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!)

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.

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.

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.

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. )

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!

Handy Tip

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