Thursday, October 11, 2012

Blah A1C

After four weeks of no appointments (I missed my last appointment when I was at the hospital), I went into the endocrinologist this morning for a regular diabetes and pregnancy check up.   Seeing as my blood glucose numbers have been all over the chart for the past several weeks, I wasn't surprised to have Dr P report my HgA1C has gone up.  At my appointment in August my number was fantastic at 5.3 which is completely within "normal people" range, but this go around my number is 6.2 which although it is still "healthy" for a diabetic, it is higher than I ought to be while pregnant.  The perinatologists don't want my HgA1C over 6.0 for fetal growth purposes, but given the steroids they injected to mature Baby's lungs if she needed to be delivered it's not at all surprising that my numbers are inflated.  As long as the number is heading back down the right direction for my next endocrinology blood panel this number should be no big deal, but if it's still high or continues to go higher, then we'll need to start worrying a bit more about the impact diabetes (on top of all the other complications) may have on delivery and Baby's health.

To give me a better shot at a lower HgA1C in a few weeks, Dr P helped me fine tune several of my carb ratios (the lowest is now 7.5 carbs:1 unit insulin) and a few of my basal rates to reflect trending dips and peaks my logs illuminated.  Given that I haven't been eating much since I've been home it's much easier to see where my respective basal and bolus rates are off; for example, my postprandial after dinner has been high several nights in a row indicating that my bolus rate after 5 PM is too low, but my afternoon blood sugars consistently dip into the 50s and 60s after several hours without food so that means my after 3 PM basal rate is too high.

I'm sure all of this will be out of date and need to be changed tomorrow (hoping and assuming my placenta is still working it's "magic"), but for the time being I should be on the right track.  Seeing as the best performance of my placenta is hell for my blood sugars and that I'm supposed to be on more bed rest rather than less, Dr P suggested that I fax her my blood sugar logs twice a week starting Monday rather than coming in to the office once a week for further insulin adjustments.  While I'm admittedly stubborn about dealing with my disease on my own, I'm actually really grateful to her for this flexibility and for her willingness to provide whatever support and assistance she can given the complexity of my situation.  I expect that if my non-existent appetite continues that she'll be mostly monitoring my basal rates for accuracy...

I honestly don't know what to make of my weight or my appetite at this point in the pregnancy, but the perinatologist on Tuesday didn't seem concerned so I'll take my cue from her.  The nurse I had today, however, was the most concerned I've seen any medical professional be about my weight. In fact, she ironically (given the number of Type 2 patients they see) encouraged me to go straight out to get a cheeseburger "or better yet, a double cheeseburger and fries" to pack on a few more pounds.  I'm still six pounds down from when I went to the hospital and I'm at the bottom end of "acceptable weight gain" for week 31 at 17 lbs, but even if my weight is a problem I highly doubt that high-fat, high-sodium fast food is the solution for me or for Baby.  Super indulgent chocolate cake with fudge, maybe, but I have yet to hear a doctor of mine prescribe that.  Perhaps that'll be a point of conversation next week?

Or maybe I'll just go for it with extra cherries and insulin on top since tomorrow is, after all, GW's 3rd birthday :)

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