Thursday, December 30, 2010


A lot of pregnant women with diabetes discover lots low blood sugars in the first trimester.  Then the numbers start to rise until their insulin demands skyrocket later on.  It's a common pattern.

So far?  My body's like, "screw common patterns!"

Like last night, I was craving seafood fried rice something awful.  I often make my own brown fried rice with fresh veggies, and a very small amount of oil at home...  But that's so not what I was craving!  I wanted oily, over-seasoned, totally unhealthy fried rice with a mix of oily seafood including unidentifiable bits that are probably squid or octopus, but maybe not.  You know the stuff, if you've done a lot of oriental food joints!  So we slipped down the road to Thai House and I ordered up that giant plate of Seafood Fried Rice.

But that's a lot of carbs and fat, so I was very deliberate about this.  I looked up the average carbs for shrimp fried rice before it arrived, evaluated the food when it got there and determined it probably didn't have as much seafood in it as the average shrimp fried rice and bumped the carbs almost all the way up to what a cup of what nothing but rice would be, delivered an 85/15 combo bolus (going closer to the 50/50 I was taught usually makes me go high), carefully spooned a two-cup portion onto my plate (in two piles, until each looked like the size and shape of my over-turned 1 cup measure), and dug in.

I suspected, if anything, that I'd go low.  I'd definitely erred on the high side of the carb count because I did not want to go high.  I feel, right now, that having to drink a box of juice to head off a low is worth avoiding highs.

But by the time we got home, probably only an hour later, I'd spiked to over 200 and dexcom was showing me a straight upward pointing arrow!

I had a lot of insulin in my system and had only eaten a short time before, but I just couldn't stare at that and do nothing!  I took another very small bolus and didn't allow myself to slug out on the couch.  I didn't feel I could exercise (I felt pretty crumby), but I tried to keep moving around and working on this little gift project for some friends.

And within like another hour, my blood sugar was perfect.


Yeah.  This one may have been extreme, but these spikes and drops are my common pattern right now, and they are killing me.  It tends to happen even when I do everything right by choosing foods that have a good balance of healthy carbs, protein, and healthy fat (unlike the seafood fried rice!) and waiting 20 minutes between bolusing and eating.


It seems like I'm slowly eliminating foods that are mysteriously worse than others (goodbye fried rice), and relying a lot on foods that have the least spike (hello salad with protein and fat, but no cheese, because for some reason shredded cheese is totally gross to me right now).  I'll get this figured out... and then it'll probably all change!

Monday, December 27, 2010

Endo Appointment Number One, Down

I met with my endo and thought it was fairly productive.  I just hope this whole every-two-weeks schedule continues to be useful through the pregnancy!

The main issue was a few unexpected highs I've had, for which she also did not see a pattern.  One was an infusion set preblem, the others were all after foods with carbs I thought I knew.  I'll be keeping a food journal and testing some of my basal rates.  In the meantime, she's having me adjust my nighttime basal rates to nudge my fasting blood glucose under 100.

I'll be counting every carb and watching my numbers like a hawk.  I'm hoping things are going to get better on their own, because I've actually had weird weeks before where my glucose just makes absolutely no sense and then goes back to normal.  I guess being pregnant doesn't exclude me from the "WTF?" qualities of this disease.

Saturday, December 25, 2010

Merry... Merriness! (And not so merry highs.)

Merry Christmas, or whatever holiday you choose to celebrate!

Our Christmas day has been quiet and lazy.  We spent Thursday night with Chad's family, and last night with my parents.  The baby received it's first gifts from Chad's mother (diapers, wet wipes, and a box of gender-neutral linens).  The two big gifts Chad and I received were Rock Band (from my parents), and vent-free gas logs for our fireplace (from Chad's parents).  Two awesome practical gifts I received were a Waterpik from Chad (because even my dental hygienist said it's tough to floss my teeth!) and a food scale from Mom.  There've been many times where I had to do some tricky stuff to figure up serving sizes while counting carbs, and this will really help me measure the stuff that's listed in grams.

I also had a Christmas Eve gift I did not want: A bad infusion site and a blood sugar of over 280.

do not want
see more Lolcats and funny pictures

Normally, something like that frustrates me.  While pregnant, it makes me question every single little action I've taken all day, blaming myself for the high blood sugar that could do harm to the baby.  Even though I logically know that no pregnant woman with T1 diabetes is safe from mistakes or accidents, it sure makes me feel like a failure.  And though I've read that an occasional, brief high blood sugar won't hurt the baby, I can't help but feel that it's really horrible at such an early stage.  After all, women with diabetes have an increased risk of miscarriage.  Even though she'll probably be understanding and simply talk to me about future prevention, I'm embarrassed for my endocrinologist to see that BG number on Monday.

But on the flip side, my numbers are normally fabulous and I've done a good job of avoiding the things that really give me trouble.  On the whole I'm doing a great job, but a high like that makes me wonder when I qualify as not doing a great job.  One high?  Two? Ten? Once a month, once a week, once a day?  I know there's no set answer, but I fear crossing this imaginary "line."

So far, no crazy symptoms, diabetes related or not.  My blood sugar hasn't started going low like it apparently does for most, and I haven't started having the typical morning sickness.  My mom told me last night that she never had much morning sickness, so I'm hoping I take after her in that respect!

No mystery food cravings or aversions, though I'm definitely more hungry than usual.  I'm trying to avoid the whole "eating for two" thing while still letting myself have a little bit extra.  Everyone has to gain weight while pregnant, but the fact is that I'm already overweight and need to keep my weight gain to whatever range my OB will recommend.

I do know that I need to start getting more active again, too.  My walks have become less frequent as the days have gotten colder, so maybe it's time to keep sneakers at the office and go walk the treadmill during lunch.

Sunday, December 19, 2010

Will there ever be a cure?

Will there ever be a cure?

It's a hot topic on D forums and blogs.  I think I most often see people say something like, "Probably, but not in my lifetime."

I'm not a naive and wishful thinker, but I'm not as jaded as a lot of veteran PWDs yet.  I haven't heard the repeated "just 5 more years" from multiple doctors.  In fact, I haven't heard that even once from a doctor (and I'm glad, because I don't think there's any way they can promise something like that right now).

My point is, I think it'll happen.  I don't actually know when, but I wouldn't be shocked at all if it happens in my lifetime.  (Not shocked, but ecstatic!)  If an actual cure doesn't happen, I am confident that diabetes care will be improved so significantly that it will almost be as good as a cure.  Maybe we won't get our beta cells back, but maybe we'll only have to give ourselves one or two injections a day to achieve healthy, steady blood sugar levels.  (I'm looking at you, SmartCells Inc.)  Or maybe someone will figure out how we can be given new beta cells that our immune systems won't attack on sight. (Russia, bravo for fearlessly exploring that frontier!  And you scientists at Washington School of Medicine, keep it up!!!)  Or maybe after the artificial pancreas becomes a reality that can be continually improved upon, someone will also develop an even faster acting insulin to pair with it, and that artificial pancreas will be developed to the point where it can function real-time based entirely on the rise and fall of blood glucose (with no need to enter carb values or temporary basal rates).

I just see so many promising ideas.  Any of these could be the development to change the lives of PWDs forever.  Maybe no one is going to hand me a pill that will cure my diabetes next year, but I do think I'll be given some life-changing treatment options in my lifetime.

Balancing Indulgences and Blood Sugar

One aspect of pregnancy that I'm finding a little bit challenging to balance so far is the food.  I try and eat mostly healthy food that treats my blood glucose well, but I also think there's no problem with a little indulgence (pregnant or not, diabetic or not).  If I were pregnant and not diabetic, I'd just treat myself while making sure I don't overdo the "eating for two" thing.  But when that giant cookie is staring me down in the store, even if I've been very good all day, I have to take pause and wonder, what will it do to my blood sugar?  Is it OK if I'm a little out of range a little of the time, or am I a bad mother if I don't make every possible effort to stay in range, such as passing on every cookie I see?  And if I can tell I'm just going to "have to" eat a baked goodie that day and I know it's better to have that cookie (which also happens to be organic and vegan) than get back to the office and end up eating a damn donut or two or three or ten, can I time my insulin just right to avoid the spike?

In that particular instance, I got the cookie, bolused for half of it and gave the insulin a few minutes to get in my system... then got weak and ate all the cookie and bolused for the rest with what turned out to be miraculously perfect blood sugar results later!  (That could certainly be a fluke, but I'm thinking of stocking up on a few of those for the next time I have an uncontrollable urge to eat a giant cookie!)

On the other hand, I gave into a craving for popcorn shrimp last night and, because a combo bolus hadn't worked for them at all once before, I did a regular bolus.  This sent me a little low, then higher than I felt at all comfortable with during pregnancy.  Cue rage bolus, which happened to slowly bring me back down into range and hold me there.

Balance is so important.  I need to keep my blood glucose down, but that doesn't mean never indulging.  It means, rather, that I have to find the indulgences that don't destroy my efforts.  Big fraking vegan cookie containing more carbs than I typically consume in an entire meal?  Win.  Reasonably sized plate of popcorn shrimp?  Lose.  Duly noted.

On an only vaguely related note, I'm having to correct a couple bad habits like not bolusing before I disconnect from my pump in the morning.  My evening basal rates are so low that disconnecting doesn't seem to make an ounce of difference, but my morning basal rates are almost 4 times higher.  If I take my shower in the morning, my BG goes up.  It always has.  My endo recommended I bolus before a morning shower, but even then I only gave myself a tiny bolus and corrected the difference later for fear of going low in the shower.  But now that my range is so much tighter, I can't afford to slack on the bolus.  It's either that or shower while connected, which I've never liked at all.  Bolus it is.

Saturday, December 18, 2010

Life's Never How You Picture It.

I haven't been to either of my doctors yet, but I've made appointments with both (already well over a dozen with my endo!) and spoken to my endo's nurse.  My blood glucose goals are now below 100 before meals, and below 120 two hours after meals.

I'm actually very close to those goals even when I don't quite meet them (and I've just made a change to my insulin pump's "target" that should finally nudge the less than perfect numbers under), and I've managed to get my spiking blood sugar to chill the hell out.  Primarily, I'm figuring out that I need to have a little more protein and healthy fat with my breakfast (when things are most likely to spike), and the same true to a lesser degree with lunch.  Dinner is never a problem.  If I eat pretty well, my evening numbers are always fabulous.

I can totally do this.

For the most part, I feel pretty good about things.  I had one night where I felt very sorry for myself...  I was realizing that this pregnancy isn't going to be "what I always wanted."  Not that I've ever been the "daydream about pregnancy and babies" type, but I always had a basic picture of how things would be:

I'd enjoy my pregnancy, dealing with whatever minor inconveniences (like morning sickness) come my way and feeling a little like an earth goddess as I bask in the miracle of creating life and letting my body do what it was designed to do.  Then when delivery came around, I'd labor at home for as long as I could, go to my hospital, and labor naturally until my doctor said, "It's now or never for the epidural."  (You see, though I fully believe the female body knows how to do this stuff on it's own, I'm way too much of a wimp to accept the level of pain that comes with pushing!!!  :p )

That's not the picture I see before me now.  I'll probably have something like 20 or 30 doctor appointments between now and then, tests that aren't normally done on "healthy" mothers, there's probably no way any OB will let me carry to full term and labor when my body decides to do it naturally, and there's likely to be much more monitoring and a higher chance of a C-section.  It's like my body is a liability instead of a miraculous tool for creating life.

Sounds crappy, doesn't it?  But it's the most bleak view (short of imagining all the things that could go wrong will go wrong).  I totally let it get to me the other night and I cried all over Chad.  (He's so sweet.)

But now, I'm realizing that everything's been pretty normal so far, so and I don't have a reason to believe that everything will be horrible the second I set foot in a doctor's office.  Yes, things are likely to be more medicalized than I want.  I accept, grudgingly.  But I can't focus on that; I have to keep it all a part of what supports me and a healthy baby.  Just like diabetes management isn't the focus of my life, but part of what supports it.

I'm also looking into having a doula, a trained professional who is there to support mom, dad, and baby through pregnancy and delivery (and sometimes for a while postpartum).  I think it would both help me focus on the wonderful things that are happening, and stay more informed and in charge during delivery.

As everyone says, the thing that counts most is having a healthy baby in the end.  I agree with that, but I also believe that is most likely to happen if the pregnancy and delivery are no more medicalized than actually necessary.  (Thank god we have OBs and the interventions that are sometimes necessary, but the US has both incredibly medicalized births and some of the worst birth statistics of the industrialized countries.)

I'm saying all this like I'm afraid I'll be swept into an O.R. the second I arrive at the hospital, but the truth is that I'm going to do everything humanly possible to keep my blood sugar normal and my OB has never given me the impression that she's big on intervention for intervention's sake.  For all I know, she'll support me in my desire for normalcy to every extent she is able.  I meet with her nurse practitioner on the 5th of January, so I'll have a better idea then of what is in store.

Sunday, December 12, 2010

Bolusing for Two!

I'm not sure I've ever mentioned that, before I was diagnosed with diabetes, my husband and I had been trying for a baby for over a year.  Not like, counting cycle days and taking my temperature to catch the moment I ovulate then calling my husband home for emergency baby-making, but we weren't preventing... and, being a little older than most first-time parents, I was starting to wonder if it wasn't time to start "really really trying" when I discovered we had to stop until I had my blood sugar under control.  Not an easy thing to be told.

And then, about a month and a half ago, my endo told me it was safe to start trying again.

Well, my body apparently agreed with her!

Friday, I was sitting at my desk at work with a pile of tissues and couple boxes of cold meds when I thought, "You know, I was supposed to start my period yesterday."  It's not so weird for my period to be late once in a while, but I realized that I was about to pop more cold meds when it was possible I could be pregnant...  So I decided I'd pick up a pregnancy test during lunch just to make sure everything was cool before I took my afternoon dose.

It was funny, sitting there eating my lunch in my car with a pregnancy test sitting on the seat next to me.  I hadn't picked it up because I thought I was pregnant, rather because I wanted to make sure I wasn't going to pickle a baby with cold meds, but it still gave me some of that giddy nervousness.  "I totally could be," I thought several times.  "It... feels like I could be."

But that still didn't mean I expected to see two lines begin to form almost instantly! I stood in the bathroom with my hands covering my mouth as the "result" window began to color even before the "control" window was touched.  "Holy crap, holy crap, holy crap!!!"

I made myself stop watching it until the two minute mark, then began my "holy crap" chant all over again.

I mean, HOLY CRAP, guys!!!

I held it in all afternoon, tempted to call my mom or post to a message board... but I couldn't until I told Chad, and I had to tell him in person!  So once I was home, he got an early Christmas gift and we were soon on the phone with our families.

Things I've observed so far:

  • I don't "feel pregnant," yet I do.  I think there was a tiny little part of me that already knew.
  • I'm excited... But others seem to be more excited for me! My theory is that this is because they aren't the ones who are going to swell up over the next 36 weeks then spend many painful hours squeezing out a baby that's going to change everything forever!  (It's all going to be worth it, but let's face it, there's also plenty to be scared of and it's only Chad and me who have to face the scary parts.)
  • Girls squeal.  :)
  • Though I don't get to enjoy the quirkiness of pregnancy yet (the belly, the cravings, the "glow"), I do get to "enjoy" all of the restrictions!  I have a cold and am on no cold meds (real Sudafed is supposed to be safe, but isn't recommended this early).  I'm developing a cold sore, but I'll just be picking up some lemon balm chapstick for that (it looks like Abreva and a couple oral meds are "category B," but I see enough discouragement online that I'd want to ask my OB first).
  • People like to joke about alcohol, tell you not to drink alcohol, or say it's so said you can't drink alcohol.  I just wish they'd stop talking about alcohol!  (Not because it makes me miss alcohol, but because it pisses me off that even those "jokes" are basically telling me what to do instead of assuming I'm an intelligent enough woman to make my own sound decision based on medical research.)
  • So far, I haven't run into any, "Are you going to die like in Steel Magnolias?!" or, "Your baby is going to be HUGE!" or, "Diabetic women shouldn't get pregnant!"  One friend asked if pregnancy might improve my diabetes, and my grandmother-in-law simply asked how it would affect things, and then asked if the baby would get it since I have it (a valid question, to which I said the baby couldn't catch it from me, but that there would be a small chance [1/100, in our case] of developing it later since it's genetic).  But from everything I've read, I probably will run into some of the more fearful comments.  I won't let it get to me, and I'll educate anyone who seems to be saying it out of concern but blow off anyone who seems to be saying it as a criticism.
So far, I'm most frustrated with blood sugar spikes.  I have to get those down, which means avoiding problem foods (why the hell did I eat that piece of delivery pizza?!?!?!) and giving myself plenty of time between the food bolus and eating.  I'll be making appointments with my doctors tomorrow, so I'm sure my endo will either have some more detailed advice or refer me to the CDE who specializes in pregnancy at her hospital.  I know the target numbers for pregnant women tend to be pretty low (I read in Balancing Pregnancy with Pre-Existing Diabetes that a common goal is no higher than 120 an hour after eating!!!), so I've gone ahead and reduced my overall target number a little bit...  It seems like a good start.

OMG guys, this is going to be wild!

(And, for the record, I really think I wasn't getting pregnant before because my body knew it wasn't healthy enough!)

Tuesday, December 7, 2010

Back on Track

It feels good to be back on track.
 And that highest peak wasn't actually as high as it looks, according to Ping.

My weekly average, according to Ping, is also back to 125 (it was creeping up into the 130s, which isn't so bad except that I'm trying reallllly heard to keep things closer to 120 while trying to conceive).

But I'm not going to get cocky about it.  Things are good, but they'll only stay that way if I keep a close eye on my BGs, count the carbs in those game night snacks, and watch for troublesome foods and habits.

Oh yeah, and watch the pizza.  Two plus slices of delivery pizza, with the crust dipped in garlic butter, is not beneficial to my BG numbers no matter what combination bolus I've tried!  But half an Amy's pizza, without additional fat like garlic butter, seems to be an acceptable indulgence.  (One slice of delivery pizza, with no garlic butter, also seems to be reasonably acceptable with a combo bolus... but it's sooooo hard to stick to one slice!!!)

Wednesday, December 1, 2010

Too Good to Last

Despite having a lot of insecurities, I also tend to be very proud of the things I do well.  Just recently, I got into a very comfortable, pleased-with-myself state of mind regarding my diabetes care.  I do this stuff really well.  Not only was I on top of things, but I significantly improved my morning numbers by myself, through two morning fasts and two basal adjustments.  I was coasting for a couple of weeks on numbers that never seemed to rise much above 140.  Things were... too good to last.  :(

Yep, that's a 286 staring back at me.  The past week, maybe two, have sucked.  That's the second 200+ number I've had, and possibly the highest number I've had since starting intensive insulin therapy (certainly the highest since they got my initial ratios close to what I needed).

What the hell?!  Things have been running generally higher, as they always tend to when hormones change at about the middle of my cycle, but worse than usual this time... and the past couple of days have gotten even worse... then a 286 for this morning for the exact same breakfast and bolus that went over perfectly yesterday morning?!  And I thought, hmm, maybe it's the infusion set or site, but no!  Everything appears fine, and my correction bolus is bringing my BG down at a rate that I would expect.  Bad insulin?  Well, it seems to work just fine on correction boluses, and I've had a couple mealtime boluses with perfect results... but I may try a new batch if things continue to look bad.

I may uncover some underlying reason, but until I figure it out, I'm just using a stronger basal dose and watching Dexcom like a hawk... and believing my fellow D bloggers more and more when they say things like, "Sometimes, this disease just makes no sense."


On a related note, while waiting for my BG of just over 200 to come down last night, I was talking to my husband about having read that a lot of PWDs tend to have some control issues, maybe even some OCD.  I totally get that now.  If I'd grown up putting so much importance in a number on a screen multiple times a day, feeling like that number is a pass or a fail, I'd probably have some sort of control issue, too.