My last post, a few months ago, detailed how I’d found out I have papillary thyroid cancer. I omitted something crucial in that post, because I wasn’t ready to blog about it. But now I am.
At the time I found out I had thyroid cancer, I was eight weeks pregnant. This is far from unprecedented — thyroid cancer, one of the few cancers that regularly strikes young women, co-occurs relatively often with pregnancy. So when I found out my diagnosis, all of a sudden the question became: when can the thyroidectomy be performed? The standard of care twenty years ago was to remove it in the second trimester. The standard of care in 2012 is to wait for the birth of the baby. I did some research, read some papers, talked to some thyroid cancer survivors. I didn’t let it overshadow my few weeks in Europe (on business, then on pleasure). When I returned to the States, my husband and I saw a thyroid surgeon that my endocrinologist trusts. I had another neck ultrasound and confirmed that the cancer is tiny and not going anywhere. I talked with my HR department. Finally, in the end, we decided to postpone the thyroidectomy until after the baby comes.
In the three or four months since that decision, it sounds funny to say that thyroid cancer has been the furthest thing from my mind. And yet somehow, it has been. All the near-impossibilities of a diabetic pregnancy have been taking up all the headspace I use for medical concerns.
I’m 26 weeks pregnant now, and it seems like every week presents a new conundrum. When I was in my first trimester, my endo put me on aggressive insulin-to-carb ratios, and my main problem was lows. Two or three hours after breakfast, I would have lows that knocked the wind out of me and sent me scrambling for the economy-sized bags of Skittles I’d had to buy. I was lucky to only wake up low once. (I don’t have a CGM.) The worst low I had, the most terrifying one of my life, was when my husband and I were out snorkeling during our belated honeymoon cruise. I was twelve weeks pregnant, give or take, and still seeing those awful lows. We’d been swimming around for a good while when I suddenly felt that heart-pounding fight-or-flight response that is my indication that I’ve plunged to 60 or worse. Then I had to swim myself to shore so I could get to the Skittles I’d brought with me. I think I was in the 50s. It took a long time before I felt safe enough to go back in the water.
I coasted along fine until well into my second trimester. Then the highs started, the “what the hell??” highs, the “I bolused properly!!” highs. It feels like every week or every two weeks, there suddenly comes a day when I can barely beat myself back under 200, and I make these ridiculous-seeming adjustments, and then I settle back into some sort of normalcy.
I can’t believe how much insulin I need now. At 6 weeks pregnant, my Total Daily Dose was around 30 units. A week ago, it was 65. Yesterday (the day I hit 26 weeks), it was 100. I used to fill my cartridge partway and leave it for four days. Now I’m lucky to make it two days on a full cartridge. I did my first cartridge refill yesterday, because I couldn’t face the thought of using a new cartridge so soon.
I read Balancing Pregnancy with Pre-Existing Diabetes months ago, before I got pregnant, but what I don’t remember much of it. What I remember:
- Insulin requirements go through the roof. (Yep. I don’t think reading that can prepare you, though.)
- The author ate the same thing for breakfast every morning, and tried to keep to very similar lunches and dinners. (This is not good advice, at least not for me. I’m on a ten-day business trip right now, stuck in a hotel room with a fridge and microwave but nothing else. I eat whatever the hotel provides me in the morning, something I can keep in the fridge for lunch, and restaurant food for dinner. There’s no way around it.)
- One woman said that other women are crazy to try this without a pump and a CGM. (Well, I have a pump . . . .)
Pregnancy with diabetes feels as though the monster I’ve been successfully keeping under the bed for years is suddenly growing larger and larger, knocking over my bed, tearing my room apart, trying to escape and rampage over the countryside. And the only weapon I have is this little pager-sized thing I keep sitting on my hip.
Having read back over everything I’ve just written, I realize I haven’t said anything about my pregnancy as it doesn’t relate to diabetes. Since I’d rather end on a sweet note, maybe I should wrap up by saying that my husband and I are totally thrilled. Normally we end every night with him telling the kid a bedtime story. (Well, not always a story, exactly. Right before I left for this trip, he was telling the kid which classic video games he’s going to play with him or her.) As much as pregnancy is not my favorite thing (besides the insulin madness, I also have sciatica, heartburn, pelvic girdle pain, and GI issues), I’m glad I’m able to fight through all the bad parts in order to create a person for me and my husband to love and and raise and teach how to play Super Mario Brothers. Only fourteen weeks to go, and I guess I can do anything for fourteen weeks.