Wednesday, October 3, 2012

Diabetes at the Hospital

You know, it is funny, but you'd expect that disease management would be easier on a sick person while admitted to the hospital than otherwise.  As I found out this past week, that is sooooooooo not the case with diabetes.  Between the nursing staff bickering at every shift change about whether or not I am capable of being on a non-diabetes diet and the various different medications that screw with blood sugar, I don't think I've had that much trouble with bg regulation in months!

So when the doctors at Stafford hospital began the mag sulfate drip on Tuesday and they administered the first round of that lung maturing steroid, they put me on a clear liquid diet as a precaution in case I would require anesthesia for an emergency c-section.  While the menu options sounded so appealing - chicken broth and sugar free red or green colored jello (yes, that is correct, the color is the flavor) - I didn't really feel like eating any way so it turned into the longest basal rate test I've ever done. 

A basal rate check is where you don't ingest anything - that's right, nothing but water - over the course of nine hours to ensure that your blood sugar stays within the right range.  If it drops in that time frame, you know your rate is too high and so you eat something and reset your rate for a bit lower.  If your blood sugar goes high in that time frame, you need to do a bolus correction and increase your basal rate.  The goal is to have your bg be in perfect ranges for the entire nine hours, but if you have to correct for either hypo- or hyperglycemic reasons you have to stop the test and start again the next day until you get it right. 

As it turned out, my basal rates were off by a pretty large margin.  I think I went in last Tuesday with a total basal rate of about 12 units per day, now that I am out of the hospital and my rates have been adjusted (one, two, three times) I am at 16.5 units a day!  Considering my daily pre-pregnancy total basal rate was barely 8 units, it's definitely showing that despite my placenta's horrific display last week and its old appearance that it's still working well enough to put out pregnancy hormones and screw my bgs up so thank God for that!

Any way, I stayed on the clear liquid diet restriction until Wednesday evening when my contractions were spaced enough to be less concerning. At that point the MFM doctor put me on a normal diet since they weren't monitoring my diabetes (a vote of confidence if I've ever had one) and just said to go light with my meals.  Of course, it was at this point that my new nurse FLIPS out that they haven't been responsible for checking my blood sugar or monitoring my diet and insists that they be in charge.  So, trying to humor her, I let her check my sugars with their little machine and it reads 45 points higher than my test kit that I've been using since I got out of the hospital in 2011.  Making a huge deal out of this, she insists their meter is right and I've got horrible self-care (not so much on the vote of confidence).  Taking a deep breath and thinking to myself that my HgA1C probably speaks better to my self-care than her opinion does, I recalibrate my test kit and find that it's reading exactly where it ought to.  The nurse of course got all sorts of huffy because of this and sent their meter down to the lab for recalibration.

Well, as it turned out - they both read right.  So when my ("correct") meter says that I am at a perfectly healthy number of 106 and their ("correct") meter is reading that I'm at 151 we're left at an impasse.  Talk about brand and kit disparity!! Fortunately, my endocrinologist has privileges at UMW Hospital and said she was fine with my test kit results due to the consistency of the numbers she sees in my logs and with mg HgA1C checks (phew!).  But, dang, it makes so much more sense to me now why the MFM at UMW and at INOVA would say to just use my kit and to be responsible for my own sugars because with that kind of inconsistency, no wonder there are issues when delivering diabetic mothers!

Thus adding another level of drama to an already emotionally and physically overwhelming experience, I felt trapped between a rock and a very hard uterus. The hospital food that was provided didn't come with nutrition information so I was left to guess on items that I wouldn't normally touch with a ten foot stick without a carb break down... the long and short of it is that I pretty much resigned myself to a low-carb or no-carb "normal" diet just to avoid the miscalculations and new found scrutiny from the nursing staff.

And of course when you mix in the second round of steroids that they administered on Wednesday night, my sugars went off the charts on Thursday. I couldn't get them back down by either repetitive rage bolusing or temporarily increasing my basal rate to 110% of normal - none of it seemed to touch the excessive sweetness coursing through my veins.

Now that I am back home things are a bit better - my two hour post prandials are still consistently high and I'm having to administer correction boluses, but as that is a sign of a healthy placenta I'm actually okay with it.  I've reprogrammed my pump more and I've scheduled another endocrinology appointment for next week, so I guess you could say this is all just part of the show...

But, you know, I've got to say that this whole ordeal has been a lot to handle.  I mean this whole pregnancy has been a roller coaster of complications and concerns and this last week was enough to push me right up to the edge.  It's one thing to be diabetic, another thing to be a pregnant diabetic, but it is an entirely over the top, unnecessary and unwelcome thing to be a pregnant diabetic with so many complications...

So, God, if you happen to be reading my blog today please cut me some slack and give my nerves a break!  I'm 30 weeks now and I want to make it as long as I can before little Baby girl here arrives, so any help or guidance I can get, I'll take.

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