All I Ever Wanted – My First of Two

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All I Ever Wanted -  My First of Two

Pictured is days after Cayla was born on June 18,1991. She looks abnormally fat, doesn’t she? She is in the Newborn Critical Care Unit. That is the look of a Macrosomic baby. She was SO sick. I was very sick as well, but not related to diabetes.

In 1990 when I found out I was pregnant with Cayla, I lived with diabetes for 15 years.

At that time I found out I was pregnant I was in my 3rd year of Nursing in College. I was only in College because my Mom told me I should get a post-secondary education “just in case”. She told me that as a woman it’s always good to have an education for when I ever needed it. I didn’t see the point at the time & so much so I was initially kicked out of my 1st year of Nursing. I cared so little about having a post secondary education. I was in love & I just wanted to get married & have a family. That’s all I cared. Before re-starting back into the last half of my 1st year, I married. That helped me re-focus on achieving the education I ‘should’ have.

In the second year of Nursing I did a rotation in the Labour & Delivery floor. Ultimately I helped with several deliveries. I ached for a baby. I wanted to be a Mom SO bad.

At that point, I had 2 goals.

1. Finish my Nursing with honours. My goal was a result of being ‘told’ I couldn’t do something. That wasn’t true, but I saw it that way. I saw it as “they kicked me out, I’ll show ‘them'” I would finish it & with pizzaz.

2. Get pregnant.

Anyone who knows me understands that when Tracy wants something, Tracy will do all the right things & take all the roads needed to achieve it. It takes some painful learning, but I get there in time.

What resulted?

1. Tracy became pregnant 2 months into the 3rd year of Nursing.

When my classmates told me it would be near impossible to finish my year out (my due date was the 1st week of July) or ask me how was I going to do it with diabetes….it made me dig in my heels deeper. I would do it all!! I would graduate from Nursing with Honours, have my baby, write my Nursing exams, become a R.N. & be the best Mom ever.

The Diabetes Complications & Control Trial had yet to begin. There were no guidelines for pregnancy. I had not seen a Diabetes Specialist in years. Thankfully I went to my Family Physician within 6 weeks of suspecting I was pregnant. Back then, the home tests to decide pregnancy were not reliant so early. By blood test, the physician confirmed I was. He immediately referred me to an Internal Medicine Physician who specialized in diabetes. It was not an easy pregnancy.

The variables:

1. My long-acting insulin therapy consisted of NPH morning & supper (today all nighttime insulin is injected at bedtime to avoid missing the coverage of the Dawn Phenomenon causing sometimes severe low blood sugars in the hours shortly after midnight).

2. My short-acting insulin therapy consisted of regular insulin, once at breakfast, once at supper. Humalog had not been launched yet. I knew by how sleepy I was after meals that the regular insulin was not covering my needs. Sometimes, I would take very small doses of regular at lunch to see if it would help. I look back & see how incredible it was that I knew if I could coordinate my meal insulin to my meal sugars I would feel better. Unfortunately, it just resulted in severe lows as it stacked throughout the day.

3. I began my Clinical Consolidation shortly after I became pregnant. I worked 40 hours/week on shift in the hospital. As well, on the weekends I wasn’t on shift at the hospital, I was working as a cashier at a grocery store to help pay the bills. Weekly hours I put in between consolidation & work until I was hospitalized at 32 weeks was in excess of 45-50 hours, not including assignments & studying.

I remember the wild swings in blood sugars. I remember panicking every time the meter I used since I was 11 showed a high or low. I knew it would hurt my baby. Even then hypoglycemia protocol was not in place. If was low, I panicked as I always did. I would drink juice & then eat & eat. What resulted was a high so high I had to take regular insulin to correct in fear I would hurt my baby. As time progressed with the pregnancy, I learned how to manage certain issues. A low treatment was a couple of mouthfuls of milk. That seemed to keep my sugars more stable then before. I decreased the amount of carbs I ate. This eliminated the wild swings.

Unfortunately, it was too late, it did not save my first-born from the complications of a poorly controlled pregnancy.

1. As soon as Cayla was born, her blood sugar was tested.  She went from 11 mmol/L (198 mg/dl) to 2 mmol/L (40 mg/dl) in a matter of minutes.

2. Throughout my illness in the hospital, not related to my diabetes, I gained 45 lbs of fluid. Cayla gained fluid as well. Upon birth she weighed 9 pounds 11 ounces because of this. When they tried to insert an IV to bring he sugar up, they had difficulties getting a vein.

3. She was very, very ill with jaundice. Not only was she placed under lights, but her body was wrapped in a specialize blanket that emitted extra phototherapy. My baby was SO yellow. They poked her little heel with a razor blade too many times. I cried as she shook & screamed when they did it. My saving grace was I saw she had spunk!!

What I describe are the behaviours & control that lead to what Cayla was born with…Macrosomia. She & I were so fortunate, she did not have any respiratory problems. She was only in CCU for 1 week. Each day they told me I couldn’t have her in my room (I was too sick to go home too) I cried. I just wanted to be a Mom.

I took mental notes of my experience with my pregnancy with Cayla. I used them to my advantage with Kurtis.

Look for my post tomorrow on my pregnancy & birth of Kurtis.

As Exciting As the Discovery of Insulin!

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As Exciting As the Discovery of Insulin!

In 1983 and for the next 10 years, researchers began to study whether intensifying diabetes management among people living with Type 1 made a difference. Up to this point there had not been long term research to provide data to prove this to institute change.

When I was diagnosed in 1975, I started on one injection of NPH and Toronto in the morning.  A Keto-Diastix before & after school & at bedtime was dipped in a urine sample to determine sugar & ketones. Little did we know that it was not an accurate test of glucose control. Every 3 months my blood work was done & thankfully my A1C as well. We would see the Paediatrician shortly after.

In 1981, an extra injection of NPH & Toronto was added at supper time. Around that same time I received my first glucose meter.

This study has changed the way people with Type 1 diabetes are managed. It was & still is exciting!

Here is what the Diabetes & Complications Control Trial is about.

There were 1,441 people from Canada & the U.S from 29 centres living with Type 1 diabetes more than 1 year but less than 15 years. They could not take part if they had too many or severe low blood sugars, severe complications or limited life expectancy. The ages studied ranged between 13 and 39. Young children were not studied. There were 2 groups; 1 had their diabetes managed intensively, the others managed as before.

The main goal was to keep blood sugars as normal as possible through a criteria of intense methods for diabetes management.

Clinical findings & significance:

1. The risk of eye complications were reduced 76%.
2. The risk of complications of the kidney were reduced by 50%.
3. The risk of nerve complications were reduced by 60%.
4. By keeping blood sugar’s as normal as possible, the onset & progression of eye, kidney & nerve damage caused by diabetes slowed.
5. Even those who had a history of poor control who sustained any type of BG lowering showed a difference in the progression of complications.
6. For those who already had eye complications by participating in intensive management of their diabetes, they saw the progression of the complication slow by 54%.

What is Intensive Management?

1. Testing BG 4 or more times a day.
2. Injecting insulin at least 3 times per day or using an insulin pump.
3. Following a diet & exercise plan.
4. Monthly visits to a health care team which consists of a physician, nurse, dietician & behavioural therapist.

Risks involved with participating in an intensive management therapy? Low blood sugars. It was clear that less stringent goals are appropriate for some patients.

This trial has become the pioneer of studies that changed the management of Type 1 diabetes . Since completion of the study in 1993 there has been further work done to answer more questions & give more data. I will continue to post on these.

Reaching Target and Realizations

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Reaching Target and Realizations

Further to my post yesterday, I met with my Diabetes Specialist today.

Albeit, I was still a little nervous. Not as much as yesterday. My “Too Funny” (see yesterdays Blog) moment helped alleviate the intensity. As I am sure you have experienced, the unknown can cause the mind to create various role plays. “If the Doctor asks this, I will say this.” “If he reacts this way to my answer, I will respond this way.”

After my “Too Funny” moment I asked myself, why am I aggressively role playing my visits?

The answers I came up with:

1. About 2 years ago I was asked by my Endocrinologist to take meds to lower my lipids & prophylactic kidney protecting meds. I reluctantly agreed although I did not see the reason. My ratio is incredible. My HDL is amazing. My kidneys are perfect. I decided about 8 months ago to stop my meds. I decided this based on 2 reasons:

First, my LDL (bad lipids) were still creeping up. Why should I keep taking a pill that was not doing it’s job?

Second, I met with my hormone specialist that deals with the bio identical hormones that I take. He convinced me that I didn’t need my lipid lowering agent. In his assessment of the medications that I took, he indicated that the lipid lowering agents would cause an increase in my bad lipids as opposed to decreasing them as they should have. He claims it was a plot by the pharmaceutical companies to amplify the symptoms so the pharmaceutical companies could sell more of the treatment. He claimed there was a better therapy that was natural & clinically worthy of taking…Astaxathanin.

I am all for ‘natural’ remedies, i.e.: therapy via food, herbs & vitamins. I believe in taking natures remedies before I will pop a pill made by the ‘powers that be’. I visit my local health food store frequently. I decided to become a one person clinical study. There is obviously no clinical significance but worthy of trying to see if it provided benefit to me. The last visit with my Endo 6 months ago showed it was going down, so I fibbed when he asked if I was compliant with my meds. I told him I was taking them off & on. I felt SO guilty! I wasn’t taking them at all but I respected him so much, I didn’t want to disappoint him. By habit, I am not a liar. As far as my diabetes goes, I am very concerned with the long term results and want to take the best course of action. With that being said, what were the implications of taking something that, up to this point, I had not seen any improvements but had a risk of side effects versus taking something that has no side effects but clinically provided signs of improvement.

2. I have always been guilty of too many low blood sugars. If I was to pick a high or low, I would pick a low. Not because it felt better, in no way did it feel better. I mean, come on, does a high or low blood sugar feel better or worse? They’re just different. I preferred them because I knew I didn’t risk complications. Frequent low blood sugars happen because I am so keen on running my sugars tight to target that I have increased the risk of lows. Also, until the past few years, I have been extremely active which have produced a lot of extra lows. I have noticed that as I get older, having low sugars is becoming very taxing. In the past 2 years my Diabetes Specialist has reinforced to me how hard these low sugars are on me (I’m feeling it!) & if they are in collaboration with a low A1C, they are not optimal. Also, I am alone throughout the night quite often. He reassured me it’s okay to run a little higher (above 6.2 – 6.4%) without the lows if it meant giving up the lows with the near normal tight control I was trying to achieve to feel good & stay safe through the night. Lows are not on purpose. They are caused because of being busy, being too active, taking too much insulin or not paying attention. In the past few years due to a lot of changes and stress in my life, I have been guilty of not paying as much attention to the fine details of my diabetes to achieve this goal.

3. In the past, a prominent Toronto Diabetes Specialist told me that due to the fact I have lived so long without complications with diabetes, I would never have any complications even if I ran higher than guidelines. I was told that my ‘success’ was purely genetic. I was excited by this but I didn’t decide to ‘screw it’ or decide that I was invincible. I’m still so afraid of complications. 38 years in, what guarantees do I have? I get nervous because I’m afraid one day he will assess my blood work, urinalysis, blood pressure or one of a number of tests and tell me I have a complication regardless of my choice for tight control.

The results of todays visit:

1. I am back on my lipid lowering agent based as my LDL has continued to increase. My one person clinical study failed.

2. I am a 10+ on a scale out of 10 on measuring stress. This will be for a few months more yet. The goal is to try to deal with it as best I can so I can manage my diabetes effectively. Cortisol & stress are a detriment to my well being with my general being, paired with living well with a chronic disease.

3. When I can afford it, I will wear a continuous glucose sensor to keep my blood sugars in check.

4. I will have fasting blood work done in 3 months to measure if the lipid lowering agents are working to decrease the LDL.

5. I will have random blood work done in 6 months & see my Endo again to see how my A1C is.

Today my A1C is 6.6. I am happy with today.