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!

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.