Third Trimester with Type One Diabetes

I almost feel like the title to this blog post should be, "Third Trimester ft. Every High Risk Possibility". If you're here reading this, buckle up. I had the most intersting, unfortunate, but magical third trimester of all time ...I'm convinced. And what's really crazy, is most, if not all, of what happened during this trimester was unrelated to diabetes.

Third trimester starts at week 28. And at week 28, things got.... hard. During this particular week, I began experiencing uncontrollable itching on my feet. I noticed each night, I would lay awake itching my feet for.....hours. I was unsure of why. My first guess was bug bites. But, at the absence of any bumps or rashes, I quickly ruled that possibility out. I started thinking maybe it was athletes foot. I had spent a significant amount of time at the gym's pool this summer as well as the locker room showers. It could have rightfully been something so simple, an over-the-counter cream would do the trick. But after buying every brand of "cortizone-10" I could find, nothing provided me with relief. Maybe it was a bit more complex, like something due to my diabetes. It had been years since I had a diabetic foot exam, so I thought after the weekend I'd schedule one of those. Unfortunately, I didn't make it to Monday without going to an urgent care first. My husband had researched the possibility of itchy feet connecting to pregnancy, and he found "ICP" or, cholestasis of pregnancy. This unfortunate hiccup involves your livers' inability to filter out bile acids, causing itchy feet, palms and if more severe, the entire body. When I had went to urgent care, they decided to run labs and assess. Unfortunately, they did not pull labs of bile acids, the one true indicator of ICP. But the doctor did look at my ALT and AST, two values that can signify if my liver is functioning appropriately. And of course, those labs came back fine. So urgent care gave me a steroid cream and sent me on my way.

However, a few more nights later with zero sleep led me to scheduling a podiatry appointment. If it wasn't internal, it's gotta be some sort of invisible rash (if there is such a thing). However, the podiatrist said this case was out of his scope of practice because it is more likely related to pregnancy. Really, dude?

So, I ended up reaching out to my OB, telling her the steps we've taken so far to understand what's going on. She called in additional labs, this time including bile acids. And after a few days of waiting, my bile acid value came back as 12, indicating a positive test for ICP. If you want to read more about ICP, I will link the Cleveland Clinic website to reference here. Essentially, there is nothing you can do about ICP during pregnancy once you have it. You can and will be medicated with Ursodial; a medicine that doesn't actually reduce the bile acid numbers but will help mitigate the symptoms. This is important to monitor because your OB will most likely not re-test you. If you symptoms become worse and overpower the medication, you can assume your ICP is getting worse and your OB may decide to re-test you then.

The Ursodial was working from weeks 29-32. I had zero symptoms and was sleeping again! But once I hit 33 weeks, I noticed that my entire body was starting to itch; not just my feet. I am not sure why this took me a few days to connect the dots that my ICP was getting worse, but it did. After many sleepless nights of itching head to toe, I reconnected with my OB who said I could increase the doseage of Ursodial as well as re-test my bile acid number. This time, it came back at 39, which meant it was headed in the "more severe" status. With that number and proof of symptoms worsening, my OB moved my induction date to 37 weeks (versus the original 38 weeks).

On Wednesday October 1st, I was having the hardest day yet. I was itching head-to-toe while working and on the highest doseage of medication. My bloodsugar was also severely low, almost the entire day. I was drinking countless juice boxes with little to no effect on my bloodsugar. This was a sign that my placentas were becoming impaired. Lastly, I began getting super sore, super swollen feet. At first, I deemed this as being on them all day working. But it was to the point I didn't want to stand to make dinner. That night, as I showered at midnight to try to cool my body off, I decided it was wise to go into L&D to get checked out.

After checking in and discussing my symptoms to the nurse, we began going through vitals and getting an IV started (if anything, they were going to help me sleep!). That's when my blood pressure came back as 170/100. We waited ten minutes to re-check, just to recieve another high number. Lo and behold, pre-eclampsia was rearing its' ugly head. With the diagnosis showing "severe", they automatically admitted me into the hospital and moved my induction date to 34 weeks, which was exactly one week from this particular night. And yes, I was taking baby asprin daily since becoming pregnant.

Mike and I were not expecting this; but to say I was proud of myself for going downtown and not "fighting it out", is an understatement. I easily could've played to "I'm tough" card and allowed the symptoms to linger, but if I had, my babies may not be here today. We made our calls to family members to expect babies in seven days.

To monitor the progression of pre-eclampsia and ICP, the nurses took my bloodwork to assess ALT, ALP and AST levels. These numbers indicate my liver not functioning properly. We also took my blood pressure every hour. Lastly, manual finger sticks were given because the doctors don't follow the continuous glucose monitors.

Thursday, my mom came from out of state. I am so grateful she did, it gave Mike the chance to leave, go home and shower, and rest. My symptoms were just the same, itchy and uncomfortable. Thursdays' progression of ICP and pre-eclampsia wasn't good though, and bled into Friday when the on-call OB said "we're going to take you in now". My numbers, this time including bile acids, were extrodinarily high. My bile acid had risen from 12, to 39, to 110. These were dangerous and damaging conditions for myself and for the babies. So, it was time to get induced!

My husband sped back to the hospital as I was signing away papers. We started the induction process around 5pm on Friday. I got it all; the prostagladin pill to get me from 0 to 1 cm, the folley balloon for another 3-4 cm, and breaking my water. If I could do it over again, I would've gotten the epidural before the folley balloon as that shit was UNCOMFY.

During this process of induction, I had to decide if I was to manage my own blood sugar during labor or if I should get on the drip. If I was to deliver at the normal 38 week mark with no complications, I was going to manage it on my own. My blood sugar was excellent most of pregnancy, with a 5.3 A1c. In my opinion, I didn't hit the resistance that everyone prepares you for either. None the less, I now had a decision to make because the doctors wanted me to take a steroid injection to speed up the babies' lung development. With them being so pre-mature, there is a risk of under developed lungs. Since this was an obvious "of course", I now had to figure out the diabetes management thing. Last time I took a steroid injection, it sent me into DKA and a near death experience. I was terrified my pump wouldn't keep up with the insulin needs a steroid brings. So, I decided to get a IV drip of insulin and sugar. And my final thoughts here are, it actually wasn't bad. It pretty much gave me freedom to un-think about diabetes for a minute (or so;)) The nurses manually checked my blood sugar instead of going off the dexcom, every hour. That was the most annoying part about it!

To get from 0 cm to 10 cm, it took about 23 hours. I was wheeled into the operating room to deliver and was surprised at how many people were in the room with me. My husband said at least 20 people. It was pretty loud and lots of conversations too. Truly, I didn't mind this. Everyone in there was playing their part to help deliver my 33.5 week old babies. And I was....kinda busy... to be worried about counting heads!

Marshall (baby A) was about 5 pushes. The hardest part was getting his head through. And because of that, I got a second degree tear. Jackson (baby B), ended up flipping to be breech. Luckily, the OB delivering me was still qualified and willing to do a breech extraction. So he asked once more if I wanted to opt in for the extraction, in which I agreed if it was still safe for my baby. Five seconds later, the OB is reaching his entire arm up my v* to get Jackson out. We were a bit concerned as he was pulling Jackson out, because his arms ended up over his head. Luckily, no broken bones and no trauma for Jackson! This moment, of delivering both Marshall and Jackson, was the most special moment of my life. I've never seen such special, beautiful, amazing boys. I know I am clearly partial.. but, I felt an immediate love I've never felt before. These little boys have forever changed my life.

Post delivery, my boys were sent to the NICU. Being born at 33.5 weeks, it was standard protocal that the babies stay in the NICU until they're 35 weeks. While in the NICU, Marshall experienced some ~scary to new parents~ episodes of bradycardia. He ended up having to stay for 17 days before coming home. Jackson was able to come home at day 10, right when he turned 35 weeks. NICU life is challenging. Your babies are not home with you and it's hard when you hear dissappointing news. But, if you're currently a NICU parent or preparing yourself for the possiblity, remember they are in there to help your child develop. At the end of the day, it is a good thing! But trust me, I, too had my fair share of tears. Each night spent at home was spent watching them on their 24/7 cameras, wishing they were here.

My babies are home now and very healthy. We're learning about the little quirks each of them have and how to navigate twin parenting. It's a challenge, but it's a miraculous blessing to say the least!

Postpartum (3 weeks)

Post delivery, I had lingering high blood pressure for about a week. I had to manually check my blood pressure at home. I also took high blood pressure medication to control it. The ICP and its' symptoms completely vanished, thank God! No more itching! As I write this 3 weeks post partum, I can tell you I feel pretty good. I have had some lingering sciatic nerve pain since delivering, but besides that I am almost back to pre-pregnancy weight and my energy levels are through the roof (compared to growing two humans). We're focused on parenting right now, and although it comes with its' challenges, I do love it.

My workouts have consisted of 60 minute walks each morning and some light band work. I also started seeing a physical therapist to get the sciatic pain under control. Nutrition-wise, I am tracking my calories to understand how much I eat every day. I also started a Factor subscription, to get some high protein, low cal lunches that are prepared in my refridgerator. We really have enjoyed Factor! Luckily, my aversion to coffee has subsided and I am able to drink my beloved nitro cold brews again!

I wanted to share all of this information with you because although I tried my damn hardest to have the most tightly controlled pregnancy, delivery and healthy babies through my T1D management... I still had insane complications. If you have type one diabetes and you're reading this, I want to first say A) you got this! It's a challenging road to keep your time in tight range, but it will pay off when you have the healthiest babies. and B) sometimes complications are inevitable and not your fault. Don't be hard on yourself if things don't go according to plan.

My Overall thoughts and feelings of living with Type One and becoming a mother

This time period was one of the hardest in my life in terms of living/breathing/eating (literally) my type one management. I know many others who don't care as deeply to control their T1 while pregnant; but I have wanted babies for so long, I knew I'd do everything in my power to keep them healthy and growing inside of me. I acheieved an A1C of 5.3 my entire pregnancy and I felt really good about it. My carb ratio started at 1 unit of insulin for every 12 grams of carbs; and I ended pregnancy at 1 unit of insulin for every 3 grams of carbs. My omnipod was lasting about 48-72 hours (but not past, or ever in the grace period). I did not eat low carb, but I eat extremely healthy in general so my carbohydrate intake doesn't normally surpass 60 grams in a sitting, including fiber sources. I exercised daily; lifting weights or running. I also took walks after lunch (most insulin resistant time) and found myself walking on my treadmill late at night to ensure my blodosugar was lower than 90 before bed. I skippped some social outtings like bachelorette parties and dinner dates that involved food that was hard to bolus for. I barely traveled because sitting in the car for hours on end normally ended up making my bloodsugar rise to 140. I pre-bolused 20-30 minutes for every meal and snack. And the entire summer, I refrained from Jeni's Ice Cream (big win). Type one mammas... no one understands this part of our pregnancy story. I can tell others "I am high risk being a type one diabetic" but the conversation normally ends there. Truthfully, I don't need people to know the sacrifices or hardships of type one diabetes; but I am about spreading awareness and hoping others in my shoes never feel alone. I urge you to share your type one journey, or any health journey you are on.. because, someone else is going through it too. And they most likely need community as well.