Revisit: There Is No Spoon.

After reflecting on the past few days' CGM graphs, I'm reminded of this post from 2011. Pregnancy is this exaggerated version of what living with diabetes has been like for me - with 100% less predictability, more exaggerated swings, and super stubborn blood sugars. While I want to achieve "perfect" numbers during this pregnancy so that we can avoid all of the stuff no one ever wants to deal with, I also have to remember that perfect doesn't exist in the real world.

But, perhaps, my best will still be good enough.

* * * * *

I'm not sure where it began.

It probably wasn't a singular moment or comment that began that ever-growing snowball. It likely was all of those little things, laid one by one on top of another; melting into a suffocating landslide of guilt and shame.

Probably, it was the college years when my A1C started climbing and I felt as though I was doing all I was able and willing to do at the time - but it was never anywhere close to good enough.

It could have been the many, many times where an endocrinologist visit ended in tears, because my answers were never the sort that could pass their test. It could have been the dread of those appointments eventually causing the pre-appointment build-up of apprehension, anxiety and just plain fear. (And then, beating myself up over canceling the appointment.)

It could have resulted from not getting to hear the experiences of other real-life patients - of not knowing one single soul on that college campus who also had type 1 diabetes. I didn't know anyone else there who was living this same routine of shoddy math, bodily defiance and food distortion that I was.

It could have been my almost certain belief that one day, because I could never "get it right", I'd inevitably lose my eyesight. Or kidneys. Or toes. Take your pick.

It could have been realizing that "good enough" might not actually be.

It was seeing the impossibly low goals that my doctor had for me, and wondering, "How on earth do people do this? How do they do this, and still live a life? How can they enjoy that life, when all they're apparently thinking and worrying about is what diabetes is doing to them?"

It was being absolutely convinced that every single other diabetic in the entire universe must have this figured out, except for me.

I was convinced that I was the only screw-up. The way my doctors reacted to my self-care only reinforced that belief - because the only reason they'd be so shocked and disappointed would be because I was their worst patient, right? Because everyone else was achieving these kinds of numbers? Isn't that what was happening?

It was partly because questions were phrased, "Why are you still high in the mornings?", and "You are low way too often; what are you doing to cause that?", and "Why didn't you do what I told you to?".

It was beating myself up over my failures, then resigning myself to futility.

It had never occurred to me that a "perfect" diabetic wasn't actually a real thing. My past experience had shown that the medical world (which was all I had at the time, as this was B.D.O.C.) tended to make it very clear that there is an acceptable range, and it's [here]. And if you can't get yourself there, it is because you aren't trying hard enough; you aren't disciplined enough; you aren't following their guidelines as you should be. The focus of blame tends to be on the patient's ability to self-manage, rather than the disease itself.

It's one of the greatest gifts that bonding with this community has given me. Though it took a while for this to really sink into the parts of my brain and heart that can truly believe something, I think I can finally start to believe that there is no "perfect". There is "try your best"; there is "learn from your mistakes"; and there is "never give up". There will be questions without answers. There will be numbers without logic.

There is no productive benefit to berating myself. There is no positive benefit to my health when I internalize what I perceive to be "failure".

I can choose to let the outcomes of my diabetes decisions define who I am and how I live my life, or I can choose to accept the reality that the only parts I can consistently control are how I feel and how I react.

I have begun to accept that there is no spoon.

High Price For High Risk.

Guest Post: WhatToExpect.com.

"My eyes immediately welled up as I realized that the two pink lines I'd seen a few days prior had not been a fluke. 'Oh, wow!' I said, as my eyes fixated on the small monitor to my right. 'It's... it already looks like a baby! Except it's sort of a shrimp with T-Rex arms, but still...'"

Also not my uterus.

My graceful descriptions of pregnancy and I can be found in a guest post on WhatToExpect.com today!

Two disclaimers: 

1. I'm super honored to be able to share my own feelings and experiences with T1D and pregnancy there, this was/is not a paid writing gig. Just me lending my voice somewhere that I think it can do some good.

2. The image embedded in that post is not of my uterus, though that kiddo is waving at the camera a bit, so it's actually pretty believable. Nicely done, WTE.

Week Twenty Seven.

You know that thing where you see a pattern of not ideal after-meal BG readings, and so you finally think to change up some basal rates, and commend yourself: "Yes! This will fix it! I am a genius!" and then you're still over 200 the next morning?

I am currently living that thing.

Pregnancy is shifting from "oh, this isn't so bad" to "oh, this is the part where it's going to get really uncomfortable, huh". I was able to use my stomach as a coaster last night, setting my empty glass on it while I fired off some emails with my phone while sitting on the couch. Every afternoon around 2:30 is when a nap sounds like the most glorious thing I've ever heard of. My feet hurt. Trying to reach those feet hurts my feelings. Every time I stand up, I feel like the first stop needs to be a bathroom. I have weird blotches on my legs that were never there before, and it's totally sexy you guys.

Have I mentioned 27 weeks? Twenty seven!

I've been putting my sewing machine to good (I hope) use the past couple of weeks:

Blame Pinterest: skirt sewn to onesie; leggings made from adult knee-high socks; Boppy cover with invisible zipper.

The production of small hand-sewn baby things helps to quell my terror at not yet having a car seat, stroller, crib, or any of a number of things I've deemed actually important. But we have time and free weekends coming up so I will allow myself to believe that my terror should be short-lived, in this regard anyway. It will all get done, and really, most of what I initially thought of as "must do" is actually "could do after she's here, with some help". It'll be fine.

Sleeping is something I'm no longer skillful at, which is a first for me. Despite usage of a body pillow, I'm still tossing and turning all night. Add in the times I need to get up and pee and it's almost as if I shouldn't bother trying.

But it's things like this that keep my focus on what's important: according to one of my pregnancy tracking apps (I might have four), Baby Girl is now around 2 lbs. and approximately the size of a head of cauliflower. Or a rutabaga, if you're someone who actually knows what one of those looks like.

Knowing we're getting closer and closer to meeting our little girl is one great prize to keep an eye on.

#DBlogWeek: Accomplishments Big and Small.

Today's prompt: We don’t always realize it, but each one of us has come a long way since diabetes first came into our life. It doesn’t matter if it’s been 5 weeks, 5 years or 50 years; you’ve done something outstanding diabetes-wise. So today, let’s share the greatest accomplishment you've made in terms of dealing with your (or your loved one’s) diabetes. No accomplishment is too big or too small - think about self-acceptance, something you’ve mastered (pump / exercise / diet / etc.), or making a tough care decision (finding a new endo or support group / choosing to use or not use a technology /etc.).

Twenty seven years is an awfully long time.

• It's as long as Carly Rae Jepsen has been alive.
• It's the amount of time the world has had to wait for peanut butter-flavored Pop Tarts to make a come back.
• It's how long ago the movie Top Gun was released.
• It's the age at which musicians should probably make sure they have a life insurance policy.
• If you own a Chevy Volt, it's how long you'll have to wait to break even.
• In that time, you will (on average) blink 216,000,000 times, take 170,294,400 breaths, and your heart will beat 1,135,296,000 times.

How many situations that most would consider "bad" could happen in that time? How many times might a person become discouraged, frustrated, or angered? How many life-altering events might happen? How many reasons might life give you that could justify giving up on your optimism?

My greatest accomplishment is that, after all these years, I am still holding on to mine.

Everything you need to know about Diabetes Blog Week can be found here!

It's Our Call.

Earlier this week I met with my regular OB for our every-four-weeks shindig. (All still looks good!) This is a doctor I'm quite fond of, who smiles easily and has confidence in both of our abilities to keep this pregnancy as healthy as can be. And if we can't? "We'll deal with that when we come to it". Always said with a smile.

I came prepared, both physically and mentally, to discuss what the next several weeks might look like. I had brought my home blood pressure monitor to check against hers, as well as a list on my phone of points to discuss so I wouldn't space anything off. Laptop in hand and smile on face, she whooshed into the room. "Kim! How are you feeling?"

Exhausted with a side of heartburn, thanks for asking. "Do you have any questions for me before we get started?"

I recounted for her my most recent experience with the high-risk OB, and expressed my concern over both his advice to ward off what he apparently feels is inevitable preeclampsia (baby aspirin!) and his take on when Baby Girl will be making her debut (37 weeks!). I told her that his seemingly only reason for wanting to deliver at 37 weeks would be because of "long-standing type 1 diabetes", despite no evidence that I have complications or any other health issue indicating early delivery would be beneficial.

Her reaction to his opinion was A-1.

"I guess I need to know how this works - who makes the calls here? I know you're the one who will be delivering, but who has the trump card on the how and when?"

She didn't pause. "It's our call - mine and yours." 

Cue giant sigh of relief!

She explained, just as I hoped she would, that while it all depends on how my body behaves over the next several weeks, there is no reason to assume we'd need to deliver so early just because I have diabetes. As we approach the homestretch of pregnancy I'll be in her office at least once a week, maybe twice, to check all of the things that could force us to an early delivery. She assured me that the only reason she's sending me to the high-risk guy is for "his opinion, and his fancy equipment". She also asked me if I'd like to see a different high-risk OB, and I'm considering it.

We talked through a couple of other things (like that baby aspirin advice, which it turns out she doesn't agree with as studies have mainly shown it effective in women who have already experienced preeclampsia in previous pregnancies, so I'm glad I held out on taking them) before she concluded: "So, my hope is that we can stretch this to 39 weeks. Is 39 weeks something you're more comfortable with?"

I wanted to hug her so hard for phrasing it the way she did. "Yes. I am totally okay with that. And who knows - I might be really ready for her to come out by the time August rolls around." "Yeah, air conditioning is going to be your best friend this summer."

Indeed. Bring it.

#DBlogWeek: Memories.

My participation in this year's Diabetes Blog Week can best be described as scattered, iffy, occasional, not as originally intended... I seem to have once again over-booked myself in terms of both projects and future energy stores. I love this event, though! Everything you need to know about Diabetes Blog Week can be found here if you're curious, and Karen is a saint in my book for organizing us all.

Today's prompt: Today we’re going to share our most memorable diabetes day. You can take this anywhere.... your or your loved one's diagnosis, a bad low, a bad high, a big success, any day that you’d like to share.

Oh, man.

It's hard to pick just one day - plenty of memories, both good and bad, have been a result of my life with diabetes.

My diagnosis story? I don't remember much about it, though I do appreciate the compassionate care I've received from medical professionals along the way. There was that time my insulin pump died and I didn't even care because MARRIED! There were times as a tween where my diabetes scared the crap out of my parents - twice they found me unresponsive in bed and had to use glucagon (though, to be fair, I actually don't remember much of that, except for the part where I woke up to see two paramedics standing in my room). Bad highs? I've had those, too.

But for all of the muck that diabetes has thrown my way, there are some pretty great memories, too: when I ran-ish a half-marathon, when I've traveled to Australia or the Dominican Republic, and during that week in Florida where I met, finally in person, so many of my good friends who also happen to have pancreas problems. Diabetes was the reason I got to attend an awesome summer camp for two years. Diabetes has helped me tell a story that did good beyond just myself, and motivated me to create something that can continue to help other people living with diabetes. It gave me a reason to dance to One Direction.

What I guess I'm saying is that diabetes has made for many memorable days in my life, but my current favorite? The day we found out I was pregnant. It was the day I first really let myself believe that maybe, just maybe, diabetes will let me live the life I want after all.

It gave me hope that this body perhaps isn't as broken as I sometimes fear.

As Soon As It's Safe.

For the entirety of my pregnancy, I've been working under a shared understanding with my regular medical team that as long as everything goes well, there is no reason I can't have a normal pregnancy.

I know; "normal" is a loaded word. What I mean by that, here, is: if my blood pressure stays where it needs to; if my type 1 diabetes behaves itself in a way that doesn't create a Snuffleupagus-sized baby (though I would totally be okay with her having his long, gorgeous eyelashes); if there are no indications that carrying Baby Girl to full-term would be detrimental to either of us, then a full-term pregnancy we shall have. There would be no reason to think otherwise.

And so far? My blood pressure is staying in range (the daily monitoring at home might even be helping it - less to stress about between appointments). While I tend to not share A1C results anymore online, I know that is something that many ladies who have pre-existing diabetes and want to become pregnant ask, so I might as well share for those curious: my first result after knowing I was pregnant was 7.1, and I've seen 6.8, 6.3, and now 6.1 this week. I'm not swelling up like a pufferfish (yet?). I've been gaining weight at a pace we're all happy with, and Baby Girl is moving around frequently. Thyroid levels? In check. Protein spilling into my urine? Nope. In fact, the only things I can complain about, post-prandials aside, is exhaustion and some mild heartburn (a fun new experience for me).

Fast forward, then, to the appointment I had last week with Charlie Brown's teacher the high-risk OB. Baby Girl was active, as usual, but also a bit shy this time, giving us a great view of her spine while shielding her heart. We couldn't get all of the heart measurements they wanted, so I'll be back again in 4 weeks with the hope that she'll be more cooperative. And her estimated weight? 31st percentile. BOOYAH!

Just as I was basking in the "yay, everything is okay!" feeling, the doctor concluded with, "Okay, so we're on point to deliver at 37 weeks!"

....

...excuse me, what?

"I was under the impression that if everything was going well, there was no reason to deliver early."

"With long-standing type 1, I want to get her out of there as soon as it's safe."

As soon as it's safe?

The words bounced around in my head for a moment before proceeding to prick at my heart. Because what he's implying is that, right now, she's not safe. That simply by having had type 1 diabetes as long as I have, despite it being reasonably well-controlled and free of major complications, her tiny apartment inside me is a danger zone. That no matter how hard I may work at it, no best effort is good enough to keep her cooking as long as she is intending to be. That, in my eyes, I can do nothing but fail to have the "normal" pregnancy I was hoping for.

I wanted to poke that doctor with something covered in bees.

He also offered his (unasked for) take on a couple of other items - that I start taking a baby aspirin daily to ward off high BP and eventual pre-eclampsia, and that the last bit of pregnancy "isn't actually insulin resistance", which he followed with some malarkey that I honestly just tuned out. I don't know what to think of this guy now - while I trust in his training and enjoy his sense of humor, what I do not trust is his confidence in calling the shots for a patient he only met a month ago, with limited knowledge of her medical history. (I also question his motive for wanting an early delivery, considering that the recent advice I've seen from the ACOG as well as from the professional organization's president himself, would directly contradict with that. Couple that with my control being "good" but "not too tight", and I fail to see where his concern can reasonably stem from.) I also question his advice on the baby aspirin, and am following up with the other members of my medical team before following through on that request. (I will say that when I relayed this all to my endo this morning, she raised the same eyebrow I did. At least I'm not alone.)

Everything seems a little more unsure now, and I don't like it.

Close Calls.

Especially today, I am thankful for technology that helps me not send myself into a hypoglycemia-induced spiral of doom.

In the past 24 hours I've managed to come dangerously close to double-bolusing for meals on two separate occasions. Luckily I had the sense to check my bolus history the first time, and notice the IOB the second time. (And yet I managed to forget nothing when I packed for the Indy trip earlier this week, which happens to me exactly never, but this really important stuff? Yeah, way too difficult to get right.)

Dealing with pregnancy brain while trying to juggle type 1 diabetes - it seems like it could be an Olympic sport.

Twinsies.

That's an impressive little algorithm you've got there, Dexcom.