Ultra-athlete, Diabetic, Pregnant, and 39...feeling like the odds are stacked right now
So I thought I might share some insight on what my past 13 weeks has been like now that the cat is kind of out of the bag. It has been a roller coaster ride like no other I have ever experienced. Moments of sheer elation that we might be able to have a kid, but more extended periods of extreme stress and anxiety living with the notion that if I screw up this tiny little peanut growing inside me will pay the price - nothing like having the weight of the world on your shoulders...
I have said for the past 5-6 years I wanted to have a child but needed to get my A1C down so I would not have a repeat of any eye damage like I suffered in 2003-2004, and of course so I could have a healthy baby. If I got my eyes in a stable state and my A1C in the target zone of 6.5 then it would be somewhat less risky. Needless to say I never reached the ideal 6.5 and although I kept trying things did not seem to be working in my favour, at least not at the pace they should have been. I was working at my own pace while fitting in the Ultra-Endurance lifestyle, managing things to suit my exercise schedule and not much else. Then the news came, we were both in denial for several days but this was real, now getting my A1C down was not going to be on my own time, it had to be NOW! and in a big hurry.
I changed my mind on whether I should go through with this every 10 minutes for about 2 weeks, until I had visited the Barbara Davis Center and got some more educated information on whether this would be a good or bad choice. As always my Doctors and the nurses at BDC were incredibly supportive and encouraging and more or less said if you want this we can make it happen, now is as good as any time, you are 39...
In fact I am at a point in life where the possible implications of having a baby at an advanced age are about equal with the the implications of having a baby when you are a diabetic. So of course we decided to put them both together and make life super challenging - mature age and almost 30 years with Diabetes what more could I ask for!
For starters I had to immediately stop taking Symlin the 'blessing' drug that has helped me manage post meal blood sugar spikes. Blood sugars now are back to spiking immediately after meals as the insulin does not seem to work for about 1-2 hours after I have injected, especially in the mornings.
Second I gave up Caffeine - after a week of trecherous headaches and feeling pretty crappy I am not just in a permanent "Grumpy" state as Stephen puts it. I pretty much have lived the past 10-15 years fueled by caffeine so this is a big change for me and one that I dont regret but the transition has been rough to say the least.
And third but not least important Diet soda - I have not given it up but I have cut back and definitely have not been consuming any of my favourite Diet Mountain Dew when energy is going south. So it has been a big adjustment, probably for the better but probably one I will not stick with once this is all done.
Everyone says the sacrifices are worth it so I am banking on that being the case.
So am I excited... well deep down yes but on the surface there is so much stress and anxiety that it is hard for me to express excitement at this early stage. There are so many risks you ask yourself many times a day - is this the right thing? should we
go through with it? And after 5 hypos requiring assistance from Stephen in the past 6weeks each time the questions re-arise. We hope all will go well and maybe things will get easier as I learn the ropes but I am not counting on it as I know this process is not easy for the non-diabetic. I hope I can be smart, and tough - we know for sure the kid is going to be tough since it has already made it this far.
WEEK 7
At 7 weeks we had an ultrasound - I cannot say much else except that it was like a lima bean with this fast pounding heartbeat. It made us melt to think there is something that little inside with a beating heart already. I was poked and proded and had copious amounts of blood drawn for all the tests that can be done at that early stage to get some baseline results. Lucky me, they also found I had low thyroid T4 levels and an enlarged thyroid so off for an ultrasound of my Thyroid gland and they started me on some thyroid medication - indicating it might just be for while I am pregnant but the likelyhood of diabetics also suffering from thyroid disorders could mean it might be medication I will be taking for life. Either way life just got a little more complicated, one more tablet to add to the injection regimen.
So what have I been doing - testing my blood sugar obcessively; exercising as much as my body can handle - and some (the and some days unfortunately have caused 4 night time hypos usually the night after I have overdone it); using the Navigator CGM as much as possible to see what my patterns are and trying to manage everything to get my A1C down.
The basic synopsis of my blood sugar patterns is, I have insulin resistance, especially in the morning. Exercise is the only thing that seems to make the insulin work (but even in the morning insulin does not work). I have to overbolus with shortacting insulin at meals to keep my bloodsugars in the normal zone, to then exercise and hit rock bottom each time I go out. Bloodsugars rise when I ride my trainer in the mornings because this preganacy - dawn phenomenon thing that seems to last from about 6am - 10:30am. Then things seem to start working a little better, I can run before lunch and get my blood sugar nice and low, then nordic ski or do some activity after work and watch it plummet so low that on occasion I have reached the low point so quickly that I dont know where I am (i.e. my ski up Vail mountain one evening, which was my usual Tuesday night expedition). Fortunately on that particular night Stephen decided he would also skate ski up, I was classic skiing and had left before him. He found me at the dragon's breath mine, disoriented, freezing cold and no idea where I was. Needless to say I have now been banned from going out at night alone anywhere except the nordic center. Blood sugars are down but safety risks for me when exercising have been extremely elevated.
WEEK 10
At 10 weeks we visited the Perinatologist, the Retinal specialist for a check of my eyes and another visit to the Barbara Davis Center.
Perniatologist was an awesome guy, gave us tonnes of extremely valuable information, but laid down the negatives in one nice neat pile - I would compare the pile to that of an elephant.
Phew... and people still want to proceed after hearing all that...
Well yes when you see that little thing squirming in my uterus, its arms and legs now waving around, all the negatives get put aside. Oh and by the way it still had a heartbeat. That was a relief after a few days of my boobs not hurting, when they had hurt non stop for about 9 weeks, I freaked out that something had gone wrong. Not to mention the 12 hour AT race I did with Wendy on the weekend, I did not push hard but it was a long effort with a peanut growing inside, I had to be worried. Yes I am now banned from any further racing too...
A1C went from 8.0 to 7.3 in 4 weeks the biggest drop I have had since visiting the Barbara Davis Center for the past 12 years, so that was good news, but still a long way to go. The literature says ideally you want your A1C to be between 5.0-6.0 during pregancy YIKES! I am not even close and dont know if I will ever get close to that but the tried and true TeamType1 challenge of "Strive for 6.5" definitely seems like it might be possible now. That is my goal. If I can get to 6.5 then I will re-evaluate the target.
My eyes are stable, fingers crossed I can keep it that way and have to have checks each trimester to re-evaluate things. This was yet another check mark in the book of positives and whether to proceed so things are looking up. Now if only the Gods could make my blood sugars right things might be almost good...but that would be too easy.
INSULIN RESISTANCE
So what does it mean to be insulin resistant. Here is a good example for you. One morning since blood sugars simply did not seem to be coming down when I had insulin and breakfast I decided to try and see how long it would take for it to come down with my breakfast bolus but no breakfast.
Hmmm.. well I had the insulin expecting in about 30 minutes to see it start dropping so I could then eat. It was also an experiment to see how long should I really wait after injecting before eating. Well 2+ hours passed blood sugar only dropped from 170 to 140. So I guess my breakfast bolus is not really for breakfast it is just an extra bolus I need to cover something other than food. Disconcerting yes, what can I do about it - NOTHING (except of course treat with the appropriate amount of insulin). Results and Conclusion - double the breakfast dose as something is wreaking havoc on my body and it is not breakfast.
Week 12
So I have just passed the week 12 mark waiting for the first trimester screening to make sure nothing is abnormal. Once I have this screening we can then determine if I should go for the somewhat risky CVS test to guarantee that the child may or may not have Downs Syndrome or a variety of other issues, or if the screening comes back with fairly normal results then I will wait and have an amniosyntesis at 15 weeks. Oh the joys of waiting for good or bad news, it is enough to cause a heart attack at this point, or at the least days of self induced depression wondering what the outcome will be.
Like clockwork - as the folks at the BDC had predicted blood sugars tend to go low from around weeks 10-13 - I have had perfect control for almost a week now, starting to wonder if I am dreaming until last night when I had my 5th hypo since beginning this journey. Thank goodness for my husband and his amazing ability to stay calm conditions of utmost adversity. I woke in a semi-comatosed state as he tried to make me eat a gu, which has definitely not ever been a voluntary food choice for me. Even with what feels like less than half my brain working I still know that I hate gu and it is like pulling teeth for him to get me to swallow the stuff. Apparently diguised on toast still does not work :)
Things seem to be getting risker by the day, Stephen seems to run through states of not knowing if he really wants me to go through with this. Having to watch me in these most unglamorous states I am sure is super worriesome and not to be taken lightly however, at this time I am committed provided the tests come through ok. The hypos need to stop, however they are inevitable when trying to get your A1C down in a hurry these are bumps in the road that I hope will soon pass.
I have tried my hardest not to back off and stay as active as always. Some days it is easy, other days I feel like a beached whale plugging along thinking - maybe it would be easier to become a couch potatoe, but that is not in my nature. I am committed to ride my bike as long as possible and still be an athlete at least until my belly is too big to balance on the bike, then I guess I will resort to swimming and walking. Oh I am already yearning for the summer days of long rides that I know I am going to miss but it is just a short snippet in my life so I am going to learn to cope... even if it does make me grumpy.
Week 13
Well I am screened and waiting for blood test results but the neck skin measurement was positive so fingers crossed all will be good. At his time the Doctor encouraged me to just wait for an amnio at 15weeks, he seemed confident that thing were looking good so I will go with that.
So until the next post hopefully I have given everyone lots of gossip and good humor.
