Sunday, July 3, 2011

Diabetes, Diabetes, and Diabetes

At the risk of offending my diabetic sisters, I want to draw some distinctions among different kinds of diabetes in an effort to clarify why I feel so strongly that Type I diabetics have the potential to be excellent candidates for natural/low-intervention childbirth.

I am not a doctor, and have not met nearly as many diabetics as, say, and endocrinologist has. So with that caveat, here's a composite profile of different kinds of diabetics, with a heavy emphasis on the psychological component:

Type II diabetes. Most women that I know with Type II diabetes are past their childbearing years. But among the women I have met within their childbearing years, all of them have struggled to lose weight for a long time (some since childhood), and some of them have given up on the project of improving their health. I think most people would agree that Type II diabetes and being overweight are intimately connected. That implies eating and exercise habits which leave something to be desired. The net result for a pregnancy? An overweight woman who may have allowed her health to take a back seat, finds herself sick and tired at the beginning of the first trimester, and is bombarded with cultural ideas that it's OK to pig out every now and then because you're "eating for two." I hope I am not over-stepping my bounds here, and I would love to hear from women with Type II diabetes who have maintained a health weight and established good, healthy eating habits. (Hint: maybe you can write a guest post for us about your fabulous natural childbirth!)

Gestational diabetes. This is a tricky one. Some women with gestational diabetes have struggled with weight, but sometimes they start out skinny as a rail and for no apparent reason develop gestational diabetes. My cousin is an excellent example. You can read her story here (it turns out she actually had Type I diabetes all along). I think what throws most women with gestational diabetes off their guard is not knowing any of the "tricks of the trade": detecting and dealing with highs and lows, knowing what foods cause what kinds of reactions, knowing when and how to exercise and eat to manage a new beast. A lot of them are probably more than able to manage healthy eating and exercise habits (as my cousin is), but have to play catch-up with the day-to-day realities of managing diabetes.

Type I diabetes. Forgive me if I use glowing terms to describe what is, any way you slice it, a disease. A malfunctioning of the human body. An illness. That being said, here's what I've found about a lot of Type I diabetics. Most of us acquired the disease at a young age, so it is just a part of life. Many of us are of a normal weight. Many of us are accustomed to tweaking our diet and exercise plans to improve our health or at least accommodate our disease. That leaves a pregnant woman with Type I diabetes in a situation very similar to the one she was in before: healthy (or at least not overweight, with its accompanying psychological and physicopathological baggage, yes I made that word up) and disciplined about her habits to keep herself healthy. Is this not one of the best ways to be when pregnant? Willing to jump through hoops, accustomed to extra testing, familiar with medical jargon, without any pretense of invincibility but with a strong conviction regarding the value of her own life and that of her baby? We know that our lives depend on modern medicine, and we are profoundly grateful, but we have gone even further than gratitude. We have grabbed that bull by the horns and are making it work for us - carb counting, insulin pumps, exercise, blood counts, and so on - because for the most part we haven't every lived life without the bucking animal between us and the ground. Is that not someone who, absent some other significant pregnancy or diabetes problem, might just be a very good candidate for childbirth without a lot of intervention?

So, overlap between these categories is inevitable and it is definitely a problem for any of us to to paint anyone with a broad brush simply on the basis of a diagnosis code. That applies to all types of diabetes. Women with Type I diabetes may struggle with their weight, and Type II diabetics may be totally on top of it. By the way, did I mention we'd love to hear about your experience with diabetes and natural childbirth? That doesn't mean that your doctor didn't intervene in any way, it only means that you wanted it, you tried, and may have succeeded or failed. We'd love to hear about it. We may even post it.

I hope I haven't offended anyone and if you are a doctor or nurse and you want to put me in my place about the diabetics with whom you have interacted, I welcome it.

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