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.

Tough Day

I got really frustrated today because of all of the "correction" doses of insulin I've been having to do between meals, and because I thought my meal schedule was too inflexible due to them...  Then everything in the world was suddenly so overwhelming, and I just let myself cry.  But after faxing my blood sugar records into my Educator and Dietitian (and after expressing my frustration), they changed my carb-to-insulin ratio and set me straight about my meal/insulin schedule.  I can eat any dang time I want and take the right amount of insulin to cover it.  It's only the insulin I take based on my existing blood sugar that I can't take too close together.

*big sigh*  I feel so much better now, but everything caught up to me for a little while, there.

Seriously, if you are a newly diagnosed diabetic, go to a diabetes educator.  And try to find one who'll do more than just teach you in a class then tell you numbers without explanation.  Yvonne, my educator, has been so totally awesome.  She clearly cares, explains the "why" for everything, and gave me her cell phone and email so I can always get in touch with her.

On another front, my mom has been talking to the Diabetes Educator at the hospital where she works.  She went ahead and asked about insulin pumps (a topic my Educator has briefly mentioned as a future likelihood), and she thinks I'll be able to get one in a reasonably short amount of time.  They just have to get me started and make sure I know what I'm doing first.  The pens/needles honestly aren't so bad, but I'm already looking forward to the reduced hassle of a pump!

12 hours into treatment...

I've given myself 4 injections so far: 3 in the belly, 1 in the thigh.  It's not bad at all.  The only time it hurt a tiny bit was the second time, when I put the needle in too slow.  But the pens make it so easy.  At some point soon, I'll post pictures.

The rapid-acting insulin I take before I eat is currently measured on a "sliding scale."  A blood sugar of 150 is supposed to be sort of a baseline number, and I inject 1 unit for every 50 over that (or half that amount for my evening snack).  The educator told me I'd be doing it differently after the class; I'll be factoring in both my blood sugar levels and the amount of carbs I'm about to eat.  For now, I'm just counting carbs to keep from going overboard.

I'm now wishing that I'd been testing my blood sugar before this so I'd be able to see the difference.  It's a little frustrating at the moment because it's still high, and it will be for a while.  I feel like the amount of insulin I'm taking just isn't enough (and it is intentionally on the conservative side until I learn more about it), but I can't drop my glucose too fast.  My levels have been so high that close-to-normal levels might feel like hypoglycemia to me right now.  I plan on doing my damnedest to keep my blood sugar at whatever goal my doctors set for me, but I guess I have to work my way down there first.

On a related note, the educator put all exercise off limits until they give me the green light.  Apparently, it's dangerous to exert yourself if your blood sugar is over 240.  And these past few months, I've been trying so hard to exercise...  And I might have been hurting myself instead of helping.  What a frustrating thought....

Diabetes Education, Part 1

I went to meter and insulin "training" yesterday.  I didn't even learn about diet and calculating the insulin I'll need before eating, and it was still so much information.

The educator was great though, and she spoke from personal experience as a Type 1 Diabetic.

After going through lots of information on each, she had me test my blood sugar while I was there (about 350).  I used a super fine lancet that Mom had gotten for me, and it didn't hurt at all.  She then had me, Chad, and Mom practice using an insulin pen on little cushions.  Since I hadn't injected any insulin yet, but she couldn't have me inject the kind I had at the time, she also made sure that I could manage to stick myself with a needle before leaving.  She sat next to me and stuck herself first, and I followed her example... with no pain at all.  Really.  It felt like a tap and then I could tell it was there, but that's it.

That was a relief.

She was a little displeased with three things my doctor had done (or not done): First, that she had told me not to start the insulin right away.  Second, that she had given me such a conservative starting point, with no rapid-acting insulin (the kind you take when you eat), when my blood sugar was so high.  Third, the doctor could have referred me to the dietitian in the same appointment, but hadn't.  She ended up calling the doctor and having her prescribe rapid-acting insulin and referring me for "Intensive Insulin Class," where I'll really learn how to calculate it properly and learn about proper diet.

MAN, I'm telling you, this is eating up my personal/sick leave...