Week Thirty One.

Last week began the phase of pregnant-while-awesome diabetic where I'm at my regular OB's office every week, for the main purpose of doing an ultrasound that checks out Baby Girl's development in several areas - a biophysical profile (or "BPP", for short). This test involves the ultrasound tech measuring things like the amount of water in the swimming pool (amniotic fluid), looks for "practice breathing" (and she's been doing that with gusto both times), and measures all parts of the baby's rapidly growing body, including heart rate and muscle tone. I think that non-diabetic people get these too, but later on in pregnancy, and not nearly as often.

A BPP is also where they estimate her current weight, and though her weight has been creeping up a bit, I'm happy that she's remaining in a normal range. So what if she ends up being a little chubbles? (And, really, with Aaron and I as her tall, non-skinny parents, the likelihood of her being a small baby was preeeeetty tiny.)

I'm also happy to say that Baby Girl has received perfect scores on both BPPs so far. Yahtzee!

As for me, everything still looks pretty good. We continue to keep an eye on my blood pressure, and I continue to wish that the nurses would give me more than 30 seconds after we've entered the exam room to check it, as the readings are always consistently higher than the ones I see at home. Heartburn has been less frequent, and while the belly has gotten more uncomfortable to lug around, I haven't let it be too much of an excuse to sit out of possible fun. (I even made it through seven innings of a College World Series game this past weekend!) While my weight gain is following a good pace, I found out at my most recent appointment that the actual belly is measuring five weeks ahead. FIVE. What?

The toughest part for me now, mentally, is that for at least another month I have no idea what The Plan To Get Her Out is. There are too many variables; too many things that can change for better or worse between now and go-time. Decisions like when, the manner of delivery; all of it rides on what happens in the coming weeks, and there's no way to really know how it will all shake out, yet. Her estimated weight, how many (and how large) the fluctuations in my blood sugar are, and many other factors will determine how we proceed. No pressure though, right?

At least I can say that the temp basal I started running last night has made some significant impact:

And sometimes, too much.

Just keep moving forward - that's what I'm telling myself. 

(Even though the mere thought of moving in any way makes me out of breath - no room for the ol' lungs anymore!)

My #DayOfDiabetes.

Yesterday found me participating in #dayofdiabetes, where I tweeted the majority of my day as someone who is both pregnant and lives with type 1 diabetes. Sorry about cloggin' up your feedz, but I wanted to be honest in what was happening, how I make decisions, and how I felt about the results of those decisions, and that takes a lot of words.

And in the spirit of honesty, I also shared what could possibly be the most facepalm-y moment in my diabetes life so far.

Well of course it's on the day I decide to tweet everything diabetes-related that I drop my pump in the (clean) toilet. #dayofdiabetes

— Kim / Diabetes (@txtngmypancreas) June 17, 2013

I saved all of my tweets through Storify, so if you'd like to go back and relive my exhilarating (not really) day, here's the link. (Tweets are organized with the newest on top, so you'll have to scroll to the bottom of the story to go chronologically. I know.)

If you'd like to explore the #dayofdiabetes events that others have contributed too, head to the Tumblr site.

I don't know that this could be called a typical day with diabetes, but seeing as how no two days are ever the same, perhaps it was.

What Helps.

Being pregnant while trying to wrangle blood sugars, blood pressure levels, morning ketones, food, boluses that seem too huge to be right, and everything else that comes with diabetes-while-gestating can feel really overwhelming sometimes.

But you know what helps me a whole lot?

(click image to enlarge, if you can't read the text)

My online friends who have either been down this road before, are going through it right now, or have supportive and wonderfully encouraging things to say (derived from compassion, not necessarily personal experience) when I post pictures like this.

They help the scary seem not quite so very.

(By the way, that bolus was for 64 carbs. Third trimester insulin requirements are no joke.)

Find Mari Ruddy.

UPDATE: Mari has been found! Check with findmariruddy.com for updates on her condition.

Have you ever heard of the ADA's Red Rider program? How about Team WILD Athletics (who so kindly sponsored one of my giveaways last December)?

The woman behind these wonderful programs (and so many other good things done for the diabetes community) is named Mari Ruddy. She has type 1 diabetes, wears an insulin pump, and she has been missing for nearly two days now.

From findmariruddy.com (which is where you'll find updates on the search):

Mari was last seen at her apartment in the St. Anthony Park neighborhood of Saint Paul, MN around 1 p.m. on 6/11/13. Mari has type-1 diabetes and wears an insulin pump. Her phone and other belongings were found in her home. She left in her car, a dark green 2002 Honda Civic, Minnesota license plate #102-LNC,  with a bike rack on top and a red Namaste bumper sticker.

Mari’s family fear that she may try to harm herself and appreciate any help locals can provide in search efforts. She may have gone to a place with spiritual significance, beauty or seclusion. Please contact Mollee at 952-406-0081 to volunteer. You can also join the search effort by connecting with this Facebook group: https://www.facebook.com/groups/172257126284014/?notif_t=group_r2j

If you have any information please call the St. Paul police at 651-266-5612 until 2 p.m. PST or 651-266-5700 after 2 p.m. and on weekends. Reference case number: 13118370.

Please keep Mari and her family in your thoughts and RTs as the more time goes by, the more dire circumstances become.

Week Thirty.

Let's start with a bumpdate, shall we?

I'm simultaneously starting to feel quite uncomfortable in my own body, yet pretty good about how that body looks. While my rib cage misses all of that luxurious room it used to have, things like random ankle swelling seem to have been a one-trick pony who has now wandered off to Montana or somewhere. The pregnancy hormones that graced me with the skin of a fifteen year-old are letting up a bit, and my inclination to care about those leg blotches seems to be inversely proportional to the temperature outside. Want to stare? Don't care.

Last night marked the first time that a stranger asked with full confidence when I was due. Yay?

Our recent visit back at the high-risk OB this week yielded several notable outcomes:

• Baby Girl finally stopped moving long enough for the doctor to look more thoroughly at her heart, which appears to have developed normally - the screening he did ruled out "about 85% of possible heart defects"
• She apparently experienced a growth spurt, as her weight is now in the 69th percentile
• Everything still looks GREAT development-wise
• She's decided that laying across my belly is obviously the most comfortable position, with her head on my right side (just under my rib cage) and her feet so thoughtfully using my bladder as an kickable ottoman
• The doctor took more time to explain his stance on the 37 weeks comment from last month, and it would require certain results from testing we'll do next time before he'd push for a 37 week delivery (which means he's respecting my preference to go 39 weeks, even if he doesn't understand it: "most women just want to not be pregnant anymore at that point")
• He and his staff give really good restaurant recommendations

So, overall, it was a good appointment. Probably the best one we've had with him so far.

I managed to spill some small ketones this morning - a during-pregnancy first - that can be attributed mostly to the fact that, what was I thinking, I actually slept through the night. Breakfast and a large amount of water intake cleared them up within a couple of hours.

And as for the non-diabetes stuff, everything's coming along there, too. I'm totally amped about the upcoming baby showers our friends and family have been so kind to plan for us, and I'm swiftly becoming addicted to the smell of Dreft as I wash the baby outfits, toys, and accessories we're storing up. Packing a hospital bag (okay, two) is a thing I've started, mostly because at least having it started makes me feel calmer.

And while I had originally planned to never post an ultrasound photo online (because somehow that just felt too private), I'm breaking my own rule. Her cheeks made me do it.

Two months to go!

Really? Okay.

Have you ever had to crank up a basal rate so high that you wondered, "How am I not dying right now"?

And have you ever, then, seen a line so steady on your CGM graph that you could swear this was a dream/nightmare/did breakfast make me hallucinate?

That.

(Not complaining - just a bit in awe that something that colossal is producing results like this right now.)

Adorably Functional.

You guys know how much I love my diabetes accessories, right? I mean, if I have to lug around all of this medical crap it might as well be packaged in a way that doesn't scream "HEY OVER HERE DIABETES". I can't tell you how many small cosmetic bags I've bought for this purpose, and while those work okay, it's nice to use something that has compartments designed specifically for the stuff I'm putting in them.

Man, wouldn't it be great if someone could fuse cute modern design with the functionality of the plain black cases our gear comes with? Wouldn't it be lovely if someone mistook your diabetes bag for just a "really cute bag and where did you get that"? Wouldn't that be Super Awesometown?

Can you see where I'm going with this?

Check out what I've been using for the past couple months, because you could win one of your very own:

The creator of this adorbs clutch is Monica Vesci, who lives with diabetes herself. Frustrated that she couldn't find a bag for her diabetes stuff that suited her needs, she launched her own business earlier this year. In her words: 

"Women should not have to be embarrassed by an ugly black medical supply case while feeling insecure about their diabetes. My vision is to provide innovative, affordable luxuries for people living with diabetes. I’d like to empower women by helping them to feel more beautiful by taking care of their diabetes with style and pride."

I've enjoyed using this clutch and have a few thoughts to share on it, but before we get to the bags themselves, let's take a few minutes to meet the woman behind them:

Kim: Hi Monica! Can you tell us a little about your own personal experiences of living with diabetes?

Monica: I was a senior in high school when I was diagnosed with type 1 diabetes in 1994. I had been ill for several months leading up to the diagnosis but it never occurred to me that my symptoms could be signaling a chronic disease. I had never heard of diabetes and I didn’t know anyone who had it, so it was a total shock. 

I came close to lapsing into a diabetic coma and was hospitalized for many days as insulin was pumped into me, working its magic. I was introduced to my diabetes self-care routine including carb counting, exercise, insulin dosing, blood sugar testing and a seriously restricted diet (no more Oreos?!) I took my diagnosis like a champ, accepting everything from the beginning and asked what I needed to do. Soon I was giving my own injections and thought “this isn’t too bad. I can do this”. I returned to high school and graduated. 

Determined to not let diabetes stop me, I left for college in upstate New York and met my local team of diabetes physicians, nurses and educators. I soon realized, however, that trying to control my diabetes was much more difficult than I had originally thought. I wanted to eat pizza, drink beer and go to the cafeteria at odd times like everyone else. But that would have a disastrous effect on my health. I was sleeping a lot, missing classes and defiantly eating things I was told not to eat. I hated diabetes!

I became depressed and withdrew from my friends and social activities. Taking medical leave, I returned to Philadelphia to get things under control. My physician explained I had accepted the stages of diabetes in the opposite order. People typically go through denial first and acceptance last, but I did the reverse. I accepted it right away and after a year I was in denial. 

A brief regimen of antidepressants and therapy helped me to get on with my life in a new, healthy way. I earned my degree in Fine Arts from Chestnut Hill College, in Philadelphia, and after six years of living with diabetes, I was finally accepting it. I was back in control.

How are you doing now?

My husband and I began pregnancy planning in January 2013. After years of multiple injections, I decided to try an innovative new pump to promote my potential health and that of our future child. Armed with research from my doctor, support from my team at Steno Diabetes Center and encouragement from my fantastic husband (who is a diabetes researcher), I am now wearing the Animas Vibe pump with the built in DexCom CGM to avoid having two medical devices with me all of the time. 

This has been one of the best decisions in my diabetes care so far. I love this pump and with my A1c where it is now we are well on our way to planning for pregnancy. It’s a very exciting time knowing that I am at my healthiest and ready to start trying for a little one.

Best of luck to you on your journey to pregnancy! (And could you sneak me one of those Vibes?) So what lead you to want to create your own bags, and how do you envision them fitting into PWD's lives?

I’ve always had a bit of an entrepreneurial spirit. I love designing and I was tired of finding my used test strips and lancets all over the house, in my clothing, in my HAIR and in the bottoms of my purses. I wanted a more practical and safer way to carry my daily diabetes supplies, and, most importantly, a place to safely and discreetly dispose of hazardous waste while on the go. I hated digging into my bags to find something only to come up with a handful of used test strips and needle pricks. I wanted to carry my supplies with style and grace. There are other lovely products on the market but I feel they are geared mostly for children or young adults and I did not find them suitable for my needs.

The Camino Clutch is unique in that it houses a personal, removable sharps container in a discreet way. It allows the user to safely and securely dispose of used test strips, needle heads and lancets in an unassuming and stylish way. The puncture-resistant container has a screw top lid that can be tightened once the container is full and the hazardous waste discarded according to municipality standards. [Editor's note: I wasn't sure how often I'd use this feature of the bag, but it really has come in handy for the times I'm doing a pump set change at work.]

This is a classy-looking Clutch Purse with enough room to carry your glam stuff and your daily diabetes supplies. I designed it to make me and you feel beautiful with diabetes. Devoid of the standard medical kit velcro and elastic, the clutch can be carried on its own as a chic purse (perfect for running errands, a lunch date or a night out on the town) or thrown into a larger tote, gym or diaper bag.

Let's talk a bit about pricing, because while the bags are gorgeous, some may not find them as affordable as some of the other bags out there. How do you feel these differ from what already exists on the market, and how did you determine your price point?

We arrived at our current price point by adding up the cost of materials, production, transport and company operations. As a startup company, we are now learning that our price point is in the higher end of what our clientele would want to pay for a diabetes supply bag. This is something we are working on because we strive to be a company providing affordable luxuries for people living with diabetes.

Our clutch differs from others with on-trend style geared toward women and not children; the inclusion of the sharps container; high quality materials and production in the U.S. I began with an idea of a high quality bag produced in the U.S., so we chose a skilled, small-scale manufacturer in Brooklyn, NY. Although production time is a bit longer and production costs a bit higher, we chose this method because the quality is top notch. 

Anything else you'd like people to know about you?

My parents and I are co-founders of “Ace For A Cure: Smashing Out Diabetes,” an annual tennis tournament, in Philadelphia, with all proceeds donated to the Juvenile Diabetes Research Foundation (JDRF) for Type 1 diabetes research. Our 8th annual tournament will be played on June 10, 2013. Our tournaments, thus far, have raised $250,000 for diabetes research.

This fundraising initiative was launched because I was concerned that we were not doing enough to support diabetes research. We decided to go with a tennis format because of our love for the game.  It is a grass court, doubles format, round robin tennis tournament that has expanded to two venues this year—the Germantown Cricket Club and the Merion Cricket Club.  If you’d like to know more about the event, become a patron, volunteer or donate a raffle gift, please visit www.jdrf.org/aceforacure.

Very cool. Thanks for sharing your story, Monica!

What I like about this bag: it's sneaky in that it doesn't *look* like a diabetes bag, it's clearly very well-made (it actually reminds me, in terms of design, construction, and quality, of a Coach bag), it has appropriately-sized pockets and loops, and the sharps container is pretty genius. While I personally would prefer the outer material to be a bit more sturdy/stiff (it softens up a tad with use), I suppose that's a good thing for when you need to cram a bunch of stuff in there. It's a very roomy bag that is even long enough to hold a Dexcom G4 sensor still in its packaging - impressive! (I should also disclose that this bag was provided to me free, for review.)

So where can you find these goodies? Here:

Web:            monicavesci.com

Twitter:         @MonicaVesci

Facebook:     facebook.com/MonicaVesci

Pinterest:      pinterest.com/monicavesci/

And how can you win a free Camino Clutch of your very own? (You get to pick the design, btw - and

you can also pick one without a flap, if that's your jam.)

1. You need to be a person with diabetes, or their caregiver.
2. To enter, visit monicavesci.com then come back and leave a comment below about the strangest/funniest/weirdest place you have found a used test strip, and which Camino Clutch you would choose if you won.
3. You can earn an extra entry for following @MonicaVesci on Twitter. (Be sure to mention that you are following her on Twitter in your comment below, for your extra entry to count!)
4. Entries must be posted by 11:59 pm CST Sunday night (6/2/13), and one winner will be chosen at random*. The winner will be announced Monday morning on this same post - so check back here! (I'll tweet and post on Facebook when the update goes live.)

Good luck to you!

*Limited to readers in the Continental U.S. only. Please do not leave your email or web address in the body of the comment. $139–149 USD total value. 

UPDATE: Congratulations to the winner - Jessi Panke!

I'll be contacting you shortly, Jessi. Thanks to everyone who commented for participating!

Puff, The Magic Cankle.

I looked down at my feet last night after I was home from work and though, "Hmm, that's not normal."

One does not have time to pretty their feet up for the camera
when there is swelling involved.

Whoooaaaa, there, left foot. What are you doing, buddy?

Up until now, my feet/ankles/anything else hasn't shown any signs of swelling, and I was really digging that. When I saw my endocrinologist on Tuesday, she examined just my feet (well, actually, now that I think about it - she physically examined just my left foot) and had said, "Well, just a little bit puffy." I frowned, and when I came back home asked Aaron to assess my foot size. Second opinion!

We both agreed that my feet didn't really look that different than normal.

Fast forward to last night.

Because calling my doctor would make too much sense, I snapped a picture and sent it to a few friends. "Is this normal? It looks way puffier than the right foot, right? Not just me?" When responses came back in the vein of, "Um, you should probably call your doctor right now", I did. (And for what it's worth, that advice matches up with what the internet says, too.) Being after hours (and in the middle of some severe weather) I spoke to the doctor on call that night, describing my situation (28 weeks, type 1 diabetes, blood pressure has been fine) (except for the first time they checked it at my appointment on Tuesday when it read 154/82, but then they checked it again and it was 122/78) and telling her about this new symptom.

"Does it hurt at all? Does it hurt to walk on?" Nope, feels just like my other foot, except for the part where I can tell that it's puffy.

"If you press your thumb down, does it leave an indention?" Hmm, I hadn't tried that (nor was I completely confident that I could reach my foot). However, I was successful. Indention made, and it stayed put for a second or so.

She ran through a couple other questions, telling me that just one swollen foot or ankle can indicate a blood clot, but since I wasn't exhibiting any of the other symptoms, it perhaps wasn't that. She recommended I keep my feet elevated for the rest of the night, laying on my left side if I could (something about taking the pressure of the uterus off of some veins and stuff), so I happily handed the dinner-assembling reins to Aaron (who made killer sandwiches, btw) and planted myself in our recliner.

Sure enough, the elevation + increased water intake + necessary dog cuddling (severe weather = shaking, scared, cuddly dog) seemed to do the trick. And this morning? My foot looks totally normal to me.

I'll be following up with my doctor this morning by phone, and hoping this is some sort of fluke whereby my left foot is just being a jerk-and-a-half.

Pregnancy! Good times!

No.

Will 15 units of Humalog cover this meal?

How about 20?

What if I do 23 units with an increased basal rate for three hours?

23 units, an increased basal rate for three hours, and I go walk for 15 minutes?

THIS IS THE WORST. Is it possible to eat breakfast without topping 200 mg/dL at the two-hour mark?

Fine. What if it's just milk, decaf coffee and-

Okay, then I'll inject-

Needless to say, I'm looking forward to my (again) visit with my endo this afternoon. The size of my recent boluses, and the increasingly stubborn insulin resistance that is the hallmark of the third trimester, is making me dizzy.

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.