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...


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.

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