Friday, November 18, 2011

It's the Blood Sugar Roller Coaster!!!

Weeeeeeeeeeee!!!!
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.

Friday, July 22, 2011

Week 36

Now at 36 weeks, we're looking at less than a week before we're considered full-term!  Wow...  There were times when this pregnancy felt like it was taking forever, but suddenly it seems like the end is right around the corner!

We had our last visit with the prenatologist Wednesday, and the news was pretty good.  The baby is estimated at 7 pounds 8 ounces and is measuring at slightly more than a week ahead.  He's measured a week ahead from the beginning, so this isn't bad news at all.  His abdomen is measuring a little big around, but not to a concerning extent.  The prenatologist's assessment: "He's a big baby, but in the normal range.  C-section is a possibility, but I consider you a candidate for vaginal delivery."  Honestly, that's a pretty great assessment!  I went into this knowing that a C-section is a more likely when the mother has diabetes, so to hear the prenatologist say I have a shot at a vaginal delivery feels like a triumph!

But the best part of visiting the prenatologist, other than hearing that the baby is healthy?  Getting to see the kid.


Aren't 4-D pictures just wild?  I bet when he's born, we'll be able to put this picture up next to him and tell that it's the same baby.

Diabetes in Pregnancy:

My prenatologist warned me that, after all the insulin increases you have to do during pregnancy, you often hit a point near the end when your needs suddenly decrease.  (Common knowledge medical opinion says it's due to the placenta breaking down, but my prenatologist thinks the baby is simply using more genergy/glucose at the end.)  I suspect I'm there.  I had a fairly bad low last night, and I seem to be struggling to keep my numbers up this morning.  Most (but not all) of my post-meal numbers are also lower.  If today continues to look that way, I'll be making some changes to my settings tomorrow.

Frustrating Pregnancy Stuff:

I went for so long with very few of those usual physical pregnancy complaints.  Now, I'm really catching up on the swelling!  My legs, ankles and feet have gotten worse and worse, with yesterday being so bad that I weighed in 13 pounds heavier at my OB's office than I had only 9 days ago!  The nurse practitioner says it was surely almost all from swelling.  I put my feet up higher and longer than usual last night and the difference was pretty significant in my feet and ankles, though my calves were still very swollen.  My feet probably won't swell much today since I stuffed them into compression socks and tennis shoes this morning, but I can already see my ankles growing despite the socks.

Sometimes in pregnancy, major swelling is also accompanied by other symptoms that point toward pre-eclampsia.  Luckily, I don't have either of the other two biggest indicators: High blood pressure and protein in my urine.  The doctor ordered some labs, including one that requires me to do the ever so fun 24-hour urine collection, to be absolutely sure.  I'm not too worried about the results, but I certainly don't mind making sure everything is OK.

Conflicting Opinions in Pregnancy:

Another frustration is contractions.  Ones I really don't even feel.  But when I go for my twice-weekly non stress tests, everything goes great except that I'm having contractions.  Sometimes it's just a scattered few, and that's not a big deal, but sometimes they're more regular or frequent.  A nurse mentioned to me that some doctors wouldn't consider even that a big deal, but my OB does.  Even though my cervix is closed and long (that means it's neither dilating nor thinning out in preparation for dilation), I've been given shots of brethine to stop the contractions a couple of times.

That. Stuff. Sucks.

The nurses warn you that it might make your heart race or make you feel out of breath.  It makes me feel way worse than that.  (I'm very sensitive to stimulants, and a nurse confirmed with me this morning that it acts very much like a stimulant.)  They also warn you that it can make blood sugar go high.  I could tell a difference with that, though it wasn't anything I couldn't keep a handle on.

But if I need to do something I don't like to keep my baby is safe and healthy, I'll do it.  Thing is... I have this gut instinct that I don't need the brethine, and that my body isn't doing anything it shouldn't do right now.  And brethine does come with some risks.  Using it to stop contractions is an off-label (though extremely common) use of the drug, and the FDA has recently added a label to it that warns against using it on pregnant women for an extended period of time.  So even though these shots are pretty short-term, I don't like them.

But my gut doesn't have a medical degree, or decades of obstetrical experience.  My gut only has "instinct."

Then I mentioned the brethine to my prenatologist, and he immediately shook his head and said, "No, they shouldn't be giving you brethine now.  Those contractions are normal.  They get your body ready for labor."  (This totally matched my own understanding of Braxton Hicks.)  I said that it seemed that regular contractions seemed to be what concerned my OB enough to give it to me.  Again, he shook his head.  "You're not feeling these contractions?  Trust me, you'll feel them if they're a problem."

OK, so now I have two conflicting medical opinions and a gut instinct to work with.  Oh, and fear.  What if I turned down brethine and the baby is born too early?  Or what if I accept the brethine and keep my body from getting ready in time for labor, or what if the drug has a direct negative effect on the baby?

I wound up deciding that today's NST would be the last one during which I would accept brethine for these contractions alone.  I told the nurse that if I had contractions, to express to my OB that I realllllly don't want to take it unless it's reallllly necessary.  I told this nurse, who has worked with me a lot, about the above conversation with my prenatologist and also that I'm really at the point where I feel like I should deny consent for the drug but am also hesitant to butt heads with the doctor who's going to deliver my baby.  The nurse said that would worry her, too.  As I watched the monitor, I saw a couple contractions... but they didn't seem at all regular.  The nurse took the sheets up to my doctor after the test had run long enough, and she came back down saying I could go.  "And I didn't tell her that you didn't want the brethine.  I said that your prenatologist had told you you shouldn't take it anymore."  It sounded like my OB didn't fully agree with that statement, but she was wasn't worried enough about the current contractions anyway.



That nurse is awesome.

And, though I plan to talk to my OB about it when I see her, the brethine might not be an issue anymore, anyway.  I'll be two days away from "full term" at my next test, and the nurse said she'd be surprised if I'm given it again at this point.

Sunday, July 10, 2011

Foods I've Been Digging

So, between diabetes with ever-increasing insulin resistance due to pregnancy and just typical pregnancy stuff, some things about my diet have changed.  Here are some things that I've really been digging and that seem to work well for me...

  1. Strawberries.  Freaking yum!  These are also one of the lowest-carb fruits so, as long as my blood sugar is at good levels, I can pass through the kitchen, grab one, and nom it without thinking of insulin.  I couldn't do that with, say, a slice of apple.
  2. Raw veggies.  Baby carrots have been really nice to snack on, even without any dip, though I do have to bolus a little for them if I'm having more than a couple.  Celery?  If I'm willing to take the time to cut it up, this is one of those no-insulin snacks for me.  Or if I want some peanut butter without a ton of carbs, this is a better option than crackers or toast.  And for our weekly RPG nights, I usually grab a bag of raw broccoli and cauliflower at the store and dump it in a bowl with a little side of ranch.  I do bolus a little for this, but it's mostly a good nosh-all-night kind of snack.
  3. Those little single-serving snack packs, the kind that are usually marketed for being 100 calories.  If I want something junky, these keep me from going overboard.
  4. The turkey burger from Carl's Jr.  No fries, just the burger.  For some reason, of all the fast food options I've tried when just desperate for fast food, this one has been the kindest to my blood sugar.  No spikes, and no fat-related rise later on.  Awesome.
  5. Peanut butter.  This is a comfort food for me, it's not high carb, and it's about the right amount of fat (good fat!) and protein that it helps smooth out sugar rises without causing a fat-related rise later on.  I've been eating a lot of this stuff since getting pregnant.
  6. Low fat milk instead of skim.  I love milk but, sadly, lactose is one of the faster-acting sugars out there.  But add a little fat to a meal and that helps chill things out.  I also made this switch early on because I kept being told I wasn't gaining enough weight.  This was an easy way to add some fat and calories.
  7. Vanilla Soy Slender.  When I want milk but my blood sugar isn't doing so great, or if I just feel like drinking a big glass of milk without all the carbs, I'll drink this stuff.  It's only 4 carbs a cup, and it totally satisfies my milk cravings.
  8. Diet Rite, especially the funky flavors.  In addition to being diet (and therefore carb free), it's also aspartame free and sodium free.  The cola is decent, but I love picking up their funkier varieties, like tangerine or cherry cola.
These have all been good choices for me.  Maybe they aren't all the best choices I could make (I could surely be better off without any fast food or junk), but they work.

Two things I'll soon be adding, with hope that they also "work for me," are prunes and watermelon.  Prunes are just to help keep things closer to normal now that I'm at a point where my digestive system is naturally running more slowly, and the watermelon is an experiment to see if it helps with swelling (something I was told and have read a couple places online).  I figure that, even if it does absolutely nothing for my swollen ankles, at least it's a good summer time fruit that's very low in carbs.

But honestly?  I can't wait to be able to eat real pizza again!!!

Friday, July 8, 2011

Things are mostly typical.

Most of my pregnancy complaints these days fall under "typical," rather than diabetes-related.
  • People making random comments about how big I am? Check.
  • Swollen ankles? Check.
  • Too tired to take the stairs if there's an elevator available? Check.
  • Carpel tunnel symptoms when I wake up in the morning? Check.
  • Peeing all the damn time? Check. (Though, this was also a common complaint of mine when I was an untreated diabetic!)
  • Hard to get comfortable in bed?  Check.
  • The kid keeps kicking me in the diaphragm? Check.
 (But, did you notice the significance of that last one?  He's kicking my diaphragm, not punching it.  He turned!  He's no longer breech.  Yay!)

That is definitely not to say that I don't struggle with my blood sugar.  My insulin to carb ratio for breakfast and lunch have almost doubled, and my Friday night blood sugar seems to be just about uncontrollable.

I've started doing non-stress tests twice a week, which means I go to the hospital and lie there with all of this stuff wrapped around my belly:


These sensors monitor the baby's heart rate (and apparently my uterus).  Every time the baby moves, I push a button that tells the nurse on duty to watch my baby's heart beat.  They're looking for the right level of increase in his heart rate.  If this ever shows that he's not reacting normally, it could indicate that he's no longer getting what he needs from my placenta.

This can take anywhere from 20 minutes to an hour, and the first time I was there for almost two hours because I was having contractions more frequently than my OB wanted.  The nurse gave me a shot to stop them and I had to wait around for 45 minutes to make sure it worked.  (These were just braxton hicks contractions, and I couldn't even feel them, so it wasn't a huge deal.)

With these tests twice a week, a weekly visit to the OB, and a twice-weekly visit to the endo, I have a minimum of three appointments a week, often four.  I'm doing my best to schedule them so I don't have to take so much leave, but I'm definitely not going to have as much paid leave as I hoped for my maternity leave!

Friday, June 24, 2011

Kind of a Big Difference...

I've mentioned before that my husband Chad decided to start watching his blood sugar after we established that he was having low blood sugar episodes, and that his fasting numbers weren't quite where he'd like them to be.  Mostly, he checks when he wakes up and whenever he feels weird.  But for the first couple of days, he did the whole shebang.  He tested before meals and two hours after meals, as I was taught to do.

So after one of those meals, he tested on his handy but very simple Relion meter, and....


Holy crap!!!  We had a moment of panic before I said, "Wait... turn it over."



Yep, confirmed... it had been upside down.

There's a pretty big difference between 201 and 102!!!

Friday, June 17, 2011

Home Stretch

Things have been going well.  My insulin-to carb ratios have been going up, up, up... but with only 9 weeks left, I'm in the home stretch.  It's not so bad seeing those doses climb knowing that, by sometime in August at the latest, they'll come right back down to normal (or even lower, for a while!).

Things are really about to get busy...  Up until now, I've had an appointment with my OB about once every 2 weeks (plus occasional drop-ins just to get weighed), an appointment with my endo once every 2 weeks, and a total of 3 appointments with the prenatalist.  Now, those appointments with the OB will go up to once a week, and we'll be adding in twice weekly non-stress tests and a weekly bio-physical profile at her hospital.

Jeebus!!!  So much for keeping some vacation time saved up for maternity leave.

Most women do get a little more attention later in the pregnancy, but I have so much because it's getting close to the point when the placenta could start breaking down due to my higher than average glucose levels.  (We are, however, starting it a couple weeks later than my OB would normally start since I've been well-controlled.)

C-section was a big topic of discussion at the last appointment, too... and it didn't have a lot to do with my diabetes/placenta.  It had to do with the fact that this kid is breech.  My OB didn't discourage me getting into positions that make it easy for him to turn and she said she'd probably be willing to do an E.V. at 37 weeks (though she has some concerns about it since there's potential to hurt the placenta), but she did tell me not to get my hopes up too much.  He's never been in a totally-head down position (that we know of from the ultrasounds), and he's been head-up for quite a while, which makes her suspect he's pretty determined to stay where he is.

And yikes, I can testify to that! He has some favorite places to kick or head-butt, and he stays there and does it so often I swear I get sore from it!  When he starts working away on my right side, sometimes he's like, POW! and I jump and yelp.  I'm always torn between applying pressure to encourage him to move a little more toward the center, or just tolerating it in case he's trying to do a somersault and turn head-down!

I certainly hope he flips so we have a shot at a vaginal delivery (my OB said breech = automatic C-section at her hospital, which is pretty typical), but I'm reminding myself that the important thing is that he arrives safely.  I also find it slightly easier to tolerate the idea of a C-section now that it's for some reason not related to the big D.  This is something that could happen to any mother and baby, and there are very few OBs left who are OK delivering a breech baby without a C-section (though midwives assist in this all the time, so a C-section isn't really always necessary).

In any case, we've also started doing some of the fun preparation for baby's arrival: putting together big items from the baby shower and filling in the gaps by buying essentials we weren't given.  (We certainly never expected to be given every essential, but we simply waited until after the shower to see what we'd still need to spend money on.)  This also means spending yet more money on top of medical expenses, so I've been doing a ton of comparison shopping.  I managed to find a great used breast pump for an awesome price on ebay, I downgraded from the nice and super-cutesy baby bottles to plain and boring but highly-rated and inexpensive bottles from the same manufacturer.  I've also created a "shopping list" on Amazon that we'll print and take with us for price-comparison when we go to Babies R Us to take advantage of the 20% off deal you get on any items from your own registry.

Phew! Baby-having is hard work even without having to watch your blood glucose like a hawk!  Thank goodness decorating the nursery is more fun than bolusing...

Thursday, June 2, 2011

Glucose Tabs and Tight Ropes

Wandering through the produce section of Walmart Neighborhood Market, I felt a little bit funny.  I glanced at Dexcom and saw a 75.  That's not far from low and Dex hadn't been having the most accurate day, so I thought I'd better make sure.  I pushed my cart out of the way near the deli counter, where a lady waiting for her order started to eye me as I fished through my giant purse, and got my meter case out.  I opened it up, inserted a strip, and tried to pull the lancer out of its elastic.

The cap popped off and went flying, bounced off a shelf, and rolled under my cart.  Dang it.  I put the lancer down... and it rolled off the meter case, bounced through the slots in the metal grocery cart, and landed underneath.  The nosey lady stared hard.

I heaved a sigh, started to move the cart out of the way, and the meter case flipped off of the produce I'd balanced it on and into the cart.

I glanced at the nosey lady and felt extreme annoyance.  At this point, I knew testing was only a formality.  I'm clumsy when I'm low, and now I was getting both frustrated and irritable.

I moved my cart, gathered and assembled everything, and tested.  55.  Not a number that makes me panic, but not a good number at all.  I fished the last four Starburst out of my purse and unwrapped and ate them as I contemplated buying pretzel crisps and hummus.  (Pretzel crisps, yes.  Hummus, not today.)  I didn't feel good at all, but just moved slowly and tried not to let my instinct to eat sugar for survival convince me to pile donuts and cookies into my cart.

Almost 15 minutes later, Dex buzzes and flashes a 44.  I've started to sweat and I definitely feel worse.  I should feel better by now.  I abandon my trip to the cracker and cookie aisle and make a B-line for the pharmacy, where I know there's a bench.... and a water fountain.  I'm powerfully thirsty (something that normally accompanies a high, but whatever).  I sit a minute to let myself hit the 15-minute mark and test again to see a 57.

Not. Good.

I don't have anymore candy in my purse, but there was a further point to heading for the pharmacy bench; it's immediately across from the diabetes supplies.

I grab a bottle of glucose tabs and, sweating on the bench, struggle to tear the plastic off of the cap.  I'm starting to feel a little embarrassed...  Am I going to have to ask someone to open this for me?  I'm not that bad off! I finally make a dent and tear the plastic back in a ribbon, get the dang thing open, and eat three tabs in rapid succession before I stick the jar in my cart and drink deeply from the fountain.

Oh glucose tabs, you may be chalky, but you are a sight for my tired, hypoglycemic eyes.


Finally content, I sat on the bench and spent at least 10 minutes (which felt more like an hour) dabbing sweat from my face and hoping I didn't look or smell too awful.  But no one seemed to be paying attention to the pasty, sweaty pregnant lady on the bench, so I figured I was probably good.  Then I started wondering... would people notice if I passed out on the bench?  Would they assume I was some weirdo who had fallen asleep and just let me get worse?  Even though I was sure I would be OK, I fingered the medical alert charm hanging from my neck to make sure it was visible.

Once I started feeling human again, I made myself stay on the bench a few more minutes for good measure.  55 is not the lowest number I've ever had, but this was by far one of my worst lows.  It felt horrible and it had been persistent.  It had actually made me worry for myself and my baby.  It reminded me that the necessary tight control I've been keeping for the health of my baby includes some danger.  When you're keeping your numbers this low, you don't have very far to fall when your numbers start to drop.  Tight control is also a tight rope.

Sunday, May 29, 2011

Sickity Sick-Sick

Friday night, I started wearing out well before our D&D game was over. Half snoozing on the couch, those still conscious took pity on me and another couch-snoozer and shut the game down. After everyone went home, I went to bed.  I eyed my Dexcom, unhappy to see a 175, and tested... Yep, high.  I bolused, but not too aggressively since I was about to sleep, and settled down for sleep.

Sort of.

My stomach started to rumble and my blood sugar would not go down. If Dexcom wasn't beeping at me, I was waking up to try and find a better position for my stomach or to drink water, pee, and try to get a handle on my blood sugar.  I finally got up around 7 am with a headache, bolused again, checked for ketones (negative) just because I had so much time trying to get my numbers down that I had to wonder, and really started trying to hydrate myself.  I then went out on the back patio with a big glass of water and a small cup of coffee.  It was a tiny bit warm, but not bad... then suddenly I had the "sweats" that I normally associate with a low blood sugar (but I certainly wasn't low) and had to run for the bathroom.  (Sorry for the TMI!)

Ohhhhh, I was sick!  That explains so damn much.

(As a quick detour for anyone going, "OMG, listeria!!!"  No, the symptoms were not a match and there hadn't been any time for an "incubation period" since I'd only just had deli meat that day at lunch and listeria takes at least 2 days to manifest symptoms. Plus, Chad got the same symptoms later in the day and hadn't eaten the deli meat I had eaten.)

I know that my blood sugar tends to run high when I have any kind of stomach upset, so I cranked up my basal insulin by 50% and sat inside in the nice air conditioning and felt sorry for myself until my blood sugar was under control again.  My stomach discomfort went away quite quickly, thank goodness, so I made a healthy but easy breakfast for us when Chad got up.  I kept feeling exhausted and headachy, I attempted and failed to nap, then I finally gave in and took some Tylenol.  Unfortunately, this meant turning off Dexcom for the rest of the day.  CGMs just don't work with Tylenol in your system, and Tylenol is all a pregnant woman can take for everyday pain.

Night-night, Dexcom:

I dislike not being able to see what my blood sugar is doing at a glance, especially since pregnancy has made things so unpredictable....  It. Was. Worth it.

I ended up feeling well enough to go to a birthday party for three good friends of mine.  I did, however, tell Chad to just go ahead without me because I knew I was going to take a looooong time getting ready with so little energy.  I felt pretty decent most of the evening, though I was tired and spacey and never got rid of my headache 100%.  Chad and I ended up leaving at the same time despite our plans that I'd head home early and he'd probably stick around.  Right around the time my headache was coming back, he said his stomach had been rumbling and he got the sweats.  Either he caught the same bug from me or we'd both picked something up from the same source and his immune system had simply held out a little longer than mine.

I went to bed with a headache again, because I just wasn't willing to take Tylenol and keep Dexcom turned off overnight.  My blood sugar had crept back up during the evening and I had to bolus not long before bed. 
I really just wasn't confident that my BG would react predictably.  Luckily, this one wasn't a constant headache but one that only throbbed with added pressure or a lot of movement.  It only nagged me whenever I rolled over, so I could actually sleep.

I'm feeling a hell of a lot better this morning.  My head still hurts with pressure (like when I sneeze, OUCH!) and my BG was a tiny bit above my below-100 fasting target when I woke up, but I'm just taking it easy and staying hydrated.

I was kicking myself repeatedly over those high BG numbers that first night, but this is yet another example of how you can do everything right and diabetes will still screw with you.  It's a manageable disease, but that doesn't mean pure dedication is going to keep it in check every single day.  Sometimes things just happen.

Friday, May 27, 2011

Flying in the Face of the APA

I've officially decided to do something that flies in the face of an American Pregnancy Association recommendation.

I'm going to eat cold cuts and deli meat.  And I'm not going to heat them all until steaming first.

Right now, the majority of you are having one of two reactions:

1. Most of you are saying, "Uhhhh, what's wrong with cold cuts and deli meat?"
or
2. A few of you are thinking, "Ohhh, but there could be bacteria, and that could be bad for the baby!"

It's not that widely known (you'd be amazed by how many blank stares I've gotten when turning down cold-cuts in the past few months!), but yes folks, pregnant women are advised by the APA to avoid eating deli meat (any cold meat that hasn't recently been heated to at least a "steaming" temperature).  The theory is that there is a slightly higher chance of food poisoning with meat that's stored and eaten cold, and if that food poisoning were caused by listeria, it might also cross the placenta and make the baby sick (sometimes dangerously so).

Is it that listeria infection is rampantly common?  Nope.  About 2,500 Americans get it a year, which is 0.0008027371616142571% of the population.  Then, is it because pregnant women are more susceptible to listeria?  A little bit, due to weakened immune systems.  27% (about 6750 people) of those 25,00 Americans who get listeriosis each year are pregnant and, since there are about 6 million pregnancies a year in the States (and just assuming that means roughly 6 million women are pregnant a year), then about 0.11249999999999999% of all pregnant American women get listeriosis.  I know that looks like a big number with all those digits, but it's actually tiny.  It would round to 0.1%.

Holy crap, I did math!!!  And I'm reasonably sure I did it correctly!

Anyway, my point is that there's a pretty slim chance of contracting listeria, and then it might not even cross the placenta to my baby.

But during the work week, what have the chances been that I would forget or neglect to pack a lunch and end up buying fast food which raises my blood sugar way out of the pregnancy target range?  I'd say those fast-food high numbers have been happening about 80% of the time, lately.  I've tried a dozen different methods to get myself to pack a reasonable lunch, and I beat myself up over every high number, but to no avail.

But before pregnancy, and before my resulting (self-imposed) deli meat ban?  I'd say I made my lunch about 75% of the time, which generally meant throwing simple, pre-made foods into my little lunch cooler with a baggie of veggies and/or fruit.  There were always some sort of deli meats in there, often as part of one of those little lunch combos I call "lunchables for grownups."

So I've made the decision based on the statistics around a possible danger for my baby vs. a verified, daily danger for my baby.  My OB harps on about my blood sugars at every single appointment, but she has never once, either in person or on the dos-and-don'ts list I was given, said that I shouldn't eat deli meat.  No, not all OBs are as concerned about listeria as the APA.  My OB is pretty chill about "restrictions" in general.  Tylenol in indicated doses, up to two servings of caffeine a day, up to two servings of nutrisweet a day, hair dying is allowed in a well-ventilated area, etc.  And what she always emphasises with me is: good blood sugar levels, above all else!

If throwing a lunchable-for-grownups in my lunch bag every day keeps me away from Sonic and therefore keeps my blood sugar down, so be it.

Thursday, May 19, 2011

Well, That's Embarrassing...

I don't use any fancy pump accessories.  I didn't get the "thigh thing," the "waist-it," or any kind of special clip or case.  I just use the clip that came with the pump and I have a couple "skins" (which I got for free) in case I'll be doing something that is more likely to knock my pump around.

Typically, I do one of the following:

  1. I put it in my pocket.  Most of the time, this means it's visible.  I do, however, have a couple dresses with pockets that allow me to hide the pump entirely by running the tubing through a tiny hole just inside the pocket.  (I just cut a hole big enough to run it through then dab some "no fray" on the edges.)
  2. Clip it to the underside of the front of my bra.  I'm busty, so this normally hides the pump-bump entirely if I'm trying to go for a more sleek fashion look.  (When I do this, I first slip the pump into a little fabric pocket I sewed myself [some people use baby socks!] so it doesn't get all sweaty against my skin.)
  3. I clip it to the side of my underwear, slightly toward the front or back so I don't have a "lumpy" looking silhouette.  This is what I almost always do when wearing a dress to work.  (This also happens to be how I always wear it when I sleep.)
So, as usual, I had my pump clipped to the side of my underwear yesterday since I was wearing a dress.  No problem.  I really don't even notice it.  But then all of the sudden, there was a tiny little...

Snap!!!

And then things just felt a little different.  I continued walking and felt my pump slowly drooping...  Huh, odd... Oh, crap!  The elastic in my waist snapped!

It normally wouldn't have made much of a difference, but the weight of my pump kept inching it downward, and I had to keep trying to subtly pull it back up.

Droop, droop, droop, subtle hike!  Droop, droop, droop, subtle hike!

At least, I hope it was subtle...

Nice.  Who'd have thought my underwear would matter that much?

Luckily, it wasn't long until lunch, so I just slipped out to the Dollar General and bought a pack of underwear.  Problem solved!

Monday, May 16, 2011

San Antonio and the Death of Dex

I spent a long weekend, out of my usual routine and either walking far more than usual or sitting still far more than usual, without Dexcom (a continuous glucose monitor).  And I was just fine.

You see, last Wednesday night (or early Thursday morning!), Dexcom vibrated to wake me and tell me I was low.  I felt OK, but tested... and I was 90.  Perfectly fine.  So I calibrated Dex and laid my head back down to sleep... only to be startled awake by an incredibly shrill BEEEEEEEEEP!!!!

I've seen other D bloggers complain that Dexcom is too quiet and won't wake them up at night.  Yeah, I don't have that problem.

I grabbed it and saw that Dex was initializing, and then that it had recovered a session.  Okayyy...  I put Dex back on the nightstand and settled back in, trying to relax...

BEEEEEEEEEP!!!!


Initializing and recovering again!
 
I went through this two more times before I turned Dex off and got out of bed, wide awake.  3:30 am.  Great.  No way I could get back to sleep, as wired as I now was.
 
I called the Dexcom service line as soon as business hours arose and they confirmed that, yeah, something pretty bad had gone wrong with the receiver, and they wanted to just replace it to be safe.  They offered to overnight it, but I asked them to wait and send it so it would arrive Monday, since I was leaving town early the next morning.  (They were, by the way, extremely awesome and offered to just overnight it to where I was going.  I didn't really feel secure about sending it to a hotel when I surely wouldn't get there until well after delivery.)
 
Friday morning, after stopping for the #7 breakfast at Cafe Antigua (this particular meal is both incredibly delicious and miraculously easy for me to bolus correctly!!!), Chad and I made the long Trek down to San Antonio for my grandmother's memorial service.  As a straight shot, it's about an 8 hour drive.  It's much longer when you're pregnant and need to make frequent stops to use the restroom and stretch your legs.  The drive wasn't bad though (especially since Chad was awesome and happily drove the whole way!), and we met up with my family on The Riverwalk when we arrived.
 
I had few blood sugar issues.  I went low twice over the weekend, but neither time was bad at all.  I probably went a little higher than I might have with Dexcom once, but it wasn't really out of my typical range, either.  Basically, I just tested more often... A lot more often.  And it was fine.  But still, there's so much that Dexcom gives me.  For example, I ate most of a sugar free fried pie and felt like maybe I'd given myself too much insulin for it.  We Dexcom, I could have just kept glancing to make sure my blood sugar wasn't dropping.  Without it, I tested like 45 minutes after eating to make sure I was going in the right direction at the right rate (I was), but I still felt kind of paranoid until the two-hour test.  And with Dexcom, I didn't feel the need to test my blood sugar before sleeping.  I just glanced to make sure it was in the right range and fell asleep with confidence that it would wake me if I went too low or too high.  Without it, I tested before sleep (a good thing too, as I was a little low at that test on Saturday night) and still worried as I fell asleep... In fact, I let myself run a tiny bit higher during some of the weekend than I normally would while pregnant and with the safety net of a CGM.
 
Things have been fine, but I'll be really happy to see that Dexcom box this afternoon!

Tuesday, May 10, 2011

"Diabetic"

I'm definitely not militant about saying "person with diabetes" instead of "diabetic."  I don't care much if people call me diabetic (either as a noun or as an adjective).  I try and respect that others might not like it and at least won't refer to anyone as "a diabetic" unless they've called themselves that.

But, I'm beginning to really see why some people dislike the very word "diabetic."

When I visit my OB, it's like diabetes labels everything about my pregnancy... in a way that I don't think is accurate.

For example, she keeps saying "diabetic placenta."  I know that what she means is "the placenta in a pregnant mother who has diabetes," so I'm not offended or going to go on about how a placenta can't be diabetic.... but I feel that calling my placenta "diabetic" feels like calling it "broken down and incapable of supporting a baby properly."  And that isn't true.

It is true that a placenta is more likely to break down too fast in a mother with diabetes.  I definitely won't deny that, or deny that it could happen in my case.  But the placenta does not break down faster simply because you are diabetic.  It breaks down faster in the presence of higher than average glucose levels.  Therefore, a very well-controlled diabetic mother might have a perfectly healthy placenta that is in tip-top shape all the way through pregnancy.

I accept that I am at a higher risk of needing interventions, but I dislike such suggestions (however unintentional) that I and my baby are doomed merely because of my diagnosis.

So, I now kind of get why some people dislike the word "diabetic."  I understood already that it comes across as a label, which many people dislike, but now I also get that it suggests a state of being more than "with diabetes" does, and a "diabetic" state suggests poor health.  Whereas, plenty of people with diabetes are actually healthy.

I am continually fascinated by the power of words.  Thoughts shape language, but language also shapes thought.

Wednesday, May 4, 2011

Diaversary: Celebrating the Best Bad News of My Life

Yesterday was my one-year diaversary, and how did I celebrate?  With cake!  Yummy, sugary, properly-bolused cake!

Chad was awesome.  I was feeling crumby from an earlier low BG and I tried extra hard to look all pathetic and tired and pregnant on the couch while I said I should eat cake for my diaversary.  So Chad went to the nearest market with a bakery and brought back both red velvet and carrot cake!


They're individual slices of cake, but still just huge!  I bolused (generously!), made marks in the icing to indicate how much I would eat so I wouldn't get carried away, and thoroughly enjoyed my treat.  Chad had some of what I didn't eat and we still had plenty of cake leftover.  That's how big these stupid (but tasty) slices of cake were!  Supposedly two servings, but really more like 4.

And this was a little celebration, as far as I'm concerned.  We weren't celebrating diabetes, we were celebrating the diagnosis and the fact that the disease is about as under control now as it could possibly be.  (But let's not fool ourselves. There's no such thing as 100% control when it comes the the big D.)  One year ago, I got the best bad news of my entire life.

My blood sugar behaved with the cake, and I went to bed feeling pretty much OK about life.  Yeah.  Life is pretty good.

Wednesday, April 27, 2011

Looking Like a Baby!

We had our second big ultrasound appointment today, with the perinatologist (an OB who specializes in high-risk pregnancies).  Everything is still looking healthy and on-track, and we were happy to see some fat on those cheeks since he was just a skeletal little thing last time!


Look at that!  He's holding his knees up to his chest with one arm, feet sticking straight out in front of him.  Definitely my favorite shot from the ultrasound session.

Starting my 24th week tomorrow, I can say that things are going very smoothly so far.  My blood sugar definitely goes out of range, but it's overall not too bad.  But the baby is doing great, and the pregnancy itself is treating me pretty well.  *knock on wood*  I haven't had much swelling, blood pressure is as awesome as always, and I feel fine.  I'm tired sometimes, more apt to sit down when I might otherwise be fine standing, and occasionally slightly uncomfortable due to the belly....  Those are my biggest physical pregnancy complaints these days, other than blood sugar being harder to control.

The baby has been busy kicking and karate chopping my insides.  It's not just taps anymore!  Sometimes there'll be a massive thump I'm just like, "DUDE! Whoa! Chill out!!!"  If I lie on my right side, he seems to act up with lots of kicking the lower right side and punching the upper left at the same time!  There have been a couple times when I was slightly amazed at how clearly he was changing position in there, and other times I'd start just feeling lots of pressure in one spot (usually lower center).  Seeing that image I posted above, I wonder if he was trying to stretch out his feet in front of him whenever I felt that!

I'll admit...  I'm not very prone to sentimentality and great big gushing emotional shows.  I've had women tell me that pregnancy is "magical."  Sorry, I feel no magic in my uterus.  I have, however, begun to enjoy the growing evidence that there's a tiny little living person inside of me!  Life and reproduction are so amazing and cool.  And I don't feel some mystical bond to my child that some women say they feel during pregnancy, but I am completely delighted when he kicks (unless I'm trying to sleep!) or responds to pressure on the belly.  I'm not an emotional gusher, and I'm really uncomfortable when other people gush over me right now, but it's still an incredible experience that I'm appreciating.

(Related to the whole lack of emotional gushing, I just recently retook the Myers-Briggs personality test and scored as an INTJ, which is sometimes referred to as "the scientist" or "the system builder." This more reserved aspect of my personality is actually very heavily covered in all of the INTJ descriptions I've read, which made me feel a little less like a freak for not being ooy-gooy over pregnancy and babies!)

Thursday, April 21, 2011

Who are You Calling Little?!?!

So not D related, but I just had to rant about this a little bit.

One of my "buttons," as my husband would call it, is when people don't take me seriously.  Sometimes this is clearly intentional stuff like being openly disregarded (do this, and you'll see what I look like when I'm irate!), but I'm also pretty sensitive to language and subtext.  I know full well that people don't have to be intentionally mean to have a negative effect on a person, a situation, or even a society.

As a result, I just absolutely couldn't stomach someone I barely know referring to me as "a little mama" in the workplace.

I totally let it slide the first time, telling myself that this person was trying to be sweet and friendly.  But then she kept saying it, and every single time I envisioned myself as a toddler playing with a baby doll.  "Little mama" just doesn't fit the image of myself that I try to believe in: a strong, smart, responsible 31 year old woman who made a significant life decision with her husband, and who is now going through a lot of work to bring a healthy human being into this world, whom I will then help guide through life.

I'm positive she meant well, and she probably doesn't quite picture me as that toddler with a baby doll, but every time she called me "little mama," it just didn't seem possible that she felt any respect for me.

I realized that I needed to find a polite way to get her to stop calling me "little mama."  It's not appropriate in a work environment, it's not appropriate with someone you barely know, and... it's really not that cute or clever anyway.  My husband and my parents have the most leeway with me when it comes to terms of endearment, and I'd have shut that one down pretty quickly!

I didn't want to have to go to her office and say, "Hey, by the way, I'd appreciate if you didn't call me little mama anymore," but I wasn't entirely sure how else to do it.  Until I just did it.

Her: Oh, here, I'll let the little mama past.
Me: *smiling* You know, I'm really not that little.
Her: Yes you are! (Believe me when I say she was not endearing herself to me with this comment!)
Me: Well, and I'm a 31 year old woman.
Her: *awkward pause & stare* You are not 31!

I suspected, during the awkward pause, that she was realizing that I felt like she was talking down to me.  However, I also knew the mention of my age would open up a mode of escape for her: a change of topic.  It seems like almost all women over 40 assume I'm much younger than I am (most women younger than that and most men either guess my age pretty accurately or just never comment on it), and I do look fairly young.  I'm well aware that, at this stage in life, this is a disadvantage for me in the workplace.  (I'm also aware that, in the future, it might become an advantage.)  Add to this the fact that I am only 5'2", and I'm at a double disadvantage when it comes to making a serious impression in the workplace.

By the way, when she said "yes you are!" to my comment that I wasn't that little, I almost wigged out on her ala Edward from Full Metal Alchemist:


But in all this, my mind was incurably boggled!  First of all, how did she ever think this cutsie term of endearment would be appropriate with a professional peer she barely knows?  Even if I'm younger than her?  Even if I were much younger?  Second, why did she make yet another comment related to my stature after I said I wasn't "that little?"  She's on the taller side of average for a woman, but surely she's aware that some short people are self-conscious about their height (if you don't "get" that, watch the above video again! :p ).  At that point, I felt like she was being genuinely rude, even if she didn't intend to insult me.  It was like pointing out someone's big nose, wide hips, or other physical feature that is the opposite of what society idealizes.  (So, thanks lady.)

Really, are people so clueless?

Prenatal Visit - Labor/Diabetes Discussion

I had another prenatal appointment yesterday.  These appointments are really much less eventful than you might think.  I step on a scale, pee in a cup, get my blood pressure taken, and let the nurse use the doppler to hear & count the baby's heartbeat.  When the doctor comes in, the only physical thing she does at all is measure my belly.  Otherwise, she usually tells me that we'll start increasing monitoring before long and then answers questions I have.

This time, she said we'll start weekly monitoring at 32 weeks (I'm currently at 23), provided there are no signs that it's needed earlier.  She said this will most often involve going to the office, having me lie down, and hooking up a monitor that will let me watch the baby (for between 30 minutes to an hour).  Every time he moves, I push a button and the monitor will record his heartbeat.  She said that if he's healthy, the heartbeat will speed up during those times.  This is, from what I've read, a "fetal non-stess test."  The point of this is that if my placenta starts to break down too early (not uncommon in diabetic women), they'll start to see signs that the baby isn't doing as well as he should.  That could signal the need for an early induction.  Early induction is something I want to avoid, but this is one of the few likely diabetes related scenarios that I knew early on would be a valid concern.  Possible large baby?  Not an excuse for early induction.  Baby not getting the nutrition he needs to survive and grow?  That makes total sense.  Induce away, doc.

I also finally asked for a few more details on handling my blood sugar and insulin during labor.  I've heard of some doctors and hospitals letting mothers with diabetes manage everything themselves, as long as they let the nurses know what their blood sugar is on a regular basis.  But I've heard of others that want to take the management away from the patient the moment they walk in the door, putting them on an insulin drip and possibly a glucose drip.

But my OB's reaction when I asked, "Will I get to keep my pump on during labor," was:

"As apposed to someone taking it away from you?  Of course."  She clearly thought it was an odd question, so I clarified that I'd heard of other patients not being allowed to manage their own diabetes during labor, that some hospitals demand an immediate insulin drip instead.  She looked slightly aghast and said, "I see no logic in that at all!  No one's going to do a better job taking care of that than you.  The nurses will ask you for your blood sugar periodically, and we'd have to take over if you were unconscious for any reason, but that's it."  (I said, "In a case like that, you feel free!")

We discussed a few details.  For example, she'd normally tell someone on injection therapy not to take their long-acting insulin during labor since blood sugar is more likely to go low than high.  In my case, I'll reduce my basal immediately and watch to see if it needs to be turned off entirely.  Like many hospitals, this one doesn't allow women to eat after they've checked in for labor and delivery.  She confirmed that if my blood sugar goes low, they can give me "something like a popsicle."  (I still plan to stash a juice box or two in my bag, just in case.  Hospitals are busy places, and I want a back-up in case it takes too long for the nurses to respond to a buzz.)

She also asked how long it takes to change my infusion site, in case I had to have an emergency C-section, "because if it's on your belly, we'd have to remove it and that might disrupt your insulin delivery at an inopportune time."  We agreed that the easiest thing would be to wear my infusion site and continuous monitor sensor someplace other than my belly for the last week of pregnancy.  That way it won't even be a concern if I end up needing a c-section.

Which reminds me of yet another doctor's appointment I need to arrange: A check up with my opthamologist.  The perinatologist recommended that, though my control is good and my retinas looked great last time, I should go ahead and get checked out before having the baby.  If I have developed retinopathy, the opthamologist might recommend against vaginal birth if there's much risk of retinal detachment.  Pushing only adds pressure to the eyes, which isn't smart if your retinas are ready to detach!  I fully expect to be told my eyes look great and pushing would be safe, but it's best to know for sure.

Saturday, April 16, 2011

Touche

Chad decided he wanted a testing kit so he can watch is blood sugar for a few days, since he's had a couple moments of what felt like crazy-low blood sugars (we tested during one of those moments once and it was something like 46!).  He also had a fasting blood sugar on the upper side of average when our GP tested it 8 or 9 months ago, and I think it's smart for anyone with any risk of diabetes to test their BG once in a while.  So I picked up a Relion Micro and box of 50 strips.  This was cheaper than if I'd just gotten him a vial of strips for the Freestyle I have but no longer use, or if I'd picked up strips to let him use my spare One Touch Ultramini (if I could find the damn thing!).

(I'm normally not one to promote Walmart, but their Relion meters and strips would be an great option for someone with diabetes and no prescription plan.  This is actually the second Relion meter I've ever purchased.  The first one served as a back up when my very first vial of strips ever ran out well before I could get the refill covered by insurance.  Later, I mailed it to someone I'd talked to online who didn't have insurance and was having trouble affording strips for the meter she already had.  When Chad said he thought he might want to keep a meter with him to test for lows, I didn't blink an eye at picking up another Relion.  Even if he never touches it again after a few tests, it's such an affordable backup to have around.)

When I got home, we got the meter set up.  He did the settings and learned the buttons while I set up the lancer and little meter case then nommed a PB&J sandwich.  ;)  Finally, he was ready to do a practice test.

He's seen me do it hundreds of times, and he's tested out of curiosity at least a couple times before.  The only direction I gave him was to wipe off his finger with an alcohol pad because he hadn't washed his hands since eating a granola bar an hour before.  Of course, his response was perfect:

"I was just going to lick my finger.  Isn't that what all the pros do?"

Touche, Chad.  Touche.

So he did his test and we watched the meter count down.

Me: 114? And you ate that bar an hour ago?  Yeah, that's a good number."

Chad: Funny, I totally knew exactly how to test, from watching you.
Me: Yeah, on the forums, we'd call you a Type 3 Diabetic.  Diagnosed as the spouse of a diabetic.
Chad: Haha!  That's good.
Chad pulls the used strip from the meter and holds it up.
Chad: So, now I throw this on the floor or leave it someone else's car, right?
Me: *Grinning.*  You've learned well.

Touche again, Chad.  Touche again.

Friday, April 15, 2011

Wouldn't Bet Money On It

Man.  Last night, we went out for our four year anniversary.  Just a nice dinner at a nice local Italian restaurant.  I ordered foods I thought were fairly easy to bolus for, and I had extra glucose tabs and starburst in my purse since I planned on getting some sort of pasta and bolusing generously for it.  My theory?  If I'm going to eat a high-carb meal (while pregnant) on a special occasion, I'd rather start to go low and have to snack/treat.  Much better than risking my blood sugar going high and spending an hour hour two trying to get back into range.  With the bolus I gave, I expected a decent post-meal number followed by a late evening of snacking on sugary things to keep from going low.

My body had other ideas.

Maybe it's because my blood sugar was going low when the meal began (so my body decided to throw some glucagon into the mix?), but Dexcom buzzed at me as we sat over our empty plates discussing some of our favorite Star Trek episodes (and some of our least favorite retcon moves in the Trek universe).  I pulled out Dex to see what he was telling me.  I was still at a decent number, but I had double arrows pointing up.  As I was confident I had enough sugar with me if things backfired, I bolused a little bit.

Repeat.

Repeat.

Repeat.

My blood sugar went over 200, despite a generous beginning bolus followed by several smaller boluses meant to try and keep things from getting any worse.  I did a little bouncing around in that range for a good hour or so... before double arrows pointing down.  I was prepared for this, though.  We were home by then, so I drank 25 carbs of juice, still ended up low, and topped myself off with four Starburst (17 carbs).

So, yeah, that didn't go quite as planned.

What frustrates me about this is that, pre-pregnancy, I don't think that would have happened.  I occasionally treated myself to properly-bolused servings of pasta, and the post-meal number was rarely a surprise.  But while pregnant, there's no telling how food will act in my system.  Even if I know the exact carb count in a food, and even if I ate the exact same meal yesterday, I wouldn't bet money on the outcome.  The best I've been able to do is avoid things that are really high fat or high carb, which is probably part of why everyone at my OB's office doesn't seem especially thrilled with my level of weight gain.

Monday, April 11, 2011

WTF, BG?

WTF? I haven't eaten in like four and a half hours! Where is this coming from?!



(It has to be fat from dinner, but it normally doesn't sneak up suddenly like this. )

Sunday, April 10, 2011

Stress and Camping

I had two interesting experiences with diabetes this week.

First, I got to see what real stress does to blood sugar.  I know I have a hard time keeping things in range when I'm living more stressful days, but I had a car accident on Thursday evening.  It was minor, absolutely no injuries and we all drove away.  A fender bender essentially, except the vehicle in front of me was an SUV with a much higher bumper than that of my sedan.  That meant her bumper hit and bend my hood, which was quite a dramatic effect in the moment.  I handled things pretty well, all things considered.  I had a few seconds of shock, but then I was the one out of the car checking to make sure everyone was right, calling 911, and guiding everyone off the road per the dispatcher's instructions.  It wasn't until the situation was under control that I started getting emotional about it.

But that doesn't mean my body wasn't responding to the perceived danger.  First, a sudden and frightening impact.  Then, taking charge of an emotionally charged situation (effectively crisis management).  And finally, dealing with the immediate aftermath.

I wound up staring down a 230 on my glucose meter, after all was said and done.  (This is an ESPECIALLY unhappy number then you're pregnant!!!!)  There could have been no standard carb or insulin explanation.  This was purely my body gearing up for what it perceived as a fight or flight situation.  That glucose was produced so I could run from a predator, or face some form of physical struggle.

It's actually pretty impressive.  It's not at all good for someone whose body can't automatically deal with excess glucose that doesn't get used, but it's a response that could really and truly assist in saving your life or livelihood if you faced a real, physical threat.

We also went camping this weekend, and I have to say that my diabetes was slightly more baffling than usual.  I should have taken pictures of my Dexcom readings, with the crazy ups and downs.  I even changed my infusion site mid trip, even though I changed it immediately before leaving home so I wouldn't have to do that, because I started thinking that maybe the site I'd chosen on my leg had weird absorption issues.  That change may have actually helped, as I had fewer spikes after that, though I also suspect that I was still fighting some continued stress over my car situation.  (Long story short, the car could absolutely be repaired to top form, but the repairs might exceed the value of this rather old car, which would mean my insurance company would declare it a "total loss." I'd rather just get it fixed if I can, since it's actually an incredibly reliable car, and I'm not sure what that will mean financially.)  I think, as the weekend went on, I relaxed and my glucose levels started getting back to normal.

It was interesting to change my site right in front of people.  Other than medical staff, it's just been my mom and my husband who've seen it.  But in this case, it's like I had a little audience.  I did avoid doing it in front of a larger crowd that included people I didn't know very well, but I didn't mind a couple friends watching.  I enjoy educating people, and these were both smart and kind people that I love.  Liz, who has seen my pump plenty of times and watched me go through this treatment journey from the very beginning, seemed a little surprised at how small the actual site ultimately is.  Between having always seen it hooked up to the pump and watching it come out of a relatively large plastic applicator, I imagine it ends up looking like not much at all when it's just been popped in!  Shannan, who had already asked lots of questions and asked to see my pump and infusion site, asked about using up one of those big plastic applicators every three days.  "Yeah," I said, "this is not an environmentally friendly disease!"  (Which is totally true. I recycle all the plastic bits I can, but those applicators count as a self-contained "sharp" and so can't go into recycling.  The same is true of syringes, pen needles, CGM applicators, and lancets. These are all medical waste to be disposed of as sharps.)  I think Chad kind of enjoyed having them see that, too.  He seemed a little bit proud as he commented that I do it all the time, and my fear of needles is just gone now.

I felt like a did a good job with food.  I made easy-to-count choices.  Like for breakfast hashbrowns, we went with the variety that comes in a "patty."  No measuring necessary.  Anything that offers portion control makes life easier!

Saturday, April 2, 2011

Handy Tip

Walking around the Medieval Fair is great for your blood sugar. Show up high, eat falafel, leave at a beautiful 81.

Monday, March 28, 2011

A conversation with Dexcom, with a sensor on its last legs:

Me: 152.
Dexcom: 208?
Me: No.  152.
Dexcom: 255?!?!
Me: No!  152!
Dexcom: OMG!  OMG!  283!!!!!!!  OMG!!!!!!!!!!!!!!!!!!!!!
Me: No, I said...
Dexcom: ???  (Translation, "OMG, I'm so freaking confused my circuits just almost exploded!")
Me: Sigh... OK, I think 8 days was this sensor's lifespan...  *stop sensor*

Sunday, March 27, 2011

Sugar: The Bitter Truth

I've been posting this video on Facebook and message boards, and discussing it with the one friend who was interested enough to watch the whole thing, so I thought, duh, I should post it on here, too.

It's about how sugar is metabolized and why fructose in particular is so bad for you.  It's not really about diabetes (though he touches on type 2 diabetes), but about how anyone's body (with insulin, natural or not) would work with sugar.  It's long and there is a point at which is gets pretty sciency (but not so sciency that I, as a layperson, couldn't get the gist of what he was saying), but I think it's fascinating.



Since the actual sugary "sweets" I eat are limited (though not eliminated) by how I choose to treat my diabetes, and since regular soda is almost non-existent in my little personal bubble, the primary thought I had was: Should I reconsider how I treat lows?  If juice is available, that's what I normally use.  My theory is that it helps replace some of the fruit nutrients that have been reduced now that I don't drink juice just to drink juice...  But it's a ton of fructose with zero fiber.  Could changing my low treatment perhaps reduce my triglycerides?  My cholesterol is in the "safe" range for a non-diabetic, but maybe that could be part of a plan to get it down to "safe for a diabetic" levels without having to take statins later.

Honestly, really interesting stuff.  It's much more revealing than the news reports that just tell you that sugar becomes belly fat and that makes you insulin resistant.

Friday, March 18, 2011

The Short and Long Haul

Things are still going pretty well.  My blood sugars are mostly within range, with those not in range not lasting long at all (except for one amazingly stubborn high a week ago, which was a slight mystery.  DO NOT WANT!).  I met with my endo yesterday and we adjusted my basals slightly to help me avoid going low right at the beginning of lunch and dinner, like I have been, though I still went low by dinner yesterday.  I'll give it another day or two to see if the change is enough before I lower it even more.

It feels really good when you have it under control, but I've learned not to get too pleased with myself.  Next thing you know, my hormones will change and I'll be looking at another mystery number.  In any case, it's probably only a matter of a couple weeks before the usual insulin resistance of pregnancy will kick in, and I'll have to keep upping my insulin over and over to keep things in check.

I also went for a weigh-in at my OB's office yesterday.  All I do on these visits is give the nurse my blood sugar records, then step on the scale and let her write down what I've gained.  Then the nurse tells me when to come back for another weigh-in.  The general routine if everything is going well is to weigh every two weeks.  If there's some kind of concern (usually no weight gain), then they have you weigh again in only one week.

I'd gained two pounds in two weeks.  My thought was, "Well, that's more gain per week than what my OB and I want me to average, but it is still within what she said is healthy."

But the nurse's reaction was twofold.  First, she exclaimed, "Two pounds!  You did good!"  Then she looked at my chart and said, "I'd better have you come back in next week so we can make sure you're still gaining."

I asked why, and she explained that I've only gained about 5.5 pounds total in three months.  So I said, "But the doctor said last time that I was right where I needed to be, and I've gained two pounds since then, in only two weeks.  Her exact words were 'You've gained three and a half pounds, so we're winning!' and said anything from a quarter of a pound to a pound a week is fine."

The nurse seemed a little confused and was looking over my chart and pointing out numbers in a scattered sort of way, and then said, "Five and half pounds in three months?  Is that good?  Is it because of your diabetes?  Is that why it's good?"

I was just kind of at a loss, because I'm pretty sure it has nothing to do with diabetes (though gaining too much would probably make things harder to control).  I was annoyed and tempted to say, "It's good because I'm already fat!" but that's really true, either.

But luckily the nurse practitioner was there, took a look at my chart, and said standard procedure was fine.  I could wait two weeks.

I'm also always surprised by the different reactions to my blood sugar that I see from different medical professionals.  When you're insulin dependant, weird things are going to happen with your blood sugars no matter how on top of them you are.  Pretty low lows are one example.  When someone like my endo or a CDE sees, say, a 46, the reaction is a calm, "Do you know what caused it?" followed by any discussion of how we might be able to prevent that situation again.  When anyone at my OB's office sees it, including my OB, they give me a shocked look and say, "What happened?!?!" with a slightly panicked voice.  I'm always slightly tempted to blink and say, "I'm insulin dependant.  That's what happened."  People who work with T1 diabetics on a regular basis see a number like that as serious, but not in the least bit surprising.  People who don't work with T1s on a regular basis see it and picture me teetering on the edge of death from some kind of bizarre twist of diabetes fate.

And, for me, 40s are rare and really really sucky, but not terrifying.  At those levels, I'm still physically and mentally together enough to treat myself.  I couldn't do algebra, hold a complex conversation, or go for a brisk walk, but reaching into my purse for glucose tabs or walking to the kitchen for juice?  Not a problem at all.  (And I do so ASAP, before I get to find out how functional I might be in the 30s.)

On the flip side, my OB doesn't even bat an eye at the frequent 60s I've been having before meals, but my endo sees frequent lows of any level as a concern.  "It is too early int he game for you to risk letting yourself become desensitized to lows.  You do not want that."  Slightly different perspectives and priorities.  My OB is primarily concerned with the health of me and the baby during my pregnancy, but my endo looks forward at the decades to come, during which I will still have diabetes (barring medical breakthrough) and have to live with any consequences that may come due to my habits today.

I'm in this diabetes thing for the long haul.