Monday, November 26, 2012

Induction begins tonight

Well, today is the day.

I go into the hospital tonight to begin fetal monitoring, receive a dose of Cervidil and then bright and early tomorrow morning we'll begin Pitocin to really get things started.  Based on my past pregnancy history and the dosing amounts he's planning, Dr. Bronsky expects that we'll have the baby by sometime tomorrow afternoon.  On one hand I am absolutely relieved to know that there is a definitive plan and an end to the pregnancy in sight, but I conversely find it a bit weird to know for a fact when the baby is arriving after so many weeks of uncertainty.

Hopefully my body will be responsive to the drugs and things will go smoothly with the induction, but seeing as I've been struggling with my blood sugar in hypERglycemic ranges the last couple days I'm a bit concerned about what this means for Baby.  I'm not sure where the high numbers are coming from exactly, but I'm trying to do whatever I can to get the numbers back down into normal ranges as soon as possible because if my sugars are high when she is born Baby will be required to go to the NICU to correct her hypoglycemia.

I think I've explained this before, but just in case I haven't or simply for review, when a fetus is in utero it's pancreas creates extra insulin to balance the excess glucose that is transmitted via the placenta from the Mom if her blood glucose is too high.  But when the baby is born and the external sugar source is cut off (literally), the insulin the newborn's pancreas is putting out becomes excessive and leads to their blood glucose dropping into dangerously low ranges.  Since the only way to correct hypoglycemia is to ingest more carbohydrates and colostrum does not contain much beyond antibodies, the NICU needs to feed the baby supplementally with sugar or formula and monitor his/her blood sugar until the baby is stable on its own.  Once the blood glucose balances out, the baby shouldn't need to stay in the NICU longer unless there are other complications that require additional intensive care... knock on wood.

I'm doing everything I can to keep things were they need to be, but if the placenta makes a last ditch effort to screw with my blood glucose then it's kind of out of my hands since hormones are simply unpredictable.  The reality is that Dr. Rogacz told me to expect Baby to go to the NICU and since we don't know with 100% certainty that her lungs will be fully developed by tonight I've kind of resigned myself to the fact that she might need more help than vitamin D like GW did when he was born.  Of course HB and I have prepared ourselves emotionally and medically for this and we're as ready as we can get...  At the most basic level, instead of using what basic brand the hospital provides, we've decided to bring our own hypoallergenic formula if Baby needs supplementation because research studies have indicated there may be a link between cow protein based formulas, type 1 mom's and babies developing autoimmune diseases later in life.  I can explain more about this research later since this topic goes hand in hand with the breast feeding post I still need to write (good thing we're not quite there yet), but we've decided not to take any chances and we're covering down on every detail we possibly can to keep her as healthy as we are able to.

Anyway, we'll see how things play out over the next two days.  I keep sending up prayers that the increased risks for infection and slower healing time because of diabetes will be of no concern coming out of this, but like I said, we'll see.  There's nothing about diabetes that makes life easy and it effects everything that involves the body -- much like carrying a baby, go figure.  I've somehow managed to avoid the swollen ankles and several other unpleasant side effects of pregnancy this go around, so here's hoping that some of the diabetes and delivery complications will be irrelevant as well.

I expect this will be my last blog post for a while since the hospital has spotty internet connectivity and I'm planning to be very busy with our TWO wonderful kids for a while...  But I'll be sure to put up an update when we get home and we're all settled (please don't call while we're at the hospital since we're not out of the woods yet).  Until then, thank you so much for reading my posts and giving me your support and encouragement over the past many months.  Writing about what is going on is a great outlet for me and, although things have been rough with the pregnancy, knowing people out there care is appreciated more than you know.

Talk soon :)

Saturday, November 24, 2012

Week 37, part two

Thankful for a labor free and turkey full Thanksgiving holiday, I was positively giddy to go into my last perinatal appointment at the Antenatal Testing Center on Friday.  Knowing that Baby's lungs aren't mature and that there wouldn't be a change in plans for what we'd do after this particular appointment ended, I felt like the day was going to be predictable pregnancy-wise for the first time in weeks.   Considering how worried I've been about the stability of my blood sugar, the occurrence of another abruption or whatever else could go wrong, it was a relief to walk in expecting a "simple" a non-stress test, my last sonogram (#20) and a quick conversation with the doc.

Being the day after a holiday, the testing center was ridiculously busy with two days worth of appointments -- there were 16 pregnant women and their spouses in the waiting room when we arrived -- we had a bit of a wait, but it was actually quite a pleasant wait because a 28 week pregnant woman came up and introduced herself to me because she saw my pump clip in my jeans pocket.  As it turned out, she has been a T1 diabetic for almost twenty years, she uses the same pump that I do and, as this is her first baby, she was glad to meet another insulin dependent mom juggling a kid and a baby.  Course I didn't have the heart to tell her that GW wasn't a diabetic baby, but it was nice none the less to swap battle stories and commiserate over the difficulty of our current circumstances... while it sounded like her diabetes gets along much better with her pregnancy than mine has, I really appreciate how this charming woman made me feel far less alone and stranded by my beta cells than I've felt in the last nine months.  So Erin, wherever you are, thank you for that!

Having seen me twice a week for what feels like months, the nurses called my family back to the NSTing area by asking GW to bring his mommy back.   While they're perfectly professional and good at their jobs, I must admit it is the personal touch these nurses give to patients like me that make me absolutely love them...  they put up with my family's quirks and a few of them have even let GW help with the testing process by allowing him to squirt the goo, place the fetal doppler and even help steer the sonogram wand.  Since things were going smoothly today and nothing was abnormal with the sono or NST, they had nothing but nice things to say and well wishes to our family upon my "graduation" from routine testing. It'll be kinda sad not to see them all the time, especially Tam and Sandy, but Lord knows there's always the next pregnancy, right?

Reviewing all the little details, checking my cervix for progress (2 CM) and confirming the plan for my induction on Tuesday, Dr. Bronsky verbally walked HB and I through the last few days of pregnancy.   Knowing my interest in moving about for the sake of labor progression, he said to fly be free and have a nice weekend but to plan on being bed bound from 8 PM Monday until post delivery (boo, walking helped so much last time) on account of how "brittle" my diabetes is and how closely they'll need to monitor the baby because of it.  While I am not thrilled to hear that, I understand the priority and I value that he's concerned with/aware of how sensitive my body is because of my stinking pancreas.   All we can hope for is stable, low (but not hypo) numbers over the next several days and through delivery...

All that being said, I've got a couple days of pregnancy left and by Tuesday (at the latest) we'll go from a family of three to a family of four.  We're going to spend the next several days enjoying our time with just GW and, hopefully, we'll go into next week with minimal complications and confidence in the arrival of a happy, healthy baby girl.

Thursday, November 22, 2012

Happy Thanksgiving!

 
Happy Thanksgiving from the odd looking place setting  :) 

Wednesday, November 21, 2012

Week 37, part one

I don't know how coherent or comprehensive this post will be, but I'm attempting to put something together before the complete emotional exhaustion of the past few days knocks me out.  That said, bear with me.

After writing my blog post Monday night, I had a bit of a melt down.  Caused in part by nerves for the amniocentesis and in part by simply being overwhelmed by the significant differences there have between this pregnancy and the first, I found myself as curled up as a nine month and one week pregnant woman can get in a heap of tears.  You see, with GW, the pregnancy couldn't have been smoother...  I didn't realize I was pregnant until week 12 so I "missed" the morning sickness phase (had it, but didn't know what it was), there weren't any medical complications and he came early and very quickly.  I wasn't restricted to bed, I was very physically active and we generally treated me like a normal woman rather than the delicate creature pregnant women actually are (I distinctly remember carrying a full size mattress from our trailer, across our lawn, into our house and upstairs by myself at 8 months because I felt I could).   Back then I didn't have a clue what I was signing up for or what I could lose if something happened to my fetus.  I didn't have the Mommy Gene, I didn't feel connected to the baby and I generally was waiting for labor to begin so that I could get my "skinny pants" figure back.

But this go around, there is nothing smooth and the stakes couldn't be higher.  Now that I fully comprehend what it means to be a Mom, just how much my son matters in my life and what extent I have given/would give or do anything for his well being and happiness, I am terrified of what a fine line I find myself walking with baby #2.  I knew things would be more complicated this go around with my diabetes, but I had no idea that things would be as hard as they actually have been.  While talking with my nurse at the Antenatal Testing Center Tuesday morning she said that "some people's bodies just don't do well with diabetes and pregnancy" and, unfortunately, that "some people" reference seems particularly relevant to me... which is why all of the complications of the past nine months culminated in a crumpled mess of weepy gooey blah that only marginally resembled me Monday night.

Ug.

So puffy eyed and physically drained, we piled into the truck and drove up to the hospital Tuesday for my amniocentesis and first week 37 prenatal check up.  It took a little while for the doctors, nursing staff and technicians to get things all sorted and settled, but after a quick sit down with Dr. Bronsky I was lying on my back repeating Hail Mary in my head and trying to remain calm for the procedure.  I'd done a bit of research on what to expect and depending on which medical website you look at the sensory explanation of an amnio ranges from a "slight, momentary burning sensation" to "pain worthy of local anesthetic" -- so really I had no clue what I'd signed myself up for as the needle and multiple syringes were laid out on my belly for quick accessibility. 

Taking deep breaths and working extremely hard to keep from contracting my core out of anxiety, Dr Bronsky did a second ultrasound of my uterus (the tech had already done the routine one -- AFI level dropped to 19.6) to locate the best place to insert the needle.  Unfortunately this turned out to be much more difficult than he anticipated because of my anterior placenta and Baby's position. So, if you remember, an anterior placenta means that it is attached to the front wall of the uterus and because I had a partial previa earlier in the pregnancy we know that it is attached quite low to the front wall.  Well, as the baby has grown, so has the placenta and now it covers the entire left half of my belly -- which made it impossible to insert the needle on that side.  Looking to the right side of my uterus, the doctor struggled to find a safe place to test because Baby is curled with her back to my right side and her feet, arms and head pointing to the left.  Since jabbing her with a needle is completely out of the question, that left little to no room for even the thinnest of needles. 

Finally selecting a tiny spot near her tush, Dr Bronsky meticulously threaded the needle between Baby, my rib cage and several many blood vessels through my abdominal wall and into my uterus.  Although I can definitively say that the needle going in wasn't so bad, the needle staying in and being tweaked this way and that to find a clear pocket of amniotic fluid hurt like freaking hell.  Back when I was hospitalized at GTU in 2010 I had to have an arterial blood draw from my wrist and, while that was the hardest blood draw I've ever had to endure, it seemed like a walk in the freaking park compared to this amnio.  OW.  It was all I could do to just keep my eyes closed, continue to breath normally and remind myself that it'd all be over soon...

After what felt like hours of torture (seriously, has anyone told DoD about this yet?) the needle was removed along with enough fluid to check on Baby's lung development and the smallest, dinkest bandaid ever was placed over my cramping, sore flesh wound.  Reminding myself this is all for Baby's own good, my minimal optimism flew out the window when Dr. Bronsky bluntly said that "you know, you can tell lung maturity based on the color of fluid and, from what I'm seeing here, we're definitely not there."  He said they'd still run the tests anyway to see if it'd be safe enough to move the induction date up, but unless things were at a certain level, he and the other doctors weren't confident enough to deliver Baby until next Tuesday -- at the earliest -- because she's just not physically ready to be outside the womb. 

So, not surprisingly, this afternoon we got the results back that confirm that Baby does not have mature lungs...  And although the docs are incredibly concerned about the perpetual drops in my blood sugar and the implications that has for placenta failure, they think it is worth the risk to leave her where she is for another week instead of guaranteeing her a trip to the NICU for breathing assistance.  This, unfortunately, is not to say that she'll have mature lungs by next Tuesday or that she'll be NICU free anyway but it's a calculated risk that the perinatologists think is the best case scenario for a high risk diabetic baby.  I guess this is a good thing that we know she's not ready to come out and that I've got another few days to try to kick this respiratory infection (still feel sick as ever and what's worse is GW caught it), but I'd be lying if I said that I wasn't distraught by the news that things are progressing like diabetes predicted.  I mean fortunately she's not a gigantic diabetes baby, but dang nabit why did my pancreas have to go and screw with her lungs when it has frankly screwed with me and Baby enough for a life time?!  I'm quite done being pregnant and I am completely over being diabetic... one is hard enough as is, but both of them? In the worst combination possible? Not cool.

With November being World Diabetes Awareness Month I feel a bit guilty at just under two years of affliction complaining about the lack of a cure, but you know what? This isn't like a prison sentence -- I didn't do something that made me deserve this disease and therefore the time of incarceration befitting my punishment.  I might not have the decades of frustration and illness that most T1s have, but I'm just as over this disease and the impact it has on my family as anyone else who needs artificial insulin...  How dare diabetes screw with my baby! How dare my pancreas give up on me when I never would have given up on it! How dare people treat me like I'm broken or, worse, like my disease is "not that bad."  This disease flat out sucks and I am frustrated about what it is putting me through and I am angry that my baby girl is being put through the wringer of every possible medical test because I'm stuck with failing beta cells.

AGG!

Since I'm still attached to my pump, still rocking my battle bandage from Tuesday and I still haven't gone into spontaneous labor, we're planning to go back into the testing center on Friday to check on Baby again.   Assuming all continues as is the doctors don't want to move back the induction from November 27, but if things change for the worse or if I go into labor on my own things may either be sooner or later than Tuesday depending on what exactly is going on.  I'll try to keep my update on Friday to something a bit less rant-ish and a bit more concise, but after months and months of high stress composure I was bound to break sometime...

Until then, have a great Thanksgiving folks!

Monday, November 19, 2012

Absolutely Awful Apprehension of Apposite Amnio

Is it just me or is there unjust alliteration in the pairing of "anxiety" and "amniocentesis"?

With the way things have been going since Friday given the increased contractions and labor symptoms I'm having, I'm a bit surprised that Baby isn't here already and that I'm actually facing the needle tomorrow...  Which, obviously, I'm not thrilled about it.  I know that amnios are done regularly and, heck, my mother even had one with me, but given the number of times I see my blood each day and the normalcy of needles in my life I am not terribly ecstatic for yet another excuse to introduce a long sharp needle to my torso.


Perhaps I'm just being a big baby (please refrain from commenting in the affirmative here), but there's just something about the idea of a needle going through my abdominal wall and into my uterus that has me thoroughly freaked out.  It's my basic understanding that it's a generally uncomfortable procedure with very little risk to Baby given the simultaneous use of ultrasound, but I'm kind of done with additional pain and I truly want nothing to do with the stress of further testing.  What's more, I'm not entirely sure what the doctors are going to use the results for in the first place... Amniotic fluid testing during the third trimester of pregnancy is done to check on fetal lung development to ensure that they're mature enough to work properly outside of the uterus.  But with the way my blood sugars have been dropping so dangerously over the past couple weeks, the doctors are talking about taking her out (I don't know if this means induction or c-section at this point) this week and the amnio results they come up with are kind of irrelevant if they think the placenta is too unstable to sustain her until next Tuesday any way.

Don't get me wrong, I'm not scared of the needle or of the pain associated with it.  I've come to accept needles as a given - kind of like the reoccurrence of morning, the unavoidable existence of taxes or the simple fact that all dinosaurs poop (thank you for that insightful revelation Buddy and Tiny Pteranodon).  The part that freaks me out is that this is something I have no prior context to gauge it in and therefore no way to know what to expect, and, also, that the results will either reinforce the current concerns that she needs to be delivered sooner rather than later or that she's got a rough week ahead of her either fighting a failing placenta or struggling to breath on her own.   Bottom line, I'm finding it scary and overwhelming to be counting down the final eight days of pregnancy without even a hint of reprieve from complication... I'd hoped to end this pregnancy on a high, spontaneous labor note but at this point I'm too tired to expend the emotional capital of hoping for something I cannot within reasonable doubt expect.  She'll come out, but only after we've bared the difficulty of pregnancy right to the bitter end.

With my first pregnancy, I went into labor on my own at week 36 and five days -- which would have been yesterday in this pregnancy.  Seeing that this pregnancy is already longer than that with GW (not just by 24 hours, but also 12 weeks longer to be excessively literal), I'm feeling quite a bit frustrated that my water hasn't broken, that labor hasn't simply started and that the anxiety of bringing this baby into the world is dragging on...   Each morning I wake up feeling like another eternity awaits me over the coming 24 hours and given all the complications we've seen over the last nine months, each minute of those hours brings me closer to the end of my rope and a hopelessly emotional precipice.  Now that I know how wonderful being a mom is and how much my babies matter to me, the stakes are higher than ever and I just want to know she's healthy, she's safe and that we've made it across the finish line together, in tact.

I know that doing the amnio is the right thing to do as far as the Perinatal Associates of NOVA are concerned and, as such, I'm on board and will let you know what we come up with.  But for the sake of honesty, my nerves currently have the best of me and I'd definitely appreciate an extra prayer to be sent up for me in the morning if you've got one...  Saint Gerard Mejella please intercede for me!

Friday, November 16, 2012

Week 36, part two

For the third night in a row, I woke up in hell this morning with my blood sugar much lower than it ought to be.  Wednesday I was 34, Thursday I was 32 and today at 2:45 AM I was 43 -- what the heck?!  I mean I love the excuse to wantonly eat simple, quick acting carbohydrates like I am a care free non-diabetic child again, but within the context of the last few weeks of a class B diabetic pregnancy I'm not thrilled in the slightest to need to open my bed side table drawer and raid the stash of sweets HB and I have stock piled for moments like this.  It'd be nice to want a piece of candy for once!!

Any way, I've been going back and forth with my new endo via the phone practically every day this week and I lowered my basal rates by 0.05 each night in an attempt to curb my plummeting blood sugars. Heck, I've practically cut the rate from 12 AM to 3 AM in half over the past three days -- but unfortunately to no avail.  Needless to say my Friday appointments with the perinatologist and endocrinologist couldn't have been better timed this week...

Still gawd-awfully sick with this respiratory infection (I'm now on a new uffdah-uffdah prescription of antibiotics and still coughing like day one), we went back to the Antenatal Testing Center this morning for yet another round of non-stress tests and my 17th sonogram.   The NST was enough reactive to pass and the AFI was much higher than last time (19 on Tuesday, 24.6 today), which the sonographer and resident (ug) dismissed as "symptomatic of being a diabetic."  However, given the smorgasbord of health complications I've had this week - an optical migraine on Sunday, the coughing and vomiting of this infection and contractions - on top of my seriously unstable blood glucose, the resident kicked my case back to Doctor Bronsky who felt it was worth a cervix exam and blood panel to make sure I didn't necessitate immediate hospitalization for preeclampsia or placenta failure.  

Fortunately the blood panel came back showing normal liver function (thank God) so immediate hospitalization wasn't necessary, however Dr Bronsky placed orders for me to have an amnioenteses done on Tuesday (day one of week 37) to evaluate Baby's lung maturity so that he can move the delivery date up from November 27 to as soon as possible.  Soooo, essentially things with my blood sugar aren't stable enough for her to make it another 10 days in utero but the doctors cannot risk her coming out too soon since diabetic babies are notorious for having immature lungs (even at "full term") and you throw in my respiratory infection in on top of that and they've got a very delicate line to walk between letting her stay in and getting her out safely.

Furthermore, from talking with Dr. Bronsky about the possible use of additional steroids as a fail-safe to help her along, HB and I found out that subsequent injections of steroids to mature a premie baby's lungs for delivery is highly controversial after the first dose and there is mixed evidence regarding not only its efficacy, but the safety of it.  So while the doctors back at Stafford Hospital on Sept 25 made the right emergency choice to administer the steroids to me for a possible pre-term delivery, the reality at this point is that my docs aren't sure what they're going to do if a) I go into spontaneous labor sooner than induced or b) if the amnio shows her lungs to be less developed than ideal for a before Nov 27 delivery.

Generally we're feeling like deer in the headlights and overwhelmed by the delicacy of the entire situation.  Having lost the mucus plug and had some show already, I'm feeling like a passenger in a uncontrollable rail car with no clear, straight forward escape plan... thank God HB is the one who has to drive the truck to NOVA, thank God the Perinatal Associates are the best of the best high risk pregnancy docs Virginia has to offer and thank God that Fairfax INOVA has one of the top 5 NICU in the country!

After leaving the testing center, we went straight to my appointment with Dr Rogacz in Fairfax.   Taking a sharpened pencil to my chart, she slashed my basal and bolus rates with the finesse of a Michelin Star Chef at the cutting board.  She then brought up the ever present topic of "when labor begins" ... to which I must say, as a pregnant woman you're constantly thinking about what's this sensation and even as a second timer I find myself worrying about whether I'll know when my water breaks, but adding diabetes management to something I'm already stressed to the gills about is simply exhausting.  It's really no wonder I'm so sick.

Any way, she walked us through what she wants me to do with my pump settings for active labor.  Similar to an endurance athletic event, which let's face it, labor is, the whole physical process of pushing a baby out of your womb causes blood glucose to fall sharply in diabetics because of expended energy... That being said, she's asked me to cut my rates from what they are "normally" (ha, as if they are stable and normal now) to my lowest setting and keeping them at that low 0.2 unit setting until the baby is out.  Of course if my blood glucose continues to drop even at that low basal rate, we'll need to decrease it further and have me put on a glucose drip to make sure I don't go into hypoglycemic shock while in active labor.  Fun stuff.

So after Baby and the placenta are out, I'll need to reprogram my pump again since I'll be back to pre-pregnancy (actually probably lower) insulin needs because the placenta will no longer be present to create an insulin-resistant environment in my body.  For this Dr. Rogacz has instructed me to initially cut all of my basal rates in half, suspend use of the symlin injections and go from there.  Being naturally so hyper-sensitive to insulin will likely make the postpartum diabetes dance a difficult one, but I've been rightly warned that any non-diabetic symptoms I may display -- in other words maybe not even needing artificial insulin -- will be temporary as my body recovers and returns to a new normal.

I only have one word to describe all of this: over-frlcking-whelming.

I wish I was in the blissful period of enjoying the last few days of pregnancy with out a care and an extra foot rub or two, but the reality is that this pregnancy will be medically complicated start to finish.  I knew what I was signing myself up for, but conceptively rationalizing risk and tangibly feeling fear are completely different things.  Honestly, I'd like to just get this show on the road already so that I can know it how things turn out, but it's out of my hands.

Wednesday, November 14, 2012

Hallelujah for Hypoglycemia! Wait, what?

So at 1:50 AM last night I woke up with a start -- something, unfortunately, that isn't uncommon any more.  Between the trips to the bathroom to vomit, the horrendous coughing episodes that violently shake our bed and the occassional contraction that reminds me that no, seriously, labor really is just around the corner I've found myself spending many an early morning wide awake for one reason or another.  But last night, in an ironic sense, was a nice change from the ordinary -- I woke up sweating, over heating and shaking in another state of hypoglycemia.

I managed to get my light on, sit up and, granted I had to stab myself twice to get enough blood for the meter, I tested my blood sugar.   The meter read 34 mg/dL.  With difficulty I managed to wake HB up and he helped me get some orange juice into my system (I also took the excuse to grab 4 pieces of candy corn - life and death situation after all).  So I sit up waiting for my blood sugar to return to normal ranges for an hour or so and by 3 AM my meter finally read a solid over night number of 94 and I was able to go back to sleep.

The funny thing about all of this is that it felt wonderful to wake up without the other symptoms I've been experiencing the last couple nights.  My hypoglycemia was so bad that I couldn't feel my throat hurting or my chest aching, I didn't notice the congestion in my nose or lungs and I felt - ironically - normal again.  Course when I woke up this morning to HB's alarm clock it was with the same coughing, gagging and contracting as yesterday so the escapade back to "normal diabetes land" was short lived and fleeting in the night. 

I called my new endocrinologist to let her know about the low and - get this she calls you back personally - she said that unless I begin to have more hypoglycemic readings during the day that the baby is likely burning through too much of my glucose over night and that is causing the severe lows at that point.  However, she continued, if the lows continue during the day then we need to worry more about the integrity of the placenta - and given that she knows what she is talking about and my perinatologists trust that she knows what she is talking about, then those are the honest to God options for explanations.

So all morning I watched my bgs stay in normal ranges as I tried to decrease my body weight by at least one lung, but this afternoon has been a different story.  My blood sugar post nap #4 was 39 mg/dL... I had juice... I checked again and it was 38 mg/dL... I corrected again... I checked again and it was back up to 39 mg/dL... I waited... I checked again and it was down to 37 mg/dL... and as of about five minutes ago it finally got up to 47 mg/dL.  Needless to say, something is wrong and the grams upon grams upon grams of carbs I've ingested to correct this low aren't going very far.  I've left a message with Dr Rogacz and I'll fax her my logs tomorrow, but seriously this is ridiculous.

Just what I needed - to be excessively sick and having more diabetes complications. If I was a betting person I'd wager that my water breaks sometime soon... because, really, why wouldn't it?

Tuesday, November 13, 2012

Week 36: Antibiotics, Contractions and Misery

It might be sunny and beautiful outside right now, but if you want my straight up honest appraisal of things I think that it is fricking pouring here inside over my head.  Since Sunday night at about 7 PM, I've had contractions at regular intervals that have been more intense and more punctual than I've experenced in several weeks. Given the distance from the doctor and the reality that GW was born at week 36 and change, HB and I decided that false alarm or not it was worth calling the perinatologist and (go figure, it'd have to be Doogie Howser on call) he said "to be better safe than sorry" and come on in for a labor check. 

So with somewhat high hopes that Baby would be born early Monday morning - Nov 12 is HB's birthday after all - we drove our way up to Fairfax INOVA without a hiccup (sign number one that we weren't having a baby).  After re-registering for labor and delivery (gotta love new hospital computer systems), we were checked into the L&D Triage bed # 5 for evaluation.  Hooked right back up to the fetal heart rate and uterine activity monitors that I seem to accessorize with daily, I watched Baby's heart beat away in complete appathy to the peaks of contractions I was showing at 8-9 minutes apart.  After about four hours of monitoring, a horrible (seriously, the worst one I've ever met) OBGYN resident came into check for dilation and with about as much grace as an elephant ripping off the door of a smart car in attempts to climb in and drive, she uncermoneously checked my cervix and mumbled her way out of the room. My nurse had to come back and translate for me that the contractions weren't causing dilation yet and that they were going to send me home because it could be a while more.

#-05 in the lower left corner shows my contractions in green and Baby's
heart rate in blue.  Fair sized contractions, but not strong enough to start labor.

Albiet slightly disappointed that the show wasn't on the road already, HB and I were glad that Baby wasn't quite ready to come out since she was only 35 weeks and 5 days at that point - which significantly increases her risks with lung development and the likelihood of a NICU stay.  Course, last Friday, Dr. Rogacz had a very serious and frank discussion with me that most type 1 babies wind up in the NICU for blood glucose abnormalities regardless of what the mommies do to prevent it... So taking a deep breath and trying to maintain the big picture here, we at least were making it one day farther along in the pregnancy than we thought when we first arrived at the hospital on Sunday night.

But would that be the end of things? Of course not! 

As we're driving back home, and yes while still contracting, I begin to cough.  By the time we got home by 2 AM, it was all I could do to make it to the bathroom where I promptly spent the next few hours lying on the floor coughing and vommiting up grotesque amounts of mucus.  Starting out clear and then turning bloody over time, one very concerned HB resolved to take me into urgent care first thing in the morning to get evaluated.  Needless to say, after spending the rest of the night with a deep chest cough and routine trips to the bathroom for more intimate sessions with the toilet, I was releived when 8 AM Monday morning finally came around and I was moved - contractions and all - back to the car for another round of medical proding. 

At urgent care, the doc ran some tests and without anything specific to go on gave me a perscription for azithromycin and told me to come back at the end of the week if I wasn't feeling better.  Not exactly the most confidence inspiring diagnosis, but it's at least something...  It was about that time that we got a call from my Mom saying that GW was throwing up as well, which as all of the mothers out there know, is just about the best news you can get when you're already sick yourself - boo! Swinging home and picking him up we took him back to the same urgent care doc (our pediatrician is up in NOVA as well) and even after he behaved so beautifully for her examination she couldn't put her finger on one specific thing that was making him ill.  Instructing us to keep him quiet and on a bland food diet, she sent him home with us with little more than a look of pity.

So, let's tally this up so far: contractions, check.  Vommitting, check check.  Coughing until crying, check.  Sick kid, check. 

What else can we add to this list?

OH YEAH! It's HB's birthday!  Given that I always have big plans to celebrate my boys on their birthdays, you can imagine the increased frustration I felt with myself for ruining HB's birthday with my attempts to cough up a lung and GW's saddening vomit episodes.  So instead of spending the day in the kitchen making him a lavish birthday cake and dinner as I normally would, I spent the day amid piles of blankets and kleenex.  I downed my first dose of antibiotics, took acetomenaphin for my newly setting in migraine and attempted to only vomit when absolutely necessary.  I don't know if any of you have ever tried to out will your body from being sick, but let me tell you, it doesn't work.  My body is just as stubborn - probably more so - than I am.  Between the respiratory thing I've contracted, body aches, head aches and these fricking inconsiderate, irrelevant contractions I don't think I could be more miserable or be more unhappy with the current state of things.

The really unfortunate thing about all of this is that if Baby decides to be born while I'm still sick and if (I'm not ready to say when yet) she needs to be in the NICU, then I can't see her. Fairfax INOVA has an increadibly strict policy for NICU visitors - as they should - and even if I'm one of the two approved people to be allowed in to see her, I can't (nor would I) go if I am even remotely sick... it's not worth the risk to her fragile immune system. Even if it'd break my heart to be away from her.  So while the doctors at my perinatal appointment this morning are pleased with Baby's development and how things look with her NST and sonogram (#16) stats -- she's 6 lbs 2 oz right now and her head size is at 38 weeks -- they're not thrilled by my continuing contractions or the thought of delivering a high risk baby to not only a high risk, but sick mother.

Awesome.

Thus under orders to do everything I possibly can to get better and quick (increased fluid intake, tylonal and loads of rest) all I can do at this point is keep things as quiet and non-stressful here as possible.  I can't do much to stop the contractions and I certainly can't replace the mucus plug that dislodged itself in anticipation of labor, but I can pray that the antibiotics work and hope that Baby waits until at least later this week to make her big (albiet she's smaller than GW was at this point) debute.

I'll keep you all posted as to how things are going...

Sunday, November 11, 2012

Week 35, part two: Beta Cells are Complicated!

Okay, so this post is coming a couple days later than it ought to have been put up - but with good reason.  It's been gorgeous here and I've been trying to soak up all of the warm sunny vibes from the world around me to balance the completely diabetes-world rocking appointment I had on Friday with my new (and might I add fabulous) Endocrinologist.  But before we get into the nitty-gritty details of what happened there, indulge me with a quick recap of the the second week 35 Baby check up...

As of Friday morning, Baby was incredibly active in her non-stress test (I credit HB for that since he sang to her) and her amniotic fluid index reading was slightly elevated but still within normal limits at just over 19.  "My doctor" was the only one of the four from the practice to be at the office rather than at the hospital testing center, so he had me see the nurse practitioner, Laura, for my check up.  With nothing earth shattering to report she ran the group-B strep test and checked for any effacement -- I hear back about the strep Tuesday at my first week 36 appointment and once again I've received compliments on my solid cervix (which I have to admit, I'm getting kind of tired of).  So she patted me on my head and sent me on my way... by far the least eventful and non-dramatic perinatal check up I've had in ages. 

So we go get lunch in Old Fairfax City while waiting for my endocrinology appointment to start, but when we eventually got there... oh my goodness, people... it was the nicest doctors office I've been in in ages AND they have the good sense to decorate with gorgeous photos of mountains (I'm a native Rocky Mountains girl, so mountains are a quick quick way to my heart).   With a 72 page chart faxed over from my old doc at UMW and a stack of freshly filled out new patient forms, the receptionist warmly welcomed me to their practice as if they'd been waiting for me for to grace them with my (albiet sickly) presence. Considering my first endo kinda dropped me on my head when we moved (we hadn't planned to change providers, but she insisted because of the "distance" ) and my second one was seriously incompetent, I think the look on my face at this woman's kindness must have been one of a deer in the head lights. What a pleasure.

Within minutes, a nurse was checking my vitals, taking blood for a HgA1C test and running through a basic history of my current diabetes status.  A few minutes later the door to the exam room opened and in walked this glowing angel of diabetes know how, Dr. Suzanne Rogacz.

Taking her time to look through my chart, to get a detailed verbal history of my life with diabetes and to talk through my current blood sugar roller coaster ride, she listened to what I said and responded to how I feel better than any specialist I've ever seen.  She didn't reprogram my pump - at all - or even ask me to take it off to verify it's settings.  She didn't ask for justification of my blood sugar logs and she confirmed that while the lows are concerning, the post-meal highs are more critical for this point in pregnancy because of the impact they have on Baby.  HALLELUJAH! After the ambivelance my last endocrinologist showed to those post prandial numbers, this was amazing to hear a licensed medical professional say something I expected!!

I'm seriously in love with her.

But, what is a good story without a twist right?  So we're going along through this appointment without surprises when WHAM! Out of the clear blue, Dr. Rogacz turns the tables and suggests that I reintroduce amylin to system ... In the two years that I've been an aggressive type 1 diabetic, I have never heard of it, I have never read about it, and I most certainly have never been told that I am missing it!!

Reading the look of confusion on my face, Dr. Rogacz explained that amylin is a hormone that is co-secreted with insulin by the beta cells of the pancreas to help regulate blood glucose.  Since my body destroyed those beta cells and made me externally dependent on synthetic resources, I'm not only naturally lacking insulin, I am also failing to self-produce amylin as well. She explained that it's not essential to "healthy living" like insulin is and that very few diabetic patients are selected to be put on amylin supplementation because it's a sensitive hormone that requires acute self-care to deal with the nuances of taking it (sever hypoglycemia becomes far more likely on amylin than just insulin by itself) and aggressive diabetes goals that are (unfortunately) uncommon with most diabetics, regardless of type.  But seeing as the hormone, which is only available in "Symlin" pen injection form, would smooth out my blood sugar patterns - making the peaks less high and the lows less low - she thinks that it could take me to the next level of blood glucose control that I am currently unable to do with an agressive insulin regimine alone.   Which, hypothetically speaking, is exactly what I need right now and what I want out of life in general --  the closer I can make my blood sugar resemble a non-diabetic's the healthier I can be for my husband and my kids.

 
Sooooooo... with little persuasion and a vote of confidence from a doctor I trust, we called the shot (haha) and I'm now injecting amylin at least three times a day in addition to wearing my 24/7/365 pocket-buddy of an insulin pump.  I'll admit that it's hard to get back into the routine of doing an injection whenever I want to eat anything more than 250 calories or 30 grams of carbs, but I'll fall into a routine one of these days and it'll eventually be old hat:  sit down evaluate the meal, input carbs into the pump and bolus insulin.  Pull out an alcohol wipe, clean off the symlin pen tip and abdominal injection site, attach the needle, set and stab. 

Simple enough, right?

We'll see how this goes.  I go back to see her again next Friday for another prenatal+endo check up.  I'm relieved to be working with someone who gets my goals and the factors that play in my individual case... she's supportive of my family planning, she's understanding of my physical goals and my running addiction, she is eager to help balance breast feeding and blood sugars... she's everything I could have asked for in an endocrinologist all wrapped up with a pretty bow. 

Merry early Christmas to me!

Wednesday, November 7, 2012

Week 35, part one

After the abominable doctors appointments I had Friday and the horrific blood glucose readings I had over the weekend, I was in full on pissy mode yesterday morning for my first week 35 perinatal appointment.  Between my baby-doc accusing me of irresponsibility and my pancreas-doc being a full on moron, it was impossible to not anticipate the worst coming into the appointment and to not expect another unnecessary, unwelcome tongue lashing.  I mean I know that these doctors are on my side and that the doc-patient relationship has been fine until now, but Friday's appointments were off putting enough to make me dread the next interaction.  It's almost like when I do an infusion change -- the needle doesn't always hurt, but once in a while I press that button and that needle jams into my skin and smarts like crazy! And, while that particular time stinks and I want nothing to do with the pain I'm in as I'm experiencing it, the next time I go to do an infusion change after the that is always worse because I'm just waiting for the sharp twinge that I just simply have zero interest inflicting upon myself.  So with a facial expression of complete exasperation mixed with anxiety, I give into the inevitable and subject myself to the (sometimes literal and sometimes figurative) jab again.

Oh the psychological stress of diabetes and pregnancy... fun stuff.

So while HB and I are waiting for round two of the verbal one-two combo (your diabetes management sucks and you're a horrible mother) to begin, I scowl my way through the (reactive) NST and (normal) AFI before being told my chart has been singularly assigned to the same doc that came down so hard on me Friday.  I was not happy.  Not only is this non-standard procedure for this practice - you usually get who you get and patients can't request to work with only one practitioner - but, while I thoroughly respect the guy and appreciate his knowledge with regards to the baby, his criticism of my diabetes control hurt like hell and I do not (repeat DO NOT) appreciate him stepping on my toes outside of his respective medical specialty lane.  Of course, this is all on top of the fact that the nurse practitioner I talked with via the phone on Monday said that this doctor is considering hospitalizing me again for the problems I'm having with my sugar control and that I should bring my hospital bag to every appointment... in other words, he's saying don't make plans.

Don't get me wrong, if I need to be monitored more closely for Baby's sake I'm fully willing to do what I need to do, but I'm not thrilled to be put through the stressful wringer of "am I coming home today?" at every single appointment!  I want to be and feel that I need to be home for GW's sake so as to keep his world as normal as possible pre-baby and Lord knows I have very little interest in bonding more with the High Risk Perinatal (HRP) Unit staff if I can avoid it.  No offense.

Clearly I was in a good mood and thrilled about the whole situation -- which of course didn't get much better when we got called back to the doctor's office to watch as he silently juggled my latest blood glucose logs, a due date calculator and flipped through my chart. Eventually looking up, the doctor confirms my gestational age as 35 weeks to the day and that the combination of my abnormal AFP levels and continuing reduction in insulin requirements means that "the placenta is conking out on us early."  Having done the research I already know this isn't a good thing and that the situation poses a bigger issue for Baby's health than anything, so it's no surprise that the doc explains that Baby may need to be delivered sooner than Nov 27 and that he's calling for more detailed sonograms to be done at least twice a week between now and delivery.  He'll be watching to see if her weight gain falls off, her non-stress tests are non-responsive, the amniotic fluid level changes dramatically or if her movements decrease because any of those symptoms will indicate that the placenta has transitioned from "just" extremely delicate and impaired to full on dysfunctional and dangerous. 

Awesome.

Amid all of this lovely news that surely did nothing to reduce my stress levels, the doctor surprised the heck out of me by going out of his way to reassure that none of this is my fault and that I'm doing an excellent job of handling what is going on.  You can imagine the look of confusion on my face...  either he genuinely altered his opinion of the situation from last Friday or he simply wanted to survive what I can only assume were death rays coming from my eye balls.  He encouragingly tells us that he made several calls and has arranged for me to see a better, NOVA based endocrinologist as soon as possible (this Friday).  So while things aren't going well placenta-wise and I am feeling beyond anxious about how the next couple weeks are going to play out, at the very least I can say I came out of yesterday's appointment with a plan for better, more consistent and aggressive medical care for the remainder of this pregnancy and beyond.  No longer having a single health care provider within an hour of our house, I guess it'd be fair to say that the writing is on the wall and it's just a matter of time before we move again... go figure.

The bottom line is that I managed to not get hospitalized yesterday and, God willing, that will stay the case at least until Friday.  My blood sugars are currently "stable" with lows only dipping into the 60s (not the 50s) and highs peaking in the 170s (not the 200s), so we continue the wait and see game that I wish with all of my heart had lower stakes.  It's funny, in a random conversation I had recently, someone assumed that my current existence is simply composed of "taking it easy at home" rather than actually doing something -- and while I have to laugh at the ignorance of the statement (clearly they'd never been on bed rest), it was beyond frustrating that this person couldn't wrap their head around the implications of what I'm medically facing.  I'm not scared of what child birth could mean to my life or safety, but the risks that go into delivering this baby into the world given the complications she is already fighting are more than enough to cause the insomnia, nausea and muscle knots that I can't shake.  I truly hate the combination of diabetes and pregnancy, the I-95 corridor and NOVA traffic, the distance to the hospital and the complete inability to predict anything with regards to delivery...  

There's nothing easy about this.  Absolutely nothing.

Monday, November 5, 2012

2:19 AM

In a pitch black room with little but the sound of HB sleeping next to me I think to myself "it's hot."  I roll over, kick the covers loose and snuggle into my pillow more and assume the excess heat is from HB or the much appreciated heated mattress pad he got for me two years ago.  But before falling back asleep then I have another thought, "I feel low. Open your eyes."

So at 2:19 AM, with shaking hand and groggy cohesive thought I reach out, turn on the bed side lamp and fumble for my test kit.  I manage to stab my arm with the lancet and press it in hard and long enough to get the right amount of blood.  I insert the test strip into the meter with some difficulty and apply the tip to the blood.  The meter beeps and I wait for it to process...

37.

With absolutely no finesse, I wake HB from his typical deep sleep and ask him for "Juice. I need you to get me 8 grams of juice."  Fortunately being a) much better and much more responsive at waking up than he used to and b) able to translate what I meant despite the rude awakening, he got up and went to the kitchen to retrieve an eight ounce glass of orange juice (23 grams carbs).  With his help I sit up and drink about five ounces of it - my correction typically only needs to be about 10-15 extra grams to come back up - and we begin to wait.

Five minutes later my hands go numb.  Eight minutes later my lips and cheeks begin to tingle.  I hate the sensation, but the cruel fact of the matter is that I was just regaining feeling.  It was a complete fluke - maybe miracle is more appropriate - that I managed to feel my body temperature change, wake up and recognize what was happening to me...  At 37 mg/dL, my blood sugar is in a scary low hypoglycemic range - one that I've been in before, but never one I've been in while pregnant.

The last time I was in the 30s was right after I was diagnosed and the doctors were still trying to figure out my insulin dosage needs.  Back then, they had me on Novalog pens for my fast acting insulin (aka bolus), Lantus pens for my slow acting insulin (aka basal) and I was on some sort of sliding scale but I couldn't tell you what that was now even if you paid me to...  all I remember is that HB and I were sitting on the couch watching Victor/Victoria when all of a sudden I began to sweat like I was in a sauna and felt like I was in - literally - hell.  My skin cold to the touch, HB didn't have an answer but we checked my blood sugar and my meter read 32 mg/dL.  I remember my doctor looking at me with some disbelief that I'd maintained consciousness with a bg reading that low and I remember feeling lucky.  As we were fine tuning my needs back then, I'm sure that hypo was because we'd over shot my bolus calculation -- but now? I have no clue what is going on, but my basal rates are still too high and I don't want to take any chances with luck.  This is my baby we're talking about and my hypoglycemic shock isn't something I want to put her through.

When my endocrinologist turned my basal rates across the board down by 0.050 units on Friday, I let her.  Getting yelled at by my perinatologist for poor diabetes care made me feel horrible and I wanted to make it right and prove to him that his criticism was out of line (which I still maintain it was).  I didn't agree with the endo that every basal rate deserved that reduction because I wasn't 100% low all the time, only at certain points during the day - especially over night and first thing in the morning.  But, going with the professional opinion, I reprogrammed my pump in the way I was told to and this weekend has been horrible.

On Saturday, my blood sugar several hours after the bolus for lunch wore off and I didn't have remaining active insulin in my system I checked my blood sugar for the sake of checking and found it comfortably sitting at 202 mg/dL -- MUCH higher than the acceptable range of 140 or below.  Deciding to think for myself, I changed the basal rate for that time of day back to what it was before my endo appt on Friday and - guess what? - I didn't have inappropriate highs or lows at that time on Sunday.  Her method of generic reduction didn't help and, despite the reductions, I've still been seeing lows... I'm completely underwhelmed by her assistance and frustrated by the persistence of numbers in the 50s and 60s!  I've started to take those numbers to almost be normal,  but 37 is a completely different ball game.  Something is definitely wrong.

I've decreased my basal rates from 12 AM to 3 AM from 0.50 units to 0.425 units and dropped my daily basal rate usage even farther to a total of 12.8 units... much less than it was just a few weeks ago when it'd gotten up over 17 units a day! I'm planning to call the perinatologist's office in the morning to make sure they know what's been happening even after I call in an "expert" and that I'm frustrated.  They really had no right to yell at me on Friday when I haven't done anything irresponsible and the source of my decreasing insulin requirements still needs to be identified rather than dismissed as my "human error."  I'm constantly correcting and continuing to fall low -- doing everything I can -- but where ever the leak is, I need the perinatologist to plug it because I'm drowning in insulin.

I'm also planning to ask them for a referral to a more consistent endocrinologist in NOVA and I hope to swap all of my medical care back up that way by the end of the week... The endocrinologist down here has been perfectly nice, but I need someone who is more aggressive and who is responsive to me and my individual needs.  It's not personal, it's medical.  Which, oh by the way, means it's incredibly personal.

It's now 3:21 AM and my blood sugar is finally up to 73 mg/dL.  HB's gone back to sleep and I'm exhausted from continuing contractions (irregular enough to ignore, but none the less uncomfortable), back pain from uterine pressure on my sciatic nerve and a general inability to get sound sleep because I'm too busy worrying.  I'm going to drink some more juice since my bg is still a bit on the low side to fall asleep with confidence and try to catch another couple hours of zzz's.


I wish I could remember what it's like to count sheep, I'm getting sick of counting glucose molecules.

Friday, November 2, 2012

Week 34, part freaking two

Hmph.  Double hmph.  And grump!

It has just been one of those no good, down right horrible, get off my back, leave me alone or give me chocolate kind of days.   I didn't sleep well last night because GW, who is usually the best snuggler in the world, kept trying to head butt me in the chest to make space for his legs to go sideways on the bed and that of course made the fact that the alarm went off extra early so that HB and I could get to the hospital on time for my bi-weekly testing all the more gruesome.  Normally an hour drive, we left an additional 30 minutes early to fight the in-bound morning traffic to NOVA and DC and managed to get to the valet parking at the hospital with a few minutes to spare before my 8:30 appt.  Of course the antenatal testing center was running a bit late and we wound up sitting for an additional 45 minutes, but whose counting? (Oh yeah, me).

So we finally get back to the non-stress testing area and it's beyond freezing -- and for those of you who do not know me personally, I do not do well with any temperature below 70 degrees F.   The nurse, who I'll admit was very nice, squirts the non-heated (gasp!) goo on the paddles and hooks it up to my belly.  About fifteen minutes into the test she grumbles about the sleeping baby, gets me cold ice water to drink (again, gasp!) hoping to wake up the baby.  After the next fifteen minutes she decided to shut off the monitor and get the doc's take on my NST since the accelerations were borderline to where they ought to be (ideally they should rise by 15 beats per minute over the course of 15 seconds or more, Baby's were going up for like 13 seconds).  Leaving me sitting there in frigid goo under an air conditioning vent for another while, she eventually came back to announce that the results were acceptable and she sends HB and I back to the waiting room for the next available sonographer.

Waddling down the hall back to the waiting room, we turn the corner and find that the formerly sparsely filled room is now as packed as it possibly can be with pregnant women and significant others.  We found ourselves a corner and, to fill the dragging time, I started counting...  at any given moment there were between 11 and 16 pregnant women in that dang room.  Some closer to popping than me, others barely showing -- but all obvious with their hospital band bracelets.  It's funny how pregnant women take on different shapes and how differently we all carry... at 8.5 months I look like the typical woman does at six months and one woman's jaw actually dropped when she learned my due date is only two weeks after hers since we look so drastically different.  Course she'll probably get lucky and meet her baby sooner than I will, so size - ladies and gentlemen - really doesn't matter.

Anyway, the sonographer finally calls me back and does the quickest sonogram of my pregnancy yet.  She absolutely knew what she was looking at and clearly took speed clicking classes because bang bang bang and "you can go sit down and the doctor will call you back shortly."  I think if I had been a normal pregnant woman and that this was one of the very few times I could see my baby on the monitor I'd have been annoyed, but since this was sonogram #15 and I wanted part two of breakfast asap it was perfectly fine with me.

So back out to the waiting room we march and waited among the collection of mamas.  We watched the third interview with Sarah Silverman on morning television, we cringed at a 3 year old little girl with horrible manners boss her mother around and we joked about our lapse in judgement at leaving our entertainment (GW) back at home.  Some time later, this random doctor comes out and calls my name and I have no freaking clue who this guy is.  His jacket says that he's a "MFM MD" which is at least one step in the right direction, but seeing as I'd never heard of him, he looked like he is 12 years old with facial hair and I admittedly have little to no faith in medical fellows I was not exactly thrilled to see a non-familiar face behind the desk.  After pulling out a phone book to sit on and figuring out which way is up on my several inches thick chart, Dougie Howser then reviews my tests says that things with the baby were fine with the exception that the AFI was a bit high (even though it was lower than Wednesday).   Understanding that it was in normal limits, I moved on from that comment and handed him a print out of my blood glucose charts from the last three days and that - my friends - began the worst part of my day...

Not understanding the charts or what information I was trying to explain to him, Dougie decides to take my print out down the hall to my normal doctor (why couldn't I just see him in the first place?) for his take on things.  The next thing I know is that we're being called into the principal's office for a serious parent-doctor sit down...  Thoroughly disappointed in my asking him for "input" (which I did not), the normal doc began a lecture about insulin care during pregnancy and how off my blood glucose numbers are and how poorly programmed my pump must be.  Looking specifically at my pump settings and seeing that my basal rate is no where close to 50% of my daily insulin usage (which it ought to be), he said that I needed to stop self-managing and start working more closely with my endocrinologist or that he'd need to take me off the pump and put me back on injections so that he could manage my glucose.

ONLY OUT OF MY COLD DEAD FINGERS WILL 
A DOCTOR PRY MY PUMP AWAY FROM ME. 
(Adapted from a Charlton Heston quote)

I attempted to explain that I've tried to work with my endocrinologist's office and that they typically aren't responsive or they just tell me to do what I'd otherwise do for myself, but that just seemed to result in more frustration on my doctor's part than understanding.  He then said that I needed to get into see my endocrinologist today for an emergency reprogramming of my pump or that I'd at the very least need to begin seeing a different NOVA based endocrinologist next week.  I tried to explain that my concern in bringing up my blood sugar with him isn't that I need external input in how to decrease my settings (that's straight forward and I've done it successfully for the last 34+ weeks without problem), but the cause of the lows -- to which he pretty much left me with no answer except "see you Tuesday."

Thus leaving the hospital in near-tears from the feeling of being completely misunderstood and the "you're a horrible mother" treatment, I immediately called the endocrinologist to pass the buck along.  Fortunately having space for me in the schedule once we got back from NOVA, I was able to get in and sit down with my endocrinologist to go through my logs with a fine tooth comb.  Agreeing with me - and the NOVA doctor - that my logs show far too many lows, she did exactly what I would have done on my own and lowered my basal rates even farther.  Cutting every single basal setting by 0.050 units, my total daily basal rates are down to 12.875 units!!  I asked her about the randomly high postprandial readings, but she said they weren't of concern to her because of the extreme prevalence of hypoglycemic lows and she lectured that those 40s and 50s should be my only concern as well.  When asked about how I should address the chastisement I received for the 50-50% ratio of daily bolus to basal insulin usage, she essentially told me that my perinatologist would just have to get over it since that's just how things are going.

So... my perinatologist yells at me for horrible diabetes care and my endocrinologist barely does anything to "solve" the problem AND neither have an explanation for why my sugars continue to drop but rather they each individually want to point the finger at the other and say, "well, that's their job."

AGH!

I don't know... I feel like my blood sugar control has been pretty good for the pregnancy all things considered.  These lows are definitely concerning to me and they make me frustrated and scared, but I can recognize them and treat them as they happen so it's not the worst case scenario of hypoglycemia I could face (knock on wood).  I'm angry that my doctor up north would blame me for the problem I am only trying to fix and I'm annoyed that my doctor down south is being so passive...   All I can say is that I am hella happy that the baby is due in 25 days or less (less, please God, let it be less) and that I can put this excessively hands on medical care out of my life for a while.  I'm looking forward to working with our pediatrician (aka a doctor for someone else, not me) for regular well-baby appointments and I cannot wait to get back into running.  Any outlet for frustration besides chocolate would be fantastic right about now, but hey, I'm a hypoglycemic, post-placenta abruption, 8.5 month pregnant woman on modified bed rest so that just isn't going to happen.

Pass the chocolate.

Hmph.