Monday, April 25, 2011

The Dexcom

Continuous Glucose Monitoring... or CGM for short. I've mentioned my trials with CGM before on the blog, when I test drove and decided to purchase the Minimed CGM last year. And now, I've moved to the Dexcom system.

It seems the past few months were filled with trials for me and the dia-beets (no, I didn't misspell it... this is my hubby's affectionate nickname for my diabetes and it's finally stuck it seems). I failed to mention to you, it seems I have a hard time blogging about the tough stuff, I'll have to work on that; but anyhow, I was denied my first time asking the insurance company for a Dexcom system last August.

I'd worn the minimed CGM for about a month when I gave up on it, with 4 months worth of sensors unopened in the box still! For me, the minimed didn't work because it's calibration mechanism required me to have a fasting and stable blood sugar at least 2 times a day (maybe more?). We all know that a very stable (ie. not on the way up at all or on the way down at all) is pretty hard to achieve, much less not eating for 2 hours when you are a diabetic. (esp when you are a stay at home mom and only get to grab handfulls of food throughout the day) :) However, having experienced the knowledge of a bloodsugar trend (ie. I'm "180 on the way up") rather than just I'm 180 and who knows if it's 180 on the way up or on the way down... I wanted that again, and I wanted it bad... only I wanted it to be accurate, which I couldn't achieve with the Minimed CGM because I couldn't calibrate the device as was necessary for the integrity of it's function.

Enter the Dexcom. I complained to my physician only 2 months after he worked to get me the MiniMed CGM how I disliked it. His response... "well you should have gotten the Dexcom, it's a different technology and it works better." UMM... where was this information 3 months ago doc? Oh wait, I'm a vain diabetic and already hate having an insulin pump on me and didn't want to add another medical device to my hot, hot body... right, that's why I went with the not-as-great CGM system. Ok, so doc, I messed up, and I want the Dex.... Wait a year and try again. So, I tried and they said no, silly girl, we just spent $1600 on the last CGM and we're not getting you another (the short of my August 2010 denial letter from the insurance company).

I was sad, I whined and complained. And then I appealed. I lost again. I whined and complained more. I didn't share the hurt with you, and then I decided to let it go, I'd learned my lesson about researching medical devices more thoroughly and about vanity.

And then... a stroke of genius hit... oh wait, my blood sugars suck (the A1C was up to 7.6) and I want to have another baby and I can't until I can get these sugars better... I should tell the insurance company that, then surely they will send me a Dexcom... survey says..... YESSSSSSSS!

I literally felt like the Dexcom fell from Heaven. I'd phoned my diabetes supply company 4 weeks ago to run the idea of a new Dexcom application to the insurance company by them and they said they'd try it, but gave me no time frame. Two weeks later I had a voicemail when I got home... "Jenn, we have your Dexcom ready to ship, we just need the ok, and it's already paid for with this year's deductible." SaaaaaWEET!

Ok, so about the Dexcom... it's the BEST BEST BESTEST thing that has ever happened to me in 16 years of having type one diabetes. I am NOT exacterating yall... I even said yall... so you know this is serious.

1) My first and most favorite thing about the Dexcom: it's ALWAYS right! if it says my blood sugar is 123, then it's really about 123 - were I to check that with a finger stick, it's usually within 5mg/dL... AMAZING. Now... you must know something about CGM when I say this... because CGM works by measuring the sugar in interstitial fluid, there is some lag them if there is a rapid change going on in your blood sugar... it takes about 10 to 20 minutes for the interstitial fluid to reflect the sugar level in your blood when a rapid change is happening. This is just a normal part of CGM technologies to date across the board, they all have this lag time because you are not measuring from in the bloodstream... you can imagine the multitude of reasons why. Anyhow, when I was on the Minimed system, even if I was stable, not going up or down from food or insulin... it would NEVER give that accurate a reflection of my finger stick blood glucose numbers. The dexcom is accurate for me. Like any CGM system, the better you are at calibration the more accuracy you get from the device, but I find that this one is SO much easier to calibrate... I don't have to do it as often, and it's smart enough to deal with a calibration when my blood sugar is on the move. Love it.

2) The sensor is SUPER comfortable. Ok, so you still have to stick something in your body and wear it all of the time, but it is TONS more comfortable than a pump site. And, in my opinion, more comfortable than the Minimed cannula for their CGM as well. The Dexcom sensor uses a wire inserted with a needle that is removed after insertion. (Oh! and on another good note, each sensor has it's own insertion device made onto it, so you don't have to keep up with a "serter"!) I have not been able to wear my insulin pump in about 6 months because I'm running a bit on the thin side with my weight these days. (what with two toddlers and all) :) I was constantly kinking even the 6mm quicksets. Bad days. However, the sensor for the Dexcom has been just fine for me, on #3 now, and they each have made it the full 7 days of recommended wear!

Here's a glance at the Dex in action. I have the sensor with transmitter attached on my back right now, and the receiver (i know, it's GIANT, they promise they are making the next one smaller... maybe even an iPod app in the works) is tucked in the waist band of my pants. As a mom of toddlers I am NEVER sitting still, and the darn device doesn't come with a clip attached, it has a case with a clip... but it sucks, so this is the best I can do for now. More on that later, because I have so much more to say and have to stop somewhere.

Please ask questions and weigh in with your CGM experiences, I'm sure pregnancy on a CGM must be so wonderful, neither Beth or I have experienced this yet!

Friday, April 22, 2011

Why Should I "Go Natural"? And, a Meditation on Christ's Suffering

I address this post particularly to the issue of avoiding pain medication during childbirth. Because "natural childbirth" involves rejecting a lot of interventions, each one of which can be debated on its own merits, I'm going to start with the one that most people think of when someone talks about "going natural" during labor: the beloved (or dreaded) epidural (and a variety of other pain medications which are administered less frequently).

A long time ago, someone asked me the following question. "Do you think all women should try to go through labor without pain medication, or is it sufficient that it is a choice?" This set the wheels in my head spinning, because if personal choice is the only thing at stake, why even consider labor without an epidural? I mean, that's like saying, "Yes, please pull on my hair, even though there's no gum or peanut butter or anything else in it and you don't have a good reason to." That's just foolish.

So then, if I think childbirth without pain medication is a better way for me, I think it is, on the whole, good for other women, too. From a strictly medical point of view, there are some acknowledged physical benefits. One is that women laboring without an epidural (I'm not sure about other pain medications) have the option of walking, squatting, getting on their hands and knees, or otherwise changing their body position to facilitate the speed of labor or the baby's passage through the birth canal. Another is the experience of many women and doctors that labor tends to slow down when pain medication is administered. Another is that some pain medication might make the baby a little drowsy, which might make breastfeeding or breathing slightly more difficult (although I don't think the effects are so significant that you would say the mother is harming or neglecting the baby by choosing this course, as some may say).

OK, so those are the reasons you may have heard already. I mention them because in case you haven't heard about them, you need to know. But, in the end, the fear of pain may drive us to pain medication even if we know that our odds of a healthy, vaginal delivery and a healthy baby are not as good when we have an epidural. Also, how many of our friends, sisters, mothers, cousins, and so on have delivered healthy babies vaginally even with an epidural? It does happen all the time.

What I really want to address in this post is two other reasons (aside from the physical benefits) why I think avoiding pain medication adds something good and beautiful to your journey as a mother. One reason is secular and one reason is religious. I'm going to start with the secular, so if you just came here to read about diabetes in pregnancy, or if Christianity freaks you out, makes you roll your eyes, or makes your blood boil, you can stop reading after that.

The first reason comes from my days as a psychology major undergraduate at the good old University of Virginia. I took a social psychology class with Timothy Wilson (one of the best I took!) and learned about cognitive dissonance. Cognitive dissonance is what makes it hard to hate people that we go out of our way to do nice things for. It's what makes fraternity brothers so loyal to their fellows that hazed them. It's why it can be dangerous for sober alcoholics to have even one drink. It's what happens because our thoughts, our emotions, and our behaviors like to be in line with one another. It means that if you behave in a certain way, you will tend towards feeling positively about your behavior and you will thoughtfully dwell on reasons that justify your behavior. It's just part of the fabric of who we are as human beings. We like our heads, hearts, and hands to be in line with one another.

How does this impact childbirth? A woman who goes through childbirth continues to think on her choices after the baby is born. A woman who goes through childbirth without pain medication will have to supply ample reasons to explain why her baby was worth the pain that she chose, even when she was faced with other options. The happy result of this self-justification is that she is convinced that her child hung the moon, is the cutest baby on earth, and that she would die for said baby. Self-justification turns into good feelings towards the baby, and positive thoughts and feelings promote a strong, early mother-baby bond.

HOLD THE PHONES! I know what you are thinking. Women who deliver babies WITH pain medication feel the same way - they are convinced that their children hung the moon, are the cutest babies on earth, and that they would die for them. And yes, I have noticed the near-universality of the phenomenon and it is beautiful. Cognitive dissonance explains this, too. Since pregnancy is no cake-walk, and childbirth can be arduous even with pain medication, most women go through the process that justifies their choices and eventually leads to a full-flowered love and affection. Even if it doesn't, the early postpartum period probably will. And even if that's not enough, sticking it out with a 2-year old will surely forge a bond that lasts a lifetime.

So women who go through childbirth without pain medication are not the only ones who experience the amazing bond that a mother has with her child. But I think that women who experience pain in childbirth are more likely to experience this bond sooner (as in, immediately) and more strongly, which would make the early postpartum period more bearable. This includes feelings of elation and a desire to gaze at and nurse their baby in spite of their fatigue. Perhaps it makes one less likely to mind getting up in the middle of the night to feed said baby, change said baby's diaper, and rock said baby back to sleep. I think this has ramifications for women who are fearful of becoming mothers, women who feel ambivalent about their pregnancies, teen mothers, and first-time mothers, in particular. Perhaps these women need to be encouraged to love their children deeply enough to feel pain for them - because it's good for their baby's health, their own health, and the health of their relationship to their child.

Alright. For those of you who are curious about my meditations on Christ's suffering and the laboring woman, read on. See warning above for others.

Today, the Church celebrates Good Friday. It is the day commemorating Christ's arrest, "trial," crucifixion, and death. For the past 38 days of Lent, we have been reflecting on this greatest of sacrifices. I have dutifully dwelled on these themes for several weeks, though I far prefer the Joyful Mysteries.

As I meditated on the scourging of Christ - when Our Lord was whipped, beaten, spat upon, and then crowned with thorns and mocked - I recoiled in fear. I thought to myself, "if God gave me such a cross, to suffer whipping and beating, I don't think I would be able to bear it honorably. I would probably be tempted to disown Him as Peter did." For as many months as I have meditated on this theme, I have had the same reaction and thought the same thing.

But the other day, for some providential reason, I recalled having been in labor last October. When I thought I couldn't do it anymore, I recalled my husband whispering in my ear: "Offer it to God." I remember, while I was in labor, imagining Christ hanging on His cross, gasping for air and struggling against the nails which held Him there. I recall holding fast to the truth that God will never give me more than I can handle - even a painful labor, or a painful death. I left these details out of my birth story because I feared they might offend, but the truth is that Christ was my Rock during my second labor. And now, my meditation on His sufferings has profited from these memories of labor. In fact, my sympathy for Him in His suffering has increased, and my confidence in God's assistance to me in my suffering has been renewed.

So here is the benefit that I propose to childbearing women. By submitting yourself to the suffering of childbirth, as Christ submitted to His own suffering, you become closer to Christ! For a woman in labor, identification with Christ's suffering brings forth new life in so many ways: the life of her child, her own spiritual intimacy with Christ (which is life-giving), and perhaps even drawing your spouse, other children, or other people witnessing closer to Our Passionate Lord. Your perception of the benefit may be immediate (drawing on His strength during labor, as I did) or come later (as I did in my Lenten prayers).

Yes, Christ had the option of foregoing His pain, just as women in childbirth also do. In fact, He would still have been wholly good if He had chosen a different path. He owed us nothing. In the same way, nearly all women who choose pain medication will remain healthy, have healthy babies, and have loving, affectionate relationships with their babies. AND THEY ARE NOT TO BE JUDGED FOR IT. I repeat, choosing suffering in childbirth is not to be considered the only right or good way to have a baby.

Wait, are you sure you heard that? Because I really mean it. I know a lot of women who have spent their bodies in labor and had an epidural at the eleventh hour because their fatigue could not be overcome. And I think these women have identified with Christ, also. Furthermore, I know many a wise and loving mother who chose epidurals from the get-go. I would be ashamed if they read this and believed I thought of them with disdain. It is no sin to choose pain medication unless it directly harms you or your child, which I think it seldom does. Women will encounter the suffering Christ as mothers at some point or another - during pregnancy, childbirth, infancy, toddlerhood, and beyond. Even still, that is not a reason for them to avoid Him during labor. We should be eager at the chance to be united to Our Lord, even in physical pain.

My point in all this is that I believe there are benefits to "natural childbirth" (read: childbirth without pain medication) beyond the physical ones. Physical risks and benefits can be weighed and debated and scientifically researched. But additional benefits await for those who unite their suffering to Our Lord, Jesus.

Thursday, April 21, 2011

And... It's a "No"

It's been awhile friends, I started this post weeks ago, and have finally found it in me to tell you the rest of the story. You may remember I had tried to see a local group of midwives in Asheville who are just plain awesome, in my opinion. Upon contacting them, I was originally told, no they wouldn't meet with me, I was automatically ruled out of their practice because of my type one diabetes. I sent a followup email explaining my birth history and asked if they would reconsider and at least meet with me to tell me no in person if they needed to. They happily agreed, and someone even visited the blog, I shared it with them in hopes it would explain a bit more. And here, then, is the rest of the story...

I had a wonderful meeting with one of the Midwives at the group I mentioned earlier. It was everything I hoped it would be and more! She listened to my story with the interest and trust I'd always hoped a medical practitioner would. She asked questions relevant to my and the baby's long term health and happiness. It wasn't all about my diabetes. Of course, we did talk about that, it is very important that she and the other midwives could trust me and my ability to control/manage the diabetes in order to protect myself and the baby. But, I left feeling like a whole person who was talking about having a baby, not like parts of me had been mothering part separated from the baby part, separated from the diabetes part of me.

She was eager to hear the stories of my pregnancies and births to understand what had lead me to seek their care. We discussed the management of my diabetes during the pregnancies and during my births. And then she began to tell me about the practice and their overseeing physician.

After we finished speaking, the midwife said there was a practice meeting scheduled the following day at which all of the midwives would be present, and they could discuss the possibility of taking me on as a patient for a future pregnancy.

Things sounded to be going quite well among the midwives, I received an encouraging phone call a few days after our meeting that "things were going quite well" and that she "thought I would be happy with the results." YAY.

Then, two days later, the midwife phoned again, and I could instantly tell it was bad news from the tone in her voice. She had been advised to run the decision by the local group of perinatologists, and had called the woman she was most familiar with there. And can we all guess what she said...of course... she thought it would be "inadvisable" for me to be followed by the midwives and recommended they suggest to me to seek care with the high risk pregnancy clinic in the area.

Towards the end of the conversation, the midwife said, "humm... I wonder if they could follow your pregnancy and we could do the birth?" I think I must have been less than clear during my meeting with her, because this was my plan all along... to see both (the midwives and the perinatologist). I must add at this point though, that I was so discouraged by something else she had said that I was unable to even clarify my huge misrepresentation... "you definitely are not a candidate for home birth though", she'd said.

I was crushed. I won't lie. I wasn't expecting her to sign me up for home birth, but I was expecting something along the lines of... home birth would only be something we could discuss toward the very end of your pregnancy based on how everything was going and assuming it all looked pretty much as perfect as we could expect.

But to hear that we weren't even going to discuss it, I didn't feel like I was trying to be naive about it, I know it's nearly unheard of, and I certainly wouldn't want to have a homebirth if it were unwise for me or the baby, but, if all things were going swell, I'd love to have the option.

Ok, so now I've walked away from the whole process (to this point) feeling like I've been on a roller coaster. I can't think of anyone other than these women I'd like to have help bring a next child into the world because of their years of experience, their medical backgrounds, and their natural and holistic approach to birth... and yet, they too, seem to see me as an impending medical disaster when "the powers that be" warned them to be wary of me. The ups and downs... the great first meeting, their desire as a group to care for me, countered by the no home birth statement and the "no" from a local perinatologist were a lot for me to process.

It's been nearly 8 weeks since that visit. Life has been crazy enough during those weeks to keep me from writing, but it's not life that kept me from sharing this story, it was the hurt. I know the midwives are still open to having a conversation should we become pregnant, and there is MUCH to hope for just in that. However, seeing that there is still much stigma surrounding diabetes and pregnancy even in a town that embraces midwives, as Asheville does, saddens me.

On a MUCH MUCH happier note... A Dexcom fell from heaven onto my front porch last week!!!! I can't wait to tell you all about it... it's literally the most amazing thing that has happened in my 16 years of diabetes.