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.

Dexcom on Its Way!

So not only am I getting an insulin pump, but I found out today that I've been approved for the Dexcom continuous glucose monitor (CGM)!

I was skeptical my insurance would approve it, because it's still so common for people to get turned down, but I'm betting the pregnancy planning is what won them over... though Mom pointed out that my situation is an unusual one, even if it's not uncommon, so they may have been prone to approving it for someone with a brand new case of Type 1 at the age of 30. She also thinks insurance companies are catching on to the fact that good treatment now is usually less expensive than complications down the road.

Caremark and BCBC of Oklahoma, your recent moves to benefit my health and treatment plan are starting to shake my whole insurance-companies-are-evil stance!

While the pump is very exciting, I'm even more excited about some of the benefits of the Dexcom. First of all, it'll warn me about lows and highs, sometimes even before I think to test for them. And I find that, while I feel most lows before they get bad, I haven't really tuned into the symptoms of highs yet. I don't pee like crazy, my thirst isn't unusual enough to tip me off, and I don't feel that "off," which I attribute to having recently spent so much time with even higher BGs as an undiagnosed diabetic. Highs just feel like more of the same to me. But now, Dexcom will buzz me when things are climbing too fast.

And, in tandem with the temporary basal options the pump gives me, I think this technology will let me exercise and be otherwise physically active without worrying as much about lows anymore. If I take a sudden nose dive, Dexcom will most likely tell me.

Badass.

Robo-Pancreas!!!

Look what I have...

That's right, I have an insulin pump!!!

It's an Animas Ping... A pink Animas Ping! I used to hate pink, but I now really appreciate it when it's an unexpected color... like in the case of a medical device.

I'm not using it until Wednesday, when I'll meet with my CDE and get the official "training." I've been playing with the functions, with a cartridge and tube full of water. Tonight, per my CDE's recommendation, I'll tape the tubing to my stomach (pump attached) so I can figure out how I'll want to sleep with it.

Aside from how awesome it is that I'll soon have more precise blood sugar control and will just have to push buttons instead of giving injections in public (not that it's embarrassing, just a hassle), I'm totally drawn in by the fun that comes along with a pump! It's a medical device, yes, but it's a gadget. It's advanced, cute, and it makes fun noises! Oh, oh... AND IT DOES MATH FOR ME!!! Sold!!!

I keep reading about T1 girls struggling to "hide" their pumps, and I'm sure I'll get tired of the questions and start tucking it away into my bra, but I currently have no anxiety over the prospect of it being visible on my everyday outfits. It's cute, and I imagine a lot of people will assume it's an MP3 player of some sort. For those who ask, my current plan is just to tell them and to answer any other questions.

I should also comment that my insurance has all worked out remarkably well! Blue Cross Blue Shield approved this earlier than their policy normally allows, and Caremark agreed to cover vials of Novolog for me right away even though I very recently refilled my prescription for the Novolog pens (technically, this was like trying to "refill" my Novolog prescription too early). I still think the system needs reform, but I have to say that I'm pleasantly surprised by how relatively few roadblocks I've hit.

And, in general, I have to say things are pretty good right now!

Not Going Broke in an Emergency

Here's a tip for anyone who gets a diagnosis that requires maintenance medication that doesn't have a clear and consistent dosage: Make sure your doctor has either written the prescription to reflect that fact, or that (s)he is totally confident they've prescribed enough for that 30 days.

My doctor initially wrote all of my prescriptions as 30 day supplies, but I ran out of blood glucose test strips long before 30 days... and my insurance refused to refill it even when she revised the prescription.

Buying test trips out-of-pocket is expensive.  My copay for 100 strips was less than $30, but out-of-pocket for 50 of them was about $70... ON SALE!!!  (Freestyle Lite strips.  You can find them for less than that if you do some googling, but they're still a little pricy.)

Well, even that 50 I picked up while waiting to see if the insurance company would decide to cover my refill after the revision wasn't going to last once they gave us a final "no."  I wasn't about to shell out another $70 if I could find another option.

And, gosh, OK, fine, I found that other option at a store we all love to hate: Walmart.

I picked up a Relion Micro (a Walmart brand) glucose meter for $12 and a 50 pack of the corresponding strips for $20.  That's less than half of what I would have paid for a 50 pack of the Freestyle strips, and now I have a back-up meter if I ever lose or break my nice one.

Though the Relion Micro is a little more cheap looking than my Freestyle Freedom Lite, I'd done my research and found good reviews and posts about it, and found that the Relion Ultima (different model by the same company) was declared a "top pick" by Consumer Reports.  And while I say it looks a little cheap, I should also point out that the Micro is little and cute, and it comes with interchangeable colored faceplates!

Mine included a bold red option, so now I have a sexy little red glucose meter!

I bitch about Walmart sometimes, but it's times like this when I realize the value (haha) it must hold for people who who live patcheck to paycheck.  I could have gotten by with buying another pack for my pricy brand name strips, but some people could not.  And if you don't have insurance, this meter might be one of the best financial choices a diabetic could make.

I should point out that I also had the same prescription issue with the needles that go on my insulin pens.  Though I hadn't run out, I counted and knew I didn't quite have enough to make it until my refill.  Cue tons of research on whether or not reuse is safe...  And as it turns out, most people in forums said they reuse their needles once or twice and the ADA has recommendations on how to safely reuse needles:

Reusing syringes may help you cut costs, avoid buying large supplies of syringes, and reduce waste. However, talk with your doctor or nurse before you begin reusing. They can help you decide whether it would be a safe choice for you. If you are ill, have open wounds on your hands, or have poor resistance to infection, you should not risk insulin syringe reuse. Syringe makers will not guarantee the sterility of syringes that are reused.
Here are some tips to keep in mind when reusing syringes:

• Keep the needle clean by keeping it capped when you're not using it.
• Never let the needle touch anything but clean skin and the top of the insulin bottle.
• Never let anyone use a syringe you've already used, and don't use anyone else's syringe.
• Cleaning it with alcohol removes the coating that helps the needle slide into the skin easily

So I reused a few of my pen needles, and I was just very careful while removing the cap and putting it back on, making sure the needle touched nothing but my prepped skin.  I store the used  & capped needle in an empty glucose strip case, which is a very convenient size, and I make sure that I only reuse a needle for the same insulin as the first use.  I've been taking a look at the needle before reusing for any obvious issues, and I know there's no blockage since you have to push a little insulin out before you even set your dose.  I can't tell a difference in pain/comfort with that one reuse, though lots of people on forums said that more than two uses starts to hurt a little.  Those needles are so fine, they start to get dull just from passing through skin!

Also, on a related note, did you know that you don't need a prescription to buy regular insulin in the United States, except in Alaska?  It's just kept behind the pharmacy counter.  And apparently, it's not insanely expensive (someone on a forum said they got a vial for $22 at Walmart).  So if you were ever in a real bind but can scrape up a little cash, there's a way you might be able to get by.  (You should absolutely still talk to your doctor about how to use regular insulin before buying it, unless it's the kind you already use!)  Here's a chart that lays out the legality of buying insulin and syringes, by state.