Friday, August 31, 2012

Carb Counting Challenge Results

So, to make things standard and therefore fair for everyone, I only used the CalorieKing.com website to gather the numbers.  Here's the final break down:

Thomas brand cinnamon raisin bagel - 58 grams carbs
3 oz cream cheese - 2.3 g
Starbucks blueberry scone - 61 g
Grande coffee with milk - 24 g
Two sugar packets - 8 g
Two medium slices bacon - 0.2 g
Two scrambled eggs - 1.5 g
Two slices white bread toast - 23.9 g
1 cup home-made hash browns - 54.8 g
One medium banana - 27 g
1 cup 2% milk - 12.4 g
1 cup multi-grain Cheerios - 24 g
Seven 4" home made buttermilk pancakes - 76.3 g
1/2 cup real maple syrup - 108 g
1 Tbsp butter:  > 0.1 g (not added to total)
12 oz fresh orange juice - 37 g

Total:  518.4 grams carbs

Thursday, August 30, 2012

Pizza protest.

And so it starts.   I am officially facing irrational insulin resistance for the first time.  Dum dum dum! 

I've read about this part of pregnancy countless times and I knew this was coming, but it's still disappointing to have it begin.  One woman I read about would bolus for a full serving of oatmeal (roughly 25 g carbs for a cup) but would eat only a tablespoon of it and her blood sugar would surge so high that the rational carb:insulin ratio for everything else would be completely irrelevant and impossible to calculate for that particular food.  Scary....

Well, I've been on a serious Greek olive kick for the past couple months (I hated them previously, gotta love pregnancy cravings) and so HB and I regularly pick up this Greek pizza from a local pizzeria that scratches the olive itch and satisfies the quick easy meal when I am slacking and don't feel like cooking (Julia Child, please pardon me for this).  According to the pizzeria's nutrition information, each slice of this Greek pizza has 17 grams of carbs and, starting yesterday, no matter how much I bolus per slice - whether I double or even triple the amount of carbs per piece - I unavoidably shoot up into the 200s.  Dang.


Even with the cravings and ease of it all, such unpredictability isn't worth it and I'm bummed that this means pizza is out...

Back when I was pregnant with GW, I had pizza pretty much every day because it was just about the only food that didn't make me feel sick and we conveniently lived next to a fantastic Italian restaurant on Pentagon Row in Arlington, VA.  All I had to do was show up and sit down and this wonderful waitress named Monica would deliver to our table these amazing (pasteurized) goat cheese and spinach salads and one of these individual size pizzas with homemade sauce and ridiculously fresh toppings... yes, I was that predictable; yes, I was there that often; yes, HB was that supportive.

I guess I can say thank God that I live an hour south of that restaurant now and that pizza isn't my only source of sustenance this go around, but none the less it's frustrating to be diabetic, it is frustrating to be a pregnant diabetic and this irrational carb juggling simply sucks.  If it wasn't hard enough already, here's a new curve ball for ya! Boo hiss!

I hope someone out there - whoever you are - orders a pizza tonight and thoroughly enjoys it in absolute protest of my pancreas' tyrannical dictatorship and its cruel and unusual rejection of what ever it so capriciously whims!

Bon Appetit!

Wednesday, August 29, 2012

And that, my friends, is the Webster's definition of amazing.

So my endocrinology appointment on Monday came and went with next to no fanfare.  I anticipated the doctor to tell me that my numbers this past week were atrocious and that my body is obviously becoming insulin resistant, but instead she looked at my numbers over the past three months and decided that I actually need to turn my sensitivity levels down from 80 ml/dl per unit of insulin to 85 and that if I continue to see regular lows I should decrease it even further to 90.  Fair enough...  beyond that she had nothing else to say about my self care and asked to see me every three weeks until the baby  is delivered.

Unfortunately their office was out of the in-office HgA1C test kits and they were unable to tell me right away the most important information of the appointment.  HB, GW and I trotted down stairs to the hospital lab to have them run the test and I must say that I had the best phlebotomist I think I've ever encountered draw my blood with absolutely zero pain.  Maybe I'm getting too used to needles, but seriously this girl managed to get four vials of blood without even the smallest pinch!

Any way, I had to wait and wait and wait and wait and... wait before finding out what the number was.  But instead of eventually receiving a random phone call from the nurse's assistant, the doctor herself called to deliver the news. My HgA1C is down and that it is the wholly impressive number of 5.3!  Yes, people, that is in non-diabetic range and, yes, I have been doing that well with my blood sugar control.  Little party for me!

For the time being, I'm continuing as is until my next appointment with her on September 14. The reason she wants to see me every three weeks until delivery is to make sure that my sugars are in the range they need to be in for the third trimester of pregnancy.  It's particularly important that my blood glucose be under control now because if they are too high too often then the baby will grow larger than she ought to and that could lead to issues with delivery.  Furthermore, it is very important that my sugars are in control with regards to my other pregnancy complications because if Baby could arrive whenever it is extremely important that my sugars are normal so that the baby is born with normal blood sugars as well.  If my sugars are high, that glucose is transmitted via the placenta to the baby and causes her pancreas to increase insulin production to combat her resulting high bgs.  But if she is born while I am hyperglycemic and she is subsequently disconnected from the placenta (aka the source of extra glucose) she will be born hypoglycemic and will need to be put in the NICU until her sugars stabilize.  Which I, obviously, want to avoid to the best of my ability.

I'm planning to keep my sugars on lock down until she's out, but even during delivery I am planning to run my own diabetes management.  Typically most hospitals want to take over checking a diabetic's sugars and administering insulin via an IV drip for the patient, but I am not comfortable with anyone's standards but my own - so I'm going to do it.  Either HB or I will check my bg every 30 minutes and we'll keep my pump on so that we can fine tune as necessary to keep me at 120 mg/dl or under throughout labor.  If I have to have an emergency c-section, obviously that goes out the window, but in all other scenarios I'll fight anyone tooth and nail to maintain as much control over my body and my pancreas as I possibly can.  It's my responsibility, after all, to grow this baby and raise her once she's out, so while I am willing to accept outside help I reject anyone's suggestion that I hand over the responsibility for my baby daughter while she is encountering the world for the first time.

Yes, I am stubborn, but you probably noticed that already.  Ah well, this stubbornness is why my HgA1C rocks the socks off of my endocrinologist... pardon me while I keep it up!


Sunday, August 26, 2012

Agh!

So there are points in each of our lives when we all have one of those moments/days/weeks/whatever that just aren't going in our favor.  You know what I am talking about - the day you wake up already late for work, get a speeding ticket on the drive in, have a fight with a friend over lunch and manage to drop a meatball down the front of your white dress right before an important briefing and then you get home to discover your pooch ate the heel off the left shoe of your favorite pair of heels - you know, those days.  I've felt like things have been going pretty well lately - nothing new to report with the pregnancy, grades came back from Middlebury and were where I wanted them, and HB and GW are well all things considered - and I have been fighting the good fight to good effect.  But then, out of the blue, diabetes struck again!

I don't know what it is about the last couple days, yesterday in particular, but my sugars have been all over the map.  One minute I am slightly low and my body is exhibiting major hypoglycemia symptoms (seriously, last night I could have been running a marathon in 150 degree weather given how fast my heart was pounding and how hot I felt) and the next my sugars are soaring higher than I've seen in I don't know how long. All I can figure is that one of the following has to be true:  A)  I've been off on my carb counting; B)  my insulin resistence is ramping up; or, C) my body just plain does not know what to do about the specific carbs I've been eating. 

It's probably a combination of all of the above at any given point, but it is frustrating none the less.  I mean to vasilate between correcting a low with my three (yes, repeat that, three) starburst and then rage bolusing (this means injecting extra "unnecessary" insulin to correct for a high faster than waiting for active insulin to work) to correct the unexpected high is simply obnoxious.  I'm sure there are those out there thinking some extremely useful thought like "well, just eat two starbursts, dummy" and while you might have a point, it's times like this that I'm sooooooooo not interested in commentary about what I should or could do better with my diet or diabetes management. No offense meant, but let it be known I beat myself up enough over abnormal blood glucose numbers for all of us thank you very much.

The cherry on top of my bad diabetes day yesterday was in the middle of the Sound of Music Sing-A-Long HB, GW and I went to (oh so much fun!!) my pump freaks the heck out and reads the stop-you-dead-in-your-tracks, armagedon-is-upon-us, you've-got-to-be-kidding-me error code: "motor error." AGH!!  So while the thousands of people around me were belting The Hills Are Alive while Maria is twirling on the big screen, I go into pre-panic mode and have to reset my pump all the while hoping to God that the mechanics of my pump really aren't failing.  Exposing my huge belly to the crowd to disconnect the infusion site, I removed the resevoir from the pump and held my breath as I watched the piston rewind back into the gear box.  It beeped - rewind successful.  I reinserted my old, still full resevoir into the pump and went through the key stoke commands to reset it and watched it intently for additional problems.  And - thank God - it worked fine.  I exposed my belly again to hook it back up and promptly joined in the chorus of nuns and would-be-nuns in "hallelujahs!" (Thank you to the male-mother superior sitting in front of us for the extra blessing, ha.)

Okay, so maybe that wasn't an actual cherry on top of that particularly bad bg day, but those heart-racing moments of concern that my plastic, artificial insulin life line had been cut off scared the boohockey out of me.  Granted, I have back up insulin in the pen form back at the house and I'm not completely in over my head if my pump does actually fail, but seeing as I'm not always home, I don't carry my insulin pens with me (they need to be refrigerated) and time without active basal insulin in my system is not healthy time for the baby, I would really rather not need to go there.  Further more, I've fine tuned my diabetes care to the point that my bolus doses are within 0.05 units of exactly where I need them to be at any given moment... with an insulin pen, you can only dose in whole numbers thus requiring too little or too much insulin.  Let it be sufficient to say that without the pump, I am pretty sure my diabetes management and my sanity would be out the window.

I know that Medtronic has a 24 hour emergency hotline for full on pancreas crisises like that and that they would have either fixed my pump or gotten a new one to me as fast as FedEx can move it, so it's not the end of the world to have it break.  But given the cost of replacing it, the efficacy of treatment on the pump and the necessity - at this point in the pregnancy in particular - to be as close to non-diabetic as a type 1 can get, I'd really just rather not go there. 

Needless to say I said several many more diabetes related prayers this morning at mass and increased my morning bolus ratio and my afternoon basal ratio to hopefully combat any resistance issues I'm starting to face.  From the other pregnancy and diabetes blogs that I follow, it seems to be pretty typical that things get a bit out of hand right about now and continue to deteriorate as the third trimester approaches and wears on.  Hopefully I'll get to expereince the frustration of third-trimester insulin woes for several many weeks and Baby will be delivered after wk 36, but we'll just have to see how all of this unfolds. 

I head into the endocrinologist tomorrow morning for my first A1C check up since early this summer and I anticipate that it will be a good number.  I've only had issues the last several days and the past three months have been solid, so we'll see where that officially puts me in the rankings...

Monday, August 20, 2012

Holy OW.

So I had a feeling that this might happen sometime soon since I'm not putting on too much weight and the baby bump is getting bigger and harder, but alas inserting my infusion site has become a ridiculously painful experience.  I went to reinsert the site at a new place on the left side of my abdomen and instead of only going into the subcutaneous fat like it usually does, the needle bounced off my abs or uterus or something and seriously hurt like all get out.

Don't get me wrong, I have a really high pain tolerance and I am used to the pinch of a two inch needle jabbing my stomach every few days, but having a needle hit muscle or something more tender than fat is SO uncomfortable.  I've had to switch my infusion sites from the parallel lines next to my belly button to my sides since Baby has oh so lovingly deposited extra cushion for Mama there... So far the swap seems to be working out, but it makes lying on my side uncomfortable and carrying a purse is a bit painful when it bounces on the site.  Oh the joys of being a diabetic!


In other news, I've been completely on the ball with checking my blood pressure twice a day, weighing in daily and checking my urine for protein to make sure preeclampsia isn't setting in.  So far things are all within normal levels and that is great.  I'm going to be talking with my perinatologist at my next appointment about whether his concerns are for "IF" preeclampsia sets in or "WHEN" it sets in.  I'm not sure what to make of this high risk pre-preeclampsia routine since preeclampsia is frankly much more intimidating to me than any of the other complications we're having with this pregnancy.

The Preexisting Diabetes and Pregnancy book I've been reading has several many stories of women who had similar combinations of complications that had their babies as early as week 30 (which, by the way, is only six weeks from now)... scary. But face it, week 30 is better than week 24 -- and week 36 is even better than week 30!!  I registered for delivery this morning with the Fairfax INOVA Women's Center and I am glad that is ready to go just in case.  I've pretty much resigned myself to the expectation that we'll likely deliver earlier than optimal and that the use of a NICU may actually be required, but that is all in God's hands and I can only hope for the best.

Wednesday, August 15, 2012

Week 23: Less pressure is good pressure

THANK GOD FOR PERINATAL ASSOCIATES OF NORTHERN VIRGINIA!! I am so glad to be back in NOVA for the quality medical care these doctors provide that I cannot even begin to articulate how relieved I am.  No offense meant to the people in Vermont that want to go to Fletcher Allen, but sign me up for comprehensive, careful prenatal care for this and all future pregnancies please!

So, as it is probably obvious, I had my first prenatal appointment back in VA yesterday afternoon.  They ran a second level-II ultrasound to double check what results were found in VT and were able to confirm with greater clarity that the baby is in fact a girl and that she is healthy.  They looked at my blood sugar logs and used the word "impressive!" to describe my self-care - GO ME.  Unfortunately, amazing diabetes control aside, the doc confirmed that there are several complications on top of my insulin dependence that makes the remainder of this pregnancy risky:  elevated Alpha Fetoprotein (AFP) levels, a partial Placenta Previa and very high risk of preeclampsia.  Let me explain:

1)  Each fetus creates a protein called Alpha Fetoprotein that is present in the fetal serum and amniotic fluid.  As a standard test between weeks 14-22, docs check the level of AFP in the maternal bloodstream to ensure that it is within normal levels (no higher than 2.0). Simply by being diabetic, the range for normal levels of AFP are lower and therefore more sensitive (no higher than 1.9) than non-diabetics; my level is 3.25.  Fortunately this abnormal number is not directly correlated with my diabetes and there was nothing I could have done to prevent it, but unfortunately it does present issues that need to be addressed on top of my diabetic-pregnancy care.

So what does this mean?  Well the initial assumption with elevated AFP levels is the presence of neural tube defects (such as Spina Bifida), which we have thoroughly ruled out through the comprehensive level-II ultrasounds.  Great right? Heck yeah... but we don't know what is causing the elevation now and that creates concerns about the structure of the placenta.  I'll be going into the doctor's office every three weeks for the time being so that they can check fetal growth and if she isn't growing at the appropriate rate for her gestational age (which she currently is) that means she isn't getting enough nutrients through the placenta and we may need to deliver her early.

2) Well the doctors in Vermont were wrong - I am not previa free.  The great news is that my Placenta Previa is in fact a partial and does have a possibility of sorting itself out between now and delivery, however the doctors here in VA are unwilling to say that it "will" move because it is much lower and closer to the cervix than it ought to be.   There is nothing that I can do to fix it and ultimately it is a wait and see what happens situation, so all I can do is hope for the best and work on damage mitigation. Between now and delivery I need to do everything in my power to make sure that I am not making the situation worse: no heavy lifting (anything over 10 lbs; btw GW weighs 36 lbs now), no exercise and increasing amounts of rest.

Keep your fingers crossed for me that the placenta continues to move up and reduces complications with delivery!

3) The new concern as a result of my diabetes mixed with both the placenta previa and elevated AFP is a higher risk for preeclampsia.  Preeclampsia is pregnancy hypertension or elevated blood pressure that results in extremely dangerous situations for both mom and baby.  If I am actually diagnosed with preeclampsia I will likely need to deliver Baby early, but for the time being I am in pre-preeclampsia mode.  So while my blood pressure is currently fantastic (yesterday it was 105/62) it can go up almost instantaneously and whatever great number I had before wont matter.  Unfortunately there isn't anything I can do to ward off preeclampsia, but I can keep an eye out for the symptoms of it and be able to respond quickly if and when it does set in.



So... the long and short of it is that my diabetes is under tight control, but that does not affect the presence or treatment of the other complications.  Worst case scenario, each individual complication is solved by emergency, early delivery so any hopes I had to make it all the way to week 38 are pretty much shot.  I'm taking things one day and one week at a time right now and trying to keep my blood pressure and stress as far down as possible.  I anticipate with HB's ACL reconstruction surgery on Friday, GW's upgrade to a real bed (buh-bye crib!) and my anticipated insulin resistance that it'll be a difficult task to keep my anxiety down, but I'm doing everything I can and the certainty of that at least makes me feel better.

Saturday, August 11, 2012

Update amid chaos...

Sorry for the hiatus everyone - between final papers for class and getting back home to Virginia it has been a crazy week and a half.  I am hoping to sit down and have some time on Sunday to answer a couple questions people have sent in... so bear with me.  I will also be posting a new Baby update after I head to the perinatologist on Tuesday to actually get answers that I've been missing for the last six weeks.  At the end of the month I check in with my endocrinologist in person and should have an updated HgA1C at that point.

I have time for one quick funny story now though...  Last week, I was talking with my endocrinologist over the phone about my blood sugars and she asked me if I was having any trouble with resistance.  After week twenty in a pregnancy - I am almost to week 23 - insulin requirements go up and up and up because of the sponge like nature of the placenta, so her question is logical and will be increasingly more common until November.  Well, at that point, I was able to articulately answer that "no, things are just fine" and that "no fine tuning is necessary."  Knowing full well that God and my pancreas have a funny and sometimes sick sense of humor, the next day my sugars were all sorts of out of whack... a day early and a dose short, eh?

Let the reindeer games begin!