The "skinny" on Drs.

The “skinny” on what? The only thing skinny on me these days is perhaps my pinky, on a good day. J

As promised, this blog is intended to present a very honest portrayal of pregnancy with type 1 diabetes, which has involved many Doctors, many finger sticks, many sonograms, many increases/ deceases in insulin and many growth and learning opportunities.

A brief background: mothers with type-1 diabetes often have pregnancies characterized by abnormally large babies with prematurely developed lungs and most often deliver between 37-39 weeks. Ironically, and thankfully, the risk of Finley getting diabetes from me is only 4%- you can tell how lucky I was to inherit this disease from my father. I kid, but I really think my parents should have played the lottery the day they discovered this.

So here goes, a brief summary of my pregnancy (to date) with type-1 diabetes:

1^st trimester

During the 1^st trimester the baby is growing tremendously and the mommy is not often feeling up to optimal eating in quantity or quality. That being said, this trimester is characterized by decreasing insulin needs and very LOW blood sugars. Like so many lows that you wonder why you’re even bothered to take insulin. During this trimester every calorie I was putting into my body was being sucked away by Finley so I lived a lot off of juice and frequent snacking to keep my blood sugar levels constant. Prior to this I was more of a breakfast, morning snack, lunch, dinner and bedtime snack person and learning to break these meals into smaller more frequent sittings was a bit challenging and a shift in the way that I knew eating.

At this point in my pregnancy I was seeing a perinatologist for monthly 3 and 4D bio-physical sonograms where they would check the heart beat and heart development. I was also seeing the OB monthly to measure my growing belly, weight and double check for the heartbeat. Finally, I was seeing an endocrinologist every 3 weeks to monitor my glucose control, adjust my insulin levels and discuss how things were going.

2^nd trimester

Once I hit the 20-week point of my 2^nd trimester the insulin demands of my body shifted drastically. As the baby continued to grow in size and in functional need, Finley demanded more insulin (a growth hormone in fetuses) from me to develop as she needed. Whereas I was mostly insulin sensitive during the 1^st tri, I became more insulin resistant as fat stores accumulated in my body. This resulted in a huge shift of insulin (an increase of about 30 units/ day) to continue to maintain my blood glucose levels while eating small, frequent meals to keep my glucose levels more stabilized.

At this point in my pregnancy I continued to see the perinatologist monthly for sonograms, bio-physical profiles, a 20-week fetal EKG and the usual OB things. Because babies do not begin to differentiate in size until the 25^th week, much focus remained on the development of Finley’s vital organs and heart.

 

3^rd trimester

About midway through the final trimester my body once again shifted from insulin resistance back to sensitivity- I’ve been lowering my insulin in 2 unit increments/ week ever since. As I understand, the baby is done growing and no longer demanding as much insulin from me. This has once again brought many low blood sugars, leaving me some days to struggle to get above 75 (post-meal.) As I’ve just hit 37 weeks (full term- woo hoo!), much of the focus has shifted on making sure that Finley continues to grow at a stable rate and that her lungs are maturing.

Throughout the 3^rd tri I’ve been seeing the perinatologist and OB bi-weekly for bio-physical sonograms and having a growth scan every month. At 34 weeks I began seeing both specialists weekly. The endocrinologist and I met weekly at the top of the 3^rd tri then tapered off to bi-weekly as insulin levels began to stabilize.

Finley had her final growth scan last week at 36.5 weeks and weighed 6lb. 15oz. (+/- 1lb.), measuring on time= great control of my diabetes! In her bio-physicals she’s been showing good practice breaths and my medical team feels that she will have mature enough lungs at birth to avoid the NICU on this basis.

The birth plan:

There are a lot of mixed reviews about type-1 mothers carrying their infants to full term so Finley will be greeting us at 38.5 weeks via a scheduled induction (date to be released in a later blog entry). I have chosen (against my wishes) to not argue with the Drs. and try for a vaginal delivery because her size appears on track. For those that haven’t gathered, I’m a huge control freak and I’m trying to be “zen” about the entire labor and delivery experience. More details on our birth plan will be coming in a future post. For now know that life with Finley is right around the corner, and to get her as a prize at the end of the journey has been worth every finger prick (avg. 15/ day), needle stick (avg. 4/ day) and Drs. appointments (avg. 1/ week) in the world!