Friday, February 25, 2011

Moving Along Pretty Smoothly

I'm at 15 weeks, and I've been feeling better lately.  Not super fantabulous, but better, and I'll take what I can get!  I'm not getting random nausea anymore, I've had days of good moods, and I actually have some focus and energy every now and then (though I'm still more tired than before pregnancy).

Blood sugars haven't been bad.  Some weirdness and randomness continues and I'm not always in range, but they're not bad and I've started stressing a little less about them.  I still see them as vitally important, but I'm able to just bolus and go on without freaking out if I'm a little high.  (I did, however, have a recent restless night due to highs followed by lows.  I'm so glad to have Dex keeping an eye on my glucose levels while I sleep, but sometimes I want to just throw him across the room!)

One annoying blood sugar trend I've been dealing with is slightly low blood sugar immediately after eating.  More often than not, I'm right around 70 when I eat lunch or dinner.  So I bolus and eat, then watch my blood sugars drop little by little for a while, probably 30 minutes, and then it finally starts coming up.  Normally, no big deal.  60s aren't bad when you know you have carbs about to kick in.  But once in a while, it'll keep dipping into the 50s.  I'm not OK with 50s.  (On those occasions, I eat a small amount of fast-acting carbs then bolus for them once my bood sugar started on an upward trend.)  Because of this trend, I've started limiting the recommended 20 minute wait between bolus and food to if I am 80+ (or 90+, if my blood sugar is on a downward slope).

I do have a "baby bump" now, and will likely be wearing maternity pants to work pretty soon.  I'm still doing the rubber band trick for now!  Other people's reactions remain the most interesting part of pregnancy for me.  My mom got excited when I told her I'm almost ready for maternity pants, for example.  I also have a very sweet coworker who has made doe-eyed comments about my belly.  "Aw, Mama!" or, "It's beautiful!"  So, very sweet, but it still makes me feel very self-conscious!  I hope it's not too regular of an occurrence for the rest of the pregnancy.

The one weird thing that gets my anxiety up a little is I feel like there's a little tension between me and my OB regarding my diabetes monitoring.  First off, she commented that she might make changes to my pump settings if she sees things imy blood sugar she wants to change.  I just said, "OK," but the truth is that I really only want my endo (and me) to make those calls.  Anything she asks me to do, I'm going to fax to my endo for approval before implementing.  It's not that I think my OB will make bad calls, but rather that I have a specialist whose entire career is centered around the management of my disease.  She's the one who's most qualified to help me manage my blood sugar.

Second, after I decided that, fine, I'll do a monthly A1c test for my OB's preference in addition to the twice-monthly fructosamine tests that my endo feels are far more useful during pregnancy, I got a little attitude from her staff because I said I'd rather do the test at my endo's office instead of the OB's office (and then the results would get faxed to my OB).

(On the phone.)
Staff: Dr. L wants you to come pick up a slip and go to the lab to do a hemoglobin A1c.
Me: Just an A1c?
Staff: Yep, just a hemoglobin A1c.
Me: I go to my endocrinologist's office next week and they'll draw blood for a fructosamine test anyway, so I'll just call and ask that they also plan to do an A1c.  And they'll fax it to you.
Staff: *with clear annoyance* Dr. L doesn't know how to follow the fructosamine tests.
Me: Yeah, I know, that's why I just said I'd have them also do an A1c at the same time.  I'd really rather get stuck once.
Staff: *sigh* I'll tell Dr. L that's what you plan to do.

The honest truth is that I also don't want to get stuck at my OB's lab anymore than I have to.  They bruise my arm every single time, and it definitely hurts more than when I have blood drawn by the nurse at my endo's office.  Plus, getting it done in one visit means I don't have to spend the extra time or gas that it takes to go to my OB's building and wait around to have my name called at the lab.  This pregnancy takes up a lot of time!!!

Wednesday, February 16, 2011

I had a visit with my endocrinologist today and, as usual, she made me feel like I'm moving forward on the right path.  We made a slight adjustment to my early morning basal insulin to get my fasting BG down a tad, but she didn't feel any other changes were warranted yet.  I had some "highs here and there," yes, but they didn't follow a pattern and I never let them last long.

But the best part is that she made me feel about a million times better about not gaining weight.  I think I managed to gain a couple pounds if her scale is the same as my OB's, but she (and her nurse) seemed slightly confused about there being any concern.  Aside from only being 14 weeks (tomorrow) into my pregnancy, she commented that much weight gain isn't really necessary as long as you're eating enough and eating well (and taking prenatals).  She also agreed that it's not relevant to my diabetes management since we know what my blood sugar is (and it's nowhere near high enough to prevent me from gaining).  Maybe that was just an off-handed comment on my OB's part, but if she expresses that concern again I'll ask her to please confer with my endo.

I also went ahead and mentioned that the hormones have been a nightmare for me emotionally, because my counselor felt that both of my doctors should know that that's going on.  She wasn't at all surprised considering my history of depression and commented that some women feel the best of their entire life, and others just ride an emotional roller coaster.  She confirmed that I'm doing everything to take care of myself (including staying on my Wellbutrin), but it honestly just makes me feel better when someone acknowledges my depression with understanding and acceptance.  I definitely feel pressure to be happy for everyone, because that's what people expect from a pregnant woman, and I've already had one person I'm close to insist that this "isn't normal," that this is a "wonderful time" and I should be happy.  I'm certain she said this in an attempt to get me to step up my attempts at treating depression, but the last thing I want is to feel abnormal (and guilty) for not being deliriously happy.  Happy about having a baby?  Yes, I am.  But happy, as in mood and attitude?  No, I am not.  And I feel like I have to apologize for it at every turn.

That said, at least my anxiety over my weight has been alleviated.  Really, I'm just not going to stress about it unless it actually looks like it's becoming problematic.

Monday, February 14, 2011

No. More. Food.

I'm pretty sure I'm hitting the phase in pregnancy where I start slowly becoming more and more insulin resistant.  At the same time, I've been "trying to gain weight" for the past few days and need to rule out the possibility that it's the higher fat in my food that's causing the change.  So today is a good, angelic food day.  A high fiber muffin and skim milk for breakfast, cheese for snacks (provided my blood sugar doesn't head downhill), and a salad (with chicken) and reduced fat cottage cheese for lunch.  Dinner might not be quite so angelic, but it's primarily late afternoon when my blood sugar gets higher than it used to.

Speaking of, I'm totally fed up with my own weight-gaining attempts.  My first thought was, "Gaining weight?  That means larger meals, more carbs, and more fat."  So I attempted this, and can I just say: "Puke!"  OK, no actual puking, but a strong desire to puke.  Let me also say "Holy freaking crap!" regarding how my blood glucose reacts to high fat these days!  It's always caused a rise at the 3 or 4 hour mark, but not like this!

So, I'm moving on to what I think is a better plan anyway:  More snacks that I already know work for me.  More cheese between meals at work (along with carrots), and more no-sugar-added ice cream in the evenings.  Or crackers and hummus (because, YUM!).

If this doesn't do the trick, I'll go to a dietitian at the diabetes center for a plan.  I don't want my next weight gain plan to include blood sugar battles like the first one.

More and more female friends are surprised my OB is at all worried about the lack of weight gain, particularly other women who were overweight going into pregnancy.  One friend only gained 3 pounds through her entire pregnancy, and her OB was just fine with it.  I probably need to gain more than she did, but still, I've decided not to stress about this.  I'm going to assume the baby is just fine until there's reason to believe otherwise.

Thursday, February 10, 2011

My Chubby Brain is Blown

Never before, in my entire life, have I been told to gain more weight. If anything, I’ve always been told I need to lose a few pounds. I’m overweight, and have crossed the line into “obese” a couple times.  But now?  I'm an overweight pregnant woman.

So, it’s just so utterly baffling to this chubby chick that my OB tells me I’m not gaining enough so far in my pregnancy.

Me? Not gaining enough? Unheard of!!!

Oh. Wait. That was before I had to count carbs and avoid too many really high fat foods.

I’m not restricting carbs or calories at all, except that I don’t choose to sit down and eat three breadsticks then order and eat a giant bowl of pasta with artery-clogging sauce. One breadstick and half a giant bowl of pasta (then maybe another half breadstick!) will do, thanks. And that’s usually already more calories than I’m “supposed” to eat in one sitting.

I am not a conservative eater by any means and, though I know better than to “eat for two” and double my food, I’ve felt sure that I've been eating more calories a day now that I’m pregnant.  I mean, I'm always hungry!!!

The nurse (or medical assistant?) who wrote down my weight at today’s weigh-in at my OB’s office said, “Just half a pound. You’re going to have to come back and weigh again next week.”

"Really?!" I said. "This is just the first day of my second trimester. I thought a lot of women don’t gain in the first trimester!”

“Maybe if you’ve gained two or three pounds by next Thursday, she won’t make you come back in. Just go to Braums every night until then!”

Braums is a regional fastfood burger and ice cream joint… really known for their ice cream. A twinge of annoyance passed through me as I remembered my last stubborn high blood sugar that happened despite a carefully calculated bolus. “Yeahhhh, that’s a little tough for a diabetic.” I got a look of sympathy, but no further suggestions.

I’ll be trying to add in more calories, but there will be no milkshake prescription for this mother-to-be. How frustrating that I need to gain weight right when blood glucose control is both more important than ever and more difficult than ever.

Not. Fair.

Tuesday, February 8, 2011


I was wandering the supermarket, which means that I was thinking about carbs.  By the time I wandered onto the "lunchbox" aisle, my thoughts had begun to turn sour.  All of those adorably portioned carby goodies stared at me.  Cookies, crackers, little crunchy bread sticks that come with their own suspiciously shelf-stable fake cheese dip, boxes containing cute little 100-calorie pack snacks.

A friend's old criticism bubbled to the surface of my memory...  People think those 100 calorie packs are a good idea, but they're not.  They're still not healthy, and you can just take a portion out of a regular sized box.

I (and she) did not know that I was diabetic at the time (I'm fairly sure it was already developing then), but now I realize that individually packaged snacks make it easier to eat snacky stuff with diabetes.  No counting crackers necessary, just grab a pack and punch the listed carbs into the insulin pump.

But my slightly sour thoughts didn't lead me to find this fact interesting.  Instead, I found it infuriating.  Other people eat straight from the box of crackers, no counting, no calculating.  That's how almost everyone else does it.  Why do I have to do it?  Why do I?  Why me?!?!

The words rang in my head with the sort of angry, distraught tone I used as a child, the one that I felt certain would illustrate to my parents just how grave an injustice it was that I couldn't do what I wanted to do, the one intended to pull at heart strings, infuse guilt, and drive home just how incredibly strong my emotions on this subject were.


I was so taken aback by this inner tantrum that I stopped right there in the aisle.  Where had that come from?  I normally don't ask "why me?" when it comes to diabetes, because I don't think there's any kind of answer other than genetics.  It occasionally strikes me as very strange to think of myself as diabetic, because I spent so much of my life without serious health concerns, but it usually ends there.

And all because I miss eating out of a full box of crackers?  I'll admit that I am readily frustrated by anything that makes simple tasks like eating more complicated, but was it really this that inspired the strongest emotional reaction I've had to diabetes in quite some time?

It's no secret that I'm under a lot more stress than usual and that my mood swings more easily, because I'm pregnant.  Maybe it was this added volatility.  Maybe I was really throwing an inner tantrum over my pregnancy being 100 times more complicated due to diabetes (as in "oh my gosh this is complicated," not "this pregnancy is full of complications").  Or maybe this tantrum was buried deep beneath the conscious logic and practicality I've held to since diagnosis.  Maybe that was my inner child finally shouting loud enough for me to hear her, finally striking that exact tone that would make the adult me stop, pay attention to her, and reconsider.

Only, dear Inner Child, I cannot reconsider diabetes.  I'd gladly change this for you if I could, because I agree, diabetes isn't fair.  It does suck.  And that big box of crackers?  I do want to blindly eat fistfulls of them on the couch without even thinking.


Friday, February 4, 2011

Prenatal Visit #2

I had my second prenatal visit yesterday, exactly at the 12 week mark. Chad went with me and we got to hear the baby's heartbeat!  I loved that we got to share that.  His excitement just encourages my own.  :)

This time I met with my doctor instead of primarily with her nurse practitioner, which is who handled most of the first appointment.  All of my labs looked good, except that the proteins in my urine were in the upper range of normal for pregnancy.  She said there's not much I can do about that other than generally taking care of myself and my kidney's.  My A1c was 5.6, which is awesome and totally thrilled her because, at first, she looked at an older lab result that was 6.1.  I'm pretty stoked about a 5.6, myself.

She took a look at my blood sugar and I had a couple post-meal numbers that were higher than she wanted, but most of it looked great.  Her guidelines are slightly looser than my endo's as she's OK with up to 135 after meals (and my endo wants under 120).  She indicated that I should definitely stick to my endo's guidelines, but that she just wasn't worried if I came in a little over 120 sometimes.  So, cool, that's good to know even though I'll still aim for below 120.

Talking about the possible effects of diabetes on my pregnancy, she wasn't discouraging.  She commented that there is a "slightly higher chance you'll have a C-section, but that does not mean you will have one."  She also said that placentas tend to "age faster" in diabetic mothers, but that has to do with higher blood sugar so the better I control it the better off my placenta will be.  Because of this, and probably because I'm statistically at a higher risk of a lot of other things just based on my diagnosis, I'll be having more ultrasounds than average and they will all be with a doctor who specializes in "fetal medicine & maternal medicine."

The only slight concern she seemed to have was that I've lost half a pound rather than gaining anything (though I'm betting I may have been a tad less hydrated than usual).  I'm supposed to go by next week just for a weigh-in, and I'll be faxing her my blood sugars every week now.  She commented that she may "tweak the settings" on my pump if she has any concerns... I didn't say it, but any "tweaks" she tells me to make are going to go through my endo before I apply them!  It's not that I don't trust her, it's just that it makes the most sense to have the doctor who specializes in my disease treatment make the decisions on that treatment!

In other news, I have new prescription coverage that only covers three glucose test strips a day for type 1 diabetics.  Three!!!  My endo's office is pretty sure they can get "prior authorization" for more, especially considering my pregnancy, but I'm still just aghast that they wouldn't automatically cover at least six (preferably eight) a day for a type 1. Do they think we never need to know our post-meal numbers?  Or that we never have low or high blood sugars that need to be confirmed with a test before we treat?  Do they honestly not know what it takes to manage type one diabetes?  I mean, wow.