Kind of a Big Difference...

I've mentioned before that my husband Chad decided to start watching his blood sugar after we established that he was having low blood sugar episodes, and that his fasting numbers weren't quite where he'd like them to be.  Mostly, he checks when he wakes up and whenever he feels weird.  But for the first couple of days, he did the whole shebang.  He tested before meals and two hours after meals, as I was taught to do.

So after one of those meals, he tested on his handy but very simple Relion meter, and....

Holy crap!!!  We had a moment of panic before I said, "Wait... turn it over."

Yep, confirmed... it had been upside down.

There's a pretty big difference between 201 and 102!!!

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...

Glucose Tabs and Tight Ropes

Wandering through the produce section of Walmart Neighborhood Market, I felt a little bit funny.  I glanced at Dexcom and saw a 75.  That's not far from low and Dex hadn't been having the most accurate day, so I thought I'd better make sure.  I pushed my cart out of the way near the deli counter, where a lady waiting for her order started to eye me as I fished through my giant purse, and got my meter case out.  I opened it up, inserted a strip, and tried to pull the lancer out of its elastic.

The cap popped off and went flying, bounced off a shelf, and rolled under my cart.  Dang it.  I put the lancer down... and it rolled off the meter case, bounced through the slots in the metal grocery cart, and landed underneath.  The nosey lady stared hard.

I heaved a sigh, started to move the cart out of the way, and the meter case flipped off of the produce I'd balanced it on and into the cart.

I glanced at the nosey lady and felt extreme annoyance.  At this point, I knew testing was only a formality.  I'm clumsy when I'm low, and now I was getting both frustrated and irritable.

I moved my cart, gathered and assembled everything, and tested.  55.  Not a number that makes me panic, but not a good number at all.  I fished the last four Starburst out of my purse and unwrapped and ate them as I contemplated buying pretzel crisps and hummus.  (Pretzel crisps, yes.  Hummus, not today.)  I didn't feel good at all, but just moved slowly and tried not to let my instinct to eat sugar for survival convince me to pile donuts and cookies into my cart.

Almost 15 minutes later, Dex buzzes and flashes a 44.  I've started to sweat and I definitely feel worse.  I should feel better by now.  I abandon my trip to the cracker and cookie aisle and make a B-line for the pharmacy, where I know there's a bench.... and a water fountain.  I'm powerfully thirsty (something that normally accompanies a high, but whatever).  I sit a minute to let myself hit the 15-minute mark and test again to see a 57.

Not. Good.

I don't have anymore candy in my purse, but there was a further point to heading for the pharmacy bench; it's immediately across from the diabetes supplies.

I grab a bottle of glucose tabs and, sweating on the bench, struggle to tear the plastic off of the cap.  I'm starting to feel a little embarrassed...  Am I going to have to ask someone to open this for me?  I'm not that bad off! I finally make a dent and tear the plastic back in a ribbon, get the dang thing open, and eat three tabs in rapid succession before I stick the jar in my cart and drink deeply from the fountain.

Oh glucose tabs, you may be chalky, but you are a sight for my tired, hypoglycemic eyes.

Finally content, I sat on the bench and spent at least 10 minutes (which felt more like an hour) dabbing sweat from my face and hoping I didn't look or smell too awful.  But no one seemed to be paying attention to the pasty, sweaty pregnant lady on the bench, so I figured I was probably good.  Then I started wondering... would people notice if I passed out on the bench?  Would they assume I was some weirdo who had fallen asleep and just let me get worse?  Even though I was sure I would be OK, I fingered the medical alert charm hanging from my neck to make sure it was visible.

Once I started feeling human again, I made myself stay on the bench a few more minutes for good measure.  55 is not the lowest number I've ever had, but this was by far one of my worst lows.  It felt horrible and it had been persistent.  It had actually made me worry for myself and my baby.  It reminded me that the necessary tight control I've been keeping for the health of my baby includes some danger.  When you're keeping your numbers this low, you don't have very far to fall when your numbers start to drop.  Tight control is also a tight rope.

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.

Flying in the Face of the APA

I've officially decided to do something that flies in the face of an American Pregnancy Association recommendation.

I'm going to eat cold cuts and deli meat.  And I'm not going to heat them all until steaming first.

Right now, the majority of you are having one of two reactions:

1. Most of you are saying, "Uhhhh, what's wrong with cold cuts and deli meat?"
or
2. A few of you are thinking, "Ohhh, but there could be bacteria, and that could be bad for the baby!"

It's not that widely known (you'd be amazed by how many blank stares I've gotten when turning down cold-cuts in the past few months!), but yes folks, pregnant women are advised by the APA to avoid eating deli meat (any cold meat that hasn't recently been heated to at least a "steaming" temperature).  The theory is that there is a slightly higher chance of food poisoning with meat that's stored and eaten cold, and if that food poisoning were caused by listeria, it might also cross the placenta and make the baby sick (sometimes dangerously so).

Is it that listeria infection is rampantly common?  Nope.  About 2,500 Americans get it a year, which is 0.0008027371616142571% of the population.  Then, is it because pregnant women are more susceptible to listeria?  A little bit, due to weakened immune systems.  27% (about 6750 people) of those 25,00 Americans who get listeriosis each year are pregnant and, since there are about 6 million pregnancies a year in the States (and just assuming that means roughly 6 million women are pregnant a year), then about 0.11249999999999999% of all pregnant American women get listeriosis.  I know that looks like a big number with all those digits, but it's actually tiny.  It would round to 0.1%.

Holy crap, I did math!!!  And I'm reasonably sure I did it correctly!

Anyway, my point is that there's a pretty slim chance of contracting listeria, and then it might not even cross the placenta to my baby.

But during the work week, what have the chances been that I would forget or neglect to pack a lunch and end up buying fast food which raises my blood sugar way out of the pregnancy target range?  I'd say those fast-food high numbers have been happening about 80% of the time, lately.  I've tried a dozen different methods to get myself to pack a reasonable lunch, and I beat myself up over every high number, but to no avail.

But before pregnancy, and before my resulting (self-imposed) deli meat ban?  I'd say I made my lunch about 75% of the time, which generally meant throwing simple, pre-made foods into my little lunch cooler with a baggie of veggies and/or fruit.  There were always some sort of deli meats in there, often as part of one of those little lunch combos I call "lunchables for grownups."

So I've made the decision based on the statistics around a possible danger for my baby vs. a verified, daily danger for my baby.  My OB harps on about my blood sugars at every single appointment, but she has never once, either in person or on the dos-and-don'ts list I was given, said that I shouldn't eat deli meat.  No, not all OBs are as concerned about listeria as the APA.  My OB is pretty chill about "restrictions" in general.  Tylenol in indicated doses, up to two servings of caffeine a day, up to two servings of nutrisweet a day, hair dying is allowed in a well-ventilated area, etc.  And what she always emphasises with me is: good blood sugar levels, above all else!

If throwing a lunchable-for-grownups in my lunch bag every day keeps me away from Sonic and therefore keeps my blood sugar down, so be it.

Well, That's Embarrassing...

I don't use any fancy pump accessories.  I didn't get the "thigh thing," the "waist-it," or any kind of special clip or case.  I just use the clip that came with the pump and I have a couple "skins" (which I got for free) in case I'll be doing something that is more likely to knock my pump around.

Typically, I do one of the following:

1. I put it in my pocket.  Most of the time, this means it's visible.  I do, however, have a couple dresses with pockets that allow me to hide the pump entirely by running the tubing through a tiny hole just inside the pocket.  (I just cut a hole big enough to run it through then dab some "no fray" on the edges.)
2. Clip it to the underside of the front of my bra.  I'm busty, so this normally hides the pump-bump entirely if I'm trying to go for a more sleek fashion look.  (When I do this, I first slip the pump into a little fabric pocket I sewed myself [some people use baby socks!] so it doesn't get all sweaty against my skin.)
3. I clip it to the side of my underwear, slightly toward the front or back so I don't have a "lumpy" looking silhouette.  This is what I almost always do when wearing a dress to work.  (This also happens to be how I always wear it when I sleep.)

So, as usual, I had my pump clipped to the side of my underwear yesterday since I was wearing a dress.  No problem.  I really don't even notice it.  But then all of the sudden, there was a tiny little...

Snap!!!

And then things just felt a little different.  I continued walking and felt my pump slowly drooping...  Huh, odd... Oh, crap!  The elastic in my waist snapped!

It normally wouldn't have made much of a difference, but the weight of my pump kept inching it downward, and I had to keep trying to subtly pull it back up.

Droop, droop, droop, subtle hike!  Droop, droop, droop, subtle hike!

At least, I hope it was subtle...

Nice.  Who'd have thought my underwear would matter that much?

Luckily, it wasn't long until lunch, so I just slipped out to the Dollar General and bought a pack of underwear.  Problem solved!

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!