It's the Blood Sugar Roller Coaster!!!

Weeeeeeeeeeee!!!!

Blood Sugar Roller Coaster!

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!

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.

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!

Prenatal Visit #3

My third prenatal visit went well enough.  The best part was when the nurse was trying to get a count on the baby's heart beat with the Doppler.  We heard it clear and strong last time, but I really got a kick out of it this time because the baby was on the move!  She'd find the heart beat, then it would just vanish and she'd be like, "Oh, you're just gonna kick away again, huh?" and start moving the Doppler.  This went on for a good 5 minutes, and she asked, "Are you feeding this child sugar or something?!  It won't stay still!!!"  It just makes the baby a little more real and interesting to know (s)he's moving around so much in there, even if I can't feel it yet.

The heartbeat was good, my belly measured at 17 weeks (I'm at 16 weeks), and I gained an appropriate 1 pound (in about two weeks).  I asked her at what rate I should gain since I'm already overweight, and she said it's the same as with any woman: anywhere from 1/4 pound to a pound a week.  She said 1/4 pound a week would be ideal, and I said that I'd really like to avoid gaining more than I need, so I'm going to think of 1/4 to 1/2 pound a week being right on target.  I don't feel like I need to worry too much, actually.  I let myself eat more than before pregnancy, but I think I keep things reasonable simply because diabetes means I can't mindlessly eat half a bag of chips or something.  I'm very conscious of every little thing I put in my mouth, so I don't think this is going to get away from me.


There was an interesting moment where that gulf I sometimes feel between me and someone without diabetes opened up.  My blood sugars have been mostly good, but I had one really crumby day on the two-week log I brought with me.  My OB asked about the high I'd had after brunch, and I explained that I'd had pancakes at diner without nutritional info, and I could really only chalk it up to those pancakes being higher in carbs than the "average" I looked up for their size (plus the fact that non-wholewheat pancakes tend to cause a bit of a spike for me, anyway).  She continued to look at that day and noted that I'd gone quite low (42, I think) after that high.  "And what happened with dinner?"  I had to pull my food log out for that one, because nothing about it stood out in my memory.  It turned out to be a meal I made at home with a known amount of carbs and a pretty reliable track record, but I went up to 160-something afterword.  But when I'd started eating, I was still in the 60s while recovering from that 40s low.  So I said, "Nothing happened, I knew the carbs in that meal.  I probably just went high because of the low.  My body can still have a glucagon reaction to a low sometimes."


She looked up and blinked in a way that made it clear she was really processing this statement.  That's when I felt that she was looking at me over that gulf.  I realized she probably technically knew this stuff, that the body makes glucagon to bring up a low blood sugar and that function isn't 100% gone in diabetics, but she's never lived it.  That 160s blood sugar was barely a blip on the radar for me because the cause was clear, so I just bolused to bring it down and moved on.  But as someone who is neither diabetic nor an expert in diabetes, she just saw a number and wondered what I did to cause yet another high.  She didn't see the pattern like I did without even trying.


I'm no expert in diabetes when you compare me to a veteran who's had it for years or a specialized health care provider, but managing type 1 diabetes for the past 10 months made me the expert in that room even though I wasn't the one with the medical degree.  It's amazing to look back to the first week after diagnosis and remember how little I really understood about my new treatment.  I've come such a long way in less than a year.

Better Than Therapy

Going to the endocrinologist is good for me. I don’t just mean it helps me stay healthy, I also mean that it helps me stay sane.


I’d gotten reasonably zen about diabetes management, especially since I was doing really well. Then I got pregnant, and zen immediately slipped from my grasp. My control on my blood sugar suffered, not due to any lack of effort or education, and my stress went through the roof in response.

In a zen state, I’d have said, “OK, my blood sugar is going higher than it should. All I can do is what I can do. Crying and feeling guilty just wastes energy.” But I was not in a zen state. You see, not only was I hormonal and dealing with life changes, but I was also reading blogs, forums, websites, and books on pregnancy with diabetes.  Everywhere I turned I read about all the horrible things that can happen if your blood sugar is high, and a high blood sugar seemed to pretty much be anything out of that super tight range for pregnancy.  I seemed to absorb other women's obsession or anxiety over this, as if I didn't have enough of my own. Though my endo’s office had called me back right away with my new blood glucose goals (under 100 before eating, under 120 two hours after), it was the internet that made me scared of higher numbers. Not even counting the occasional and mysterious 200+ number that happened even when I did everything by the book, I felt like a horrible mother who was actively mutating my own baby whenever I decided to indulge in a treat (say, a small ice cream?) and came in somewhere closer to 150 two hours later.

*cue internal freak-out and self-guilt-trip*

But visits to my endocrinologist have put things in perspective every time, so far. Never once has she criticized me, never once has she told me that a number is dangerous, never once did she suggest I need to try harder. No. She even told me the first time I came in with numbers that upset me, “I’m not worried.” She doesn’t worry, she deals. “Numbers like these will happen, but we need to figure out how to keep them from happening too often.” Then we’d discuss a game plan.

Yesterday’s visit with her was fabulous. I handed her a sheet with numbers that were much improved, but definitely not even close to perfect. We were both on the exact same page about how to fix them, and she made some adjustments to my morning basal and evening I:C. She said that I was really doing well overall, and I walked out feeling not like I had failed with those less-than-perfect numbers, but that I had done a great job of improving them and was leaving with a plan to make them even better, maybe even get them in line once and for all… Well, once and until my insulin needs change again! Damn hormones!

Too Good to Last

Despite having a lot of insecurities, I also tend to be very proud of the things I do well.  Just recently, I got into a very comfortable, pleased-with-myself state of mind regarding my diabetes care.  I do this stuff really well.  Not only was I on top of things, but I significantly improved my morning numbers by myself, through two morning fasts and two basal adjustments.  I was coasting for a couple of weeks on numbers that never seemed to rise much above 140.  Things were... too good to last.  :(

Yep, that's a 286 staring back at me.  The past week, maybe two, have sucked.  That's the second 200+ number I've had, and possibly the highest number I've had since starting intensive insulin therapy (certainly the highest since they got my initial ratios close to what I needed).

What the hell?!  Things have been running generally higher, as they always tend to when hormones change at about the middle of my cycle, but worse than usual this time... and the past couple of days have gotten even worse... then a 286 for this morning for the exact same breakfast and bolus that went over perfectly yesterday morning?!  And I thought, hmm, maybe it's the infusion set or site, but no!  Everything appears fine, and my correction bolus is bringing my BG down at a rate that I would expect.  Bad insulin?  Well, it seems to work just fine on correction boluses, and I've had a couple mealtime boluses with perfect results... but I may try a new batch if things continue to look bad.

I may uncover some underlying reason, but until I figure it out, I'm just using a stronger basal dose and watching Dexcom like a hawk... and believing my fellow D bloggers more and more when they say things like, "Sometimes, this disease just makes no sense."

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On a related note, while waiting for my BG of just over 200 to come down last night, I was talking to my husband about having read that a lot of PWDs tend to have some control issues, maybe even some OCD.  I totally get that now.  If I'd grown up putting so much importance in a number on a screen multiple times a day, feeling like that number is a pass or a fail, I'd probably have some sort of control issue, too.