting and moving on – I’m still tired of the constant focus on blood sugars and basal rates and food. These things are part of the management of type 1 diabetes whether pregnant or not, and there is really no escaping them, but the last 20 weeks have been more intense, more rapidly changing and with higher stakes than ever before. When I’m not pregnant, a whole fortnight of poor control will pale in to insignificance against the years of type 1 in my past and future. In this pregnancy, a week of poor control is one fortieth of this baby’s development time frame. There isn’t much time to make up for mistakes, and the stakes just feel so massive.

It’s really not helped by the fact that I know things will only get tougher throughout the remaining weeks, with insulin requirements expected to change ever more rapidly (more on this soon).

At this morning’s routine diabetes antenatal visit, everyone was very upbeat and positive. My blood pressure remains good and my A1c excellent. We listened to the baby’s heart beat thundering along. It’s a sound that makes me smile every time. The midwife and obstetrician have no concerns. I spent time going over my DexCom data and insulin doses with the Diabetes Specialist Nurse (DSN). Although we made some minor tweaks, she has no concerns either – apparently everything looks great and I’m doing well. Even the dietician is happy and feels I’m successfully balancing my desire to restrict carbs in order to maintain better numbers with the need to eat a balanced diet for mine and the baby’s sake.

It’s all good.

But I can’t wait for this to be over, really I can’t.

Jun 26 / Caro

‘More’ Does Not Mean ‘Faster’

More insulin will not make blood glucose levels go down faster, just further. In exactly the same way, more carbs taken to treat a low blood sugar will not make it rise any quicker, just further.

I know this.

So why do I persist in over-bolusing and repeat bolusing until my insulin doses are stacked as high as the sky, just because I’ve not seen a downward movement quick enough? When I know that I have enough insulin on board to treat the blood sugar level I’m at, why do I get impatient and add more? Sometimes as little as twenty minutes after taking the first bolus, I’m adding another unit, because the number hasn’t changed. My pump history is littered with random boluses delivered, in almost Pavlovian fashion, in response to the High Alert tone from the CGM.

But all it does is initiate a roller coaster ride. A crashing low follows, which leaves me drained and sweaty, with a pounding heart and an irrepressible urge to eat the entire contents of the kitchen. One (appropriately sized) gulp of Lucozade becomes two. Then three. And four, because I still feel rubbish. Before I know it the bottle is empty and I’ve consumed the better part of 90 grams of carbohydrate. It won’t get me up any faster though….

It’s a vicious cycle and it’s all anxiety led.

I’m so fearful of highs these days, and the damage that they may be doing to my unborn child. Once I see a sharp upward trend, or a high number, I become obsessed with reversing it. The anxiety about that number overtakes all rational thought about stacking boluses and bringing the number down safely. And once I’m low, the familiar anxiety about passing out or harming myself and others wraps itself around me. The adrenaline surge that comes with the low blood sugar territory sets me on edge, and rational thought is dulled by the fog that descends when my brain is lacking in glucose to fuel it. All I want to do is eat, until the feeling goes away.

Some days I feel like I’m pogoing from low to high and back again. That in itself is an enormous frustration and causes yet more fear – of what those variations are doing to my A1c and my baby. Surely all this bouncing about can’t be good for him or her?

But I’m the only person who can stop this particular roller coaster. I know that I need to step away from the carbs when I’m low, and back off the bolus button when I’m high. I know that I need to learn patience and remember that ‘more’ will get me there at exactly the same speed. It just means I won’t stop when I’m where I want to be.

It’s just so much easier said than done.

Jun 24 / Caro

Stealing My Pregnancy Thunder

This is going to sound bratish to the extreme. And petty. And childish. But I’m just being honest.

I was a bit gutted that a work colleague announced she was nine weeks pregnant when I was six weeks. I felt as though she’d beaten me to it. I suppose I felt like she stole my thunder. After months of good natured ribbing from colleagues who knew that I had a maternal side that was desperate to be unleashed, I was so excited to tell them that yes, I”m going to be a mummy. I suppose it sounds bratish because I make it sound as though wanted to be all “look at me” about being pregnant, but suddenly it felt as though the shine had been taken off it, and I thought that by the time I was ready to disclose my own pregnancy at 12 weeks, no one would be excited for me.

In the end it didn’t work out that way. Everyone was just as excited and full of questions for me as I think they would have been had I been the only one with a baby in my belly. But somehow it still didn’t feel right. It’s a small workplace and I felt squeezed, constantly comparing what was happening and what we were doing. Others couldn’t help comparing us either – especially when my bump began to show a couple of weeks ago, and earlier than hers. I felt as though I was being criticised. A fatty with my belly clearing poking out before it was meant to. In all likelihood no one was really thinking anything of the sort. In all likelihood they just aren’t that interested in our pregnancies, but I still feel uneasy about it.

And I suppose being so close to someone – seeing them everyday – who was pregnant at such a close stage sort of rubs my face in the fact that my pregnancy is not “normal”, “straightforward” or “low risk”. And also made that fact apparent to everyone else. It’s highlighted the differences in our pregnancy experiences.

You can’t resent another person for being pregnant. In all probability they want it as much as you. And you can never know someone else’s true story – how long they’ve been waiting and trying or what obstacles they’ve encountered along the way. It’s not jealously that I feel, just disappointment that it’s changed the pregnancy journey for me from how I imagined it would be.

Jun 23 / Caro

Flangelina

Coming up with a name for our child is not proving to be a joyful part of this pregnancy. By the time we’ve excluded what we consider to be “made-up” names, plus anything that really doesn’t work with our surname, we’ve already narrowed it down quite a lot. We don’t want our child to share their name with every other child in their class at school, but nor do we want something so unusual that it raises eyebrows. Then we have to contend with the fact that working with the public has given me negative associations for an awful lot more names. And don’t forget we eventually have to agree. One of us liking something isn’t really enough.

The leading boy’s name for now appears to be “nameless”. Has a certain ring to it, I think.

By comparison, coming up with a nickname for the bump was very easy, in that it just sort of happened. I didn’t consciously want to nickname our baby before it is born, but it does become hard work constantly referring to it as “the baby” or “him or her” (since we don’t know which variety we’re getting). And “it” just feels a bit impersonal. Equally though, I didn’t want to call it “bump”, “bean” or “flump”, because that is what every other…. well, bump, bean and flump, is called.

Somehow, our little one came to be referred to as Flangelina.

If I tell you part of the reason why, you’ll probably be right on the phone to Social Services demanding to know who let us get pregnant and ensuring they are fully aware of the sort of parents that are about to be unleashed on an unsuspecting unborn baby. But I’ll tell you anyway.

It comes down to the fact that “Flange” is one of Ian’s favourite words. And somehow a joke started that we should give our baby a good engineering related name… like Flangelina. It never failed to raise a giggle. (I can hear you dialling…. What can I say? We’re silly like that!)

It’s certainly stuck. We both refer to the baby as Flangelina, and address my belly as Flangelina too.

I’ll apologise to you now, baby. Especially if you happen to be a boy baby. But it could have been worse. Your Daddy also likes the Wankel Rotary Engine….

Jun 21 / Caro

Half Way?

So, I’m at nineteen weeks in to this pregnancy. We’re well in to the second trimester and the baby is turning into a little mover and shaker inside my belly, which is definitely looking much rounder and poking out much more than ever before – certainly beyond squeezing in to my pre-pregnancy jeans!

It’s still all just a little bit unreal though. Despite those fluttering kicks and my changing shape, not to mention my continued paranoid stalking of my blood sugars, I still get a bit of a shock when I remind myself that this is really happening. It’s going so fast, and this nineteen week marker could well be the half-way point for us in our journey – which I’m trying to regard as the warm-up to the big event that is parenthood.

It’s fairly standard protocol for women with diabetes to be induced at 38 weeks gestation. This is due in part to the tendency for babies of diabetic mums to be bigger than average, but more importantly it’s because of the tendency for the placenta to deteriorate more rapidly in women with diabetes than in women without. I’m not totally crazy about the idea of induction, for complicated reasons that deserve a post of their own, but equally I want what’s best for the baby. At the end of the day I’d probably let them hang me upside down by my ankles for a week if I knew it would lead to a safe, healthy and happy baby.

But if I am induced at 38 weeks, then that is as far ahead of me now as the beginning of this pregnancy is behind me. Looking at it that way, it feels like it’s going to be here in no time at all. And I still feel scarily unprepared for the single biggest change that has happened in my life to date. The practicalities I think I can deal with. I may not know how to bath a baby at this point in time, but I know I can figure it out and there will be plenty of people on hand to help with the day to day issues like feeding. It’s the emotional side of things that terrifies me. The fact that life will never, ever be quite the same again and I have no way of knowing what our “new normal” will be. It scares the control freak inside me.

That said, I cannot wait to meet our child. To find out exactly who this person is that we’ve created, and I’ve been doing my best to keep safe. And most of all I can’t wait to know that they are safe. I want to know that I’ve succeeded in providing a good environment for them to grow. Then I can focus on becoming the good mum I so hope that I can be.

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