Breast feeding and type 1 diabetes

I discussed breast feeding with Prof Bonnici before I was even pregnant. He advised that I breast feed exclusively for 6 months because even though it's not proven to be more effective, it wouldn't hurt doing it anyway. So I took 6 months off work to do just that and had light (or something) put on my nipples to harden them so that they wouldn't hurt. I also used some nipple cream to assist, if you have it available then why not :)

My blood sugar went low after I started breast feeding and I went hypo quite often. So to prevent this I had to snack or drink juice before and during feeding. Granted I should have done this all the time but when your child wants to drink, it's tough prioritising yourself!

My daughter has just turned 1 and I still breast feed. I figure that if the recommended age of breast feeding is until 2, I should do it for as long as possible. Granted, it's not always the easiest. My daughter doesn't drink milk from a bottle because she wants it directly from the source! Sometimes I feel like a cow....but it's great for bonding so I get over the cow feeling very quickly. I do however make sure that I sing that Old McDonald had a cow first lol

When I returned to work, I expressed for months but since my daughter didn't want to drink it from the bottle I used it for her cereal instead. She would drink rooibos tea and water while waiting for me to come from work and then it was 'nenni' time. Actually 'nenni' was her first word, so you can see her priorities lol

Now I had to learn to prioritise myself and my eating/drinking. This is easier said than done as your body releasing adrenaline when your baby cries so that you can get up and do something about it. However, having diabetes means that I have to fight against the urge to do that and eat first. I can't lie and say that this always happens or that it happens sometimes. Actually my instinct takes over most of the time. My husband is very concerned about this as he keeps reminding me that I can't take care of her if I'm hypo or in a coma! Yes, I know this logically but instinct wins over LOGIC! I have to learn to compromise and find middle ground though.....Also I have to learn that it's ok for her to cry for a few minutes while I go get some juice.

Breast feeding has multiple benefits, not only if your baby is at higher risk for diabetes. I find it easier and fed her wherever I went, with the help of a feeding bib. It was made by my mom in law but you can buy them at baby city. It's a cover so that you aren't exposed but you don't have to go find somewhere private. Plus it burns calories and I was back to my pre-pregnancy weight within a month :)

I'd advise all mothers, with diabetes and without, to breast feed. It's natural, contains all your baby needs and is excellent for bonding. My daughter is still a mommy's girl because of it and I'm enjoying it while it lasts :)

Labor and type 1 diabetes

I started 'spotting' (bleeding) on Wednesday morning. I called my gynae who wanted me to be admitted to hospital so that they could check. She found nothing wrong EXCEPT that I was showing mild contractions already so I was discharged on Thursday. Sr Anke, my nurse educator also came to check as my gynae wanted my endo there when I went into labor as she was not used to dealing with diabetics on an insulin pump.

So the day would finally be arriving! Hello nervousness, anxiety and EXCITEMENT :)

So after supper on  Friday evening, my husband and I went out for supper, I felt slight cramps. I actually didn't really know that I was in labor because my water never broke and it sure as heck didn't look like what it did on TV! So I thought, Braxton Higgs - WRONG!

Friday night the pains got more intense but my husband slept through a lot of my contractions. I actually ended up pinching him awake. He did call the hospital though to find out if they could prescribe me anything for pain but they said that I could be in labor and that I should come in. At that point I didn't want to be a big baby and go in for nothing but shucks it was getting more and more painful as time progressed.



On Saturday morning I was almost crying with the pain. A builder was coming to complete the wall but I literally stood across the road and told my husband to take me to hospital 'NOW!'. Forget the darn builder!! When I got to hospital I was still bleeding and they were going to check to see if I was dilated. Hello PAIN! I'm sure that not all woman experience pain then but shucks I could have passed up that experience. I heard the nurse tell they gynae on duty that I was in pain but this was probably just due to me being very anxious and afraid - oh hell YES!

When she could eventually finish the examination I was 3cm dilated. Then the question 'would I like an epidural?'. Did they even have to ask me that - Of course! BUT all the anaesthetist were busy so they gave me an epidural injection while I waited. Thank goodness for Dr. Lee who came to administer the epidural and did such a great job that it was less painful than my drip.

My gynae came in at noon and after another exam told that it would be another 6 hours. Yes, 6 hours! My epidural worked so well that I felt absolutely nothing but I could still feel my feet (my friend couldn't feel hers). However, it seemed to work too well so it got turned off and I got oxytocine to make my contractions stronger because I needed to push harder. I really didn't know that pushing on demand like I was constipated would be so tough lol I reduced my basal insulin so that I wouldn't complicate the process by going hypo.

I had to stop pushing because the umbilical cord was around our daughters neck. I heard that she had lots of hair (not unexpected :) but her heart beat and my temperature were rising. My gynae thought that I could push her out but gave me some help via suction when this happed. At 19:09 our beautiful daughter was born :D

I got to hold her while my husband did the iqaama and athaan (religious - call to prayer) in her ears. Then I got to nurse her as well. She latched on nicely and the family was outside waiting to see her but I was busy puking my guts out (downside of epidural). Hence the first pic they saw were of her tiny feet :)

They eventually got to see her when my husband took her out to get tested for diabetes and all the other checks. I was told that she was fine and had an APGAR score of 9, also normal blood glucose levels  :)

HELLO MOTHERHOOD :)

3rd trimester with type 1 diabetes

I've learnt that even though I could have expected my insulin resistance to improve, it did not really happen for me. So I injected well into my 3rd trimester because I was still somewhat insulin resistant.



Source: http://www.pfizer4life.com/en/MomsToBe/YouAndYourBaby/ThirdTrimester.aspx

I had all the foetal assessments done and was happy to learn that our baby didn't have anything I needed to worry about. Oh, I didn't have the test done to check whether the baby would be at risk of down syndrome. My view is that I would not have ended my pregnancy in that case anyway so why bother taking the test.

My gynae was a tiny bit concerned about the weight of my our baby though. She was growing at a tremendous speed and there was a risk that I would not have been able to give natural birth. I was told at the foetal assessment that I was most likely to be induced at 38 weeks to prevent the baby from growing too large at full term.

However, the risk with induction is that there is also an increased risk of a c-section. So I had to brace myself for the fact that I could in all likelihood have a c-section even though I would have preferred a natural birth (with epidural of course. I'm not that into pain lol).

At my 37 week scan our baby was 3.8kg (+-300 grams). I was scheduled to come in for an induction the next week. However, my gynae warned that kids have their own schedules and that I could go into labour before that date. She also said that if our baby was more than 4kg that I would be schedule for a c-section and not induced. There was a risk that the shoulders would get stuck and we were not willing to take that risk.

The assessment also showed that there was a 90% chance that we were having a girl :) YIPPEEE pink! Almost time for labor - scary!!

A tragedy of errors with type 1 diabetes - when everything that can go wrong, DOES!

Did you ever have one of those days where everything just seemed to go wrong? Well here's the story of one of my days!

It started late at night when my pump gave me low battery alerts. I was too tired to get up and replace the batteries so I did the next best thing (or so I thought). I turned off my sensor as that was the biggest consumer of battery power. Hello, Fazlyn - NO ALERTS! But I thought, how bad can it be until morning? Seriously? VERY BAD!

I woke up later with a blood sugar of more than 20! Being pregnant, that is NEVER good for the baby and I was still insulin resistant. So out comes my insulin pen and lots of insulin.

It seems that since I had turned off my sensor I did not receive notification that my infusion site was problematic (yes, and I already had limited space because my tummy was no longer an option). So I was getting very little or NO insulin at all and had my sensor been on I would've know this and changed my infusion site. So all of this could have been avoided had I just woken my husband up to get the battery and even put it in or even help change my infusion site (yes, he had to help because I couldn't insert a new infusion site into my back).

Luckily though I didn't go severely hypo after because of the amount of insulin I gave. I tend to overcompensate when I see high blood sugars. It's like all my alarms in my head go off at the same time! But I decided to give myself a break and take the pressure off by saying that my daughter would still be ok (I said a prayer for this) since I don't go this high often. Also, I'm only human and even though I was being very silly and even irrational - these things do happen.

Needless to say I made sure they didn't happen again!

2nd Trimester with type 1 diabetes - welcome insulin resistance :(

Hi all,

It's been a while since I've last blogged but needless to say that I've had my hands and feet full :) My all day sickness (aka morning sickness) eventually subsided in my 2nd trimester and I felt a lot better BUT hello insulin resistance!




Source: http://www.reproduction-online.org/content/140/3/365/F3.expansion.html

I could look at food and it would increase my blood sugar! Even food that I could eat previously, e.g. proteins, without giving insulin now required insulin. Not small doses, actually LOTS of insulin. My gynae was concerned because I showed some ketones in my urine despite taking all precautions to keep my blood sugars normal. 

My HBa1c was still within a normal and safe range but my pump kept beeping for high levels and high predictors almost all times of the day! It was annoying and worrying so something had to be done! 

My solution - I would inject 20 units of Apidra (my insulin) at 11am every day. Failing to do this my blood sugars would run 'high' (e.g. above 8.0) most of the day. So even though I wore a pump, I was still injecting and using a lot more insulin just because I needed so much more to control my blood sugars. 

I couldn't wait until 3rd trimester for my blood sugars to get back into it's usual range and my body to respond in the way it did previously..... only time would tell though as I've learnt that not all people react in the same way and no 2 pregnant women seem to be exactly alike. 

The main thing though was ensuring that my baby was safe and not affected by high blood sugars. So I did what any mother would do - everything it took! 

The funny side of type 1 diabetes

Yes, I know that having type 1 diabetes is a condition that requires attention and that has consequences if not well controlled. However, some moments you just have to sit back and laugh out loud (LOL)!

So these are some of my LOL moments:

• When I was still at university and it was time to test & give an injection, I would do so without thinking. However, later I was told and saw the look of HORROR on some of the faces of my friends around me who didn't know I had diabetes. Their looks were classic, especially when I lifted a bit of my top up to inject! LOL
• When I went to Malaysia and my pump set off the detector, they asked if I had a phone and then I lifted up my dress to show them my pump instead. Yes, I was wearing a tights underneath but they got so embarrassed that they sent me behind a curtain to a woman LOL
• At work when my pump beeps for low or high glucose readings I just lift up my dress to check, however the guys around me start to think I'm working at Teasers LOL
• In all of the above cases I wear either a pair of tights or a petticoat but my friend jokes that one day I will forget to put this on and they will have a show LOL  I think it's just wishful thinking on his part :)
• I received a silver award in the Learning and Growth category at work at the very lavish function. Even though I put my sensor alerts off it still starting sounding like an ambulance when I had to go up on stage mainly due to my blood sugar dropping below 3. Luckily this noise was blocked out by the sound of the clapping and I didn't have to lift my dress up as I wore a skirt and top LOL
• My colleague teased me that for graduation night (when I received my M.Com) I would go up on stage and then would have to lift my dress up to take care of my pump. Actually that would have happened as I gave insulin without realising that every time I would put something to my mouth to eat someone would call me. So I checked my pump before going up on stage, switched off my basal so that I would not beep and spared myself the embarrassing moment of telling hundreds of people why I was lifting my dress up and didn't get this moment captured on capture or video LOL

So while having this condition is not really funny, you have to appreciate the funny moments for what they are. It stops you from going completely INSANE! LOL

Eid (or other religious or general celebration) and the impact on type 1 diabetes

Eid is the celebration held after the month of Ramadaan, when the moon has been sighted. Like other religious, traditional or general celebration (e.g. graduations, birthdays etc.) celebrations generally affect blood sugar control NEGATIVELY.

With so many delights on offer, from breyani to trifle to all sorts of different treats and sweets, it's difficult for anyone to resist. However, not resisting or changing your insulin to accommodate this increase in carbohydrates makes most blood sugars rise like a rocket! (unless you're exercising of course...but come on, this is unlikely on a day like Eid or Christmas). 

So instead of trying to stop the person with diabetes from having ANY treats, moderation is probably the better option. This includes amending the day's insulin requirements. Also if you are making a 'diabetic-friendly' option, it is probably best that EVERYONE eats it, so that we don't feel excluded or 'alien'.

There are other scenarios as well though....for me, I would give my insulin in advance (the 4 times a day injecting option) to accommodate the things I thought I was going to eat. However, I then decided not to have those options and go HYPO! Needless to say this didn't impress my mom much as we had to stop enroute to family members to stop and buy a chocolate. So regardless of having soooooo many carb-rich options available, I just didn't eat as much or whatever I thought I would have. There is a slight problem with planning TOO much lol

Now, on my pump I don't have these issues. If there is something I really want to have, in moderation of course, I just give the neccessary increase in bolus. It makes life so much easier as I don't have to prepare in advance or have to deal with high blood sugars levels later :)

In addition planning 'blood sugar control friendly' parties may be a challenge, but there are many recipe books (I have a good one) that provide options that everyone will enjoy. At the end of the day it is about the enjoyment of all of these occasions, let's not let hypers or hypos get in the way :)