Parenting Lessons Learned

It's hard to believe I've already been a mom for one and a half years! Time really does fly when you're having fun. :)

True to form, I have a list (a Google Document) that I routinely update with things I want to remember for a potential future parenthood round 2 - things that went well (or didn't) with our now-toddler daughter, as well as things I was needlessly concerned about (or not concerned about enough). Now obviously every kid is different, and what works with one won't necessarily work with another, but still - I feel like it can't hurt to try to be prepared (my motto for pretty much everything), which is why I started making this list anyway.

And then I thought - maybe other Type As like me would also be interested to hear my takes, just in case they experience something similar. I could make this a blog post! So here we are.

This public version of my list is only part of my list - the things I learned and pieces of advice I have to offer that I thought would be most universally applicable/adaptable for different kinds of families with different parenting styles (though I'm sure even in this curated list my parenting biases shine through).

Without further ado, the eclectic assortment of parenting experience/advice I've (so far) accumulated:

• Buy newborn size diapers. I knew I'd be having an above-average-size baby (she ended up being 8 lbs 10 oz at birth), that newborn size diapers were only recommended up to 10 lbs, and that size 1 diapers fit well starting at around 8 lbs - so I figured if we wanted to use newborn diapers at the beginning it would only be for a few days before we'd switch to size 1s anyway, and that the diapers we took home from the hospital would more than cover those few days. Alas, I was wrong - in my parenting inexperience, I severely underestimated 1) how many diapers a newborn can go through in a day, 2) how long the umbilical cord stump can stay on (our daughter's didn't come off until the pediatrician took it off at her 3-week appointment), and 3) the fact that all babies lose weight during the first 24 hours - and can take 2-3 weeks to get back up to birth weight again. The newborn size diapers have that little cutout for the umbilical stump (at least, the Huggies brand does), but size 1 diapers don't. For that reason alone (but also because our daughter hovered around the 8 lb mark for several days longer than I thought she would), we ended up using newborn size diapers for at least 3-4 weeks - which necessitated running out and buying a couple boxes past the freebies the hospital gave us.

• If you're breastfeeding, use diaper rash cream/ointment after every diaper change for the first two months. I bought diaper rash cream/ointment for each changing table (we put one upstairs and one downstairs), and another set for the diaper bag and car. One and a half years later, we haven't used it all; since our daughter started solid foods around 6 months old, we've had to use it maybe once or twice a month. BUT I do wish we'd used it more frequently when she was a newborn, especially those first few months. Breastfed babies have soft poo, and a LOT of poo (at least ours did - I swear, nearly every diaper we changed had some poo) - and when they're pooping that frequently, the bum is sure to get irritated. Just trust me on this. Better to over-cream/ointment than not do it enough, and then have to make a pediatrician appointment to get a prescription for the high-quality cream/ointment stuff.

• If you are concerned about any aspect of breastfeeding - call a lactation consultant! I thought I was doing pretty good with everything, and knew what I was doing - but when our daughter hadn't gained back to her birthweight yet by two weeks, our pediatrician recommended we either call a lactation consultant, or supplement with formula. We started with the first (and ended up also doing the second) - and let met just say, the lactation consultant we saw was so amazing and reassuring. Yes, it turned out, I did know what I was doing - but it was great to hear that from a professional... and get tips for how to do certain things even better. In those hectic early weeks, it was such a relief to get that professional reassurance. And most insurances (including ours) cover up to two sessions! Ours was an at-home consultant (it was January 2020, just before the pandemic), and she came over and watched me do a feed in our own living room. It was great! And then she was available via text when I had follow-up questions during the next couple weeks after that, too.

• It is okay to supplement with formula. I dreamed of "exclusively breastfeeding," so it was really hard for me to hear that it might be a good idea to give our daughter some formula. I worried that there was something wrong with my breastmilk (quality-wise and/or quantity-wise) that made me "unfit" to breastfeed. I worried that she would struggle with differentiating between the bottle and breast (and would prefer the bottle). And I worried that if I started supplementing with a little formula, there would be no going back to "exclusive breastfeeding" at a point in the future - like once you start formula you can never go back again. Thankfully, all those worries were completely unfounded. We gave our daughter one bottle of formula a day for a few weeks, until she was back to birthweight and her bilirubin levels were back to near-normal levels (she had a bit of "long-term" jaundice). She took to the bottle just fine, and didn't have any confusion between the two. And when she was healthy, we dropped the formula, and she was just as content to go back to exclusive breastfeeding... Of course, if it hadn't worked out that way and I hadn't been able to continue breastfeeding after all - that also would've been okay. My mother formula-fed me in the '80s, and I turned out just fine. Breastmilk, formula - it doesn't matter. Fed is best. (Looking back with several months of hindsight, it really does seem silly how much we worried over something so minor - but that's life parenting a newborn, I guess. Every decision seems so fraught, because their little lives seem so fragile.) 

• If you want your baby to be able to drink from a bottle, keep giving bottles once they are introduced. For a bit after we stopped the formula, we still gave a bottle (for one feed per day) of pumped breastmilk, both so my husband could help with feeding, and so that she would continue to be competent with bottle drinking if we were to need to leave her in someone else's care while we went out for a date night or something. We did that once (her aunt babysat her, and gave her a bottle) - but then the pandemic hit, and socializing/leaving-the-house-at-all were out the window, and when the only reason we were giving bottles was so my husband could do a feed, it just didn't seem worth it anymore. I still had to pump while he was giving her the bottle, to keep my milk production up, and it was more work to pump and clean all the pump parts (and bottles) than to just breastfeed instead. So for a few months, I exclusively breastfed. No more bottles... but by summer 2020, things were opening up again, and there would be occasions (rare, but still not never) when I wouldn't be around for a feed (e.g. if I had a doctor's appointment). And when my husband tried to give her a bottle - she refused it. Thankfully, she was almost 6 months by that time, and once we hit that milestone, if she was hungry when I happened to be out of the house, my husband could just feed her some food purees instead until I got home (since I was only ever gone for an hour or two at most anyway). Not using bottles had some perks (we never had to wean her off the bottle!) - but definitely some drawbacks, too. For one thing, I had to do every. single. feed. Even the ones in the middle of the night. Every night. For another, what was the point of having an "emergency supply" of frozen, pumped breastmilk if she was never going to drink it? (I creatively used it to make a bunch of frozen food purees instead.) And finally, to this day she does not like drinking milk from a cup, even now that we're trying to do cow's milk now, rather than breastmilk or formula. Even adding chocolate or strawberry flavoring to it, she will not do it. I suspect she wouldn't have that aversion if she'd had milk more frequently from sources other than me.

• Replace your breast pump parts regularly! You're supposed to get new parts and switch them out every 3 months. This includes the flanges, filters, tubing, and collection bottles. I figured it was just a "recommendation" and didn't really bother being super vigilant about it at first - the pump still worked just fine, so why change them? But then I caved and gave it a try - and it was worlds different. I thought my pump was working just fine with old parts, but I was wrong. It's like changing the toothbrush head on your electric toothbrush - you know how it feels crazy powerful that first week after you replace it, and your teeth have never felt cleaner? Suddenly I was getting like twice the amount of milk I'd been getting before. Of course, with everything else going on with parenting, it's easy to lose track of time and forget when it's been three months - so make it an alarm on your phone/calendar app! (And if you're noticing any issues, or see any cracks in the plastic, definitely feel free to change the parts out even sooner!)

• Once your baby starts eating solid foods, make sure you clean the food bibs really well. (I'm talking about the plastic bibs here, which are easy to wipe food off of. Teething bibs are another story.) We just kind of wiped the food bibs off after a meal, or washed them in the sink when we did the rest of the dishes at the end of the day. After a few months of this, we noticed black spots on the little velcro strips - mold. We tossed the bibs and bought new ones, and this time we did two things differently: 1) We still usually waited until the end of the day to thoroughly clean them, but in the meantime, we didn't just throw them in the sink with other dirty dishes to sit in water. We kept them separate (and dry), on the counter, until they were ready to be cleaned. And 2) whenever we did a load of our daughter's laundry (so once or twice a week), we threw all the bibs in the washing machine with her clothes, and then hung them to dry.

• Keep nursing pads stocked until you are completely done with breastfeeding. Once I had my supply well-established and we were past the first couple of months, I (wrongly) figured I wasn't going to have any leaking problems anymore. I even returned an unopened box to the store. But then she started solid foods (and so she nursed a little less); and then we moved her to her crib in her own room (and so she nursed a little less); and then we did some sleep training so she would sleep better through the night (and so she nursed a little less)... and every time one of those transitions happened, and my body had to readjust to a new schedule, there would be at least a day or two of leakage problems. Needless to say, I ended up buying another box to replace the one I'd returned.

• Don't be afraid to sleep train! - and to get help from a sleep consultant. Figuring out how to get your child to sleep is HARD. Especially because - it keeps changing! What your little one is capable of, and the amount of sleep they need, keeps changing as they grow up. And so many things disrupt sleep - Developmental milestones cause sleep regressions! Teething causes sleep regressions! And everything you read online is contradictory and different. Sleep training (which for the uninitiated means helping your child learn how to put themselves to sleep without relying on nursing or rocking to sleep) comes in many forms, and there is countless debate about what process is best - but the truth is, ALL of the processes involve at least SOME amount of crying. And it is SO hard to hear that crying. But just because your baby is crying doesn't mean they are in Major Distress - it just means they are acknowledging that their routine, and the process that they used to use to fall asleep, has changed; they can't speak yet, so the only way they can communicate is crying. We tried sleep training a couple different times, in a couple different ways, and kept struggling to stay consistent until we finally hired a sleep consultant to give us reassurances (and hold us accountable), throughout the process. And it was SO worth it. Our daughter is now an amazing sleeper (knock on wood), with very little effort on our part other than "suck it up and endure hearing her crying a little more than usual for a couple days".

• The ideal two-nap schedule is: naps at 9 am and 1 or 1:30 pm. Most kids do two naps from about 7-8 months until sometime between 14-18 months, when they drop down to one nap. This was one of the things we learned from our sleep consultant - there are natural time periods when a baby of that age is more likely to be tired, and thus more easily able to fall asleep for a nap. If you can line their napping schedule up with those times, napping won't be such a struggle every day. And wouldn't you know it, a few small adjustments to her napping schedule so that she woke up for the day around 7 am, took her first nap starting at 9 am, and her second nap starting at 1 or 1:30 pm (depending on how long the first nap was), and she was sleeping SO much better.

• Teething does not always follow the "schedule." On two separate occasions, we took our daughter to the pediatrician, because she was having symptoms of teething, but "according to the schedule" she shouldn't have been teething again yet. The first time was around 9-10 months, when she seemed to be teething on and off for about 6 weeks straight, as her 4 lateral incisors came in. We thought there was no way she'd STILL be teething 6 weeks later, right? So we brought her in to see if maybe all her ear-tugging and rubbing was due to an ear infection. It wasn't. The second time was just after she turned a year old, when she was swallowing so much saliva she was wheezing a little. It seemed like she was getting her first molars in, "but how could she be?" we reasoned, when she wasn't "due" for molars for at least another two months? Again, we were wrong; it was just teething... I can't tell you the number of times I searched for teething schedules online, to check when her next teeth were "supposed" to be coming in - And it seemed the more I looked at those charts, the more wrong they were for our daughter. Her teeth did not come in the "right order" or during the anticipated time range - especially the older she got. For example, her bottom canine teeth came in first, even though the top canines are "supposed to". According to the chart, the bottom canines typically come in between 17-23 months; hers both came in early, at 13.5 months. At 1.5 years old, she now has all 20 of her baby teeth.

• You don't have to listen to age recommendations for food or toys. Because many of our daughter's teeth came in early, before the "typical range," she seemed ready to try other foods sooner. When she was 10 months, I was feeding her snacks and meals marked "12+ months" and now at 18 months, I've already been feeding her some snacks marked "2+ years" for a few months now. Unless there's an ingredients-related reason to wait (like not giving anything with honey in it until after 1 year old), the age recommendations are really just that - recommendations - and you can feel free to ignore them. You know your child best, and what they're capable of. I was always around to supervise when she tried something new, and if she seemed to struggle with it too much, I'd wait a couple weeks or months before offering it again a second time. Same with toys - the age recommendations on a box are there either 1) to tell you what age range MOST kids would get the MOST out of that toy, or 2) for liability reasons (e.g. just in case a small part broke off the toy and became a choking hazard). Our daughter had a crawling tunnel at 9 months that she loved to army-crawl through - but according to the box, the recommended ages were 3+ years! Then there were other toys we got her that were certainly a little advanced to what she was able to do when we first introduced them - but she found other ways to play with them that she enjoyed, even if it wasn't what the toy manufacturer intended. We got her a little car ramp toy marked 18+ months, which we gave to her when she was a year old. She could not put the cars on the little ramp herself at that age, but she loved watching us put the cars on the ramp for her, and she liked playing with the cars on their own. There were four cars of different colors, and she liked lining the cars up with the different colored ramps that matched the cars. She played with the toy that way for a few months, until around 15-16 months old, when she was finally able to line up the cars to fit them onto the ramp, so that she could play with the toy by herself as intended.

• Be prepared to waste food. Lots of food. Advice for feeding toddlers is like: "Offer a variety of foods, so they are introduced to a variety of flavors and textures!" "You may need to offer a food upwards of 20 times before they're ready to try it - so even if they don't like something the first time, don't give up; try again!" "Every meal - AND snack - should be balanced, with protein/dairy AND fruit/veg." "Give your kid options - they'll be more likely to eat if they're choosing what to eat!" "Don't force them to eat. Offer food and then let them decide how much to eat." All of those are great advice - BUT they also necessitate food waste. Keeping the house stocked with fresh fruits so that I can offer a banana or a kiwi as a snack, means sometimes the bananas (or kiwis) won't get eaten in time before they go bad. And that's not even counting the balanced plates that are prepared, only for them to refuse any of the things on their plate (even if they're things they asked for). I knew there would be some food waste, but I gotta say - I was not prepared for just how much food would end up in the trash every day (or, to our vet's chagrin, the dog's mouth). You either have to get creative for how to store and repurpose leftovers, or you have to just give in the inevitable food waste, try not to feel guilty about it, and get used to taking the trash out more often before the trash bags start to smell.

• Children develop at their own pace - and that's perfectly okay! Our daughter was not an early walker, or an early talker. (I blame the pandemic and our limited ability to socialize and take her out places to see other kids for at least some of that - but even during non-pandemic times, there are still always kids who walk or talk earlier, and others who walk or talk later, so who knows.) There were even times when her doctors expressed some concern that she wasn't hitting certain milestones soon enough - but from our standpoint, I was much less concerned. She likes to do things on her own, and if we tried to push her to practice cruising or walking, or tried to prompt her to repeat sounds or words after us, she would have zero interest. I knew she was capable; she just didn't want to yet. I could see that she was making progress in her own way, at her own pace, and was perfect fine with that - so I tried to be fine with that too. :)

I'm sure there's a ton more lessons I've already forgotten - but at least that list is a pretty good start. :)

2021 Diabetes Update

There really isn't much new to report on the subject of my diabetes, but there are a couple things of note: 

I'm still taking Levemir and Novolog insulin, and still breastfeeding my now almost-1.5-year-old daughter (usually about 3 times a day) - though it's hard to tell how much milk she's actually getting these days... I think she mostly wants to continue breastfeeding for the mama snuggles. :) Because I'm nursing a lot less frequently than I used to be, I end up having to increase my Levemir (long-acting) insulin by 1 or 2 units every couple months or so - my fasting blood sugars start slowly creeping up, and if they're consistently above 110 or so for a week or two, that's when I experiment with adding another unit of Levemir, usually at bedtime, though sometimes for my both my evening and morning doses. My doctors told me that would likely be the case - that as I breastfed less, or weaned completely, my insulin needs would increase. Currently, I'm taking 6 u. Levemir in the morning and 7 u. at bedtime. For meals, I usually take 2 u. Novolog with breakfast and 2 u. with dinner. Lunch tends to be a smaller meal, and often with less carbs, so I can often get away with not taking any insulin with lunch - but if it has more carbs than my typical lunch, I really should take 1-2 u. of Novolog at lunchtime too (though I don't always remember). 

I also continue to use the Dexcom G6 CGM (continuous glucose monitor), which is back to being pretty darn accurate (most of the time) now that I'm no longer pregnant or immediately postpartum. The biggest problem I've had with it lately is that Dexcom apparently changed the adhesive used to get the sensor stick to the skin - before, I would have problems with the adhesive coming off before the sensor's 10 days were up, and I had to use another overlay patch to make sure the adhesive stayed in place; now, the adhesive sticks a lot better but it also gives my skin a bit of a rash. I am not the only one experiencing this over the last year - there are a lot of forums dedicated to people discussing their skin's sudden allergic reaction to the adhesive, and various tips/hacks they've tried for how to fix it. I talked to both my PCP and my endocrinologist about it - the PCP was a little horrified at all the red patches all over my abdomen, and told me stop using the Dexcom at once, and talk to my endocrinologist about getting a different type of CGM instead; meanwhile my endocrinologist was like "how much does the rash bother you? because the G6 is the best CGM on the market right now, so if you like how it's working for you otherwise, you might just have to deal with the rash..." We've moved since then, and I've yet to see my new doctor (I have an appointment tomorrow, actually!), so we'll see if they say anything new. I've been dealing with it for the last year, and my skin seems to be having less of a problem with it over time, so unless a really easy solution comes along, I'll probably just continue with the G6. The rash is localized to where the adhesive patch is, and it might be itchy for the first day or two or wearing a new sensor. When I remove the sensor after 10 days, there's a red mark where the patch used to be. It was taking a month or so before that red mark would fade (so that I would have at least 2 or 3 red marks of previous patches on my abdomen all at once, in various stages of redness), but now they're fading faster, and by the time the next sensor's 10 days are up, the previous red mark is now more or less completely gone.

One of my biggest worries about my diabetes this past year was obviously the covid-19 pandemic. Type 1 diabetes was one of the chronic conditions in the "higher risk" category, meaning that if I contracted covid-19 I was at a higher risk of having a severe illness. Because of this designation, I spent the last year being more vigilant than many people. With a few exceptions early on in the pandemic, we had groceries delivered or picked up groceries curbside nearly every week. We didn't go out anywhere, or take our baby out anywhere, other than outdoor locations like parks where social distancing was fairly easy to maintain. It was such a relief to be able to finally get my covid-19 vaccine. I got the first dose of the Pfizer vaccine in March and the second dose in April, and didn't have any side effects with either, other than a sore arm at the injection site for about 24 hours after the shot. In early May I was considered "fully vaccinated" (two weeks after my 2nd dose), and we've spent the last month slowly starting to venture out more places - while still following CDC recommended guidelines for mask-wearing and social distancing.

The final diabetes update I want to mention is this amazing way to organize my diabetic supplies, which my husband came up with and executed soon after we moved into our new house. I wanted a way to be able to keep all my supplies that I use on a daily or near-daily basis organized and close to the kitchen table, while not taking up space on the kitchen table itself, or on the kitchen island. These supplies include my insulin pens (which are not kept in the fridge after they are opened and in use), my pen needles, my sharps container (a half-gallon size empty milk jug), my meter and test strips (for times when I need to double check what my CGM is telling me), and my little notebook where I keep track of food data and when I take my insulin. (Extra supplies, such as extra boxes of needles, lancets, and CGM sensors, I keep on a high shelf in the kitchen pantry, since I only need those every 10 days (for the CGM sensors) or every 15 days or so (for the needles). And extra insulin that haven't been started yet are stored in the refrigerator.) My husband attached this little basket to the side of the fridge for me, large enough to store my daily supplies, and also added a little shelf underneath it, on a hinge so I could fold it up when not in use, or fold it down when I needed to rest my insulin pens there while taking insulin, or my notebook there when I needed to jot down a note. I really love this system (it's been working great for me for the last 4 months we've been living here), and I really appreciate him building it for me! I just had to show it off/brag about him here. :)

Thanksgiving

It's Thanksgiving week! Since I have no new art to show you (see my previous post about moving), I thought I'd take some time to list all the things I have to be thankful for this year instead. I know for many 2020 has been a really rough year, in many ways - and I feel very fortunate to have so have so much to be thankful for in such a bleak time.

The year started with the birth of my daughter on January 1st. What a way to start the year! It has been amazing these last ten and a half months watching her grow. From nursing to pureed foods and sippy cups, and now to eating the food off our plates; from barely being able to lift up her head to learning how to roll and sit and crawl and stand; from sleeping constantly to never wanting to sleep at all (why sleep when there's so many things to learn, so many rooms to explore, so many ways to play!) - she has been a constant source of wonder and joy throughout 2020.

On a similar note, I am also so thankful for my husband, who is the best dad to our daughter. The pandemic meant all of his classes for his master's program went fully online in the spring; once he found a job and started working full-time again, that was also remote. I love having him home so much, especially while our daughter is so young; even if he's working, he's still close enough that he can join us for walks around the neighborhood or a bit of playtime during his lunch break. He has gotten to watch her grow just as intimately as I have, and they have a wonderful bond. It's also been amazing for me, to have someone around to help get her down for naps and bedtimes when she just refuses to sleep, and to share in some of the daily stresses of parenting a baby.

I am thankful to have spent the majority of this year in Rochester Hills, which has so many great outdoor spaces. Over the summer, when we were bored staying inside our house but didn't feel comfortable taking our daughter to all of the places I'd once imagined taking her during her first year (to the library, and to stores, and to the zoo, and to anywhere else fun I could think of), we still had plenty of opportunities of places to go. We visited several nearby parks and took her on walks (in her stroller or in a baby carrier) along the Clinton River Trail, which was a lot of fun for her and our dog, and great fresh air and exercise for all of us.

I'm grateful that my husband was able to find a job he's really excited about, working for a non-profit he's really excited about, and that his new employers value his health and are taking this pandemic seriously. I'm also grateful that we were able to find a house we love in a neighborhood we love in Ann Arbor, and that we have the time to move there more gradually than we otherwise probably would if my husband wasn't working remotely and was already in the Ann Arbor office.

I'm thankful for our families - those who have been able to visit (once the stay-home order was lifted), entertain the baby, and help us move; and those who live farther away but still made time for countless Skype and Zoom calls to visit with our daughter safely (and virtually). They say it takes a village to raise a child, and this pandemic has isolated many from their villages; I'm so appreciative of the efforts made to make sure that wasn't our fate.

5 Months of Motherhood

When I planned making a blog post after a few months of motherhood, I didn't expect it to be quite like this one. I envisioned a quick check-in where I would reflect back on how things have been going, and how much (or how little) art and writing I've been able to do compared to what I thought I'd be able to squeeze in, now that baby duty is taking up so much of my time. I counted on sleepless nights and long days, crying jags and learning curves, as I learned what my daughter needed from me - and when. But I didn't anticipate a global pandemic casting a shadow over these first several months, and how that might factor into my art and writing plans.

Michigan was under stay-at-home orders from mid-March until the end of May - 2.5 months altogether. Or, to put another way, half of my daughter's life to date (she turns 5 months old today). In many ways, our lives were not upended by this nearly as much as other people's lives were. We were already basically social distancing while our baby was young - limiting visitors to those who had received flu shots, and avoiding taking her out into any crowded public spaces. Furthermore, I was already planning to be home with her full time (ramping up to working from home part-time around the 3 month mark), and my husband was finishing the last bit of his master's degree by driving the one-hour commute to campus twice a week for classes. We had already restructured our lives to being home with the baby as much as possible - so when the pandemic altered our work and schooling, it was only "in our favor," letting us be available to our baby even more. My working from home was pushed back (with no events happening, there's little to design flyers and emails for, so I haven't been needed); and instead of going to Ann Arbor, my husband's classes moved online, letting him be home with us all 7 days a week. It's never a good time for tens of thousands of deaths - but from our standpoint, being granted even more time at home with our baby has actually been really nice.

Still, if you thought both of us being home all the time meant I had even more time to do all that art and writing I'd planned on doing, you'd be wrong. I did manage to complete two 8"x10" colored pencil drawings since our daughter was born - but these were both done in January/February, before the pandemic hit our state, and before the stay-at-home orders began. I've done very little art (and no writing) since.

It's not that I don't have time for it - after all, I managed to squeeze in some time in January/February. It's just that it hasn't been a priority for me lately. For one thing, as our daughter got a little older, and staying awake longer, it's been so fun and rewarding to spend that awake time with her every day, playing and taking pictures and videos of her. Even when my husband is available to watch her and I could take a break, I often choose not to, just because I don't want to leave her side. I'd probably feel this way regardless, but I'm guessing that the pandemic has exacerbated this feeling. When we can't leave the house, and no one but my husband and I can see her every day, it seems more important to witness and document all of those moments, and to share daily photos and videos with the grandparents, who haven't been able to visit during all this.

Another aspect is that I feel obligated to make the most of our time at home with her, since she's "missing out" on other experiences outside the home. It's true we wouldn't have been doing much with her yet anyway, but I had wanted to start taking her to storytimes at the library, or just to different stores to let her look around and experience new things. Now, if I want her to see something new, I have to try to find a corner of the house we haven't spent much time in yet. Expanding her horizons is not as "easy" as packing up the diaper bag and heading out somewhere (though that is never easy either, I'm sure!). We're lucky that she's still so small, and that so many things are new to her. I feel so bad for parents stuck at home with toddlers or kids, whose worlds had already opened up a little past their own houses, only to have this situation shrink their worlds smaller again. Our daughter doesn't yet know what she's missing out on.

Still, she isn't playing or feeding ALL the time - she's a baby, and she also naps. And that was when I'd planned to do any art or writing I wanted to do - while the baby was sleeping. But she isn't the best at napping during the day, and I suspect that's because she hasn't had to be. Instead of trying to make her conform to our schedules, we didn't really have a schedule anymore - and so were able to let her dictate her own routine however she wanted. Plus, we're both always home to hold her or pick her up if she cries, or rock her to sleep so she doesn't have to self-soothe. For a long time, she wouldn't nap in her crib at all - only in our arms (though she's starting to finally get a little better at that). Part of me wonders also if she'd be a better napper if her world was more "exciting" during the day. If we could pack her up and take her out somewhere, to show her a totally new place she hasn't seen before, would that extra bit of stimulation tire her out more, and help her sleep better?

She still often naps for only 30-45 minutes at a time, which means she ends up taking 4 short naps like that throughout the day. In the last month or so, I've been trying to rectify that - trying to encourage her to sleep longer, so she can also go longer between naps, so that we're only down to 3 naps a day. It's hard to get anything done when I only have a 30-minute window. It's not impossible, but it's harder. And when I don't have the motivation to prioritize squeezing in 30 minutes of work on a colored pencil drawing... it doesn't get done. I was able to do it early on, in January/February. But now it's harder. For the first part of the stay-at-home order, I was on my phone a LOT, reading news articles and keeping track of how many new cases and deaths there were - in the world, in the U.S., in Michigan, in our area. It burned me out a little - it left little time to work on any of my creative pursuits, and with little motivation to do so. I've also been doing more planning - planning dinners several days in advance, looking up new recipes to try to be creative with what ingredients we already have on hand in the pantry (and yes - hopping on the quarantine baking train), and those things also take up time I might otherwise spend on art or writing.

All of this is to say... I am very "behind" on the plans I'd made for creating art this year. All of the posts you've seen these past few months, and many of the ones I have scheduled for later in the year, are all things I made in 2019 (though the next two posts will be of the colored pencil drawings I did in January/February). I kind of figured I was overestimating how much time I'd have, and that I'd fall behind on my plans for 2020 artwork - but I didn't think it would be because of a pandemic. I hope to start making more art again in June, and getting back to my plans. Once our baby starts napping a little better (more consistently, for longer time spans, and actually IN her crib), that will help; so too will the grandparents being able to visit again, and the weather (finally!) getting nice enough to go out to parks, etc. I think that the more time we're able to spend with other people, or out of the house, the less pressure I'll feel to be present with her for ALL of the time spent at home with just us and her - I'll allow myself to sneak away and steal 30 minutes here or there for some art projects, knowing that I already did a lot to stimulate her at other times of day.

Or, you know, I'm just kidding myself again, and when I reevaluate in another few months, I'll find that I'm still super behind on all my artwork plans. :)

Diabetes & Pregnancy: The 4th Trimester

NOTE:
This post is a continuation of a series about managing my diabetes while trying to get pregnant and being pregnant. For more, you can check out these previous posts:

Diabetes Type 1.5/LADA
Diabetes & Miscarriage
Diabetes & Pregnancy: The 1st Trimester
Diabetes & Pregnancy: The 2nd Trimester
Diabetes & Pregnancy: The 3rd Trimester
Diabetes & Pregnancy: Childbirth

As always, these posts are not meant to be taken as medical advice, and merely discuss my personal experience with my specific diabetes. Everybody's experiences are different, and I am only speaking about mine.

***

My last post about my diabetes talked only a little about how my blood sugars and insulin needs changed after giving birth on New Year's day, January 1st, 2020. The focus of that post was more about managing my diabetes during labor and delivery, with just a few passing comments about changes that happened in those first few days after, while I was still in the hospital. This post will pick up where that one left off, continuing through the first three months postpartum - a time period some refer to as the "4th trimester," when a person's body readjusts to a state of no longer being pregnant.

Before becoming pregnant, I had only been on Levemir (basal insulin); I had no prescription for Novolog (mealtime insulin) until I first saw MFM at 8 weeks gestation. (MFM = maternal fetal medicine, the doctors and nurses who helped me manage my diabetes while pregnant.) My pre-pregnancy Levemir doses were 5 u. in the morning and 7 u. at night, for a total of 12 u. Over the course of 9 months of pregnancy, my total Levemir increased to 16 u., though we shifted when the bulk of it was taken, to 10 u. in the morning and 6 u. at night. I also started taking insulin with meals; by the end of my pregnancy, I was taking 12 u. Novolog with breakfast, 5 u. with lunch, and 6 u. with dinner. This increase in insulin requirements happens because the placenta causes insulin resistance - meaning that my body needs more insulin to process the same amount of blood sugar. (Though to be fair, I also wasn't eating the same amount of carbs during pregnancy as I had been before... Once I had access to mealtime insulin, I didn't need to be on a lower-carb diet anymore - and was actually told NOT to be, since growing a baby requires quite a bit of energy from carbohydrates. So I also was giving my body more blood sugar to process, as well.)

It was expected that after giving birth, my insulin needs would go back down to approximately what they'd been before getting pregnant. But I wanted to continue taking mealtime insulin after giving birth so I had a bit more flexibility with the amount of carbs I was "permitted" to eat - especially since I was planning on breastfeeding for the first several months of my baby's life, and would need similar dietary needs for breastfeeding as I had while pregnant. And that meant I couldn't just revert back to exactly what I had been taking pre-pregnancy, when I was taking enough basal insulin to cover post-meal glucose spikes as well. Still, those pre-pregnancy doses gave us a baseline to start at, with the expectation that it might take a bit of time to figure out exactly what insulin doses I should be taking for my basal insulin and at meals.

Taking all that into consideration, MFM recommended that I try 4 u. Levemir in the morning and 8 u. Levemir at night, for a total of 12 u. of basal insulin (same as I'd been taking pre-pregnancy). They also suggested that I try NOT taking any mealtime insulin at first, doing only 1-2 u. corrective doses if my blood sugar was high two hours after eating, until I better understood how much insulin it might be prudent to take with each meal. I wasn't super into that idea (it seemed like the first step toward ending up back where I was pre-pregnancy - only taking basal insulin and not having access to mealtime insulin), but they were the recommendations I brought with me to the hospital nonetheless, and what I planned to implement in the first few days after delivery.

That plan lasted one meal.

Other than a 2 am snack a few hours after giving birth, my first real meal postpartum was breakfast on January 2nd. Following MFM's plan, I took 4 u. Levemir and no fast-acting mealtime insulin. Three hours later, my blood sugar was at 197, and I took a corrective dose of 1 u. - which did the trick and brought me back down to normal ranges. Still, I was over that nonsense. Managing my diabetes at the hospital required jumping through a ridiculous series of hoops multiple times a day: reminding the nursing staff when to check my blood sugar (per their own protocols - I had my own ways of checking my blood sugar on my own any time I wanted), asking the nursing staff for access to insulin, having a doctor sign off on the dose, and waiting for the insulin to be brought into the room - all while my hospital cafeteria food grew cold as I waited. Taking a "wait and see" approach with every meal just meant even more of a hassle - a hassle I didn't need on top of everything else. We were dealing with my baby daughter's low blood sugar, treating her with glucose gel and formula, and trying to establish breastfeeding; I didn't want to be subjected to extra blood sugar checks in the middle of all that, making decisions to correct highs after the fact. It seemed easier to just take preemptive insulin and avoid the highs in the first place.

Of course, I was also still very much in the mindset of keeping a very tight control over my blood sugars - a mindset that it was hard to get out of. For the past year and a half, I'd tried to keep my blood sugars below 120 at all times - during my first pregnancy (which lasted 8 weeks and ended in miscarriage), during my second pregnancy (which was full-term), and during the months in between, when I started using my CGM and we were trying to get pregnant again. When you start thinking of anything above 120 as bad, 197 seems downright criminal. (Compare that to the typical recommendation for (non-pregnant) diabetics: keeping blood sugars below 180. If that's the goal, 197 doesn't seem nearly as off-target.)

There was also this: I expected to experience lows postpartum. I'd read that some diabetics struggle with low blood sugars when breastfeeding, and so had taken precautions to strategically leave snacks around my house in the places I planned to do a lot of nursing, just in case that became an issue for me. I also brought a lot of snacks with me to the hospital, for this same reason. So I felt more prepared (both mentally and literally) to deal with the possibility of lows than highs.

All of this meant I started requesting 1-2 u. of mealtime insulin with breakfast, lunch, and dinner (depending on what my blood sugars were before eating, and what exactly I was planning to eat). I suspected this might require a change to my basal insulin, since now my total insulin levels were likely higher than they needed to be - but I figured it'd be easier to take too much insulin and then treat with more snacks if I needed to, than to not be taking enough insulin, and need to add more - especially since I often had to wait at least a half hour (and sometimes as much as an hour or more) between my request for insulin and when the hospital staff would bring it to me.

Still, even with that extra mealtime insulin I started taking, I didn't experience a postpartum low until 6 am on January 4th. I was getting so little sleep (up all hours of the night trying to breastfeed or pump, and visiting my baby girl, who had been taken to the NICU for a couple days to monitor her nasal congestion, breathing, and jaundice levels) that I was often hungry and ate frequent snacks - my body's way of compensating for lack of sleep, I guess. I decided to run an experiment; the night of January 3rd-4th, I didn't eat any snacks after 10 pm. Finally, I saw the low blood sugar I was expecting. When the nurses came to check my fasting blood sugar, I was at 61; my CGM said 62. During my pregnancy, I only very rarely felt hypoglycemia symptoms; for my first postpartum low I again didn't feel any symptoms. The nurses brought me graham crackers, and I ate those before breakfast.

I was discharged later that day, even though my baby was still in the NICU. We were allowed to board in another hospital room closer to the NICU for a couple days. My insulin pens were returned to me, and I was once again able to manage my own diabetes, but we were still on the hospital premises until our baby was also discharged on January 6th. I knew from the "experiment" I'd done that I had to eat a snack at least once overnight - one of the times I was up anyway, nursing or pumping - or risk going too low. Alternatively, now that I had access to my own insulin again, I also had the option of adjusting my insulin however I saw fit, without having to run it by the hospital staff. I could choose to not take insulin with a snack or meal, and then more easily correct it after the fact, if I saw myself going too high. Or I could decrease my basal insulin, to compensate for the fact that I was taking more mealtime insulin than MFM had originally suggested.

At first, I continued to follow the insulin plan I had been doing (4 u. Levemir in the morning, 8 u. Levemir at night, and 2 u. Novolog with breakfast, lunch, and dinner), making sure to eat snacks in between meals when needed, and at least once overnight. I made it through the night of January 4th-5th this way with no problems. But the next night, my CGM urgent low alert went off before I ate my middle-of-the-night snack, and I found myself needing juice and a snack during one of the few chunks of time I'd been able to set aside for sleeping. A few hours later, when I woke up to eat breakfast, I was back down to 74 again - not low, but getting close.

I was beginning to understand that I was trying to keep unnecessarily tight control over my blood sugars. I didn't need to subject myself to occasional hypoglycemia in an attempt to keep my highs from getting too high; I wasn't pregnant anymore, and didn't need to stay below 120. Now, it was more important for me to avoid lows, rather than to avoid highs - especially if my body was still unaware of my hypoglycemia, showing no symptoms. What might happen if I was unknowingly low while holding and carrying around my newborn? I had to ease up on my blood sugar control to take better care of myself - so I could also take better care of her.

My daughter was discharged later that day, and we finally got to take her home. At home, I ran an even greater risk of hypoglycemia for two reasons: 1) I had access to a wider variety of food, including options with fewer carbs, meaning I ate fewer total carbs throughout the day than I had at the hospital, and 2) now that she was no longer in the NICU, she was under my and my husband's care 24/7, without help from the NICU nurses. It was harder to find time to eat several snacks throughout the day just to keep my blood sugars up, when I was responsible for every feed (no more supplementing with formula!). That night, my blood sugar was at 77 at 10 pm. I decided it was time to start decreasing my insulin; I took 6 u. Levemir instead of 8.

This was the right choice - my blood sugars stayed pretty steady within a good range of 70-140 over the next couple of days. I hadn't had another overnight low. Still, when I called MFM to discuss the change I'd made to my nighttime insulin, they recommended that I decrease it even further, going down to 4 u. Levemir at night. They also suggested I cut my lunchtime dose to 1 u. instead of 2 u. (Though, I admit - going through the whole process of using an insulin pen needle to take only 1 u. seems a bit silly to me... I usually choose to either not take any insulin, or to take 2 u., depending on what my blood sugar is before eating and what I plan to eat.) 

A few weeks later, I switched my care back to my regular endocrinologist, and he agreed with my decision to continue taking those doses (or near those doses, per my discretion) - so that's precisely what I've been doing since January 8th:

- 4 u. Levemir in the morning

- 2 u. Novolog with breakfast

- 0-2 u. Novolog with lunch

- 2 u. Novolog with dinner

- 4 u. Levemir at bedtime

This seems to be a good amount of insulin for me. There are times when I see slightly higher numbers than I grew used to seeing over the last 1.5 years - but those "highs" aren't too high, just higher than what I was aiming for when I was pregnant. There are also times when I have occasional low blood sugars. But both scenarios seem less frequent than I was experiencing when pregnant - my blood sugar in general stays steadier, with fewer peaks or valleys. Everything acts a little more predictably, and easier to control.

In fact, everything has gotten so much "easier" that I've stopped counting calories and carbs of the things I eat. I still try to eyeball portion sizes and guess how many carbs I'm eating, but I don't add everything together when I make a recipe. Maybe I've just gotten better at guessing what 40-50 g. carbs looks like, after meticulously counting everything for several months; or maybe it really is that my blood sugars are steadier even if my estimate is "off" and I'm closer to 30 or 60 g. It probably also helps that I continue to use my CGM (continuous glucose monitor) - I can see at a glance what my blood sugar is doing and if it's trending up or down, which in turn influences what I decide to eat for a given meal or snack.

When I started making this change, I thought I'd only do it for a couple months. Recording every gram of carbohydrates I ate was just too much to keep track of on top of recording nursing sessions and diaper changes. (The first I'm still keeping track of, so I know how often (and how long) my baby eats; the second we kept track of for only the first 3 weeks or so, to make sure she was having enough wet/dirty diapers). But as time went on, and my blood sugars still stayed within a good range, I decided to continue being "more lax" about what I was eating. 

Constantly counting carbs can start to feel like an eating disorder after awhile - even if it's done for a healthy reason, like knowing how much insulin to take. I find that it can really start to negatively impact how I feel about certain foods, leading to me thinking of foods as "good" or "bad" - and myself as "good" or "bad" depending on what I choose to eat. I want to model for my daughter how to have a healthy relationship with my body and food. I don't want her growing up thinking that some foods are "bad", nor do I want her seeing me obsessing over numbers and constantly adding up nutrition facts in my head to determine whether or not I can allow myself to eat something in that moment. I don't want to pass on disordered eating to her.

If/when I am pregnant again in the future, I will probably have to revert back to my hyper-vigilance, making note of everything I eat. Not only is it important to have tight blood sugar control during pregnancy - it's also a lot harder. Part of that is because the targets are stricter - but it's also just hard to keep up with the changes a pregnant person's body is going through. Eating 30 g. of carbs vs. 60 g. of carbs makes a much bigger difference, and everything seems to follow a much less predictable pattern, which makes simply "eyeballing" foods a lot more difficult. 

In fact, I may even have to revert back to recording what I'm eating once I stop breastfeeding, and my body once again readjusts to a new normal. My endocrinologist told me that I will likely continue to need only about 12-14 total units of insulin a day as long as I'm exclusively breastfeeding. Not only does nursing burn calories - it also creates another avenue for excess glucose to exit my body, in addition to the traditional avenue of urine. (For those who don"t know, the full scientific name diabetes mellitus actually comes from the Greek words for "sweet urine".) Of course, I don't want to give my baby excess glucose through my breastmilk - but the fact remains, in those rare times when my blood sugars are a little too high, I probably do... to the benefit of my own blood sugar, at the expense of hers. (Thankfully, my baby's pancreas is better equipped to handle that excess.) Once we start introducing solid foods in a few months and she starts breastfeeding less and less frequently, my insulin needs are likely to increase a little again. But for now, I seem to be doing okay without recording everything I eat, and I intend to continue doing it this way until my blood sugars show that that approach is no longer working. I'm hoping that, moving forward, keeping such careful track of my carbs will be a the exception rather than the rule - something I only do temporarily, when pregnant or going through a similar hormonal shift (e.g. menopause), or when I'm making a lifestyle change (e.g. weaning off breastfeeding, or if I suddenly decided to start training for a marathon or something - HA!).

Another thing I've had to readjust since giving birth is how I wear my CGM sensor. During pregnancy, I had so many problems with my CGM giving me false low alerts, or going entirely offline and being unable to register my blood sugar, that I started wearing it on the back of my upper arms instead of on my abdomen. (My growing baby bump made it hard to have enough available belly fat for the CGM, which is inserted into subcutaneous fat tissue.) For the first few weeks after giving birth, I continued to wear it on my arm - until my arm started giving me the same sorts of problems. My postpartum body now had plenty of belly fat to work with - and my arms did not, as my baby continued to grow and I spent much of my days carrying her and holding her. So I switched back to putting my CGM sensor on my abdomen instead.

There is one final aspect I want to talk about - the guilt and worry that comes with being a diabetic mother. Every time my baby has a health problem, I wonder if my diabetes caused it. When my baby had some trouble with nasal congestion and breathing in those first few days after birth, was it because of all the IV fluids I was given during induction - something that wouldn't have had to happen if I hadn't been diabetic? When she had jaundice - both in those initial days and over the course of the next several weeks, in what was ultimately determined to be "breast milk" jaundice - was it because I, a diabetic, was breastfeeding her? When her blood work came back indicating high liver enzymes for several weeks in a row, even after her jaundice had finally disappeared, was it because nine months in a diabetic womb, or months of being breastfed by a diabetic, or just an unfortunate combination of my "autoimmune disorder" genes, had somehow damaged her liver or some other liver-adjacent organ (such as the insulin-producing pancreas)? 

We all have predispositions we might pass along to our children, and things that we've experienced that we want to see our children spared from - but from my perspective, being diabetic seems to amplify those worries. I'm not just worried about passing along some bad genes or less desirable habits - I also worry what the physical environment I'm exposing my daughter to. Hopefully as she gets older - once she has spent more time outside my body than inside of it, and as I wean her off my breastmilk someday - her body will feel less connected to my own, and those worries, at least, will start to fade. Then my diabetes and the choices I make for how best to manage it will only affect my body, my health - and not also hers.