I'm pregnant!!

I'm 21 weeks along and still can't really believe it! I am having a C-section scheduled for Dec. 29, 2008, and we found out we're having a little girl! We are so excited. (I'm having a C-section because I broke my pelvis in a car accident several years ago-- not because of my T1.) Here is a picture of all the tests I took in May, when we found out I was expecting! (You can tell that I always like to double-check everything, right?!)

So far, everything has been great. I am sort of nervous, though, for the 24-week mark, because that's when my blood pressure might start to elevate, since I have had T1 for several years and my risk for pre-eclampsia is therefore significantly elevated. Right now, I check my bp every night, check for ketones every morning, and of course check my bg several times a day... and I record all these readings. At 24 weeks, I will start checking my urine for protein every morning (as well as ketones), weighing myself every morning (oh great), and checking my bp twice a day. I am praying that I won't have pre-eclampsia! For some reason, pre-e is my biggest fear.
Tests, tests, and more tests
When women with D say that pregnancy is a lot of work, they're not kidding!! You not only need to stay on top of all these tests and numbers, but you go to the doctor all the time too. I didn't tell my boss at work until I was about 18 weeks along, and I pretty much HAD to tell him because I was leaving early/coming in late pretty frequently because of all the appointments. I see a perinatalogist and my endo pretty frequently-- I see the peri about every 3 weeks and my endo and CDE about every 6 weeks. I am also seeing my opthamologist twice during the pregnancy-- my next visit with him is at 24 weeks. I have also learned that you have to have your standard A1c, fructosamine, microalumbin, and thyroid function tests every six weeks, plus other special tests for the baby. So those tests also require time off. I had to do a 24-hour urine collection in my first trimester, just so they'd have a baseline protein/creatinine reading to use for comparison later. I also had a nuchal translucency scan at 12 weeks, which tests for Down syndrome and other chromosomal abnormalities. The nuchal came back with a great result-- the riskk for this baby having a chromosomal abnormality is about 1 in 10,000, which is the best it can be. At 17 weeks, I had an alpha fetoprotein (AFP) test, which is a blood test that measures a protein in my blood. For PWD who depend on insulin, the threshold for an acceptable level of that protein is lower than the rest of the population. I couldn't really get a clear answer on WHY this is, but kept getting answers based on the fact that it is a statistical measurement. Anyway, for women who do not take insulin, their level is abnormal if it is above 22 (I think-- I am relying on my memory of what the dr. told me here!). For women with D who take insulin, their cut-off is 19. My level was 19.2, so it was a little elevated. For that reason, they did another ultrasound to look at the baby's spine, because an elevated AFP level can indicate spina bifida or other problems that occur when a baby's organs haven't closed-up all the way, such as kidneys, abdominal wall, and (the worst) the brain. From they ultrasound, they determined that my level of 19.2 was insignificant, because the baby looked perfect. Only then did they also tell me that the test isn't very reliable. Geez!!
I also went to a pediatric cardiologist, who did a fetal echocardiogram. He determined that the baby's heart looks great, but that she will have a heart murmur because one of her heart walls had not closed all the way, so a tiny amount of blood leaks between two of the chambers. I'm going to go back and have another fetal echo at 33 weeks, so that we can see if that wall went ahead and closed. He said it almost certainly has nothing to do with my T1-- people have these types of heart murmurs all the time and they're really not anything to worry about. My husband and my brother both heart murmurs, so I wonder if it's genetic.
Here's a picture of me at 18 weeks... I am still not showing too much. (I just look fat!)

Random info for women with D who are thinking of getting pregnant
So here are some tips that I wish I'd known before getting pregnant (both D-related and non-D-related!):
* If you sleep on your back, it is really hard to teach yourself to sleep on your side!!! You have to start sleeping on your left side at 20 weeks.
* You will be low ALL THE TIME during your first trimester. And you must have calories on board before you go to sleep or you will wake up with ketones, and they make you feel queasy. My experience was that the baby takes TONS of carbs/sugar out of your blood to develop during the first trimester.
* Complications with the pregnancy are not inevitable. It really has to do with your A1c more that anything. My A1c has stayed below 6, so my peri does not seem concerned. We're going to carefully watch the baby's weight gain in the coming weeks, but right now, she measures in the 45th percentile.
* Exercise is your best friend... Knock on wood, but I still have not had to increase any of my insulin doses and I'm almost 22 weeks. I've heard that you're supposed to hit insulin resistance at around 20 weeks because of the hormones that the placenta secretes, but I truly believe you can delay this resistance if you stick with your exercise routine. Sometimes I jog, but I usually just walk or use the elliptical at the gym, and I get at least one 35-minute session of exercise 6-7 days a week. And I am currently taking about 24 units of insulin a day.
* You will gain weight in the first trimester because you have to keep eating to treat the lows. I lowered my doses countless times but still kept getting low. I have issues with the weight gain, but keep telling myself that it's worth it and that I'll lose it after December!!
* Don't freak out if your bg spikes. Spikes do happen when you're pregnant, but my experience has been that they're less frequent; you're on the bg roller coaster a lot less frequently than before. I had a bad spike at 13 weeks because my pump site CAME OUT at work and I didn't know it! I freaked out. But my A1c was still good, and we can't tell that the spike affected the baby at all. About once or twice a week, my bg will be around or above 200. I don't freak out about these, but I just get them down as quickly as possible.
* Use exercise to treat high bg's when you can. If my bg creeps up above 150, I go for a walk. I work near the National Mall in D.C. and will leave my office (if I don't have a meeting or anything scheduled) and go for a brisk walk for 15 minutes. It works so much more quickly than a bolus.
* Find some good online resources and read about the experiences of other women with D... I love http://www.diabeticmommy.com, Kendra's blog at http://sugarsick.blogspot.com, the pregnancy blog at http://www.diabetessisters.org/, http://thesweetnesswithin.blogspot.com/, and http://www.type1mum.net/blog//.
* I recommend thinking about how to tell people that you're pregnant and preparing yourself for all kinds of reactions. Relatives can say rude things when they hear you're expecting if they know you have T1. All the more reason why I am so private about my T1. But sometimes people blab about your T1 even though they know you are private about it.... this is probably a topic for another blog post, though! LOL
I'll try to post more tips as I learn more. These are just from my own experience...
Any other ladies out there who have been pregnant with T1? Please let me know if you have any advice!! :)