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.