Archive for January 2011

Just in case

January 28, 2011

My colleagues at work ask, “So, when will Lukas get a little brother or sister?”

Strangers at the grocery store ask, “Are you ready for baby number two yet?”

Family members ask, “When will we meet grand baby/niece/nephew number two?”

Even doctors comment, “When you’re ready to have another baby, come back and see me.”

Usually I smile and shrug, or say something non-committal like “I guess we’ll just have to wait and see” or “Oh, I don’t know.” But inside, I’m thinking, “Are you kidding me?”

You see, a diabetic pregnancy is hard. And postpartum is no walk in the park, either. Whether you’re thinking about the 16 BG tests a day or the three doctor appointments a week, or the three-day labor that ended in a c-section, it was all just plain hard. And then there’s the grueling newborn feeding schedule. And the ricochetting BGs as your hormones readjust. And the ricochetting moods. And the c-section recovery. And the exhaustion. I can remember standing in the shower one day when Lukas was just a couple of weeks old. I was not standing there because I was still showering. I was standing there because I was simply too tired to step out, dry off, and get dressed. And I thought, “Who would ever do this again?”

I think everyone has these thoughts during those first few months. They just don’t talk about it or share it with prospective parents. Because if they did, they  might scare you away from experiencing parenthood for yourself.

And that would be a shame, because while you do have these thoughts, these moments of complete and total exhaustion, you also have these moments of absolute bliss. When he smiles at you as he dozes off. when he erupts in laughter at your silly face. When he FINALLY rolls over. When he discovers his feet. When he reaches for you to pick him up. When his face lights up at the site of you after a long day at work.

For the most part, we are past the sleepless nights and never-ending feedings in my house. We’ve hit a stride of sorts. But I’m still in the “I don’t even want to think about it” frame of mind when it comes to another pregnancy.

I was cleaning out the closet the other day and I came across my maternity jeans. I held them up and wondered at the fact that my belly was actually that big. Then I folded them neatly and put them into the donation bag.

But a few days later I returned to the donation bag and pulled the maternity jeans back out. I unfolded them and looked at them again, and then placed them on the highest shelf in my closet, in the back where I can’t even see them.

I’m watching Lukas nap right now in his favorite bouncy chair. And I am so content. Just the thought of another diabetic pregnancy is enough to wear me out. But I’ve still got those maternity jeans. Just in case.

Ode to Dunkin Donuts

January 26, 2011

Coffee just right — it’s nutty, not bitter.

I could shout it from the rooftops, or announce it on Twitter.

 

And the flavor shots, there are so many, it’s hard to decide.

With no sweeteners or calories, I’ll take another on the side.

 

But the donuts, my weakness, especially Blueberry and Jelly.

Oh why must you inflate both my BGs and my belly?

 

Thank goodness for the Smart Menu, with egg whites and flatbreads.

Low calories, carbs, and fat, my reason to rise from bed.

 

And the prices? Not bad, in fact they’re downright good.

About half the price of the other chains in my ‘hood.

 

The hours, they’re impressive, too, at 24/7.

Day or night, and night or day, it’s like coffee heaven.

 

My friends, they drink Starbucks with sweet flavors like Pumpkin

But me? No way, I’ve converted. I run on Dunkin.

Metformin: Another tool in my toolbox

January 25, 2011

My last appointment with my Endocrinologist was at the end of August. It was my second post-pregnancy appointment, and I was a little nervous about how things would shake out. You see, between colic and reflux for Lukas and insomnia and exhaustion for me, the Big D had sort of taken a back seat.

But things had been on the upswing for the last month or so, and while my A1C had soared from 5.4 to 6.2, I was still well within the acceptable range for an adult (non-pregnant) diabetic.

The doctor had little in the way of suggestions for improvement, so I asked him what he thought about either Metformin or Symlin. My weight had dropped off significantly during the first few months after the pregnancy, but had since leveled off and my BMI has been pushing the line between overweight and obese for years now. And try as I might, I just cannot seem to bring it down. No amount of exercise or dieting seems to help. And despite careful attention to carbs and calories, my insulin needs just keep going up. And up.

Like almost every other Endocrinologist I’ve ever had, my current doctor is not concerned about my weight. And my insulin needs, while much higher than they used to be, are relatively low when compared to those of other, more insulin-resistant diabetics. He is delighted that my A1cs are so good, and chalks up my extra weight to the extra calories consumed while treating frequent lows. But when it gets hard to find clothes that fit, and when it’s uncomfortable to bend over to tie your shoes, it’s time to do something.

I’m not sure that I convinced him that those extra calories were not at fault, but he was willing to try something new. We decided against Symlin because of the contraindication for patients with delayed gastric emptying. While I am not officially diagnosed with gastroparesis, we are fairly certain that my stomach empties slowly. And I tried Symlin when it first came out. Twice. It left me feeling like I had a lead balloon lodged in my stomach. So Metformin it was. He thinks that the extended release version works better, so I tried that. Luckily enough, one of the local grocery store chains offers Metformin for free, so I did not even have to pay for it.

I have to admit, though, the first few weeks were rough. The intestinal pain was enough to leave me, at times, unable to complete a sentence. It also gave me that full-stomach, lump-in-the-throat feeling, especially if I ate more than about 30-45 grams of carb at a time. And I occasionally experienced acid reflux. But my fasting numbers started to drop after just two doses. Before taking Metformin, I was taking about 18.5 units of basal insulin. Now I’m taking 16.8. Sure, that’s not a huge decrease, but I am back to almost the exact amount of basal insulin I was taking before my insulin needs started to rise.

And the intestinal distress is more or less gone now. Only occasionally, after a really carb-heavy meal will I feel the effects. I don’t mind this side effect, though. It works as a sort of negative incentive; I am less likely to eat a whole box of macaroni and cheese because I know that if I do I will have to deal with the consequences.

Unfortunately, the Metformin has not helped with my bolus needs, which are my biggest concern. Over the course of the last five years, I have gone from a carb ratio of 1:15 (one unit of insulin for every 15 grams of carb) to 1:9 (one unit of insulin for every nine grams of carb). I have found that Metformin does nothing to reduce this insulin requirement.

Interestingly enough, it does delay the spike from the carbs I eat, but does nothing to smooth out the spike. So if I eat a carb-heavy, but low-fat meal like spaghetti, the spike can occur a full six hours after I eat. Crazy, huh?

The one exception to this rule appears to be pizza, which seems easier to manage since starting Metformin.  That in and of itself could be considered a win, right? Since I started Metformin, I can predict that the post-pizza spike will occur at about 3 hours post meal and will last for about six hours. So I typically use a dual wave bolus, delivering 65% now and 35% over the course of the next three hours. And the clincher is that I don’t bolus until AFTER I eat. It seems that the delayed digestion of the high-fat food dovetails nearly perfectly with the peak of the insulin when I wait to deliver the insulin for this extra hour or so.

Another interesting tidbit: I was sick for about a week with the stomach flu and did not take my Metformin. As you might expect, my basal needs increased after about two days of not taking the med. When I went back on the drug, though, it was more effective for about the first week. That is, I needed even less basal insulin during that first week than I normally do when I am taking Metformin.

I have not lost any weight as a result of taking Metformin, which is disappointing. But I haven’t gained any, either. So I still weigh less now than I did before I became pregnant. It’s not exactly the result I was hoping for, but it could be worse.

So what’s the verdict? I wasn’t expecting a magic bullet when I decided to give Metformin a try. And I am happy that it is helping with my basal rates and my “pizza management”. So while the results are not overwhelming, I think I’ll keep taking it. It’s just another tool in my diabetes toolbox. And who couldn’t use more of those?

The day I met Ted Danson

January 21, 2011

I live a pretty mundane life, really. Diabetes aside, things around here are typically pretty normal. Maybe even boring. So when a head hunter called about a potential new job in a new location, I thought, “Sure, why not?”

The phone interviews went well and before I knew it, we were making arrangements for an in-person interview. The next thing I knew, we were boarding a plane for an overnight trip to Greenwood, MS.

We had done our homework before we left, so we knew that Greenwood was a small town. But we were intrigued by the Mississippi delta culture, and thought the warm climate, good job opportunity, and low cost-of-living might make the move worthwhile.

We were a bit taken aback, though, when we arrived in this speck of a town. I mean it is really small. Really small. And the nearest “city” is over two hours away.

The town is not without it’s charm, though. It has a quaint (really quaint) downtown, some great “home cookin'”-type restaurants, and some of the friendliest people you’ve ever met. And the place is apparently popular with Hollywood, too. They like to film movies there because of the genuine southern charm and the lack of paparazzi. I guess the photographers can’t be bothered to follow the stars all the way to the Mississippi delta.

The company that I was interviewing with put us up in this awesome five-start hotel. The place seems kind of odd sitting in the quaint downtown, but, I have to say, it was one of the nicest hotels I’ve ever stayed at. And I guess the town needs a place to house all of those movie stars when they come to film movies.

After a nice night’s sleep in a wonderful bed, and a nice shower in a spa-like bathroom, I dressed in my “interview suit,” turned my pump to “vibrate” and my husband and I walked down to the breakfast room. Still half asleep, I piled scrambled eggs, fresh fruit, and bacon on my plate. From over my shoulder, I heard “Good morning”. I glanced back to see a white-haired, well-groomed man with a newspaper and a coffee cup. I smiled, said good morning, and returned my focus to my plate.

Back at the table, my husband leaned over to me and whispered, “I think that’s Ted Danson.”

“Really?” I asked, fork mid-air. “The guy I said good morning to?

“Yeah. He’s sitting at that table by the kitchen,” he said motioning with his head.

As nonchalantly as possible, I craned my neck to see the table behind me on the other side of the room. The man was reading his newspaper. Sure enough, it was Ted.

I returned to my breakfast and tried to focus. Ted received something from one of the workers in the kitchen, they exchanged pleasantries and then he left. As we were leaving our table, one of the workers came out of the kitchen to ask, “Is that guy the one from TV? You know the show where he is a doctor?”

It was interesting to me that this guy would think of Ted Danson as Becker, the grouchy doctor. I always think of him as Sam Malone, the bartender on Cheers.

On our way out of the breakfast room, we passed Mary Steenburgen, Ted’s wife, in the hallway. How cool is that?

Later that day, while lunching with the HR Manager, we saw Ted and his wife again in a quaint little bistro cafe (Like I said, this place is small.)

We flew home that afternoon, and I didn’t get an offer for the job. But I’m sure glad I got the opportunity to visit Greenwood, MS.

New School Lunch Guidelines

January 19, 2011

Did you see that the USDA is planning to announce new school lunch guidelines? I nearly choked on my tea when I read the headline over at  Fed Up with School Lunch on Friday morning.

I was skeptical when I opened the link. We all know how well the existing regulations are serving our children, but I was pleasantly surprised by the new guidelines:

Limit starchy vegetables such as potatoes, corn, and peas to one cup (two servings) per week.

Finally! Schools will now be required to offer nutrient and vitamin rich vegetables in place of the calorie dense but nutritionally weak French fries, instant mashed potatoes, canned peas and baked beans.

Reduce sodium levels by more than half over the course of the next ten years.

According to this USA Today article, the average high school lunch now has about 1,600 milligrams of sodium. The recommended daily allowance (RDA) of sodium for high school-aged children is between 1,500 and 2,300. One school lunch contains the maximum amount of sodium many high school students should consume in the whole day! The new regulations would limit sodium in high school lunches to a much more reasonable 740 milligrams, and even less for younger children whose recommended daily allowances for sodium are even lower. Nice work!

Establish calorie maximums.

You might recall that I reported in Pet Peeve: Unhealthy School Lunches that current regulations set a minimum number of calories, but do not set a maximum number of calories:

So while the school is required to serve at least 667 calories per week to its K-6 grade students, it can offer WAY more calories than that. And as the calorie count goes up, so does the allowable fat amount because the fat restriction is a percentage of the total calories provided.

According to the USA Today, the new calorie allowances would be,  “For lunch: 550 to 650 calories for kindergarten through fifth grade; 600 to 700 for grades 6 through 8; 750 to 850 for grades 9 through 12.”

This improvement is positive on several levels: First, it breaks the calorie requirements down by age group. This allows the requirement to more closely match the actual calorie requirements of the students because older children typically require more calories than do younger children. Second, the allowances are more in line with the USDA’s actual recommended daily allowances for children (depending on age and gender, the maximum number of calories allowed by the new regulation is roughly one third to one half of the recommended daily allowance of calories. Third, it places a cap on the number of calories the school can offer, limiting the ingestion of empty calories and, instead, encouraging schools to focus on nutrient and vitamin-rich foods.

For more information on the recommended daily allowance of calories for children see TABLE 3. Estimated Calorie Requirements (in Kilocalories) for Each Gender and Age Group at Three Levels of Physical Activity in Dietary Guidelines for Americans 2005, Chapter 2 Adequate Nutrients Within Calorie Needs at http://www.health.gov/dietaryguidelines/dga2005/document/html/chapter2.htm.

Limit milk offerings to only 1% or fat free milk.

Well, this is a start. Previously, schools were permitted to offer milk with any fat content. Now they are required to reduce the fat content, but they can still offer flavored milk (chocolate and strawberry) Hopefully the calorie requirements above will further force their hands, though. Chocolate milk, at 158 calories per half pint, would eat up about a quarter of the calories allowed in a lunch for students in kindergarten through fifth grade. I still wonder why we couldn’t offer water. It’s free and we all need it. My guess is that we have the dairy lobby to blame for this one.

Increase the variety of vegetable offerings.

During each week, schools must offer at least one serving of each of the following types of vegetables: orange vegetables (including carrots, sweet potatoes, and summer squash), green leafy vegetables, beans, and starchy vegetables (you might also notice that starchy vegetables are also limited to one serving by the “Limit starchy vegetables” requirement). The hope here is to increase students’ exposure to a variety of vegetables. Certainly a step in the right direction. Schools will also be required to offer one serving of fruit with breakfast and 1.5 servings of vegetables at lunch. The current requirement is a weekly one, which means schools could theoretically offer all of the required fruit and vegetable servings in on meal while the rest of the week’s meals are devoid of any fruits or vegetables.

Increase whole grain offerings to at least half of the total grain offerings.

The current regulations do not require whole grains at all, which helps explain the pasty white landscape of today’s school lunch. At least half of the pasta, buns, rolls, and rice would be replaced with whole wheat, whole grain, or brown versions immediately and all grains would be whole grain two years after implementation. Yay!

Minimize trans fat

The new regulation requires schools to use foods that contain zero grams of trans fat per serving, as indicated on the food’s nutrition label. As long as schools use the prescribed serving sizes, we should be good here. Because a food can actually have up to a half gram of trans fat per serving before the manufacturer is required to list the grams of trans fat on the label, if the school uses large quantities of these foods, they could unknowingly be serving more than acceptable levels of trans fat.

You can read the entire proposed regulation here.

The USDA is seeking input from the public on the new requirements. You can tell them what you think on regulations.gov at http://www.regulations.gov/#!documentDetail;D=FNS-2007-0038-0001. Your responses must be received by April 13th. If all goes well, the new requirements should be in place (and on our children’s lunch trays by the start of the 2011-2012 school year.

Despite a couple of shortcomings, the new regulations look promising. It’s too bad that the regulation does not put a cap on sugars, for example, but hopefully the calorie cap will help toward that end. I hate to get too excited, but this one could really work.

References

USDA calls for dramatic change in school lunches in The USA Today, http://www.usatoday.com/yourlife/food/diet-nutrition/2011-01-12-schoollunch13_ST_N.htm?csp=34news

Good news in school food on Fed Up With School Lunch, http://fedupwithschoollunch.blogspot.com/

USDA Unveils New School Lunch Standards on Food Safety News, http://www.foodsafetynews.com/2011/01/usda-unveils-new-school-lunch-standards/

Exclusive: USDA to Announce Healthier New School Lunch Guidelines on ABC News/Health, http://abcnews.go.com/Health/ConsumerNews/usda-announce-school-lunch-guidelines/story?id=12603193

How Will the New USDA Guidelines Improve School Lunch? in Health, http://health.change.org/blog/view/how_will_the_new_usda_guidelines_improve_school_lunch

USDA announces new nutrition standards for school lunch program on Nourishing Thoughts, http://www.nourishinteractive.com/blog/2011/01/17/usda-announces-new-nutrition-standards-for-school-lunch-program/

7 CFR Parts 201 and 220, Nutrition Standards in the National School Lunch Program and School Breakfast Programs; Proposed Rule in the Department of Agriculture’s Federal Register Part III, http://www.fns.usda.gov/cnd/governance/regulations/2011-01-13.pdf

The other kind of pumping

January 18, 2011

I met some other moms this weekend for a couple of hours of scrapbooking. Yes, I know, I don’t really seem like the scrapbooking type, do I? But motherhood has done weird things to me. I suddenly have this unquenchable urge to capture every waking moment of my child’s life on film. And then to arrange that film in a book … decorated with witty quotes cut from extravagant papers and elaborate stickers, jewels, and decals. I think I might have finally lost it.

But that’s not the point of this post. You see, while I was happily snipping and arranging and sticking, we were chatting about this and that. One of the moms is a nurse and we had been discussing how I had forgotten my meter and that I might need to run to the drugstore to pick up a cheap one for the day. Then she asked me, “So, are you still pumping?”

I replied, “Oh, yeah. I’ve been pumping since college.” And then I looked up from my pile of scraps and noticed the incredulous look on her face.

We stared at each other for a moment before she said with a nervous laugh, “Oh, no,I meant milk. Are you still pumping breast milk for Lukas?”

“Oh.” I could feel the heat rising in my cheeks. I stammered a bit before sputtering, “Uh … No. We are strictly formula-feeding now.”

She nodded and I scoured my brain for a witty comment to save this awkward moment. Nothing came to me, though, so we just smiled nervously and then returned to snipping and sticking.

Diabetes might have stolen my islet cells, and my gastric nerve-endings, and maybe even my youth. But it’s motherhood that stole my brain.

Mommy’s First Christmas

January 14, 2011

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Lukas is seven months old now and I just can’t believe it. On the one hand, it seems like we have been through so much together already … reflux and colic, breastfeeding and formula, checkups and shots, teething and real food. But on the other hand, it seems like just yesterday I was crawling out of bed every two to three hours to soothe, comfort, and feed. Like just yesterday he could barely lift his head.

And today? He has TWO teeth! And he rolls and lifts and pulls himself up with the best of them. He loves to sit and play with his toys … as long as he thinks you are behind him. If he notices that you are not there to catch him, he topples over. Silly guy! His seemingly endless cries have turned to mostly giggles and guffaws. He laughs hysterically when I kiss his tummy and when daddy makes funny faces. He still loves bath time. And his activity center. And his playmat. He babbles and talks to anyone (or anything) that will listen. Da-da-da-da is a common phrase, but sadly, we’re still working on ma-ma.

So I guess you would not be surprised to hear that baby’s first Christmas was a joy for all of us. Lukas enjoyed opening gifts … and eating the wrapping paper. Mommy spent a fair amount of time picking soggy bits of paper out of his mouth, but I wouldn’t have it any other way.

It is strange how his addition to our little family has changed our lives. I can’t say that we felt incomplete, or like our lives were missing something before he was here, but there is a definite sense of “whole” since he has joined us. When he is playing, engrossed in the fine details of a special toy, I sometimes take a minute just to look at him. Wow. I can’t believe that he’s here and he’s healthy and he’s so perfect. It sure was a lot of work, but it was all worth it.

And then he spits up all over his onesie, or poops down the leg of his sleeper and I am no longer free to daydream. But as I’m changing his diaper, or his sleeper, or his shirt, I’m still content. It’s still worth it.