Pregnancy with Type 1 Diabetes--The Book and The Authors

Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Gary Scheiner (00:16):
Welcome to Think Like a Pancreas, the podcast where our goal is
to keep you informed, inspired, and alittle entertained on all things diabetes.
The information contained in thisprogram is based on the experience
and opinions of the IntegratedDiabetes Services clinical team.
Please discuss any changes to yourtreatment plan with your personal

(00:37):
healthcare provider before implementing.

Jennifer Smith (00:39):
Hi, I'm Jennifer Smith.
I'm a registered dietician,certified diabetes care and education
specialist with integrated Diabetes.
And we are going to chat todaywith my very good friend and
colleague, Ginger Vieira.

Ginger Vieira (00:52):
Hello.
Hello, hello, hello.

It's a special treat to be able to chat with you outside
of just our normal conversation.

So yeah.

So Ginger, tell us a little bit about you.

Oh, um, I've lived with type one for 25 years.
I also have celiac andfibromyalgia and chronic fatigue.
And I have two kids who youknow, of course, and Jenny was my
coach for pregnancy number one.
And then I got, I got to write a bookwith Jenny during pregnancy number two.
Oh my God,

Which is the topic of our session today.

Yeah.

Yeah, absolutely.
I know we had, during yourfirst pregnancy, we had chatted
about putting a book together.

I was taking notes for that book while we, right?

Yes, absolutely.
And then I think both of our kiddos,two, were right around the time
that we put the book out, correct?

Yeah.
No,

2017

those children.
Yep.
Those kids were both born like a couplemonths before the book published.
Yeah, because I remember beinglike, Jenny, if we don't get this
done before these second kidsarrive, it's never gonna happen.
I remember knowing that for sure.

Yep.
I know.
Yeah.
Conan was born in, um.
2017, January.
Okay.
And I think our bookcame out in what March?

Yes.
'cause Violet was born in May.

May.
Yes.
It was like it was go time.
It was, we need to move right now, right?

Yeah.
Yeah.

So, yay.

And here it is for anybody watching Pregnancy with Type one diabetes.
This is the second edition.
So we have a brand new beautifulcover that we're really excited about

and lots of new, new things.
I mean, and, and as we've said, ourpurpose in putting the book together
really is because at the time, I mean,I have, I had my first before you and
realized very quickly that all theinformation that I had was because
I was really looking it up myself.
Not that I didn't have a goodguiding MFM team or my, you know,

(02:50):
maternal fetal medicine OB team.
They were great, but they just,like you found, they just didn't
have all the answers that were theday-to-day things that you experienced.

I mean, I got zero actual diabetes, manage... I, I don't, I didn't
even, I wouldn't even go to, I don'teven know what it would've been like
if I had to actually depend on thosepeople for actual diabetes management.
I don't remember what kind ofled me to how I, I think I had
already worked with you prior topregnancy on other diabetes things.
Yeah.

(03:23):
And so then, and so then I knew Iwanted to hire you for, 'cause I
also didn't have an endocrinologistI trusted or liked at all.

Yes, I do recall that.

Yeah.

You were kind of floundering for somebody who could, I
mean, you're very knowledgeable with allthe experience that you have in exercise
and managing that way and having livedwith diabetes a long time already,
it's not like you didn't have a base.

Sure.
Right.

Beyond even that base.
Right?

Yeah.

But um, to have somebody on your team.

Yeah,

so to speak, to be,

I mean, otherwise I would've had no real diabetes
support beyond that OB team.

Right.

And I do remember also when we were writing the book,
we approached some of the leadingorganizations, diabetes organizations,
said, would you wanna publish this?
And they all said, no.
That audience is too small tobother publishing a book for.
And that,

well, they did say that it was needed.
They
said it was a highly needed reference.

Critical.
Critical, but not worth it,

but not worth it from a monetary standpoint because again, our
audience was too small, unfortunately,which I don't believe is the case.
I think, I think it's truly thatthe audience is small because.
People are already a little bit behindfrom what I've found in just as your,
your frustration with trying to findan endocrinologist who could actually

mm-hmm.

Be where you were in understanding of your diabetes management.
I think there are a lot of people likethat, that also then may not know what
they're missing, and so then they justmove along, navigating with the care
team that they've got, because that'sall that they think is really needed.
That's unfortunate because again, audiencewise, we might have a small population,

(05:05):
but I think within that population thereare enough people who really don't,
who don't understand diabetes, and thenwhen you move into working diabetes
along with a pregnancy, it becomes evenmore stressful, difficult, frustrating.
You know, there are a lot of unknown.

Yeah, I mean it's the most challenging thing a woman
with type one could decide to do.
It's like, it's so, it's scary 'causeyou're like, you know, it's not,
now your blood sugars impact thisgrowing little creature and their
daily safety and your daily safety.
And one thing that I really rememberrealizing the most during my pregnancies

(05:42):
is just you do not know how your body isgonna respond to pregnancy until you're
pregnant and every phase of pregnancy anddelivery is different, and just because
you might be super healthy or superfit, or you've never had some kind of
complication related to anything in yourlife, pregnancy is a stress test that
your body has never gone under before.

(06:03):
You know?

Yeah.
And that's why I think, you know, whenwe started putting together and you were
making all of your wonderful notes abouteverything through your pregnancies
in the idea to put a book together.
That's something that weemphasize and talk a lot about.
This may be a starting point.
This is what to look for or withinthis timeframe of pregnancy, and

(06:26):
that's why we go through by month tomonth within each of the trimesters
to be able to say, these are thethings that you could see happening.
It may not be a hundredpercent this way for you.
We are all different.
Right?

Yeah.

But knowing that this is what is supposed to be happening
during this time of pregnancy, and Ithink that has, it holds value, right?
Because unfortunately a lot of doctors,they may look at your numbers, they
may look at your glucose charts andthey may look at the amounts of insulin
that you're using and maybe give yousmall pointers in, in that realm, but

(06:59):
it leaves the woman wondering, is thisis what's supposed to be happening?

Yeah, I've gotten messages from women, or I've seen posts from
women who you know, don't have ourbook and don't have you as a coach.
And they say, oh, I had constantdaily lows during my first trimester.
It was so crazy.
And no one said to them, Hey, that'snormal, but also that's a sign that
you need to adjust your insulin doses.

(07:24):
You shouldn't... right?
And, and they don't have that educationsupport and that's just so scary.
It's, they're just enduring crazylows for two months, you know?

Without either no one adjusting correctly, which I
find an awful lot unfortunately,where one piece of insulin is
adjusted, but others are left out.
But it goes beyond just insulin.
It goes into more of the,the structure of their day.
And then where again, arethey in their pregnancy?
Should this be a more sensitive time?

(07:55):
Are you coming into more resistance?
Is it normal for things to bedropping off or escalating?
How are you feeling?
How are you eating?
Like, like all of these pieces thatthey sort of get the personal, I
guess the human piece gets left out.

Yeah.
And the real life, day to day,this is how to navigate this.
Yeah.

Yes.
It's, um, so yeah, I mean,it's, it was super exciting to
have all of your, your diary.
I think that's what I hear a lot ofpeople comment about is your diary,
honestly just of your feelingswent into each of those pieces.

Yeah.
And when I look at them now, likewhen we were doing the second edition,
like part of me desperately wantedto rewrite it 'cause I'm like,
oh my gosh, I sound ridiculous.
I'm like, Nope, that was my diary.
That was genuinely how I felt andthat was genuinely what was going on.
Don't touch it.
And aside from correcting a fewtypos, I did not change a thing
because that is the real experienceand that's what's helpful, right?

It is.
And that actually, the piece that I,I took from that idea of putting a
diary together goes into, when I talkwith women and get the opportunity to
work individually with somebody, it'sa diary of potential future use too.

Mm-hmm.

Right?
The ability to have not only yourfeelings, but also, hey, I know
last pregnancy I adjusted by thismuch at this point in my pregnancy.
I know what to potentially expect comingand it makes, if you're planning another
child, it makes that a little less scary.

Yeah,

because you have almost a, a plan, right?

Yeah.
Yeah.
And you have a wholenew set of confidence.
I mean, with my second pregnancy,I didn't even, you know, you have
this whole other kid already here,you can't obsess in the same way.
And I know my A1C was roughly thesame, but I know that the amount
of mental energy I was puttinginto it was very different.
And it was just a different, it wasmore like, I'm gonna do the best I can

(09:50):
and I'm not gonna freak out about this.
You know?

Right.
Well, and that, that's another goodpoint about like the freaking out, you
know, part of it, I think at any, andwe talk a lot about that in the book,
is there's not gonna be a flat line.
There's not gonna be a hundred percentperfect, and you have to know that
what we're aiming for is the bigpicture of management, and the one
time that your blood sugar's 180, 200,it's not overall the biggest piece

(10:16):
that's going to make the difference.
Instead, it's the broad pictureof, well, you're not sitting
at 200 for five days in a row.
It was a blip.
It is what it's, you tookcare of it, you know?

Yeah.

It was those pieces.
And then second pregnancy, you cansay, okay, I did this successfully.
Yes.
This is what happened.
And with managing yourself and anotherlittle person, there's more on the table.
You might actually have a similarA1C, but maybe now there's a
little bit more variability to it.

Yeah.
'Jennifer Smith: cause you're not just able to manage you.
Right.
No, it's a whole different thing.

Yeah.
I, I think those nuances come in wheneveryou have a learned experience and
realize, I had success in this and Icould do this again, or I can do it again.
Right?

And that being said, like my second pregnancy was fraught
with weird complications thathad nothing to do with diabetes.
I was terribly sick starting month four.
Basically my stomach started producingan ungodly amount of stomach acid
and it made me puke every time I ate.
And so I had to avoid certain foodsthat, you know, like even just tomatoes

(11:28):
or anything with any degree of acid.
Um, I couldn't handle even theslightest bit of like a french fry.
No way.
Like, and, and then in mylast two months I really.
I am certain I was in preeclampsia,especially the last month, but like
the last, the, the second to lastmonth, I was easing my way into it.

(11:48):
The last month I was in preeclampsia,but my healthcare team said
everything was fine on paper becauseI have low blood pressure to start.
So my blood pressure was never high.
I was still within normal and they,but my feet, I was gaining a half
a pound of fluid a day in my feet.
My feet were so swollen in thelast two weeks of my pregnancy

(12:09):
that like My skin was first.

I remember talking with you.
I, I remember texting with youat that point of your concern
and worry and that they weren't

Yeah.

Addressing it.

I was on the edge of tears all day, every day.
I felt like my body was shutting down.
I, my husband would come home fromwork and I would just burst into tears.
I was hanging on by a thread tryingto take care of my 2-year-old,
and I did go to the hospital andI was like, something's not right.
And this woman who got heavilyreprimanded, she apparently

(12:41):
has a terrible reputation.
But you know when when you go into OBteams, you get whoever's there that day.

On rotation.
Exactly.
Yeah.

Yes.
She was awful.
And she looked at me andshe, and I was in tears.
I was like, something's not right.
But again, everything was right on paper.
I looked completely fine and, andshe's like, well, we understand
you're feeling emotional, but it's ourjob to do what's best for the baby.
And I was like, I'm trying to do what'sbest for the baby, something's not right.

(13:10):
And finally one of them, one, the kindof head of the team sat with me and he
listened to me and I was like, listen,look it, I just published this book.
Like I know my diabetes

I know what I'm talking about.

I know my health.
Yeah.
And he looked at it and he started totake me seriously and it shouldn't,
it shouldn't take that, right?
That shouldn't be necessary, but hesaid we will do a, a test on the baby's
lungs by doing this like long needlethrough your abdomen into the uterus.
Somehow they, they get the fluid,and if her lungs are fully developed,
we'll do a c-section three days early.

(13:42):
Like they'd already waited way toolong, but I am certain that if they
had waited longer, I would've beenhaving an emergency C-section instead
of a really peaceful, calm C-section.
Because a week after she was born,I nearly bled to death in bed,
taking a nap with her at home.
We'd just gotten back fromthe hospital and I woke up.

(14:02):
Blood was pouring from my body.
I was hemorrhaging, and theylater determined that my uterus.
It was like, would've never beenable, capable of a contraction
and that it wasn't doing any ofthe postpartum contracting it's
supposed to do to manage bleeding.
Yeah.
And I was just filling up with bloodclots until it finally burst and I
lost enough blood to need a, um, bloodtransfusion, but my blood pressure was

(14:26):
high enough that they didn't do one.

Wow.

Yeah.
So anyway, this is crazy.

Well, I think the big, the big thing out of
that is you really have to learnagain, put your big girl pants on.

Yeah.

Put your feet down and, and honestly say something's not right.
I need to talk to another person.
I need to talk to somebodyhigher up than you.
Call in, you know, specialty, even ifit's waved away by them then as nothing
really is a concern, you kind of haveto almost like seat yourself there and
be very vocal because otherwise you maynot get heard and I'm honestly surprised

(14:59):
in what you were feeling like that theyhadn't done more than just looking at
your swelling and your blood pressure.
I mean, there are other tests thatcan be done from a. In evaluation
for preeclampsia, that should havehonestly been done to disprove what
you thought was going on, right?

No, I was dismissed heavily.
Yeah.

Yeah.
Their job is to do allof the tests necessary.

Yeah.
Yeah.
And you know, in the ultrasounds,Violet looked happy in there.
She didn't look stressed out, but yeah,so they, yeah, I was dismissed heavily.
And,,,

so they told you you had a happy looking little, little,

yeah.

Infant inside?

Yeah.
I mean, I still just remember thoselast two weeks of just being at home,
just struggling to feel like, I feellike my body is trying to shut down.
And I do feel like it was givingeverything it could to Violet.
And so there was very little left for me.
Yeah.
And I'm glad it did that Violet was born.
She's happy as a clam.

Yeah.

She's been operating at a thousand percent ever since and we're
all coping with the aftermath of that.

You know, the other thing that it, it also brings up
is, I've long felt that people withdiabetes have an internal, almost
like that sixth sense, right?

Yes.
Because we have to,

we have to know something is off.

Yeah.
Something.
We're more in tune with every singlething in our body than a non-diabetic,
because that's how we survive the day.

Yep.
Even getting, getting sick, manypeople can tell because we use that
wonderful device now that the CGM right?
And many people can tell even beforethey're having symptoms of a cold or
rep respiratory illness or somethinglike that, my blood sugar is high.
Okay?
It shouldn't be high.
I've changed my insulin, I've taken moreinsulin, I've changed my pump site, or

(16:43):
whatever it is, and it's still high.
And then two or three days later,which that 48 to 72 hour lead
in really getting symptomatic.
Oh.
Now I'm blowing my nose all the time.
Clearly I was getting sick.
But those are things that youlearn again, 25, and now I've
had diabetes for 37 years.

Hmm.

I mean, honestly, these are things that you, you pile up
at and you file away for when needed.
You pull the file drawer out.
It's like, this isn't right.

Yeah.

So yeah.
Anyway.
Yeah.

So long story short is no two pregnancies are the same.

No, no.

You speak up for yourself

and speak up for yourself.
But again, the value to why weactually also did a second edition.

Mm-hmm.

Things in diabetes, in the world of diabetes, they change.
And in the past 10 years,they have changed very much.
They've changed over and over,even on year to year basis
for turning over technology.
We're advancing that technology.
The technology is gettingmore, more useful.
I don't like using the word smartbecause they aren't really, it's

(17:48):
not thinking technology yet.
So I don't like to use the word smartbecause it's not truly learning anything.

Yeah.

But with technology that can do more, I think we, the
person with diabetes, we get smarter.

Yeah.

About navigating the variables.
And because our technology can nowmeet us with what it can do when we
tell it to, it can be a huge value.
So, um, one of the best sections thatI feel really proud that we added
to the book is all about the newertechnology, the AID technology or
the automated insulin delivery stuff.

(18:21):
It has and holds so much value forthose who choose to use technology.
I'm, I'm working with a coupleof women right now who are using
multiple daily injections, justlike you did, and have for a really
long time and it can work both ways.

Yep,

absolutely.

If you're willing to take all the injections, it can work just fine.

That's right.

Yeah.

I know.
I remember when we were working,working, working together in your first
pregnancy, I think it was like 16 to 20injections a day sometimes, depending
on what you were seeing happening,and little nudges that you had to give
to things because, oh, this blip up.
I know if I don't correct itand I can't get out for a walk
right now, I need to manage it.
Right?

Right.
And if you're not willing to stop and takea smidge of insulin, you know, like I was
drawing it up in the syringe and like,

Right.

It wasn't even a unit, it wasn't even a half
unit, it was just a smidge.
If you're not willing to do that.
You probably wanna be on a pump, correct?

Yeah.
And again, today's pumps that dodeliver, especially if you're able to
use them pretty much automated, thefull pregnancy, and some women can and
some women can't, but if you can, thoselittle smidgens that you were giving

mm-hmm.

Could be automatically being delivered by the pump, depending
on which system you're using, um, andhow it's set up for it to work for you.
And the other, the other thing that Ilike that we did is we, we did some of
the out of the box thinking about usingthe technology because unfortunately,
even eons ago, the baseline of educationcoming from a true brick and mortar

(19:56):
kind of clinical practice is, thisis what's in the box that says to do,
this is how you're going to use it.
And we know with diabetes thatthere is a lot of out of the box
gray area thinking that goes intomanaging all of the variables.
And then when you pile in pregnancy,on top of that, we have to pull
tools out that maybe you would neveruse, you know, maybe with a pump.

(20:20):
We also use an injected kind of insulin.
Normally somebody wouldn't really do that.

Yeah.

But there are all these little pieces that can be done.

Yeah.

But many practices aren't unfortunately

gonna teach that.
No.

They're not gonna teach that.
In fact, I just had a really interestingconversation with a physician on the
West coast who, they are using in theirpractice, Afrezza during pregnancy.

All right.
Yeah.
I didn't, that didn't, I didn'thave that when I was pregnant,
but I can only imagine No.
What that would've done for my pregnancy.
Yeah.

And it's not approved, right?

No.

Because nobody's really doing something.

They're not gonna study it.
That's, they don't have themoney to put into that, right?

And it's the concern of what class or what category inhaled,
which for those of you don't know,afrezza is an inhaled insulin, right?
So we don't inject it.
It goes into our lungs.
It gets absorbed very evenly andvery quickly through your little
alveoli, kind of in the lungs, right?
And you use afrezza already.

I do it.
Love that.

You know what it does.
But in pregnancy, I mean whetherit's gestational or type one or type
two diabetes, there's a giganticbenefit to being able to address so
many of the things that someone mightexperience during their pregnancy.

Yeah.

That it could fix faster than our current even
technology or injections can do.

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And now back to our program.

This is driving me crazy.

I saw a peak of your, our, our other, our
first book on your back shelf.

Oh yeah.
It's back there.
There,

yeah.
Um, but I think, you know, in termsof what you could expect, um, we've
added a number of other things.
We added a whole sectionon different medications.
And again,

yes, because that was not a thing back during the first edition of
this book, so we, we talk about GLP-1sand... jenny, do you have... a question
on that because I have several friendswith type one who took a GLP-1 to prepare
for their wedding to help with the weightgain that they've experienced, stubborn
insulin resistance and et cetera, whenthey were diagnosed in their twenties.

Okay.

And they lost that weight that they were really frustrated
with, and then they eventually wannastart planning for pregnancy and
have to go off the GLP-1 and then

Present a gain.

A lot of weight.
Yeah.
Are they gonna change that recommendation?

They're doing studies.

Okay.

To evaluate.
There is one, there's onestudy that I'm aware of.
There may be more at this point.
In fact, I think it's a study that weput the link to in our book about it.
It came from a study in type twopopulation and it studied the
women essentially who had stillused during, at least the first
trimester, a GLP-1, not, but notdefined by any brand, just a GLP-1,

(23:39):
and what they looked at then was this kindof outcome of not only the pregnancy, but
also was the baby born with any issues?
I can't remember how long they followedthe kids' post delivery 'cause GLP-1s,
despite them being very, very popular now,they've been on the market in other forms.

Yeah.

Still injectable for a really long time, but those
versions unfortunately just didn'thave the strength that oomph behind
them that our current day GLP-1s have.
They were beneficial butnot like what we have.
So that study in, in pregnancy, they'rereally not only looking at pregnancy,
but they're also looking at evenGLP-1 for true approval in type 1.

But is it only in type ones living with obesity
or is it gonna be all type one?
I guess it'll open the gateway.

It'll open the gateway, essentially.
Yeah, because I think that there isa lot of, there's a lot we don't know
honestly about metabolism and howthings shift when we live with an
autoimmune condition and we have tomanage our own insulin because there are,

and all the other hormones that are affected.

All the other affected, yeah.
Correct.

I take a micro dose of a GLP-1 now, and it's just so
helpful and I don't use it forweight loss, but it's life changing.
Yeah.

It is.
And so hopefully there is, there'sgonna be enough information and data
that can be put together for itssustained use throughout pregnancy
because there is, as you were gettingto, you know, before we're talking here,
it's, well, what do you do about that?
I've prepared so well.
I've gotten to a point of havingreally now tightened my, my diabetes

(25:18):
management because this medicationhelped me and my weight loss.
It helped with that.

Yeah.
And then right when you're tryingto get pregnant or you are pregnant,
you have to go off the medication,then your weight starts climbing.
Your insulin needs are completelychanging just from that, and you're
trying to figure out pregnancy.
I mean, it's just kind of cruel.

It is.
And some of the, you know, the manypregnancy, like how you feel in early
pregnancy too, all of those kinds ofthings, food aversions and whatnot,
we very much know that the GLP-1s havean impact on how your brain starts
to relearn how to think about food.

Mm-hmm.

You know, a lot of people say that, that food noise or

Yeah.
It goes away.

It goes away.

Gone.
Yep.

And I've even heard from a number of people who
didn't realize how strong it was.

Yeah.

Until they start, like they felt like they had really good
management and navigation of food.
And it wasn't that they could feel thedraw, but once they started using the
medication, they could tell that there wassomething like a switch that flips off.

Yeah.
Don't even get me started.
We'll end up on a GLP-1 topichere, but Yeah, it's amazing.
It's amazing.

It is yeah, but you're right in, in questioning as a lot of
people do, and we had to say, obviouslyin the book right now, it's not approved,
but nothing in our book is medical advice.
It is right.

It's a book.

It's a book about pregnancy type one diabetes.

Yep.

Yes.
For support with lots andlots of good information about
how things should be managed.
But the, you know, I think, I'd becurious how many people are using a
GLP-1 right now and have continued toutilize one, whether with or without
their doctor's continued support.

Okay.

Right, you know, and I, I question that mainly because,
again, having talked to this wonderfuldoctor about just afrezza and the fact
of realizing the numerous benefitswhen you're looking at all the pieces
that you have to manage in pregnancywith diabetes and transferring that
over to another medication like this,that, gosh, we see all of the benefits.

(27:23):
Yeah, and we see the struggle.
I mean, what's the main?
What's the main worry inpregnancy with diabetes?

High blood sugar after eating?

Right.
High blood sugars or high blood sugarsafter eating or managing around eating,
and it becomes harder and harder andharder as you move through each of the,

and insulin sensitivity, or, you know,
combating insulin resistance.

And it's the timing of the insulin and it's all of those things.
And not only now you don't useone and a half units, you're
using five units of insulin.
And for those using pump sites,it becomes a strategy of is
the pump site oversaturated?
Because now my doses are like 70 units aday versus they used to be 25 units a day.
And

yeah,

you've done everything to manage.
It's not like you're sitting down andeating three chocolate cakes a day.
It's your body's hormone action

yeah.

Working against you and it's not,

I'm gonna take a dose of AZA right now.
Actually.

You go right ahead.
Yay.

My morning little spike is

post breakfast navigation is,

no, I haven't had breakfast.
This is because I skip breakfast.
'cause I practice intermittent fasting.

Yeah.

It around this time.
I already took a little half unit ofNovoLog an hour ago, but it's not enough.

Yay.
Easy.

That was it.

That was it.

And by the way, I did that with one hand 'cause my
other hand is holding my computerso that, that fan click noise stops.
Yeah.
One handed insulin dose.
That's hmm.
Right.

That's pretty fancy.
Yeah.
And you don't have any of the,I mean obviously you did it and
you don't even have a cough.

Right, you watched it.

A lot of people complain about is a, is kind of a
cough, which I also understand that mostpeople get over that pretty quickly.

Yeah.

And have found tricks around it like taking some water,

drink some water,

drink some water after kind of thing,

if I have a sore throat for other reasons, like if I'm sick,
Afrezza can be very difficult to take.
Like if my throat is reallyhurting, it's like painful to take.
It's like, mmm, stick with injectionsas much as possible today, you know?

Yeah.

But that's pretty rare

and I like the the in and out effect of it.
Like it really has a very quick,and then it's kind of gone
again benefit in pregnancy.

Don't even get me started, Jenny.

Don't seem very...

it would be amazing.
Yeah.

Amazing.
In and out.
And if you have your basals quite wellset, whether using injected basal or
using a pump that you've tested yourrates and your settings and everything,
utilizing that and allowing it to finishoff and then the basal just takes over

and then you go on a walk with three dogs and
you don't worry about lows.
Not one bit

Yep or four today.

Four.

But yeah, I mean I, other than that, you know, I think, I
think the value of what we, what we puttogether in terms of the book has a lot
of value in for those who have, I knowwe've gotten a lot of comments, yeah.

Yeah.
Well, and you know, not everybodycan afford to have Jenny.

That's true.

Every week with them.
So that's really what we wanted isa book that you could have with you
that's not like having Jenny with you,but it's as close as you're gonna get.
Right.
Yeah.
Because you're not gonna get whatJenny can give you from the average OB

No.

Or even the average endocrinologist.

And I, I will, that's a really good point to make too, because
I think some people feel as thoughif they're in, if they're in a good,
large enough area, a big enough citywith valuable endocrine or high risk
types of practices, gosh, I should beable to get everything that I need.

Mm-hmm.

These should be the highest educated compared to
the middle of nowhere somewhere.
Right?
And I've not found that to be true.

Hmm.

I found practices that are or should be.
They're well known.
They have many accolades, youknow, from many different places.
They've got really quality practitionerson their team, and unfortunately, some of
the places still seem to give the blackand white, this is what it should be.

(31:18):
This is where your targets are.

Yeah.

They don't understand.
They're not.
I don't know if they don't understandor they're not willing to get down
to that human level of discussionabout diabetes and management.

But you know, I mean, we know that most of us prefer
diabetes educators or endocrinologistswho also have diabetes themselves.
So you take it to the next level,you're the next level of subspecialty.
You're the diabetes educator who has typeone who has been through pregnancy, and
it adds that real life understanding that.

(31:50):
You don't know it if you'venever been through it.

That's exactly right.
I know, and we've bothhad, we both had C-section.

Mm-hmm.

So that's another piece that in terms of question,
a lot of women say, well, I hearthat people with diabetes often
end up having a C-section anyway.
So why should I plan?
You know, when I work with somebodypersonally, and I know that we
went through it in the book too,in fact, I think this book, we
put together a, the typical plan

mm-hmm.

For going in for labor and delivery, to have an idea
of a plan of action to discuss withyour care team before you go in.
So you know, what is their protocol andwhat do you really, what are you going
to do for your diabetes management.

Mm-hmm.

It adds just that talk point.
I put together something similar,but I think something that's really
important to go over is that justbecause you have diabetes doesn't
mean you're going to have a C-section.

No.
Yeah,

it doesn't, and just because you have diabetes doesn't
mean that you have to be induced.
Right?
There are, there are practicesthat are very willing to continue
to look at how are you managing?
What's the baby's health?
What does the health ofthe placenta look like?
You know, are there anysigns of placental failure?
Are you having excessive swelling?
Those signs for, you know,issues that come much later or

(33:04):
closer to the delivery time.

Yeah.

And those practices, they look at the real pieces and
say, well, you're doing really well.
The baby's doing real

good.
Yeah,

everything gets great.
Why would we induce?
Most practices do have kind of a hard stopsomewhere between 39 and 40 weeks where
they say, we'll give you to this point,and then we, we really should be inducing.
Then there are other practiceswho do a lot more scare
tactic, and that's frustrating.
It's, you know, and they go the scaretactic route of things like still

(33:32):
birth, and like the longer you wait,the more likely you are to have a
still birth because you have diabetes.
But the statistics, to myknowledge that they're using for...
using not only old information, butinformation that is relative to people
who didn't have well managed diabetes.

Right.
Because their A1cs were high and Yeah.

During their pregnancies,

because it's also old information that
didn't have today's technology.

Right?

It's just, it's so kind of.

Yes, exactly.

So outdated.
It's useless.

What needs to be brought together is women, like I have
the privilege of, of helping manage.

Yeah.

Or those who maybe had a resource like our book to manage
on their own and they really did.

And look at the rates there.

Yeah.
Look at the rates there.
What is their outcome compared to thosewho didn't have that extra handholding
and then make a judgment call to pass off.
Don't just use a scare tactic.

Yeah, and our reasons for needing C-sections are so different.
I needed, they tried toinduce me at 39 weeks.
I had one quasi sort of contraction.
I was like, oh yeah, I thinkthat was a contraction.
And, but I later discovered thanks tomy second pregnancy, bleeding to death,
that I really don't think my uterus iscapable of contracting, contracting.
Yeah.

(34:46):
And so two C-sections werein my future no matter what.
Honestly.

Had you caught any...
sorry, go ahead.

I was just gonna say I, I'm fine with it.
I, I have a friend who's deliveredvaginally and she's got a lot of
issues, you know, besides, uh,scar and some, some funky skin.
I don't, I don't have any issuesbecause I didn't deliver vaginally.

Right.
Yeah.

It's all, it's all a trade off of one thing or another.

And, uh, you know, what are we aiming for, especially
in a pregnancy with diabetes whereyou are so tightly managing almost
everything that you're doing.
What's the end goal?
The end goal is a healthy baby thatyou're bringing into your family.

And a healthy mama at the end.

Healthy mom.

The mother who's alive and a baby who's alive and safe.
Yeah.

And safe.
And healthy.

Yeah.

And the way that the baby comes into the world, it's
a piece of the story, but it's,

yeah, I don't, I mean, no, I've never done it vaginally, but it
still felt pretty crazy amazing special.

It was.
Yep.

Yeah, I mean, I don't you, you still meet your baby.
They still lay it on top of yourchest and you're like, oh my god.
Yeah.
You know?
So, yeah,

I know.
One of the things that the my boysreally like to do on their birthday,
they like to get their baby album out,like just their first year, which has
their, like their birthday, right?
And we tell them the storyof how they were born.

Oh, cute.

You know, everything that, you know, in the hospital
who came to visit them and then,you know, all of that kinda stuff.
So it's, it's still a, a wonderfulmemory of them coming into our life.
So Yeah, and I had avery different reason.
I mean, they essentially, after havingmanaged really, really, really well

Sure.

Over the course of my whole first pregnancy, three days like
they were... I had a really, I hada great practice that I worked with.
I really enjoyed my MFM team.
Um, and about three days before Iwas scheduled to potentially have an
induction because I hadn't gone intolabor yet, they did that final sort
of like evaluation, a growth scan.

Mm-hmm.

And they were like, I don't know, your baby's
like really big all of a sudden.

Oh, that's right.

And I was like, what do you mean?
They, and we didn't know whether it was aboy or girl because we didn't wanna know,
and so they're saying, you know, big baby.
They were averaging, you know, he was,it's gonna be like 10 and a half pounds.
I was like, no, no.
Like, we need another person in here.
I was like angry.
Really angry at that point.
And uh, even the MFM came in,she's like, well, I'm measuring
kind of at least similar enough.

(37:15):
She said, yes, these scans can be,you know, upwards of 20% off, but
she said, the way that we're able tomeasure at this point, it does look.
So I'm really encouraging.
I mean, I'm not a bigperson, neither are you.
And she's like, I don't, I don'treally think that even if we did
induce right now, nothing's lookinglike we couldn't do that, but
she's like, size wise, i'm reallyencouraging you to have a C-section.

(37:37):
Mm. And so that's what we did.
I mean, I was bawling.
I was, I was just so upset.
And my husband was really the onewho said, you know this, you've
worked really hard as we just said.
This is the way that the baby is gonnabe with, and I mean, sure it made me
feel a little bit better, but I wasstill really and bothered and frustrated

(37:57):
and like all of a sudden like angry atmyself, like, what did I not do right.
And then he was born and hewas eight and a half pounds.
Yeah.
So as you know with a first C-section,you either go into labor naturally,
with a second most practices won'tdo any induction if you've had a
C-section for risk of hemorrhage.

(38:20):
I've encountered a few willing todo like, a balloon dilation kind
of to get things going or whatever,but most won't do an induction.

And you know, that reminds me, I was on Pitocin for like
two and a half days and I was 0% dilated.
Yeah, it was brutal.
I would never do Pitocin again.
Yeah, I had no reaction to it.

No reaction, yeah, so then I

Except swelling and, and misery, but yeah.

And misery not the way that you want that to go at all.
You're like, I'm here to havea baby and have a lovely day.

Yeah.
I felt pretty sick by the time she wasdelivered via C-section, the first baby,
because I'd been on Pitocin for so long.
It was too much.
Yeah.

Yeah.
So, yeah, both of us had sort of scheduledC-sections for section second then.
I mean, they were giving it as longas they could, obviously for the
potential of it actually labor.

Yeah.
And do you feel, do you feel likeclinically they should have just given
you a chance to try delivering him?

I do at this point still harboring some, yeah,
desire to have had that chance.

Yeah.

But again, there's been so much post baby, right?
There's so much.

Yeah, it's, that's one moment.
Well, I'll tell you my motherwho's five foot four, she's teeny.
She has to lie in order to donate bloodabout her weight 'cause she doesn't
even qualify for the weight limit.
One of my brothers was like13 pounds when he was born.

Holy cow.

Yeah.
And she delivered him vaginally

naturally.

So they shouldn't do that.
You know, the, the femalebody is designed normally.
Mine's not designed to givebirth, but other people's
are, they should let you try.
I think.

Well, and I had two very healthy, normal weight babies, right?
That were

mine, were mine, were in the eights as well.
And they, because of my size, they'retelling me, oh, those babies are big.
And my mom, all my mom'skids were very large.
I was a month early as a twin.
I was six and a half pounds, which is

And was your brother about the same size?

Yeah.
He was like a few ounces bigger.
Yeah.
Okay.
And you know, so like the, maybethis is just what my babies weigh.
Why do you have to sayit's 'cause of my diabetes?
It's just annoying.

Right.
And they, even my, my MFM with my firstwas astounded that they were so wrong
in measurement, but all along she said,I would never have guessed, even if
he had been as big as big, I would'venever guessed that it was relative to
your diabetes because of the way thatyou managed and not only looking at,
I mean they actually did beyond A1C.

(40:44):
They did something called, called aperosamine as well, which is a, it's
not tied to your red blood cellsand which in pregnancy, the A1C can
be off and it can be misleading.
It can be lower than it truly,honestly is bodily, and so they would
do a fructosamine to get a closer.
And even that was well within therange that it was supposed to be.

(41:05):
It was in, you know, the non-diabetesspecific kind of range, which

yeah, you're Jenny Smith.
I'm sure you're, I remember you weretrying to convince me that I should
eat frozen, uh, take a yogurt, alemon yogurt, put it in the freezer
and pretend it was ice cream.
I'm like, Jenny, I am not doing,I'm going to eat ice cream.

Yeah, just dose for it.

Yeah, that's what Jenny was doing.
So I'm sure your bloodsugars were just fine.

They were just fine.
Yeah, they really were.

But, well, you know, I had friends of mine were giving birth to their
babies, like friends from high school inthe years after mine were born and their
babies weighed the same weight I did, butthey weren't told those were big babies.
This is just what babies weigh, right?

I know we have a, we have a friend whose baby was
nine pounds 13 ounces, no diabetes.
She did not have gestationaldiabetes, totally healthy pregnancy,
just had a really big baby.
So, I don't know, there's very gray areas

annoying

in that, that are very frustrating.
And you know, having worked priorto working for Integrated, I've also
worked previously in clinical, um, likeoutpatient where I've also seen women
who despite trying to manage blood sugarreally well and having higher than desired
blood sugars have had teeny, teeny.

(42:22):
So growth restricted babiescould also happen with mismanaged
diabetes during a pregnancy.
So it's, you know, there are multiplepieces that could not be right.
But then there are also things for womenwho don't have any diabetes or known

Yeah,

health issues and, and who have kids who got
things that aren't right either.

Right?
It's like you just, there's so muchout of your control, so you have to
really keep that in mind as you approachwell delivery day obviously, but also
even just every month before it's like

right.

And I mean, we still joke today, Violet thinks
it's hilarious, Uh, we say like,yeah, Lucy was such a good baby.
She didn't give me a lot oftrouble when she was in my belly.
And Violet started trying tokill me around month four.
A, that's, that's how we describe it.
And we all laugh.

And now she's still your spirited little,

yeah.
She's still, she has mellowed out.
She was a ping pong ballfor like the first six years
and she is more focused now.

More focused,

yeah.

Energy.

And she can focus on tasks for more than 20 seconds now.
It's great.
Yeah, yeah,

yeah.
I know.
And, and it is pretty amazing allthe things that in life, no matter
how long you've had diabetes beforeyou choose to have a child, there are
learning pieces that you take, that youkind of take with you into pregnancy

yeah.

For managing well and even things that you learn...
well, I guess I was navigatingthis not quite in the right way.
It looked okay, but now that I have,now that I'm pregnant, gosh, I can
really tell that probably wasn't thegreatest thing for me to be doing.
And you can kind of clean some thingsup and sometimes those then end up
sticking with you beyond pregnancy too,

for sure.
I mean, before I started thinking aboutpregnancy, my A1C was in the high sixes.
I hadn't really gotten a CGM yet,and so I got a CGM in preparation for
pregnancy and, I mean, what I learned inpreparing for pregnancy and then managing
during pregnancy changed everythingabout how I manage diabetes today.
And it may, you know, I manage thosesame pregnancy A1C levels mm-hmm.

(44:26):
Every, every month.
You know what I mean?
Yeah.
And so it's, it's a massivelearning opportunity that, yeah.
It's yeah.

And there are even some things, I remember you even
tried going to an insulin pump

for one month

prior to pregnancy because you, you were
like, okay, I'll give it a try.
And I'm, I really am hoping thatit's gonna give me the, the bit more.
That I might

and that I wouldn't hate it.

Then you're like, no, no.
I think you texted me likeI'm ripping this thing off.
Yeah, like, I can't do this anymore.

My husband, my then husband, he was like,
wow, you're really liking this.
And because I liked it for, about aweek and a half, and then for about
two and a half weeks, I was like, Ugh.
And then that last little stretch,I was like, no, I am not doing this.
This exactly what I hate aboutall pumps and pods, and I'm done.

(45:19):
Yeah,

and it's okay.
Yeah,

I do.

Again, it's okay.
You learned to navigate and youlearned to manage, and you knew that
you were taking on something thatyou had experience with, but that it
was going to be kind of amplified.

Yeah.

In what you

I'd already gotten my A1C down under six on MDI.
I knew I could do it and

Right.

I mean, honestly, like, yeah, I'm way more lax in how I manage
today than when I'm pregnant because Ijust don't give a shit to that extent.
But my A1C still comes out to bebasically under six every time.
So yeah, it's just, yeah, it's funny.

Yeah.
I think there are things that you travelthat, that travel with you too, and
how you help your kids navigate things.

Mm-hmm.

Because of the learning that you put into your own self-care
and ultimately their care, you know?

Yeah.

When they're inside, um, that kind of go forward in,
in what you teach them how to do.
I know I've taught my kids a heck of alot about just nutrition and being active.

Oh yeah.
I mean also they watch me take injections.
They just, they have a resilienceabout, about them that is, and a
maturity about them that is differentthan their peers because of, and I,
so I'll tell you 'cause I know this isa, a big concern a lot of women have.
Will my child get diabetes?
I screened both my kids a whole bunch forT1D autoantibodies through trialnet.org.

(46:41):
They tested negative.
My 10-year-old was justdiagnosed last week with Celiac.

Oh, wow.

Yeah, and she's being such a champ about it.
She's like, really?
She.
She wasn't super sick, but her bowelmovements were just not healthy.
And I, I knew for a few monthsI was like, this isn't right.
And, but I waited till her annual,I was like, I think something's not
right with her digestion and her,

did they just do the antibody testing for her?

For celiac?
Yeah.
Yeah.
And the nurse practitioner has typeone, so like I never get dismissed
or anything, which is so nice.
And, uh, so it came back positive.
We're gonna do an endoscopy nextweek to just double confirm, but
Lucy's like, she's like, doesthis have gluten and does this?
And I was like, thatdoes, and that doesn't.
She goes, great.
And I'm like, and we can gotry these to swap out for that.

(47:26):
And she's like, okay.
And she just is being so cool about it.
And I am then of course veryworried that she's on the path to
developing type one, even though pastautoantibody tests said she wasn't.
We are gonna test her again of course.
And I'm in a blessed position of knowingall these clinical trial people through
my work at Diabetes Nerd, and I'm gonnabe on a pretty intense mission to get

(47:51):
that kid into, um, a couple clinicaltrials if she does test positive.
So, yeah.

Yeah.
It's the, um, I was gonna say too, sosome people who have, as an adult, as
you do, have Celiac and you've managedyour own very well, some families end
up just being pretty much gluten-freein their whole house already, even
though they're the only one, right?
With celiac or some type of, you know,

mm-hmm

allergy or intolerance to a particular food they just keep
it out and so everybody else is notexposed anyway, but it sounds like you
pretty much do that for yourself or had

yeah, because

the option to do whatever.

My kids eat a lot of pot... they, they eat a
bunch of stuff that I don't eat.
Like they're obsessed with buttered pasta.
I could go the rest of my lifewithout ever eating buttered
pasta, you know what I mean?
Um, and, and just differentlittle kids snacks.
So I, I did keep them glutenfree until they got to preschool.
Just 'cause it was easyto, right, at home.

Yep.

And then I didn't have a good reason to keep them gluten-free
in preschool, so I didn't, but yeah.
So

you've also exposed, I mean that's a, you brought up a good
point about will my child have typeone or other autoimmune types of things
and from a family standpoint, knowingyour family history is very valuable.

Mm-hmm.

And then we both did kind of the same thing in
terms of I did dairy as well.

Mm-hmm.

But I mainly focused on like the cow's milk, dairy.
I know it's kind of controversial.
It's like a 50/50.

Yeah.
I didn't give mine cow's milk, but Idid use formula that had dairy in it, so

Okay.
Yeah,

they were getting dairy.

It's still there.
And we did like mostlygoats milk, sheep's milk.
I guess they, they wereexposed but not to cow's milk.

Yeah.
Right.

And then we did mostly gluten-free stuff
up until about the age of two.
Um, and that was just the standpointof, that's also when I stopped nursed.
Um, and again, there is, if you can andyou are willing and it works, then great.
And if not, there are, obviously there aremilk banks and there's formula and there's
nourishing your baby is very valuablein whatever way that you can feed them.

I did it for as long as I could bear.

Yes,

I hated it.
Yeah.

Yeah.
Um, but then, you know, uh, they wereboth about two when I stopped nursing.

Mm-hmm.

And so that was, I felt like it was a point of
allowing my milk to be valuable interms of just immune and whatnot.

Yeah.

They were being introduced to foods and whatever, and
then it is like the more they get intoplay dates and going to a school or
going to a daycare or whatever it is.
There's only so much that you can do.

Yeah.
Yeah.
Well, we, it sounds like we need todo another episode that's postpartum.

Thank you very, very much.
Again, if you are wanting our newestbook you can easily find it on Amazon.

Amazon for sure.
under Type one diabetes orvisit diabetes nerd.com.
You can find it there too.

Fantastic.
Thanks so much, Ginger.

Thanks Jenny.

Thanks for tuning in to Think Like A Pancreas, the podcast.
If you enjoy today's episode, don'tforget to like, follow or subscribe
on your favorite podcast app.
Think Like a Pancreas... thepodcast is brought to you by
Integrated Diabetes Services.
Where experience meets expertise,passion meets compassion and diabetes

(51:05):
care is personal because we live it too.
Our team of clinicians all livingwith type one diabetes understands
the challenges firsthand.
We're here to help no matter where youare in the world, and glucose management
to self-care strategies, the latesttech, sports and exercise, weight
loss type one, pregnancy and emotionalwellbeing, we've got you covered.

(51:29):
We offer consultations inEnglish and Spanish via phone,
video, chat, email and text.
Wanna learn more?
Visit integrateddiabetes.com or emailinfo at integrateddiabetes.com to schedule
consultation On behalf of think like apancreas, the podcast, I'm Gary Scheiner.

(51:51):
Wishing you
a
fantastic week ahead, and don'tforget to think like a pancreas..

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