Xander's Arrival Story Part 4

That first night after Xander was born was tough. Xander spent most of it in the nursery because none of us had had any sleep in what seemed like ages and I needed to recover. As exhausted as I was, I didn’t sleep well at all. A c-section is major abdominal surgery and I was seriously uncomfortable as a result, the nurse had to wake me up frequently to check how things were going, my blood sugar was trending low, and I was still throwing up like nobody’s business.


At one point, determined to get at least a little sleep, I asked the nurse to please put me on a dextrose drip. This nurse (who was not my favorite in general!) actually seemed hesitant, and then said that it would mean taking me off of the pitocin for a while. It was suddenly clear to me why I was still throwing up. I told her to switch it anyway and we could just switch back once my blood sugar was up, because being constantly in the 50s and 60s very simply isn’t healthy. She made the switch, my throwing up slowed down, and my numbers started to rise. (I also wasn’t in a rush to get back on the pit, because it was really just supplemental to what my body would do naturally to return the uterus back to normal.)

After that, everything was manageable again. I had lows, especially since I didn't feel up to eating full meals right away, but I could hold food and drinks down once I was off the pit the next morning. Other than having to ask for a lot of juice and soda, diabetes kind of dropped into the background again for the rest of our hospital stay.

Of which I am glad, because we had other things to focus on.


 
Xander was healthy, and seemed just so perfect! At 8 pounds 10 ounces, he was on the bigger side of normal (but was actually smaller than I was when I was born). The other common risk when a mother has diabetes is that the baby’s blood sugar can drop right after birth. Xander’s was described as “borderline” on the first test, but they simply fed him and all of the following tests were normal.


Chad, Xander, and I were Tired with a capital T. There were times when it took me 10 minutes to test my blood sugar because I would fall asleep 4 times before I finished. Seriously, I’m not exaggerating! Really! Chad has a little story about one time when I was going to put my glasses on, but I paused with the glasses suspended a few inches away from my face… and just dosed off in that position for a minute. When I came to, I just finished putting them on like nothing had happened.

But like I said, all three of us were tired. Chad was trying to feed Xander a bottle on Xander's second night and was just nodding off repeatedly. The nurse told him that if we’re going to give him bottles, “We can do that. Don’t try to be a hero. Let us keep him in the nursery, and you get some sleep.” I imagine this must have been a relief to him since I really couldn’t do much that day after Xander was born. Having a C-section makes even walking to the bathroom and back hard work, much less changing diapers and bouncing babies. Chad was suddenly thrown into the task of taking care of both of us. We let Xander go for the night and finally got some decent sleep.

To sum up the timeline: We went into the hospital Friday evening, Xander was born Saturday (August 13th) evening, and we left the hospital Tuesday afternoon. The entire experience was exhausting, but the results were so worth it.


Going home... Please focus on how cute Xander is and not on how
aweful I look when swollen and without makeup!

Xander's Arrival Story Part 3

I'm finally posting the next installment.  I think I'll make a goal of posting the last installment by the end of this upcoming weekend!

They mentioned starting me on pitocin very early in the game because I wasn’t feeling any contractions, but I really wasn’t interested in that stuff. Contractions started not long after they got me all hooked up to the monitors, and I told the nurse that I didn’t want pit as long as my body was laboring on its own. I settled down to try to get some sleep, but I really didn’t get much at all. I’m guessing I had maybe an hour total, considering the disruption of contractions and nurses. Overall though, early contractions were not bad.


In the morning, the nurse pointed out that my contractions had gotten further apart and I was on a time-crunch since my labor had started with my water breaking. This hospital, like most, had a policy of doing a c-section 24 hours after that happens.

I was terrified of the stuff because of what some mothers had told me about their experiences with it, but agreed to the pit... but only after tears and a phone call from my own doctor. Long story short, I believed that pit was Xander’s best chance of being born vaginally.

Once I agreed to pit, I also planned on getting an epidural before contractions got intense. The pit didn’t “hit me” like I’ve heard so many women say. I could tell the contractions were picking up, but they still weren’t bad. After a while, at a point when the contractions were getting slightly harder to manage but not so bad that a contraction would prevent me from staying still, the anesthesiologist came to see how I was doing. He’d talked to me about the epidural the last evening and I really liked him and the way he talked to me. He obviously believed epidurals were a very good thing, but I didn’t feel pressured or talked down to when I expressed concerns. I decided this was a good stage, so he went to get what he needed for the epidural.

This was more scary and disconcerting than painful. Had I felt the same pain in my arm, it would have been an “ouch” moment. But when it’s going into your spine, it’s an, “OMG, needling in my freaking spine!!!!” moment when your lizard brain starts screaming. Your spinal cord is, after all, essential to your body working correctly! I had to struggle not to squirm, but once it was over it was worth it. My legs grew comfortably warm and I was actually more comfortable than I’d been in at least two months!

But they continued to up the pit, and that was about the last time I was 100% independent in managing my blood sugar.

There was a drawback to these interventions, and I’m convinced it was most likely caused by the pitocin. I started puking, which meant I couldn’t keep any sugar down when my glucose levels went low. At first I struggled to keep up, with marginal luck. At some point though, they hooked me up to an IV drip for a bit, and things smoothed out.

Worse than that, Xander’s heart rate dropped whenever I threw up. It lasted long enough at one point that a group of nurses came in and started manipulating me, turning me from one side to the other, and then finally putting a sensor on Xander’s head (so they wouldn’t lose track of his beat). That was truly scary. It also would have been truly painful, if it weren’t for the epidural. Vaginal exams before the epidural were, by far, the most painful experience of my entire labor. Putting the sensor in surely would have been even worse, especially considering it took multiple tries to get it in place.

I believe I labored for a total of 22 hours. Nearing the end of that, the doctor on call double checked and found that Xander still had not dropped, and my dilation hadn’t progressed well. I had a brief amount of time during which I could wait, but the chances of things not ending in a C-section were now extremely slim.

The doctor and a nurse stood there waiting for my decision, and practically all I could think of was how completely wrong it was to have to make such important decisions at a time when I was so utterly exhausted that I probably couldn’t have decided which flavor of popsicle to eat anymore. Chad asked them to leave for a minute, and both he and my Mom said they thought it was the best decision. I think I probably asked them a couple questions, and then I agreed.

And things were set in motion.

Everything was something of a blur from this point on and, once I was in the operating room with the anesthesiologist starting to deliver that cocktail of meds, my memory is very spotty. I know I couldn’t move myself to the table on my own even though my epidural was a “walking epidural,” because I was just so exhausted and had barely been able to shift my pregnant body around even before labor. I’d carried in my Dexcom, which I clutched in one hand, but had given my meter to my husband. He was sent to a room to get into scrubs and was soon over my shoulder. The anesthesiologist was over the other shoulder, and he described everything that was happening to me. He told me what to expect, which was mostly changes in pressure. I do recall that when he told me they were about to pull the baby out, I expected one sweeping motion but instead felt a lot of digging and manipulating before he was pulled free. I remember hearing his complaining voice and I remember him being shown to me, but I was so exhausted and drugged that I could barely see him. Chad went with Xander for the weighing and examination, as we’d discussed he would do if Xander couldn’t be immediately handed to us. Being sewed back up was slightly painful and the anesthesiologist asked if he could give me more anesthesia, warning that I wouldn’t remember the remainder of the procedure.

I’m pretty sure I wasn’t actually knocked out from the last dose, but my next memory is of being in a patient room, and being asked if I wanted to hold my baby.

To follow, recovery and first days with Xander…

Xander's Arrival Story Pt. 2

Part of why I scheduled an induction for Xander on his due date was because I wanted to give him the chance to arrive both naturally and in his own time (without passing his due date).  As I mentioned, it was a hard decision when faced with the likelihood of a C-section no matter what we tried.  I went home, put my feet up until my afternoon work shift, and texted Chad.  He agreed with my choice, which made me feel a little more secure.  I went into work at 1 and said goodbye to my coworkers for a time, since I would begin my maternity leave on Monday... giving me a chance to rest for a few days before delivery.

Or so I planned!

That evening, Chad picked up a couple movies from a Redbox and dinner from Macaroni Grill.  I chose Eggplant Parmesan since there are urban legends about that dish inducing labor, even making one restaurant famous for their Eggplant Parmigiana Babies!  I ate half of it, put the other away, and relaxed on the couch... propped up on cushions with my feet as high as I could get them comfortably.

But, when you're as big as a whale, nothing is very comfortable for long.  I shifted repeatedly, which was honestly quite an effort.  At one point a struggled to shift my weight and move my legs... and something suddenly didn't feel the same.  I heaved myself off the couch and hobbled to the bathroom, and I knew by the time I closed the door that my water had broken.

I used the restroom, tried to calm myself down.  I was nervous as hell, and a little scared.  As soon as I felt I could hobble to the door without flooding the floor, I did so.  I opened it and said, "Ummmm.  My water just broke!"

Chad answered with something like, "Are you serious?!" and appeared at the bathroom door with wide eyes and half-eaten ice cream bar in his hands.  I really wished I had a camera to capture that!

So I directed him to the list of things that still needed to go in my overnight bag, called the labor and delivery department to confirm that water breaking means I had to come in immediately (I'd hoped to labor at home for a while if not induced), called my mother, got a couple little things myself while also managing my broken water mess, and soon we were on our way... and driving through a mild thunderstorm.

After getting checked in, in a gown, and set up on monitors in bed, I had Chad bring me my bag of diabetes supplies so I could refill my insulin cartridge.  I probably had enough, considering they don't let you eat anything during labor at that hospital, but I wanted to be positive.  I also reduced my basal rate by half... and there were several times when I took it down to 25% or even 0.  I really managed my own blood sugar and was never bothered by a nurse about it.  Quite different than what some other mothers with diabetes have reported!  It really went pretty well as long as I labored without any interventions.  I sometimes went low, but was allowed to eat popsicles to bring it back up.  That worked just fine.  It really wasn't until interventions came into play that I couldn't handle it 100% on my own.  But for that first night, I was fine and happy that Xander's time was approaching based on him and my body being ready, not based on a deadline... whatever the end result might be.



To be continued...

Xander's Arrival Story

Things have been a little busy around here, and I anticipate that this story will take at least two or three posts, but please let me make a little jump to the end and introduce you to the newest sweetie in my life, Xander!!!

I suppose the facts give away a little of the story I'll be telling, but Xander (short for Alexander, pronounced "Zander") was born on August 13th, weighing 8 pounds 10 ounces.  He's an absolute bundle of sweet.

He, his daddy (Chad), and I have been doing pretty well... Especially since Chad is taking two weeks off to enjoy his new son and avoid me having 90% of the sudden new-baby responsibilities, and also because my wonderful mother has been visiting and helping on a regular basis.  I'm definitely having post-partum depression issues (this was expected, considering that it's so common and I'm more prone to depression than most), but honestly, things are actually good despite that.  I have a wonderful support system.

Now, on to...

Xander's Arrival Story

It's been a while since I posted because, first, I was just too exhausted from late-pregnancy to have much energy even for blogging.  I started working half days to help my extremely swollen feet/ankles/legs and to get more sleep.  It was only swelling though, as both my blood pressure and urine tests showed no other symptoms of pre-eclampsia.  I started seeing my blood sugar plummet too, but every test showed that the baby was just fine.

On Friday August 12th I went for what I knew would likely be my last prenatal visit with my OB.  I was 39 weeks and 1 day, putting me in the zone where she'd want to induce if conditions were right... only they weren't.  My cervix showed zero signs of preparing for delivery and Xander had not dropped.  She said that, since things were looking so healthy and I was being was so closely monitored, she was willing to give me a few more days (but not past my due date) to see if things would progress on their own... though she sincerely doubted they would and, in fact, anticipated a C-section even if labor started naturally (and even more so if we induced without any further natural progression).  I told her that yes, I wanted to give my body the chance to do things on its own.  But she wanted a plan of action.  The options: Schedule a c-section or schedule an induction (which was likely to end in a c-section).  It was actually a harder decision than I expected since I didn't want a C-section, but I was being told that I would likely just go through labor and end up with a C-section anyway.  Still, I decided to schedule an induction on Xander's due date, August 18th.

To be continued...

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.

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.

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!!!

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!

Home Stretch

Things have been going well.  My insulin-to carb ratios have been going up, up, up... but with only 9 weeks left, I'm in the home stretch.  It's not so bad seeing those doses climb knowing that, by sometime in August at the latest, they'll come right back down to normal (or even lower, for a while!).

Things are really about to get busy...  Up until now, I've had an appointment with my OB about once every 2 weeks (plus occasional drop-ins just to get weighed), an appointment with my endo once every 2 weeks, and a total of 3 appointments with the prenatalist.  Now, those appointments with the OB will go up to once a week, and we'll be adding in twice weekly non-stress tests and a weekly bio-physical profile at her hospital.

Jeebus!!!  So much for keeping some vacation time saved up for maternity leave.

Most women do get a little more attention later in the pregnancy, but I have so much because it's getting close to the point when the placenta could start breaking down due to my higher than average glucose levels.  (We are, however, starting it a couple weeks later than my OB would normally start since I've been well-controlled.)

C-section was a big topic of discussion at the last appointment, too... and it didn't have a lot to do with my diabetes/placenta.  It had to do with the fact that this kid is breech.  My OB didn't discourage me getting into positions that make it easy for him to turn and she said she'd probably be willing to do an E.V. at 37 weeks (though she has some concerns about it since there's potential to hurt the placenta), but she did tell me not to get my hopes up too much.  He's never been in a totally-head down position (that we know of from the ultrasounds), and he's been head-up for quite a while, which makes her suspect he's pretty determined to stay where he is.

And yikes, I can testify to that! He has some favorite places to kick or head-butt, and he stays there and does it so often I swear I get sore from it!  When he starts working away on my right side, sometimes he's like, POW! and I jump and yelp.  I'm always torn between applying pressure to encourage him to move a little more toward the center, or just tolerating it in case he's trying to do a somersault and turn head-down!

I certainly hope he flips so we have a shot at a vaginal delivery (my OB said breech = automatic C-section at her hospital, which is pretty typical), but I'm reminding myself that the important thing is that he arrives safely.  I also find it slightly easier to tolerate the idea of a C-section now that it's for some reason not related to the big D.  This is something that could happen to any mother and baby, and there are very few OBs left who are OK delivering a breech baby without a C-section (though midwives assist in this all the time, so a C-section isn't really always necessary).

In any case, we've also started doing some of the fun preparation for baby's arrival: putting together big items from the baby shower and filling in the gaps by buying essentials we weren't given.  (We certainly never expected to be given every essential, but we simply waited until after the shower to see what we'd still need to spend money on.)  This also means spending yet more money on top of medical expenses, so I've been doing a ton of comparison shopping.  I managed to find a great used breast pump for an awesome price on ebay, I downgraded from the nice and super-cutesy baby bottles to plain and boring but highly-rated and inexpensive bottles from the same manufacturer.  I've also created a "shopping list" on Amazon that we'll print and take with us for price-comparison when we go to Babies R Us to take advantage of the 20% off deal you get on any items from your own registry.

Phew! Baby-having is hard work even without having to watch your blood glucose like a hawk!  Thank goodness decorating the nursery is more fun than bolusing...

San Antonio and the Death of Dex

I spent a long weekend, out of my usual routine and either walking far more than usual or sitting still far more than usual, without Dexcom (a continuous glucose monitor).  And I was just fine.

You see, last Wednesday night (or early Thursday morning!), Dexcom vibrated to wake me and tell me I was low.  I felt OK, but tested... and I was 90.  Perfectly fine.  So I calibrated Dex and laid my head back down to sleep... only to be startled awake by an incredibly shrill BEEEEEEEEEP!!!!

I've seen other D bloggers complain that Dexcom is too quiet and won't wake them up at night.  Yeah, I don't have that problem.

I grabbed it and saw that Dex was initializing, and then that it had recovered a session.  Okayyy...  I put Dex back on the nightstand and settled back in, trying to relax...

BEEEEEEEEEP!!!!


Initializing and recovering again!
 
I went through this two more times before I turned Dex off and got out of bed, wide awake.  3:30 am.  Great.  No way I could get back to sleep, as wired as I now was.
 
I called the Dexcom service line as soon as business hours arose and they confirmed that, yeah, something pretty bad had gone wrong with the receiver, and they wanted to just replace it to be safe.  They offered to overnight it, but I asked them to wait and send it so it would arrive Monday, since I was leaving town early the next morning.  (They were, by the way, extremely awesome and offered to just overnight it to where I was going.  I didn't really feel secure about sending it to a hotel when I surely wouldn't get there until well after delivery.)
 
Friday morning, after stopping for the #7 breakfast at Cafe Antigua (this particular meal is both incredibly delicious and miraculously easy for me to bolus correctly!!!), Chad and I made the long Trek down to San Antonio for my grandmother's memorial service.  As a straight shot, it's about an 8 hour drive.  It's much longer when you're pregnant and need to make frequent stops to use the restroom and stretch your legs.  The drive wasn't bad though (especially since Chad was awesome and happily drove the whole way!), and we met up with my family on The Riverwalk when we arrived.
 
I had few blood sugar issues.  I went low twice over the weekend, but neither time was bad at all.  I probably went a little higher than I might have with Dexcom once, but it wasn't really out of my typical range, either.  Basically, I just tested more often... A lot more often.  And it was fine.  But still, there's so much that Dexcom gives me.  For example, I ate most of a sugar free fried pie and felt like maybe I'd given myself too much insulin for it.  We Dexcom, I could have just kept glancing to make sure my blood sugar wasn't dropping.  Without it, I tested like 45 minutes after eating to make sure I was going in the right direction at the right rate (I was), but I still felt kind of paranoid until the two-hour test.  And with Dexcom, I didn't feel the need to test my blood sugar before sleeping.  I just glanced to make sure it was in the right range and fell asleep with confidence that it would wake me if I went too low or too high.  Without it, I tested before sleep (a good thing too, as I was a little low at that test on Saturday night) and still worried as I fell asleep... In fact, I let myself run a tiny bit higher during some of the weekend than I normally would while pregnant and with the safety net of a CGM.
 
Things have been fine, but I'll be really happy to see that Dexcom box this afternoon!

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?

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.

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.

First Major Ultrasound

We had the first ultrasound today, other than the quick peek they took at my first prenatal visit when the baby was about the size of a peanut. It was totally fun to watch, but let's get the big part out of the way first:


The doc said, "Everything looks great."  *sigh of relief*

The size is right, resulting in an estimated due date at August 15th.  That's a mere 3 days earlier than the due date my OB gave me based on the date of my last period.  He did a great job of explaining what he was looking for regarding abnormalities, and confirmed that everything he saw pointed toward normal development.  He wants to see me again in six weeks so he can get a better look at the heart after a little more development, but said it currently looks great, too.

On to the fun stuff:  It's a boy!!!  I had actually suspected as much, because I noticed some of my body hair getting a little more noticeable and remembered my mom commenting that she'd noticed darker hair on her face when she was pregnant with my brother.  I guess it's all the testosterone it takes to turn a boy into a boy.  It'll have some effect on the mom, too.  Chad and I really didn't have much preference for gender (I've always said I'd love to have one of each), so the cool thing about knowing it's a boy is that we can really start working on names and pick out some boyish stuff for the registry.

He was a mover, too!  He kept kicking those little feet and thrashing those little arms, especially when the tech tried to get him to open up a hand.  This matched right up with his over-activity at the last OB's visit, while the nurse tried to get a count on his heartbeat.  He was just pushing himself all over the place!

We did have a little diabetes gem with the doctor.

Doc: So, tell me about your diabetes?  How long have you had it?
Me: I was diagnosed in May, so less than a year.
Doc: Uhuh.  And they thought it was type 1?  (Sounding skeptical.)
Me: Yeah, I was making hardly any insulin at the time of diagnosis.
Doc: That's interesting, because you're not the typical age to get type 1.  (Sounding even more skeptical.)
Me: Well, I'm not the typical age to get type 2 either, which is probably why my doctor decided to test for the type.
Doc: And who do you have as your endocrinologist?
Me: Dr. K.
Doc: Good.  (He finally sounded satisfied here, so I guess he trusts her judgement.)

After the doctor left the room, Chad gave me a patronizing look and said, "Are you surrrrre you're type 1?"  I could only shake my head and say, "Yeah, like they pass out type 1 diagnoses willy nilly to 30 year-olds."

This stuff is part of why I advocate; my pet cause is telling adults to never take it for granted that it's type 2 based entirely on age.  It's actually not uncommon for adults to get type 1 (just not as common), but even a lot of medical professionals are really quick to assume type 2.

Oh, and those 4D pictures?  Cool, but also kinda creepy.

(They seem to be extra creepy at this stage, because a baby doesn't have much fat at 17 weeks and so looks a little skeletal.)

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.

Yet another appointment... but a good one.

I had a appointment with my endo yesterday, and all was well.  Since getting pregnant, I always feel like my blood sugars are doing horribly, but when we look at them, I usually realize they're not nearly as bad as I think.  She confirmed this and said I'm doing great.  I'm out of range every now and then, but they aren't terrible numbers and I always bring them right down.

I asked that they go ahead and do an A1c every other visit since my OB simply isn't interested in learning to use Fructosamine results.  My endo simply said that's fine, but the nurse seemed a little baffled that my OB is so insistent on having an A1c every month when she knows I have an endo who's in charge of the diabetes side of my care.  She seemed practically flabbergasted when I told her that my OB had commented that she might want to make changes to my pump settings at some point.  I shared in her annoyance (because it felt good!), but I really just chalk this up to the fact that OBs normally working with mothers who get gestational diabetes.  In those cases, I'm sure it's almost always the OB who's in charge of that care.  She's just used to it.

My endo said toward the end of the appointment that she thinks I'm doing great, especially "for a true insulin dependant diabetic."  I smiled and said, "Well, I suspect I still get a little help from my pancreas."  She said, "You know, I think you're probably right, and that's really great that you still have some back-up for pregnancy."  I then mentioned to her that I sometimes suspect I'm actually a late-stage 1.5 or LADA, because I'm pretty sure I had symptoms for a couple years before diagnosis.  She said with both type 1 and type 2 in my family history, she wouldn't be surprised at all.  We then chatted a minute about how easy it is to misdiagnose a diabetes, especially by assuming someone must have type 2 if they're adult of obese.  I really am very lucky that the GP I went to not only tested my blood sugar in the first place, but also bothered to run tests to figure out what kind of diabetes I had once it looked inevitable.

I have a visit with my OB this afternoon, and I'm hoping it goes just as well.  I forgot to pay attention to my weight at the endo's office yesterday, so I'm curious to see if I've gained anything this time.  I hope I've gained at one or two pounds so she doesn't have me coming in for weekly weigh-ins again... That was way annoying.

Moving Along Pretty Smoothly

I'm at 15 weeks, and I've been feeling better lately.  Not super fantabulous, but better, and I'll take what I can get!  I'm not getting random nausea anymore, I've had days of good moods, and I actually have some focus and energy every now and then (though I'm still more tired than before pregnancy).

Blood sugars haven't been bad.  Some weirdness and randomness continues and I'm not always in range, but they're not bad and I've started stressing a little less about them.  I still see them as vitally important, but I'm able to just bolus and go on without freaking out if I'm a little high.  (I did, however, have a recent restless night due to highs followed by lows.  I'm so glad to have Dex keeping an eye on my glucose levels while I sleep, but sometimes I want to just throw him across the room!)

One annoying blood sugar trend I've been dealing with is slightly low blood sugar immediately after eating.  More often than not, I'm right around 70 when I eat lunch or dinner.  So I bolus and eat, then watch my blood sugars drop little by little for a while, probably 30 minutes, and then it finally starts coming up.  Normally, no big deal.  60s aren't bad when you know you have carbs about to kick in.  But once in a while, it'll keep dipping into the 50s.  I'm not OK with 50s.  (On those occasions, I eat a small amount of fast-acting carbs then bolus for them once my bood sugar started on an upward trend.)  Because of this trend, I've started limiting the recommended 20 minute wait between bolus and food to if I am 80+ (or 90+, if my blood sugar is on a downward slope).

I do have a "baby bump" now, and will likely be wearing maternity pants to work pretty soon.  I'm still doing the rubber band trick for now!  Other people's reactions remain the most interesting part of pregnancy for me.  My mom got excited when I told her I'm almost ready for maternity pants, for example.  I also have a very sweet coworker who has made doe-eyed comments about my belly.  "Aw, Mama!" or, "It's beautiful!"  So, very sweet, but it still makes me feel very self-conscious!  I hope it's not too regular of an occurrence for the rest of the pregnancy.

The one weird thing that gets my anxiety up a little is I feel like there's a little tension between me and my OB regarding my diabetes monitoring.  First off, she commented that she might make changes to my pump settings if she sees things imy blood sugar she wants to change.  I just said, "OK," but the truth is that I really only want my endo (and me) to make those calls.  Anything she asks me to do, I'm going to fax to my endo for approval before implementing.  It's not that I think my OB will make bad calls, but rather that I have a specialist whose entire career is centered around the management of my disease.  She's the one who's most qualified to help me manage my blood sugar.

Second, after I decided that, fine, I'll do a monthly A1c test for my OB's preference in addition to the twice-monthly fructosamine tests that my endo feels are far more useful during pregnancy, I got a little attitude from her staff because I said I'd rather do the test at my endo's office instead of the OB's office (and then the results would get faxed to my OB).

(On the phone.)
Staff: Dr. L wants you to come pick up a slip and go to the lab to do a hemoglobin A1c.
Me: Just an A1c?
Staff: Yep, just a hemoglobin A1c.
Me: I go to my endocrinologist's office next week and they'll draw blood for a fructosamine test anyway, so I'll just call and ask that they also plan to do an A1c.  And they'll fax it to you.
Staff: *with clear annoyance* Dr. L doesn't know how to follow the fructosamine tests.
Me: Yeah, I know, that's why I just said I'd have them also do an A1c at the same time.  I'd really rather get stuck once.
Staff: *sigh* I'll tell Dr. L that's what you plan to do.

The honest truth is that I also don't want to get stuck at my OB's lab anymore than I have to.  They bruise my arm every single time, and it definitely hurts more than when I have blood drawn by the nurse at my endo's office.  Plus, getting it done in one visit means I don't have to spend the extra time or gas that it takes to go to my OB's building and wait around to have my name called at the lab.  This pregnancy takes up a lot of time!!!

I had a visit with my endocrinologist today and, as usual, she made me feel like I'm moving forward on the right path.  We made a slight adjustment to my early morning basal insulin to get my fasting BG down a tad, but she didn't feel any other changes were warranted yet.  I had some "highs here and there," yes, but they didn't follow a pattern and I never let them last long.

But the best part is that she made me feel about a million times better about not gaining weight.  I think I managed to gain a couple pounds if her scale is the same as my OB's, but she (and her nurse) seemed slightly confused about there being any concern.  Aside from only being 14 weeks (tomorrow) into my pregnancy, she commented that much weight gain isn't really necessary as long as you're eating enough and eating well (and taking prenatals).  She also agreed that it's not relevant to my diabetes management since we know what my blood sugar is (and it's nowhere near high enough to prevent me from gaining).  Maybe that was just an off-handed comment on my OB's part, but if she expresses that concern again I'll ask her to please confer with my endo.

I also went ahead and mentioned that the hormones have been a nightmare for me emotionally, because my counselor felt that both of my doctors should know that that's going on.  She wasn't at all surprised considering my history of depression and commented that some women feel the best of their entire life, and others just ride an emotional roller coaster.  She confirmed that I'm doing everything to take care of myself (including staying on my Wellbutrin), but it honestly just makes me feel better when someone acknowledges my depression with understanding and acceptance.  I definitely feel pressure to be happy for everyone, because that's what people expect from a pregnant woman, and I've already had one person I'm close to insist that this "isn't normal," that this is a "wonderful time" and I should be happy.  I'm certain she said this in an attempt to get me to step up my attempts at treating depression, but the last thing I want is to feel abnormal (and guilty) for not being deliriously happy.  Happy about having a baby?  Yes, I am.  But happy, as in mood and attitude?  No, I am not.  And I feel like I have to apologize for it at every turn.

That said, at least my anxiety over my weight has been alleviated.  Really, I'm just not going to stress about it unless it actually looks like it's becoming problematic.

No. More. Food.

I'm pretty sure I'm hitting the phase in pregnancy where I start slowly becoming more and more insulin resistant.  At the same time, I've been "trying to gain weight" for the past few days and need to rule out the possibility that it's the higher fat in my food that's causing the change.  So today is a good, angelic food day.  A high fiber muffin and skim milk for breakfast, cheese for snacks (provided my blood sugar doesn't head downhill), and a salad (with chicken) and reduced fat cottage cheese for lunch.  Dinner might not be quite so angelic, but it's primarily late afternoon when my blood sugar gets higher than it used to.

Speaking of, I'm totally fed up with my own weight-gaining attempts.  My first thought was, "Gaining weight?  That means larger meals, more carbs, and more fat."  So I attempted this, and can I just say: "Puke!"  OK, no actual puking, but a strong desire to puke.  Let me also say "Holy freaking crap!" regarding how my blood glucose reacts to high fat these days!  It's always caused a rise at the 3 or 4 hour mark, but not like this!

So, I'm moving on to what I think is a better plan anyway:  More snacks that I already know work for me.  More cheese between meals at work (along with carrots), and more no-sugar-added ice cream in the evenings.  Or crackers and hummus (because, YUM!).

If this doesn't do the trick, I'll go to a dietitian at the diabetes center for a plan.  I don't want my next weight gain plan to include blood sugar battles like the first one.

More and more female friends are surprised my OB is at all worried about the lack of weight gain, particularly other women who were overweight going into pregnancy.  One friend only gained 3 pounds through her entire pregnancy, and her OB was just fine with it.  I probably need to gain more than she did, but still, I've decided not to stress about this.  I'm going to assume the baby is just fine until there's reason to believe otherwise.

My Chubby Brain is Blown

Never before, in my entire life, have I been told to gain more weight. If anything, I’ve always been told I need to lose a few pounds. I’m overweight, and have crossed the line into “obese” a couple times.  But now?  I'm an overweight pregnant woman.


So, it’s just so utterly baffling to this chubby chick that my OB tells me I’m not gaining enough so far in my pregnancy.

Me? Not gaining enough? Unheard of!!!

Oh. Wait. That was before I had to count carbs and avoid too many really high fat foods.

I’m not restricting carbs or calories at all, except that I don’t choose to sit down and eat three breadsticks then order and eat a giant bowl of pasta with artery-clogging sauce. One breadstick and half a giant bowl of pasta (then maybe another half breadstick!) will do, thanks. And that’s usually already more calories than I’m “supposed” to eat in one sitting.

I am not a conservative eater by any means and, though I know better than to “eat for two” and double my food, I’ve felt sure that I've been eating more calories a day now that I’m pregnant.  I mean, I'm always hungry!!!

The nurse (or medical assistant?) who wrote down my weight at today’s weigh-in at my OB’s office said, “Just half a pound. You’re going to have to come back and weigh again next week.”

"Really?!" I said. "This is just the first day of my second trimester. I thought a lot of women don’t gain in the first trimester!”

“Maybe if you’ve gained two or three pounds by next Thursday, she won’t make you come back in. Just go to Braums every night until then!”

Braums is a regional fastfood burger and ice cream joint… really known for their ice cream. A twinge of annoyance passed through me as I remembered my last stubborn high blood sugar that happened despite a carefully calculated bolus. “Yeahhhh, that’s a little tough for a diabetic.” I got a look of sympathy, but no further suggestions.

I’ll be trying to add in more calories, but there will be no milkshake prescription for this mother-to-be. How frustrating that I need to gain weight right when blood glucose control is both more important than ever and more difficult than ever.

Not. Fair.