Serving Up Diabetes

In an effort to add some quick nutritional insight to those of us too darn busy to read the latest Self or Men’s Health magazine or who are annoyed by Dr. Oz… I wanted to add a new ‘segment’ to my blog.  Each Friday I will post a quick ‘Five’ with steps on how to change or work on certain things with our diabetes and/or nutrition.

This week I wanted to touch on sodium.  Sodium is a vice for many people with and without diabetes.  More so in the last couple of decades, with the piles and piles of processed food down our grocery store isles, we can’t seem to avoid sodium.  For people with any type of diabetes, we know that our blood pressure and our heart health is always part of our concern for potential complications in the future.  While blood sugar management is a top priority for reducing the risk of complications, diet is just about a tie breaker with blood sugar control and sodium is a true cheater.

Many people don’t realize that MANY low fat or low carb items still taste great because the manufacturer has blinded our taste buds with added sodium.  Here are 5 things you can do on your next trip to the grocery store to cut back on your sodium intake ASAP!  Just for the record; the American Heart Association recommends a conservative number for daily sodium intake of less than 1500 mg.  This is less than other governing bodies such as the USDA recommends.  I agree that it is better to air on the side of caution as many Americans can consume triple what the AHA recommends during a dinner at the average steak restaurant!

1) Soup isle: stock up on low sodium chicken broth, and some organic low sodium soups such as Amy’s Organic creamy tomato!  Soup is an obvious sodium culprit, and the lower sodium versions don’t taste any different.  You can ALWAYS use low sodium chicken broth/stalk for so many recipes.

2) Deli counter: Not that I encourage consuming a ham sandwich on a daily basis, it is still processed meat, but if you like a sandwich on occasion, go for the lower sodium baked ham, turkey breast and American cheese, I PROMISE you will NOT notice a difference!  I like the Sara Lee and Boar’s Head low sodium brand.  The grocery store ‘Thin and Trim’ brand is also tasty.

3) Spice isle: Most people already know this but just in case… Use Garlic and Onion POWDER not SALT for seasoning.  For garlic salt/powder for example It’s a difference of 1/4 tsp is 490 mg vs.  nearly ZERO! I often use a blend of garlic powder, onion powder, ground black pepper and extra virgin olive oil on boneless skinless chicken breast.

4) Cereal/Protein Bars: I know I am a sucker for a quick protein or cereal bar when I am on the road all day for work.  I pile them in my purse and will eat them as both a snack and for lunch if I am having a super busy day.  This is not good practice to do all the time, but keep an eye on all those ‘healthy’ bar options, many are packed with saturated fat and sodium.  Aim for one that is less than 140 mg.

5) The Salt Shaker: DON’T USE ONE!  No need to even have it on the table

The following are guidelines from FDA and taken from the Academy of Nutrition and Dietetics website at www.eatright.org:

• “Sodium-Free” or “Salt-Free” Less than 5 mg of sodium per labeled serving.
• “Very Low Sodium”/”Very Low Salt” 35 mg or less of sodium per serving.
• “Low Sodium” or “Low Salt” 140 mg or less of sodium per serving.
• “Reduced Sodium” or “Reduced Salt” At least 25 percent less sodium per serving than a similar product.
• “Lightly Salted” or “Light in Sodium” At least 50 percent less sodium per serving than a similar product
• “No Salt Added” or “Unsalted” This means the food doesn’t have any extra salt, not that it is totally salt-free. The FDA says companies must add, “This Is Not a Sodium Free Food,” on their information panel to differentiate between be a food that is “Unsalted” and one that is “Salt Free.”

*Just as a reminder… I do not get paid to endorse any specific brands.

It’s a good day in my house when I remember to check my blood sugar before 11am.  It’s a blurry eyed and weary day when I look down to see that I’ve forgotten to wipe (ehem, lick) the blood from my last finger stick and it is now on the swaddle of the snoring baby that I am holding onto.  Lovely, blood on my baby.  It’s a great day when my baby takes nice long peaceful naps and I can not only cook a healthy dinner, but I can also take the time to eat it.  It’s a really bad day when I look at myself in the mirror and can’t tell if the bags under my eyes look worse than the infusion site I haven’t changed in 5 days.

I am learning.  I am learning how to be a mom, and a middle-of-the road diabetic, not too hard on myself but not completely negligent either.  I have been just starting to slowly catch up on sleep now that my little one is about 10 weeks old and very slowly starting to give me more time in between nursing sessions at night.  I have been wanting to write a helpful nutrition blog, something that pertains to summer coming upon us and how we can nutritionally take advantage of what the season has to offer… but instead I find my brain fighting its way out of the fog that has been sleep deprivation and adoring my beautiful little girl all while preparing to go back to work in two weeks.

So, what I thought would be helpful is a quick post on what I have learned about balancing nutrition and health to best manage my erratic diabetes control during this crazy time in my life.  This can pertain to anyone going through anything that seems to tug them away from their diabetes control for longer than they would like.  Diabetes is like a good drink (can you tell I miss my hard alcohol?), it’s one part blood sugar checks, one part insulin management, and one part nutrition.  If you really let any one of those go by the way side for too long, it doesn’t matter how good you can handle the other two… you’ll end up slumped over.

I now have a little bit better of an understanding of the excuse many give, “I have no time to prepare meals, eat healthy, watch my carbs let alone count them… etc.”  For me, cooking and grocery shopping is actually a release.  It makes me feel normal during a time when I am all out of sorts and my priority is to feed my baby before I feed myself.  Cooking and planning meals is something my husband and I enjoy doing together, and we appreciate the time it takes to put them together.  So I have made sure not to sacrifice this part of our routine as often as I can, even through the exhaustion and piles of laundry.  I have learned that if you make nutrition and cooking a priority, just as anything else in your household may take , you can fit it in and make it work.  Once you do this, your blood sugars will follow suite.

Nights when I am able to get a good balance of protein, be it a simple chicken dish or steak tips on the grill thanks to the warmer weather, along with a good serving of veggies, I know my blood sugars will thank me before bed, as will my slowly disappearing bags under my eyes due to the iron replenishment.   Nutrition runs more than your blood sugars, and you need to remember that.  It runs you energy, your mood and ultimately how good you can be for those around you.  And if you ask my husband, he will tell you that when I’m hungry I’m a bear, when I’m high I’m a bear, and when I’m hungry and have a high blood sugar… I might as well be at the zoo.  If all you have in your house to curb your hunger are quick snacks like cookies or chips, then you will eat them out of pure ease, and you will only leave yourself feeling empty and energy depleted hours later, only to go back and cycle for more of the same empty calories.  Your energy will suffer and so will your blood sugars, which will only rollercoaster up and down.  I am guilty as charged with doing this.

Non of us can be the perfect diabetics every day.  But by making small goals, and keeping nutrition at the very top of those goals, the rest will in fact fall into place.  I feel best on days when I am able to fuel up on whole grain toast for breakfast, with a greek yogurt for a mid morning snack (sometimes I will throw a few chocolate chips in my yogurt to satisfy my need for sweets), and then eat a healthy sandwich with protein and whole grains for lunch, nuts or a filling fruit like a banana (packed with potassium and B vitamins, great for a nursing mom) for a snack and then lean protein and veggies for dinner.  Days when I am in a rush, or the cabinets are empty because it’s time to get to the grocery store are days when I notice my energy is lacking, and my blood sugars pay a price.  I snack on whatever is left over, which may include something salty or sugar because I just need a quick ‘fix’ before the next diaper change, or when there is nothing in the house to eat for lunch and I can’t get out to get something to eat and end up just eating a breakfast bar, I feel depleted and tired.

Make it a priority to keep yourself away from the cycle of empty food days.  The energy you put into making a grocery list, or cooking a meal will pay you back ten-fold when you reap the benefits of making healthy eating a priority!

Okay, for my regular readers who are not in the child-bearing stage in their lives, I apologize, as I am sure you are looking for my next informative blog regarding food and nutrition tips for blood sugar management.  Well, I promise I will get back to those types of blogs, but right now, as far as nutrition goes, I am lucky if I remember to eat these days let alone make sure I am getting all the nutrients I need.  This is because my body is not my own!  I wanted to write a quick blog on the trials and tribulations of being a breastfeeding mom with diabetes.  I feel that the real raw details are never talked about when it comes to the challenges that can potentially be expected when diving chest first into exclusively breastfeeding your baby…oh, and trying to remember to take care of your chronic disease.

I had done so much reading and research to prepare for this baby that I could have made it a full-time job.  What I learned through my search were the following key points regarding breastfeeding:

• Skin to skin as soon as possible after birth will help the baby to take to breastfeeding sooner and more naturally. *I was very lucky in that after voicing my want for skin-to-skin to every nurse and doctor that came in my room right before my c-section, that they allowed my baby to lay right on my chest while they stitched me up.  This was huge! She stayed there the entire time and then when they wheeled me to recovery they put her right back on my chest to start nursing right away.
• Rooming-in (keeping the baby in the room with you and not in the nursery) improves breastfeeding outcomes.  *This should be common sense! If your baby isn’t in the room with you, how can you pick up on hunger cues? How can you learn what their needs are which are so vital in the first hours and days?  If you want to exclusively breastfeed, you’re going to need to wake up all the time anyways to nurse, so what would it matter if the baby is in the nursery or in your room… she may as well be right there next to you.  We didn’t let our little bundle out of our site except for when they had to take her to the nursery to do newborn testing on her.
• No pacifiers? This is controversial.  Some doctors and lactation consultants say that use of a pacifier will potentially deter the baby’s ability to properly latch when initiating breastfeeding, and might confuse them.  Other professionals say that it doesn’t make any difference.  What I can say is that there are many hospitals in the nation trying to achieve something called ‘Baby Friendly’ status, which is an exclusive breastfeeding badge of honor where they can attest to well over 90% of their new mom’s exclusively breastfeed.  Part of the Baby Friendly accreditation includes not using pacifiers at all in those first few days.  *We weren’t really trying to keep a pacifier from our baby girl after the first couple of weeks, but when we did finally try to give her one (when the fussiness started to make me think I was losing my mind), she wouldn’t take it anyways.
• Lactation support.  *This is KEY!  I took a breastfeeding class months before I gave birth, I read 2 books, I watched YouTube video’s on achieving the perfect latch and I hired a lactation consultant to come to our house (I even had her come right before the baby was born so that she could fill my husband in on everything so that he was on the same page as me).  One of the main reasons that new mom’s give up on breastfeeding is due to pain and an improper latch.  By utilizing the lactation consultants in the hospital, you can do your best to make sure you don’t leave that hospital without at least understanding what a proper latch should look like.  We are still working on our latch everyday, and it’s been 6 weeks! It is a learned skill for both mom and baby.  My lactation consultant also was key at troubleshooting a range of issues I was having, including discovering that some intense pain I was experiencing was due to a yeast infection on my breasts (this is as common as mastitis, another painful condition from breastfeeding).  Once I was treated for that, the pain disappeared almost immediately.

I know that this may seem a bit obsessive, to have done this much work and preparation for something that is supposed to come naturally for both mom and baby.  Not everyone has to do this much up front work!!  I am just someone who likes to know what to expect, good and bad, so that I can be prepared and do my best to succeed no matter what challenges may present themselves.  I can honestly say that without doing everything I did, I would have absolutely given up on breastfeeding in that first week.  There would have been nothing wrong with that!  But this was a personal goal of mine.  Knowing that there is some small research that shows that exclusively breastfeeding for at least 2-3 months can reduce the risk of my baby getting Type 1 diabetes… I probably would have walked on hot coals while breastfeeding knowing this.

Also, I think it is important to note the following:  Many people talk about the ‘baby blues’ and the shifts in hormones that can make any new mom overly emotional in the first few days and weeks following delivery.  Sleep deprivation and extreme breastfeeding pain, coupled with erratic blood sugars and malnutrition (choosing between a nap and a meal…the nap often wins) can mean exagerate the baby blues and may or may not lead to post partum depression (you are allowed to just feel plain overwhelmed without it being more then that!).  I had to take a step back a week or so ago and say, “Is all of this too much?  Is it stopping me from enjoying my baby and all of these precious moments that will go by in an instant?”  I made the decision that if the pain didn’t subside that I would start pumping and giving more bottles and even supplement formula if need be.  Luckily, this revelation came right when the pain finally started to go away and when I was starting to get a little more rest.  But just keep in mind, losing your sanity won’t do you or your baby any good, so no need to be a hero.

Managing my blood sugars while nursing has been no easy task, but I try to take it one day at a time.  When baby is going through a growth spurt, the constant nursing acts as a natural bolus and I seem to not need that much insulin.  However, when I do go high, the highs spike quickly and are difficult to get down.  I have heard that if you nurse with a high blood sugar, the baby will taste ‘sweet milk’ and become accustomed to it or hate it.  I haven’t found either to be the case, as I don’t think she notices when my blood sugars are high, but I would be lying if I didn’t say I felt guilty knowing she was drinking milk when I am 300.  It just doesn’t seem okay.  I do the best I can at remembering to count carbs, when I can remember to eat.  My fears about having severe lows  while sleeping are stronger than ever, as now when my head hits the pillow, I am in the deepest sleep of my life until that squeaking little noise in the bassinet next to me wakes me up for the next feeding session.  I try to always make sure I check right before I crash on the pillow and I’ll eat a few glucose tabs if I’m below 110 just to be safe.  I try to wear my sensor as often as I can.

Here is a list of some of the benefits of breastfeeding and below it are a list of all the things to consider when you have diabetes and you are breastfeeding:

• Promotes bonding between baby and mother
• Helps mom recover better after birth (uterine contraction, decreases bleeding, etc)
• Eliminates need to prepare, mix and wash feeding equipment
• Saves money spent on formula
• Breastmilk is high in natural antibodies, probiotics and vital nutrients that no formula can exactly mimic that are essential for baby’s growth and developement
• Decreases risk of breast cancer and ovarian cancer for mom
• Aids in maternal weight loss (burns an extra 300-500 calories a day!)
• Provides immune protection for baby (breastfed babies may not get sick as often)
• Prevents or decreases risk of allergies and autoimmune diseases such as type 1 diabetes, asthma and some digestive disorders.
• Many cognitive and emotional/psychological benefits

*Note: pumping breastmilk is very beneficial and better than no breastmilk at all.  However, mom’s who do not feed right from the breast and choose to only pump (from the beginning on) run the risk that their milk production will go down a lot sooner.  Having the baby feed right from the breast is a different sort of sucking then any pump can truly mimic so there may be a chance that the breasts will not continue to produce enough milk to keep up with growth for a long stretch of time.  Also, pumped breastmilk that is refrigerated or frozen, while still amazing as far as nutritional properties, does break down a bit nutritionally and isn’t as potent as milk directly from the breast.  Most lactation consultants will recommend not introducing a bottle until week 4-5.  This will help so that the baby can get comfortable with use of a bottle without getting confused.  Also, if you are going to just exclusively pump, and put ALL that work into pumping, storing, washing, etc., why wouldn’t you just feed right from the breast if you are able to?

Oh, just on a side note, so that people don’t think I am a breastfeeding crazy person… I strongly support the use of formula.  There are many different kinds of formula out there, and for the most part any will do.  However, if you are looking to reduce the risk of allergy and autoimmune diseases, you should choose a formula that has broken down proteins.  Ask your doctor for more info.  While breastfed babies have softer stools and don’t spit up as much as formula fed babies, formula is perfectly great when mom is unable to or chooses not to breastfeed.  I strongly believe in the research that supports formula with broken down proteins.  Why would you want to feed your baby a formula that has whole protein (exposing the baby’s tiny tummy to these giant particles?)  Not enough mom’s ask their pediatricians about the specifics of formula options, so I highly recommend you research this as much as you would research a daycare; after all, it’s what you feed your baby all day!

The reality of breastfeeding with diabetes: (the picture above says it all!)

• I can’t find a comfortable spot for my pump when I’m nursing.  My nursing pillow makes my pump dig into the side of my hip.
• I have to carry a number of things with me in my diaper bag and have on all floors of my house: meter and test strips, insulin in case my pump runs out in the middle of the night because I forgot to change it during the day, glucose tabs, nipple creams, gas drops for baby, my breast pump and parts, extra strength tylenol for any pain, extra test strips…the list goes on!
• It’s difficult to remember when the last time I changed my pump site was because all my days and nights blend together.  I have to write this down to keep track.
• I have gotten blood from my finger on my baby’s onesie, which makes me feel bad.
• I actually just remembered while I am typing this that I need to order more test strips from my online pharmacy as I am running low…crap.
• You not only feel completely helpless when you are low in the middle of the night, but when you are nursing your baby and you can see the juice box on the table in front of you but you can’t reach it… it’s when you wish telepathy was real and it could wake up my snoring husband in the other room.
• You are more susceptible to infection; yeast infection on your breasts, mastitis (which includes fever and flu-like illness), especially when your blood sugars are running higher.  Luckily, the act of nursing alone helps to protect your body, but some things are unavoidable.
• You are doubly as exhausted as anyone else who is in your shoes. Battling the ups and downs of blood sugars along with any pain and sleep deprivation, it’s harder than anyone ever tells you it is. But it is SO worth it to just suck it up for a short time!
• Carpel tunnel syndrome: some people with diabetes are more susceptible to this, and so imagine constantly manipulating your wrists to get your baby’s squirmy little head to latch on, and then holding it there.  We have these rolled up fabric pieces all of the house to use to put under my wrists to ease the pressure when nursing; although when I can’t find one or it’s out of reach when I sit down to nurse, it’s extremely frustrating.  Also, my little one is fussy at the end of the day for hours on end, and so my left arm/shoulder/wrist feels like it’s on fire most of the time from holding her for long periods.
• Taking the time to pump; and I’m not talking about insulin pumping.  Now that I am at the stage where I am beginning to pump my breastmilk to start storing it away, I have very limited time.  I have to make a choice, for the 1.5 hours my little one naps at a time, I can either: eat, shower, pump my breastmilk, and try to change my pump site somewhere in there, or maybe do some much needed house cleaning.
• Support: Spousal and family support is KEY! If people don’t get that you are completely overwhelmed and exhausted, and if they expect too much from you emotionally or physically then they are not being helpful or understanding and you should not have them around.  Some may assume you are overwhelmed by blood sugar shifts or hormone changes, but don’t let anyone’s assumptions mask what is really going on, you are a NEW MOM and you just need TIME (it also doesn’t mean you have post partum depression, as you are allowed to cry for no reason at all)! Surround yourself with those that can be sensitive to your needs right now and don’t need anything from you in return, those who will be understanding but not pushy.  My husband has been key in my success as a new mom and especially my success with breastfeeding.  He is always neutral and helpful and mostly just lets me vent.

This was a lot of information for a blog post, and I am happy to elaborate on any of this if anyone wants more details.  I don’t want this information to scare people away from all the benefits of breastfeeding, or on the contrary make people feel that breastfeeding is the only way.  Every baby is different and every mom, or diabetic mom, is also different.  Do what makes sense for you and your baby.

Given my recent experience from an in-patient perspective, I thought I would share my insights on how I would do things differently when advocating for my diabetes care during a routine hospital stay.  I haven’t been hospitalized since the day I was diagnosed, well over 22 years ago, this is obviously a good thing that I have not had to worry about.  However, with anticipating my impending c-section and lengthy hospital stay in the postpartum unit, I knew that my baby’s health would be the nurses primary concern, and that my diabetes would be an afterthought.  Well, I was not so pleasantly surprised at how hands-on the rounding physicians and residents would be regarding every last detail of my blood sugars and pump settings.

I chose the particular doctors and hospital that I gave birth at because they are world-class in care for high-risk pregnancies, particularly with Type 1 mom’s.  I knew that I didn’t really need anyone to adjust my settings for me, but given the likelihood that I would need some assistance, particularly on the day that I was to give birth, I wanted to make sure I was in the best care possible, which I was, but in turn I ended up becoming quite a problem patient for those on-call Endo’s trying to help me.

I was completely prepared for the day of my c-section to relinquish all control and hand it over the glucose and insulin drip IV’s and the labor and delivery nurse.  Thus I allowed them to not only take over my entire lower half of my body but also for my pump.  This wasn’t easy, but I was at least prepared for it.  They did a great job, and kept my blood sugars stable at right around 80-100 before, during and after delivery.  Unfortunately, it is easy to forget that not only do hospitals have policies that they must abide by, but that the doctors and nurses are just legally doing what is required of them when it comes to following their policies.  By me being difficult and constantly questioning “why” didn’t do anything but frustrate those trying to care for me.  They wouldn’t let me leave the labor and delivery unit until I was over 100, and so when I stayed 98 for over an hour and they wouldn’t move me, you can imagine I began to question authority.  The good news was, I didn’t push it too far because my baby girl was right beside me, which is all I really cared about.

Once in my postpartum room and for the remaining days of my inpatient stay, I had the Endo on-call as well as many nursing students come into my room to see what my last blood sugar reading was, this was okay.  Where I had an issue, was that on their little list of things to ask me, they would constantly come and quiz me “Can you tell me what your basal rate is right now?”  By the third person asking this I said, “My pump does the thinking for me, whatever your chart says my basal rate should be at 6am, that is what it is! It changes on its own!”  Now, I understand they were just doing their job, but this is where the staff need to be inserviced on insulin pumps, since many of the nurses actually admitted to me they had no idea how a pump worked.  Also, the biggest thing I regret, was not listening to my gut when it came to my post pregnancy pump settings.  My Endo, doing what she thought was best and based on the fact that the average women with Type 1 needs next to no insulin right after giving birth, had cut my basals by almost 75%.  I thought this was way too much, but I listened to her advice.  For the days following the birth, and even now, four weeks later, I am still struggling with highs.  I never went below 60 in the hospital, which for me, is not that low.  The Endo on call ended up arguing with me because he wanted me to cut back on my basal, when I had only 1 low (with no pattern to give reason for lowering it), and I said “No!”.  There is no pattern!  Everyone kept telling me how bad my lows would be once my milk production ramped up along with my nursing.  Well, it NEVER happened.  I do have lows here and there, but they are all manageable.  Here I am four weeks later, still trying to adjust my basals and other pump settings to find a happy medium.  If I had followed my gut, and the fact that I know my diabetes and my body better than anyone else, I like to think I could have avoided some of this frustration.

I can appreciate the policies that are in place and the medical professionals who try to go off of their experience with other patient cases, but at the end of the day, here is what I would have done differently:

• Communicated with my Endo before giving birth that I wasn’t comfortable with the settings we agreed upon and try to find a happy medium that wouldn’t put me at risk.
• Do a better job of communicating with the nursing staff while in the hospital; including writing my basals on a large notecard to keep next to my bed so when they came in to ask me every 6 hours what it was, I could just point to it!
• Fix the time on my damn meter so that when they wanted to know what my blood sugar was the last time I checked it, I could answer them (without making up a number to get them to leave the room) through my sleep deprived and fuzzy brain on pain meds, I could barely remember what my last BG was.
• Do a better job at respecting the fact that they have a job to do, and instead of getting frustrated with them, stop and explain that I’m not comfortable with their recommendations and that as long as I am able to feel my lows, adjust my own settings and check my own blood sugars that they respect my decisions on how I manage my diabetes.
• When I got home, I should have put my sensor on RIGHT away to determine what needed to be changed in my settings.  I was a bit overwhelmed with  a newborn, so didn’t get around to putting on my sensor until a week ago (which I still have yet to upload and send to my Endo).
• If you are planning a routine hospital stay, make sure you are aware of the policies and procedures that they following regarding diabetes control.  If you are not comfortable with something, make sure you find out how much room they will actually allow you to control your own diabetes.  Remember, you are legally in the care of someone else, so there is a very fine line, as everything needs to be documented… if you saw my discharge papers, they probably say:

“Bitch in room 580… her blood sugar must be high” Oh well!

Day 16 of captivity with this squeaking, grunting (sometimes screeching) little adorable nocturnal creature that is draining me of every ounce of sleep and love that I have available… and I don’t mind one bit.  I don’t care how exhausted I am, I would rather just stare at her than nap.  Figuring out where my diabetes management fits into this strange place of sleep deprivation and enjoying my newborn has been interesting to say the least.

I was standing at the kitchen sink at some odd hour of the early morning and had an itch on my side.  When I went to scratch it, I realized I hadn’t removed my old pump site from when I put a new one in over a day ago.  Wow.  I had been wearing two pump sites for over a day with no clue.  The good news was, I had remembered to change my pump site at all.  Being the OCD person that I am, in preparation for having the baby I created a check-list for myself that I could look at each day once she arrived, even when I don’t know what day it is.. this list includes such things as: changed pump site, did my husband change cat litter, did I take a nap today, and did I shower.  This kind of list is a necessity for someone like me, who has been trained, in particular over the last 9 months, to be hyper vigilant about my blood sugars.  Two weeks ago I was up to a total of 90 plus units a day, needing to change my pump reservoir almost daily, and now a full reservoir could last me an entire week since my insulin needs have plummeted after the birth.

Being okay with letting my blood sugars hover in the 180′s has been one of the most difficult things for me.  In a sense, I am needing to train myself that along with functioning on 3 hours of sleep, it’s okay to function with numbers in the high 100′s.  This is important right now, as I am breastfeeding around the clock, which has extreme unpredictability on my numbers.  Often times I can drop 50 points from beginning to end of a feeding session, and other times nursing has no effect and my blood sugars won’t budge without a bolus.  It has been a lot of trial and error.  I have to make decisions when I can barely see straight about whether or not I should bolus for a snack or for a high, and if it will get in the way of me nursing at 2am, which comes with its own set of frustrations.  Breastfeeding successfully was a goal of mine, and thankfully my little girl is taking to it (but not without a lot of pain and frustration in the first couple of weeks).  For someone with diabetes, breastfeeding has numerous benefits, beyond being the ideal source of nutrition for my baby, there is some research that shows it may even help to reduce the risk of my own child getting Type 1 someday, as it offers immune protection like non other.  At the end of the day, whether I was feeding her a bottle or nursing her, my blood sugars are still gong to have a mind of their own!

One thing with breastfeeding is that you are thirsty ALL the time.  This often makes it difficult for me to sense if I am low or high, as thirst has always been a symptom of mine for lows and highs.  The other day, I wasn’t feeling great, and checked my blood sugar, and beyond belief I looked down to see a number I hadn’t seen in probably 5 years… 465.  What?  Was my meter broken?  Did I have diaper cream on my finger that was skewing the result?  I cleaned my finger and checked again, nope, still 465.  I can’t even tell you what I ate or what I didn’t take for insulin that caused this.  I looked at my check-list to assure I had indeed changed my pump site recently, and then I looked down at my tubing and site, everything looked intact.  Oh no, would this be too high to nurse my little girl at the next feeding?  Would she think she was sucking on a lolly pop?  I have read various things about feeding when you have a high blood sugar, and for the most part, it’s not really supposed to have an effect.  I bolused, and knew I had at least an hour or so before her next feeding, so it would be coming down by then.

It’s crazy, how completely unpredictable diabetes constantly is.  Just when you think you’ve got it figured out, it completely throws you for a loop.  My doctors have told me to not stress out about any fluke highs, my baby is here now and she is healthy, and that is most important.  They know I have spent the last year being extremely buttoned up with my diabetes, and they expect things to go a little wacky now that my main focus is my baby.

For so long my rituals consisted of just taking care of me and my blood sugars.  Now, my ritual consists of : Check blood, treat/bolus, change diaper, nurse, burp, keep track of feedings and baby poops, check blood, treat/bolus, try to sleep 20 minutes… and REPEAT.

Well, it’s been one year since I embarked on this blogging adventure in diabetes.  Thanks to my dear D-Friend, Moira McCarthy Stanford, who encouraged me to “build a platform” if I ever wanted to be successful in making a name for myself as a trusted diabetes resource.  As part of a long-term goal of publishing a thick manuscript that is sitting idle on my desk with loads of grammar and spelling mistakes, I hope to continue to explore and expand my diabetes knowledge and share what I know and what I think is important for my readers to know, and continue to do it with a little bit of flair, raw emotion, and dry humor, to allow my readers to get to know me as a true and honest voice for diabetes.

Over the last year, I have changed the name of my blog from ‘Busy Bag’ to ‘Serving Up Diabetes’.  I did this to make my content crystal clear to my readers, so instead of having a play-on-words, I would let my readers know right off the bat that I am here to serve up nutrition information, general diabetes and technology information, and most of all serving it up for REAL, with the truth and honesty behind all my thoughts as I continue on this journey through life with a chronic disease.  All I could have hoped for was to provide some nutrition advice for those with any type of diabetes who have been confused by the media or by their own diabetes care providers.  Also, I have only hoped to be able to lend some clarification about the misconceptions of this disease for those that have unfortunately become, to no fault of their own, ignorant due to the portrayal of diabetes by the media and inaccurate resources.

What I have been able to accomplish has been so much more and I want to say ‘thank you’ to those of you, near and far, that have supported me and looked to my blog for a quick resource or to really relate.  I have reconnected with old friends from diabetes camp, I have gained followers from spouses of people with Type 2 diabetes, I have reached a number of young women, like myself, who are embarking on their journey of pregnancy with diabetes and hold so much hope knowing that there are others out there who are going through it too.

I wish I had started this blog a long time ago.  No matter how few or how many people actually read my tid bits, the fact that I will receive a private email or message every so often telling me that someone really resonated with my words means so very much.

I don’t get paid to write this blog, and I don’t get paid to do all the volunteer speaking I do.  I do this because I am incredibly passionate about raising awareness and educating others about diabetes.  Someday, I’m not gonna lie, I wouldn’t mind getting paid, should I ever have a book published or th E Channel decides to do a true hollywood story on my life… but until then, I’m happy just providing useful antidotes to others.

Over this last year, my blog topics have teetered between nutrition facts as they relate to diabetes, pregnancy, and the emotional impact of this disease.  For the next year, I plan to continue to offer nutritional information, as well as sharing with my readers how I will go about continuing to keep my health (or trying to) front and center while being the best mom I can be.  If there are ever any topics that my readers would like me to write about, please feel free to post ideas, as I am open!

…It’s amazing how one year ago when I started this blog, I also started working on my quest for a healthy pregnancy.  I am happy to share that I gave birth to a beautiful and perfectly healthy little (well, big) girl over a week ago.  She was 10 pounds and came via c-section.  We made it through those first few days in the hospital and I managed my blood sugars well enough while they kept an eye on hers, as it was slightly low at birth.  However, I have been able to fully nurse successfully, which has been a goal of mine, and continue to try to figure out managing being a new sleep deprived mom while also trying to not put my diabetes on the back burner.  I am so looking forward to sharing how the ups and downs of managing diabetes as a new mom will play out… but right now I am a bit pre occupied with the love of my life (sorry to those who want pics, etc, but I’m keeping her all for myself right now

Thanks for all the support and continue taking care of YOU!

I just wanted to share with my readers, before I become a bit preoccupied with a newborn and I may be quiet on the blog front for a bit, that there is hope for all those stereotypes out there regarding Type 1 pregnancies. I am happy to say, and believe I can safely say, I have defied the odds of the typical Type 1 pregnancy.  I am now 38 weeks and 3 days along…my baby girl is pretty much full term!  My blood pressure has not strayed from normal even once, surprising even myself, as I was convinced I would end up with preeclampsia at some point during my pregnancy, because I had chronic high blood pressure prior to pregnancy.

I have been able to keep my A1c under 5.7 throughout the entire pregnancy, even with some insulin resistant spurts that really tested my basal rates.  My baby is 8.1 pounds, as of her last weigh in about a week ago, but to blame having diabetes on her size is really a stretch.  My husband is 6’4″ and we were both 9 pound babies.  So I can happily pat myself on the back and know that I have done ALL I could possibly do to give my baby the best chance possible, and keep myself in the best condition possible.
My OB is aware that I would very much like to try to avoid a c-section if at all possible (though I am not completely against it should I go to the 40 week mark), so I have been doing all kinds of things to try to get labor started on my own…to no avail just yet.  It is important for me, in particular (everyone is different) to try to give birth naturally (with an epidural of COURSE), so that I can have that special bonding moment with my new baby that a surgical room doesn’t always lend too.  I am also on a quest to keep my BG’s right in target, so should I go into labor at any moment, my little bambino won’t have a low blood sugar from compensating for my highs, which may require her to get a bottle, instead of being able to go right to breastfeeding, which is something else that is very important to me.

With all of this said, I just wanted to share this with those of you who have just started on your pregnancy journey and have a stirring anxiety lurking in your minds.  Do the best you can, that’s all you can do!  I wasn’t perfect throughout this entire pregnancy, but seeing the way I have been able to keep my blood pressure down and my A1c in check, and such, I know it is possible.  Now, I am also aware, it doesn’t matter if you are the perfect diabetic, that sometimes ‘it is what it is’ and certain obstacles can be unavoidable.  But don’t beat yourself up!
If I can give any advice, it’s that you should continue, even up till this point at the very end, to take care of YOU and your body.  I have kept up with walking 2 miles at least 3 days a week, when I feel up to it, and have not stopped drinking plenty of water each day.  I have tried to make time to rest my mind and not allow stressful situations to effect my blood sugars.  Again though, just to make sure you are aware that I’m not perfect, I have completely replaced at least one snack a day with a decadent dessert… compensating with insulin of course, but eating sweets like it was my last day on earth has sort of become an uncontrollable thing here at the end of my pregnancy that I have forgiven myself for.

It’s amazing how many people just don’t understand why I can’t just sit around, on my butt, all day, resting and eating and waiting for my baby to arrive.  If I did that, I fully believe my end result would have been different.  Keeping busy for me is more than just an OCD issue, it’s my life-line.
I am hopeful that the end result of my baby arriving here will be drama free… however, if she is anything like her mother, I’m sure she’ll try to push me to limit somehow!

It may seem to be common sense for anyone living with Type 1 or Type 2 diabetes, to always make sure you have plenty of supplies to manage your blood sugars. However, sometimes time gets away from us, and emergencies creep up and all of a sudden we open the fridge to find just a half vial of insulin left or one vial of test strips at our disposal until our new prescription can be filled. While some of this may seem to be obvious, you would be surprised.  I often surprise myself  how frequently I say ‘oh crap’… when I’ve realized I’m  in a supply jam. With the impending blizzard upon us this weekend, although it may be too late to do anything about a supply shortage at this very moment, here are some things to keep in mind for times when you need to ration supplies:

• Always make sure you have at least one month’s supply of insulin and test strips available as a back-up, no matter what. How can you do that? Well, you can try to get a sample of insulin and test strips from your Endo office next time you go in, and keep that as emergency. Also, it’s not a bad idea to have your prescription say that you check your BG 10 times a day (even if you only check 6-8, or that you take 40 units a day of insulin, even if you only take 30), this will allow your supply to last longer.
•  Keep tabs on expiration dates! Just as they say in the restaurant business, FIFO (first in first out), make sure you are using the insulin and test strips that are oldest first, and stack your new ones in the back.
• ALWAYS have syringes available, especially if you are on a pump or insulin pen. It is important to keep syringes everywhere; in your meter case, car, and home. This way, if your pump breaks, you run out of infusion sets, or if you insulin pen caps run out, you can, in an emergency (and this is NOT MEDICAL advice, just a trick of the trade that can be used in an EMERGENCY…) you can take a syringe and put it into the tip of the reservoir or pen that contains insulin and extract a few units. This is NOT meant to be done regularly, as this is not really a safe practice, but it is an option if you’re in a jam.
•  Remember: If you are on an MDI regimen of long acting and short acting insulin, and if you run out of long acting insulin, you can really only use short-acting alone for about 2 hours before you will really need some basal insulin back in your system. So if you are running low on long acting, call your doctor to see if you can maybe lower your dose to make it last you an extra day, and adjust your eating so that you don’t run into unwanted highs.
• As for pump supplies, try to always have extra, and always keep a vial of Lantus or other long-acting in the fridge, in case your pump breaks. – If you are NOT the one with diabetes, and it is an elderly relative, please try to help make sure they are prepared for an emergency as well.

Many of these tips should be common sense, but it’s important to reiterate them. People have survived on much less for diabetes care products over the last 100 years, so you CAN make it work without panicking.

I am sure by now many people have already long forgotten their New Year’s resolutions (I mean, it has almost been a month since we made them!).  I am always thinking about how I can do something differently with this disease that I have been so graciously blessed with, and how I can make my life a bit easier and inspire others to do the same.  No matter if you have lived with Type 1 diabetes for most of your life, or if you have just been diagnosed (or even misdiagnosed with Type 2 when you are really Type 1), or if you are just getting used to a change in diet and lifestyle due to a Type 2 diagnoses, there is no time like the present to do things a little differently.  Here are some ideas:

• Take time to update yourself on diabetes research, technology and cure updates:
  • Regardless of whether you follow the JDRF, ADA or any other diabetes organization; take the time to ask your Endo next time you are in the office what they know or have learned about regarding the fight for the cure, the artificial pancreas project, or stem cell research.  Things are changing all the time out there as far as funding from both federal and private organizations for a cure for diabetes, and unless you do your own research, how do you know exactly where your donations are going?  It’s also nice to get your facts straight, so that the next time someone asks why the doctors can’t just give you a new pancreas, you can kindly explain some important facts to them.
  • In regards to technology, take a step back and look into what’s ‘hot’ and what’s ‘not’ by lurking around the online diabetes community.  Read blogs and forums from people like brokenpancreas.org, tudiabetes.com, despitediabetes.com or me!  Check out a blog posting I wrote a while back about technology.  It’s important to decide what’s best for your needs when it comes to taking care of your diabetes.  While an insulin pump is great for some, it may not be for everyone.  Do your homework, and don’t be afraid to challenge the medical device and insurance companies.  It may take a lot of leg work, but if it’s something that is expensive and life-changing for you, it’s worth the upfront work!
• Volunteer, get involved, or make a connection:
  • It’s okay if you don’t have a free second in your day to even check your email, let alone spend hours volunteering for any cause that is near and dear to your heart.  Life is tough these days, and with the economy the way it is, and many people working like dogs to just pay their mortgage, and maybe taking care of a child with diabetes or yourself is hard enough.  However, if you look into it a little more, many diabetes organizations don’t require that much time.  Even if all you can give is 3 hours every 6 months to work a booth at a health fair or spend an hour once a month calling newly diagnosed families, it makes a world of difference.  If you don’t live near a JDRF or ADA hub, think outside the box.  I recently emailed one of the local mother’s clubs that I joined to just let them know that I am an advocate for diabetes education and if anyone knows of anyone in town who needs support, to please reach out to me.  You can also look into your local hospital to see if there is a support group.  Often times those support groups get stale very quickly and can use a breath of fresh air from someone who is passionate and willing to listen and share their experiences with living with diabetes.  If leaving the house is just out of the question due to time constraints, then reach out online.  It’s sometimes helpful to add some positive words or encouragement to someone on an online diabetes chat forum who may be down in the dumps or has recently found out bad news about their disease management.
  • Connect with old friends and find new ones.  By reaching out to old diabetes chums you may have shared a cabin with 15 summers ago, or by connecting with a random patient waiting at your next doctor appointment, you never know what similarities can get brought up!  It’s amazing how so many of us living with this disease, no matter how differently we may live our lives or what our backgrounds may be, are going through the EXACT same thing.  Diabetes is a very emotional disease, and when you can connect with someone, even if it’s just for a few minutes, it’s like a year’s worth of therapy!
• Be an advocate, but take a step back and get off your soap box if no one is listening!
  • For me, the best thing about writing this blog is no one could read it, or a 100 people could read it, and I will never know if I really got my message across to those that I really want to HEAR it, but I know I’ve made a difference in someone’s life.  If that doesn’t make sense, then let me explain.  I am constantly trying to right the wrongs and the misperceptions of this disease to anyone who ever asks a simple question about it.  Instead of just simply answering a question about my diabetes with ‘yes’ or ‘no’, I feel compelled to go into a lengthy explanation and sound like an old geezer by saying things like ‘well, back in the days before there was fast acting insulin…’  Recently, someone said to me, “Why do you always feel the need to enlighten those around you, especially when they don’t want to hear you?”  This resonated deeply with me.  No matter how many times I try to explain Type 1 vs. Type 2, or why it’s okay that I can eat cake sometimes, but not all the time…. I need to take a breather.  As diabetics, we often make our disease look easy, and so then when we complain about it, people are confused.  If you have tried numerous times to educate and get people around you to truly understand (i.e. a teacher, a boss, a close family member), take it all with a grain of salt and know that they will only absorb so much.  Just make sure they know enough to help keep you safe in an emergency situation, and other then that, let them judge away and be confused when you either reach for the second cupcake or say no to the heaping of mashed potatoes at dinner.

Finally, Stop beating yourself up!  Or at least, work on not beating yourself up so much.  Try to find a balance in your life this year, anyway you can! 

 What would it be like to sleep through an entire night without needing to wake up even once?  I can only imagine how good that sleep must be.  When living with diabetes, not only do we often need to relieve our bladders multiple times in the middle of the night (either because we are drinking more water throughout the day, or more juice, or because our kidneys aren’t at 100%…), but we also have to worry about being woken up in a cold sweat wondering where we are and why we are soaking wet.

That feeling is like no other.  Waking up out of a dead sleep, only to have soaked through your pajama shirt, with your hair sticking to the side of your temple and an unquenchable thirst that comes over you.  All you want is something cold, to drink, or to put on your forehead.  You also have to pee, but you can’t decide which you should do first; treat the low, or pee.  Your body goes on auto-pilot: Juice, food, must-get-to-refrigerator.  You start wondering, ‘How low am I?  Geez, I would bet I’m at least 30 or lower.’  But as much as you would like to check your blood sugar, wash your face and change your shirt, you can’t do any of that until you get some sugar in your system.

The kitchen is quiet; all you can hear is the wind outside and the heat coming through the vents.  You open the fridge, and make a quick decision; juice, or if there is none, then you go for the milk (not fast acting, but will do the trick in the next 10-15 minutes).  The next decision is the best part of being awake at some god awful hour:  what dessert do I have lingering in the cabinets that I’ve been dying to get my hands on…. Oh, yum, the Pepperidge farm cookies that my husband hid from me… ooh, I’ll take a few of those.  If there isn’t anything ‘fun’ to eat, then you settle in for the good old peanut butter crackers and take a trip down memory lane to the lows that you would share with friends at camp on hot summer nights when all they gave you were dry glucose tabs and nabs (peanut butter crackers).

You settle in your seat at the kitchen counter and go to town on your treatment of choice.  You can’t get enough juice or milk to quench your thirst.  You try to ration the liquid to make sure you have enough for each bite of cookie or cracker.  You know you need to stop, stop at some point, or else you WILL over-treat.  Some nights your brain is able to tell your hand to stop feeding your mouth, other nights it fails, and your slumber will be interrupted again an hour or two later with a blood sugar of 250 and a different unquenchable thirst… for water.

It doesn’t matter how many juice boxes my husband puts on my nightstand.  It wouldn’t even matter if I had a mini-fridge within arms reach of my bed.  This is just the journey I take during my 3am adventures.  I have tried, through trial and error, to avoid these severe lows.  It has been extremely difficult during pregnancy due to my constantly changing insulin needs.  A few weeks ago I was having a period of extreme highs in the middle of the night, so I increased my basal rates to take care of that.  For whatever reason, my insulin needs have changed again, and now I am experiencing  lows in the middle of the night.  There is such a delicate balance sometimes, and we just need to communicate with our doctors and adjust the proper pump or insulin settings, a little bit at a time.  I have learned increasing or decreasing my basals too drastically usually doesn’t work.

Here are some things to consider when managing early morning lows:

• Review your blood sugars with your Endo or CDE, where a sensor if you can.  Note that basal rates usually need to be adjusted at least an hour before you see the pattern of lows.
• Depending on the time of lows, i.e. 11pm, midnight, 2am…. Etc., they may be correlated with what you ate or didn’t eat for dinner.  If you eat a very low carb meal one night, and had a low in the middle of the night, and then the next night you ate a very high carb/fat meal, and had a high in the middle of the night, then you can bet you need to adjust your insulin to carb ratio or account for those extra high or low carb meals before you fall asleep with a correction dose or a snack.
• If you take injections, especially if you are on an old school regimen of NPH and fast acting insulin; it is always a good idea to eat a high protein snack before bed.  The protein and fat in something like cheese or peanut butter will linger around in your blood stream and help to decrease severe nighttime lows.  If you are on a regimen like this, I beg you to challenge your physician on changing you to newer long acting insulin or to consider a pump (if it is appropriate for your type of diabetes).
• Do your very best NOT to over-treat your mid-night lows.  As difficult as it is, you will pay a price.  Try your darndest to stick to the rule of 15:  Treat with 15 grams of fast acting carbs, and wait 15 minutes and then check your blood sugar again to see if it has come up.  If not, treat with another 15.  This is SO much easier said than done, trust me, I get it.  If you are REALLY low, it’s okay to stray a bit from this rule, but it might even be smart to wake up your spouse or someone else in the house to help you.  I don’t always do this, but my husband usually rolls over in bed and mumbles every 5 minutes ‘you okay?  just to make sure I’m responding.

Also, if you’re like me, and you use these dead of night lows as an excuse to chow on the dessert downstairs, at least sip some juice next to your bedside before you make the sweaty trek into the unknown of the dark kitchen….and make sure you shut the refrigerator door tightly before going back to bed; I didn’t one night and woke up the next morning to a fridge full of warm food that had to be thrown out!  So now I get back into bed and my husband mumbles ‘You okay? Did you shut the fridge?’

Be safe, Be smart, and pay attention to patterns with your blood sugars!