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!