Friday, November 18, 2011

It's the Blood Sugar Roller Coaster!!!

Blood Sugar Roller Coaster!

Monday, November 7, 2011

Xander's Arrival Story Part 4

That first night after Xander was born was tough. Xander spent most of it in the nursery because none of us had had any sleep in what seemed like ages and I needed to recover. As exhausted as I was, I didn’t sleep well at all. A c-section is major abdominal surgery and I was seriously uncomfortable as a result, the nurse had to wake me up frequently to check how things were going, my blood sugar was trending low, and I was still throwing up like nobody’s business.

At one point, determined to get at least a little sleep, I asked the nurse to please put me on a dextrose drip. This nurse (who was not my favorite in general!) actually seemed hesitant, and then said that it would mean taking me off of the pitocin for a while. It was suddenly clear to me why I was still throwing up. I told her to switch it anyway and we could just switch back once my blood sugar was up, because being constantly in the 50s and 60s very simply isn’t healthy. She made the switch, my throwing up slowed down, and my numbers started to rise. (I also wasn’t in a rush to get back on the pit, because it was really just supplemental to what my body would do naturally to return the uterus back to normal.)

After that, everything was manageable again. I had lows, especially since I didn't feel up to eating full meals right away, but I could hold food and drinks down once I was off the pit the next morning. Other than having to ask for a lot of juice and soda, diabetes kind of dropped into the background again for the rest of our hospital stay.

Of which I am glad, because we had other things to focus on.

Xander was healthy, and seemed just so perfect! At 8 pounds 10 ounces, he was on the bigger side of normal (but was actually smaller than I was when I was born). The other common risk when a mother has diabetes is that the baby’s blood sugar can drop right after birth. Xander’s was described as “borderline” on the first test, but they simply fed him and all of the following tests were normal.

Chad, Xander, and I were Tired with a capital T. There were times when it took me 10 minutes to test my blood sugar because I would fall asleep 4 times before I finished. Seriously, I’m not exaggerating! Really! Chad has a little story about one time when I was going to put my glasses on, but I paused with the glasses suspended a few inches away from my face… and just dosed off in that position for a minute. When I came to, I just finished putting them on like nothing had happened.

But like I said, all three of us were tired. Chad was trying to feed Xander a bottle on Xander's second night and was just nodding off repeatedly. The nurse told him that if we’re going to give him bottles, “We can do that. Don’t try to be a hero. Let us keep him in the nursery, and you get some sleep.” I imagine this must have been a relief to him since I really couldn’t do much that day after Xander was born. Having a C-section makes even walking to the bathroom and back hard work, much less changing diapers and bouncing babies. Chad was suddenly thrown into the task of taking care of both of us. We let Xander go for the night and finally got some decent sleep.

To sum up the timeline: We went into the hospital Friday evening, Xander was born Saturday (August 13th) evening, and we left the hospital Tuesday afternoon. The entire experience was exhausting, but the results were so worth it.

Going home... Please focus on how cute Xander is and not on how
aweful I look when swollen and without makeup!

Thursday, November 3, 2011

In The Meantime...

I'll talk more about the initial adjustments when I give you installation four of "Xander's Arrival Story," but let me tell you, delivering a baby is like hitting "reset" on your insulin needs.  I still need far less than before pregnancy, let alone compared to needs during pregnancy!  But it's all in flux.  My one month average blood sugar?  116.  My most recent one week average? 145.
Can you tell by looking at those numbers that I started back to work almost two weeks ago? Yeah, pretty clear what's thrown a wrench in the gears.  I've had a few 200+ numbers sneak in there during work hours.  I finally took 20 minutes this morning to look at time of day averages and adjust my overnight basal rate and up the insulin on my breakfast and lunch I:C ratios. With both a baby and work to keep up with Time to get this under control.

I only have one set of organs, after all.  It's kind of important to take care of them!

Xander's Arrival Story Part 3

I'm finally posting the next installment.  I think I'll make a goal of posting the last installment by the end of this upcoming weekend!

They mentioned starting me on pitocin very early in the game because I wasn’t feeling any contractions, but I really wasn’t interested in that stuff. Contractions started not long after they got me all hooked up to the monitors, and I told the nurse that I didn’t want pit as long as my body was laboring on its own. I settled down to try to get some sleep, but I really didn’t get much at all. I’m guessing I had maybe an hour total, considering the disruption of contractions and nurses. Overall though, early contractions were not bad.

In the morning, the nurse pointed out that my contractions had gotten further apart and I was on a time-crunch since my labor had started with my water breaking. This hospital, like most, had a policy of doing a c-section 24 hours after that happens.

I was terrified of the stuff because of what some mothers had told me about their experiences with it, but agreed to the pit... but only after tears and a phone call from my own doctor. Long story short, I believed that pit was Xander’s best chance of being born vaginally.

Once I agreed to pit, I also planned on getting an epidural before contractions got intense. The pit didn’t “hit me” like I’ve heard so many women say. I could tell the contractions were picking up, but they still weren’t bad. After a while, at a point when the contractions were getting slightly harder to manage but not so bad that a contraction would prevent me from staying still, the anesthesiologist came to see how I was doing. He’d talked to me about the epidural the last evening and I really liked him and the way he talked to me. He obviously believed epidurals were a very good thing, but I didn’t feel pressured or talked down to when I expressed concerns. I decided this was a good stage, so he went to get what he needed for the epidural.

This was more scary and disconcerting than painful. Had I felt the same pain in my arm, it would have been an “ouch” moment. But when it’s going into your spine, it’s an, “OMG, needling in my freaking spine!!!!” moment when your lizard brain starts screaming. Your spinal cord is, after all, essential to your body working correctly! I had to struggle not to squirm, but once it was over it was worth it. My legs grew comfortably warm and I was actually more comfortable than I’d been in at least two months!

But they continued to up the pit, and that was about the last time I was 100% independent in managing my blood sugar.

There was a drawback to these interventions, and I’m convinced it was most likely caused by the pitocin. I started puking, which meant I couldn’t keep any sugar down when my glucose levels went low. At first I struggled to keep up, with marginal luck. At some point though, they hooked me up to an IV drip for a bit, and things smoothed out.

Worse than that, Xander’s heart rate dropped whenever I threw up. It lasted long enough at one point that a group of nurses came in and started manipulating me, turning me from one side to the other, and then finally putting a sensor on Xander’s head (so they wouldn’t lose track of his beat). That was truly scary. It also would have been truly painful, if it weren’t for the epidural. Vaginal exams before the epidural were, by far, the most painful experience of my entire labor. Putting the sensor in surely would have been even worse, especially considering it took multiple tries to get it in place.

I believe I labored for a total of 22 hours. Nearing the end of that, the doctor on call double checked and found that Xander still had not dropped, and my dilation hadn’t progressed well. I had a brief amount of time during which I could wait, but the chances of things not ending in a C-section were now extremely slim.

The doctor and a nurse stood there waiting for my decision, and practically all I could think of was how completely wrong it was to have to make such important decisions at a time when I was so utterly exhausted that I probably couldn’t have decided which flavor of popsicle to eat anymore. Chad asked them to leave for a minute, and both he and my Mom said they thought it was the best decision. I think I probably asked them a couple questions, and then I agreed.

And things were set in motion.

Everything was something of a blur from this point on and, once I was in the operating room with the anesthesiologist starting to deliver that cocktail of meds, my memory is very spotty. I know I couldn’t move myself to the table on my own even though my epidural was a “walking epidural,” because I was just so exhausted and had barely been able to shift my pregnant body around even before labor. I’d carried in my Dexcom, which I clutched in one hand, but had given my meter to my husband. He was sent to a room to get into scrubs and was soon over my shoulder. The anesthesiologist was over the other shoulder, and he described everything that was happening to me. He told me what to expect, which was mostly changes in pressure. I do recall that when he told me they were about to pull the baby out, I expected one sweeping motion but instead felt a lot of digging and manipulating before he was pulled free. I remember hearing his complaining voice and I remember him being shown to me, but I was so exhausted and drugged that I could barely see him. Chad went with Xander for the weighing and examination, as we’d discussed he would do if Xander couldn’t be immediately handed to us. Being sewed back up was slightly painful and the anesthesiologist asked if he could give me more anesthesia, warning that I wouldn’t remember the remainder of the procedure.

I’m pretty sure I wasn’t actually knocked out from the last dose, but my next memory is of being in a patient room, and being asked if I wanted to hold my baby.

To follow, recovery and first days with Xander…

Tuesday, August 30, 2011

Xander's Arrival Story Pt. 2

Part of why I scheduled an induction for Xander on his due date was because I wanted to give him the chance to arrive both naturally and in his own time (without passing his due date).  As I mentioned, it was a hard decision when faced with the likelihood of a C-section no matter what we tried.  I went home, put my feet up until my afternoon work shift, and texted Chad.  He agreed with my choice, which made me feel a little more secure.  I went into work at 1 and said goodbye to my coworkers for a time, since I would begin my maternity leave on Monday... giving me a chance to rest for a few days before delivery.

Or so I planned!

That evening, Chad picked up a couple movies from a Redbox and dinner from Macaroni Grill.  I chose Eggplant Parmesan since there are urban legends about that dish inducing labor, even making one restaurant famous for their Eggplant Parmigiana Babies!  I ate half of it, put the other away, and relaxed on the couch... propped up on cushions with my feet as high as I could get them comfortably.

But, when you're as big as a whale, nothing is very comfortable for long.  I shifted repeatedly, which was honestly quite an effort.  At one point a struggled to shift my weight and move my legs... and something suddenly didn't feel the same.  I heaved myself off the couch and hobbled to the bathroom, and I knew by the time I closed the door that my water had broken.

I used the restroom, tried to calm myself down.  I was nervous as hell, and a little scared.  As soon as I felt I could hobble to the door without flooding the floor, I did so.  I opened it and said, "Ummmm.  My water just broke!"

Chad answered with something like, "Are you serious?!" and appeared at the bathroom door with wide eyes and half-eaten ice cream bar in his hands.  I really wished I had a camera to capture that!

So I directed him to the list of things that still needed to go in my overnight bag, called the labor and delivery department to confirm that water breaking means I had to come in immediately (I'd hoped to labor at home for a while if not induced), called my mother, got a couple little things myself while also managing my broken water mess, and soon we were on our way... and driving through a mild thunderstorm.

After getting checked in, in a gown, and set up on monitors in bed, I had Chad bring me my bag of diabetes supplies so I could refill my insulin cartridge.  I probably had enough, considering they don't let you eat anything during labor at that hospital, but I wanted to be positive.  I also reduced my basal rate by half... and there were several times when I took it down to 25% or even 0.  I really managed my own blood sugar and was never bothered by a nurse about it.  Quite different than what some other mothers with diabetes have reported!  It really went pretty well as long as I labored without any interventions.  I sometimes went low, but was allowed to eat popsicles to bring it back up.  That worked just fine.  It really wasn't until interventions came into play that I couldn't handle it 100% on my own.  But for that first night, I was fine and happy that Xander's time was approaching based on him and my body being ready, not based on a deadline... whatever the end result might be.

To be continued...

Saturday, August 20, 2011

Xander's Arrival Story

Things have been a little busy around here, and I anticipate that this story will take at least two or three posts, but please let me make a little jump to the end and introduce you to the newest sweetie in my life, Xander!!!

I suppose the facts give away a little of the story I'll be telling, but Xander (short for Alexander, pronounced "Zander") was born on August 13th, weighing 8 pounds 10 ounces.  He's an absolute bundle of sweet.

He, his daddy (Chad), and I have been doing pretty well... Especially since Chad is taking two weeks off to enjoy his new son and avoid me having 90% of the sudden new-baby responsibilities, and also because my wonderful mother has been visiting and helping on a regular basis.  I'm definitely having post-partum depression issues (this was expected, considering that it's so common and I'm more prone to depression than most), but honestly, things are actually good despite that.  I have a wonderful support system.

Now, on to...

Xander's Arrival Story

It's been a while since I posted because, first, I was just too exhausted from late-pregnancy to have much energy even for blogging.  I started working half days to help my extremely swollen feet/ankles/legs and to get more sleep.  It was only swelling though, as both my blood pressure and urine tests showed no other symptoms of pre-eclampsia.  I started seeing my blood sugar plummet too, but every test showed that the baby was just fine.

On Friday August 12th I went for what I knew would likely be my last prenatal visit with my OB.  I was 39 weeks and 1 day, putting me in the zone where she'd want to induce if conditions were right... only they weren't.  My cervix showed zero signs of preparing for delivery and Xander had not dropped.  She said that, since things were looking so healthy and I was being was so closely monitored, she was willing to give me a few more days (but not past my due date) to see if things would progress on their own... though she sincerely doubted they would and, in fact, anticipated a C-section even if labor started naturally (and even more so if we induced without any further natural progression).  I told her that yes, I wanted to give my body the chance to do things on its own.  But she wanted a plan of action.  The options: Schedule a c-section or schedule an induction (which was likely to end in a c-section).  It was actually a harder decision than I expected since I didn't want a C-section, but I was being told that I would likely just go through labor and end up with a C-section anyway.  Still, I decided to schedule an induction on Xander's due date, August 18th.

To be continued...

Wednesday, July 27, 2011

This is Why I'll Have a Secret Stash of Juice

My number one complaint about my OB is that I always have to wait on her.  At my appointment yesterday, I sat an hour in the waiting area and another hour in the exam room.  Nearing the end of this, I was getting really weepy about the fact that I'd gone from feeling uncomfortably puffy before my arrival to feeling like I was dragging around dead weight below the knees.

Seriously, if you're going to make pregnant women wait around two hours for an appointment, at least provide some way for them to prop their feet up a bit!

But as I struggled just to stop crying, I had to stop and think... Wait... This is the time of day when, at the office, I keep my Dexcom in plain sight to watch for sudden drops in blood sugar... only I'm taking a couple days off from Dexcom.  (I can't really put it on my belly anymore, and it doesn't seem to work as well on my lower back.  Frustrated, I'm taking a break before I try again.)

I tested and saw a 59.  I dug for starburst in my purse and unearthed three of them.  I ate them and then caved into the voice in my head that told me it would not be enough and ventured out to the front desk to snag a sucker.  A few minutes later, I tested at 55 and went back out to the desk for some hard candy.  My OB was out there looking at my chart by that point, so I said I just needed to grab some candy for my blood sugar.  Her nurse practitioner overheard this and said, "Do you need some glucose tabs?  I have a stash, because my husband is diabetic."  I gladly accepted three tabs (they may be gross, but they're faster than most candy) and headed back into the exam room.

My OB entered and declaired, "Well dear, first things first, you're carrying the wrong thing to bring your blood sugar up!"

I was starting to break into a sweat but, struggling to seem together, I said, "I always have glucose tabs in the car, but candy is usually fine.  I just forgot to put more to my purse, is all."

Then she surprised me with, "Wellllll, shouldn't you eat something like peanut butter?"

Um.  Wait.  What?  I'd assumed she meant I should have had glucose in my purse instead of candy, since it's faster.  I'd thought that was a little bit nit-picky, but whatever.  This, however, was just... wrong.

"Well, no," I said, as respectfully as I could.  "Peanut butter would help keep my blood sugar up once I have it up, but it would take forever to raise it.  It's mostly fat and protein."  (Not to mention, it took about 30 carbs and a temporarily reduced basal rate to bring me back up to a BG of 99.  Even if peanut butter were an appropriate choice, 30 carbs of it would be about... 8 tablespoons?  That's half a cup of peanut butter! As much as I love the stuff, I'm pretty sure that'd make me puke!)

She answered with a simple "oh," and went back to my chart.

And that, my dear friends, is part of why I'll have a secret stash of clear juice in my bag while laboring in the hospital.  Even among medical professionals, there's misinformation regarding diabetes (or at least information geared more toward type 2).  I feel pretty strongly that I need to be able to handle things myself, when it comes down to it.