Sleep is for the weak. Not really. I’d love to get some.
Most people know that getting sleep while pregnant is challenging, but throw type 1 diabetes into the mix and sleep becomes almost impossible. Right now, I’m averaging 1-2 good nights of sleep a week. I have a few new readers so I’m going to be thorough with the diabetes terms, but all you folks without working pancreases can feel free to skip those sections.
Anyone with type 1 diabetes knows that a full night of rest AND good blood sugars are a luxury. If your blood sugar is too high, you wake up in the night to pee (or worse). If your blood sugar is too low you have to wake up to eat a snack (which is oh so fun when you are a) tired b) not hungry or c) on any kind of weight loss program). In the case of low blood sugars, you hope that your body wakes itself up, albeit confused, shaky, in a cold sweat, with a racing heart rate, or general weakness. Every person with type 1 diabetes keeps some form of sugar on their bedside table to avoid getting out of bed and hiking to the kitchen for some juice. For non-diabetics to understand, you know that feeling when you are snug under your covers and don’t want to get up on a Saturday morning? Imagine that feeling except your life depends on it and it’s harder because your body and mind are in a weird state of confusion. For me, I keep Hi-C and fruit snacks on my night stand. This is something people with diabetes deal with silently every night, and for me I’ve been dealing with this for almost 19 years.
Now throw into that mix pregnancy with diabetes. I have my continuous glucose monitor set to alert me when my blood sugar gets below 60 or above 130. This means that if I’m actually sleeping soundly, I will get alerted with a shrill deafening sound (my husband and I think it sounds like a smoke detector) if my blood sugar passes those thresholds. Since I cannot “trust” my sensor while sleeping (I’ll get to that in a minute), I have to turn on my bedside lamp and check my blood sugar with my meter, then in a state of sleepy haze I have to decide how much to eat or how much insulin to give. Often if I am low now, I count out 4 or 5 fruit snacks and only eat those because I know eating the whole pack of fruit snacks will send me past my tiny goal range of 65-130. The goal range is so small, every tiny thing you put in your mouth counts. I compare it to trying to land a fighter jet on a battleship, there are those that can do it, but they have had years of Air Force/Naval/Army training, and it is no easy feat.
My insulin requirements change roughly every 2-3 days, so if something works Monday, it may not work by Wednesday. That’s part of being pregnant with type 1. You’re trying to hit a moving target and if you make one shot, you should celebrate that success, but the likelihood you make the next is very small.
Pregnancy with diabetes also means eating and giving insulin on a consistent basis to limit the variables of your “blood sugar equation”. This includes the time meals are eaten. I’ve written about this before. Because my body is constantly growing and hormone levels are all over the place, keeping the things I can control the same, makes blood sugar management slightly easier. This means, for all of pregnancy I have eaten a strict diet: 31 g of carb for breakfast, 40-45g of carb for lunch, and 40-45g of carb for dinner. When people that don’t know about pregnancy and diabetes tell me not to worry about food, that I’m “eating for 2” it annoys me. But they just don’t know, so I shrug it off. In the words of Bambi “If you don’t have anything nice to say, don’t say anything at all.” Also I’m often too tired to go into a long explanation about diabetes management.
For me, I experience the most insulin resistance in the morning. My basal rate (or my background insulin) is highest from 3am to 8am. On the weekdays this works great because I eat breakfast around 6:45. On the weekends I do not wake up at 6:45 to eat breakfast although I do wake up often to treat low blood sugars. Even when I want to sleep in, I can’t because diabetes wakes me up. Lately I have tried waking up at 4am and setting a 60% temp basal for 5 hours which has worked great! I coast thru the morning in the 90s!
Continuous Glucose Monitors and Insulin Pumps: I am at the point in my pregnancy where only 4 sites work for my CGM; my upper thighs (right and left) and my arms (right and left). (I’ve talked before about how my skin is now too tight and stretched in a lot of my normal areas) These sites work great when I’m not pregnant, but now as I can only sleep on my side, I HAVE to sleep on the side without the CGM. If i sleep on my CGM the pressure leads to false readings which will sometimes cause one the alerts I talked about earlier. This is why I have to check my blood sugar at every alert and cannot just “trust” the CGM. This week I was alerted to a low of 59 and when I tested I was 76. Medtronic promises their CGMs are within 20% of actual blood sugars, so when you are 76, 20% is about 15-16 points. This makes a big difference when your goal range is very tight (like in pregnancy).
Not only can I not sleep on my continuous glucose monitor but it has to be close to my pump so that the wireless bluetooth system works and sends the data. Pre-pregnancy when I slept I wore my pump on a belt clip on the waste band of my shorts right underneath my belly button, that way when I sleep on my side it’s not uncomfortable. I can’t do that any more because of my bump. If I sleep with my pump clipped to my middle it pokes the baby and my bladder. My pump site is usually in my lower hip or upper thigh, but my tubing is only 18″ long. Now that I am pregnant I have trouble getting that to stretch around my belly. This is especially the case if I have my pump in my left thigh and my CGM in my right arm. And God forbid a pregnant woman should sleep on her back!! Just writing this out makes me frustrated. At night I often feel like I’m playing a cruel, sleepless game of twister. And if I’m uncomfortable and have to roll over I have to sit up (not easy with a bowling ball in your abdomen) and then switch sides to prevent a device from ripping out.
Right now I am sleeping with my pump loose next to me and just pray my husband or I don’t roll on to it in the night. Because remember those shrill alerts I talked about earlier? They also happen when the pump isn’t close enough to the CGM and can’t receive the data signal. Something that happens all the time, now that my stomach is so large.
Alas after all that, I do deal with normal every day pregnant woman symptoms; waking up to go to the bathroom 2-3 times a night, being too hot, being generally uncomfortable, and not being able to sleep because I’m thinking about all the things that could go wrong in pregnancy.
So when people say I better get ready for sleepless nights with an infant, I laugh. I haven’t had a full night’s sleep since July 31, 1998 (my diagnosis) and I doubt my parents have either. But this is the first time my sleepless nights have been dedicated to keeping someone else alive. And that makes the labor sweeter.
So what helps? Knowing that all the hard work I am doing will lead to a beautiful infant. It truly is a labor of love. Knowing that I am 27 (almost 28 weeks) into this 39 week journey and haven’t failed. Knowing that this is something that not everyone has the strength to do, and I am not only doing it, but succeeding. My baby is currently healthy and happy and that is attributed to no one else but me.
Also this maternity pillow helps (if you buy it on amazon make sure to log in on smile.amazon.com and set your charity to JDRF): https://www.amazon.com/gp/product/B01GERV18W/ref=oh_aui_detailpage_o09_s00?ie=UTF8&psc=1
You can find Jenny and Ginger’s book (which has been my bible the past 7 months, at least) here: https://www.amazon.com/Pregnancy-Type-Diabetes-Month-Month/dp/1544267347/ref=sr_1_1?ie=UTF8&qid=1499274400&sr=8-1&keywords=pregnancy+with+type+1+diabetes