Who said sugar is sweet?: Week 34, part one

Wednesday, October 31, 2012

Week 34, part one

As an exciting post-Hurricane Sandy and Halloween outing, the whole family came along with me to the perinatologist office today for my week 34 non-stress test (NST), amniotic fluid index (AFI) reading and check up. HB, who is the most wonderful, involved father I know, always comes but today was a bit of a treat because my Mom came along totting a very sharply dressed snowman. I was quite flattered that GW received as many compliments on his home made costume as he did, but given the fact he is such a dang cute kid in the first place I give him all the credit for wearing the outfit with such success... course wearing a jumpsuit of 100% polar fleece inside a warm doctors office for two hours turned out to be a bit tricky (especially since he skipped his nap today), but he managed just fine and put smiles on several many faces. Particularly mine.

So... the appointment. Tam, the sonographer, did a partial sonogram for a basic biophysical profile (BPP) reading since they comprehensively looked at the baby's weight and my cervix thickness last week. It is my general understanding that the doctors only do a full sonogram examination of the baby every three weeks because so many things can vary from one week to the next that it's not worth the extra stress if something may be a simple "water weight" change. Any way, Tam spent the sonogram focusing on Baby's heart rate, her breathing patterns, her muscle tone, her movement and amniotic fluid levels (22.3) - to which I am happy to report Baby got the perfect score of 8/8. She also did another 3D ultrasound and, for the third time this pregnancy, we got to see our little angel's face... granted she stuck her tongue out at the camera today, but hey she's supposed to be practicing that - she's got a big brother to contend with after all!

After the sonogram, the nurses had me do my second weekly NST. Since she was more active after I downed Starburst last week to correct for a low, I checked my blood sugar before starting, noted I was trending low and did the same this week to try to save time. Unfortunately Baby was set and determined to sleep through the Mommy-provided stimulus and after sitting there strapped by a belly band to a loud "wubba-wubba" machine for 45 minutes the nurse came in and gave her a vibroacoustic prod... Having never experienced this before, I must say it's kind of startled me when the nurse first pulled out this wand thing because I didn't know if I should expect a shock or what. But essentially a vibroacoustic stimulator is a hand held machine that sends vibrating sound stimulus into the uterus to invoke a fetal heart rate acceleration - which is the whole point of the NST in the first place. After that the baby responded within the limits they look for at this stage in the game and I was taken off the machine after another 15 minutes.

Bored out of his mind, GW requested to go read a toy book (pregnancy magazine) in the lobby with Grandma and so HB and I went back just the two of us for our meeting with the one and only Dr. Bronsky. I gave him my blood sugar logs and for a matter of several minutes (which felt like several hours) he was dead silent as he looked at my numbers and began strategically flipping through my chart. As I've previously shared here and outwardly complained about at all of my recent appointments, my blood sugar has been continuing to drop into hypoglycemic ranges that aren't normal or ideal for this point in the pregnancy. Since my last blog post where I indicated that my basal rate was decreased to the "low" daily total of 15.3 units I've had to further decrease it to 13.9 units - and I am still seeing numbers in the 40s and 50s! So, finally, he spoke up and said with a voice of mixed relief and concern that the results of my AFI and NST today are fantastic but that the lows in my blood sugar logs likely indicates a problem they're not seeing with the placenta. As the implications of this can be dangerous and my diabetes is "very serious" (his words, not mine), these numbers warrant the doctors to be even more cautious as we finish out the pregnancy and Dr. Bronksy requested that I come in twice a week to the hospital for my testing so that they can monitor Baby more closely and "retrieve" her immediately as necessary.

So as of this Friday morning at 8:30 AM, I begin my new routine of every Tuesday and Friday doctors appointments for the next several weeks of third trimester fun. With any luck there wont be reason to justify more frequent appointments than that between now and delivery, but we'll see if we actually make it to the induction date - which YES we did set today.

Drum roll please...

If for whatever reason I do not go into spontaneous labor before week 38, the doctors have scheduled Baby to be born on Tuesday, November 27! Dr. Bronsky explained that he'll have me come in the night before to be put on Cervidil and, depending on how things went with that, the morning of Nov 27 he'd would start Pitocin and artificially rupture the amniotic sac. If things progress slowly, he said that we could expect to have Baby mid afternoon that day; but when HB mentioned how quick active labor was for my first birth, Dr. Bronsky said it could be much quicker than that.

As I'd rather go into labor spontaneously than wait for this little whumpus to come out on a specifically circled date on the calendar (yes, I think that is weird), I am somewhat hopeful that she'll decide to pleasantly surprise me between now and then with an awkward gush and sharp twinge of pain. Regardless, even if I don't go into labor on my own before then, it sounds like the docs are confident that I'll be able to have the vaginal birth that I've been hoping for and for that I thank God! With how complicated things have been it's at least nice to know that Plan A is what I wanted all along and that Plan B is there as needed...

Since my hands are shaking and my bg is probably low that is all for now. I'll be back again on Friday with another update from the land of the overly poked and prodded.

Love,

Diabetic Mommy of One, soon to be Two

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Diabetic Vocabulary

Active Insulin: after injecting a bolus, the insulin in the body is "actively" working to lower out of range blood sugars or compensate for digested carbs.

Amylin: A peptide hormone that is co-secreted by the beta cells of the pancreas to help the body naturally control blood sugar. While insulin directly targets glucose in the blood stream, amylin slows the stomach from emptying and promotes satiety, which prevents post-prandial hyperglycemia. Just like with insulin, type 1 diabetics do not produce amylin and type 2 diabetics become resistant to it and both types may need for it to be synthetically substituted via injection. (Brand name I use is Symlin)

Basal: acting the way the pancreas does naturally, insulin therapy requires small amounts of "background" basal insulin to be continuously released throughout the day to manage normal blood sugar fluctuations.

Beta Cells: Composing 65 to 80% of the cells in an islet cell cluster, the beta cells of the pancreas produce insulin for the body to regulate glucose. In type 1 diabetics, there is an autoimmune response that destroys these cells and prevents the islets from natural insulin production.

Blood Glucose (BG): the amount of sugar present in blood. A non-diabetic person will maintain a blood sugar reading between 70 and 100 mg/dl. A type 1 diabetic requires the use of artificial insulin to manually replicate such control.

Bolus: additional insulin a diabetic administers "on demand" to compensate for high blood sugar readings or the number of grams of carbohydrates eaten at a meal.

Cannula: a small plastic tube that is inserted into the skin for insulin delivery. This is a specific part of the infusion set.

Continuous Glucose Monitor (CGM): an additional piece of equipment that is attached to the body and automatically checks the body's blood glucose levels every few minutes. It is used to track the upward or downward trending of sugars as they happen and thus allows for tighter glucose control.

Dawn Phenomenon: an abnormal early morning blood glucose rise between 2 AM and 8 AM caused by the body's natural hormone release cycle.

Diabetic Ketoacidosis (DKA): a potentially life-threatening medical complication that results from severe insulin shortages in type 1 diabetics. It is usually the first symptom of previously undiagnosed diabetes and is considered to be curable with adequate, timely treatment.

Glucagon: a hormone that is naturally secreted by the pancreas of non-diabetics to raise blood glucose levels. A diabetic patient needs an emergency injection of artificial glucagon when unconscious as a result of hypoglycemia. (Note: there is a glucagon injection kit in my purse at all times)

Hemoglobin A1C (HgA1C): a blood test reading that measures the average blood glucose of a person over the past three months. A non-diabetic will have a HgA1C between 4 and 5.9% where as a poorly controlled diabetic patient it will be above 8%. In well controlled diabetic patient it will be below 7.0%.

Honeymoon phase: a period following diagnosis where the pancreas may continue to produce or, in some cases, increase production of insulin. This phase may temporarily decrease initial insulin requirements, but will eventually end and cause the diabetic's biosynthetic insulin requirements to increases.

Hyperglycemia: a condition where there is an excess amount of sugar in the blood (above 200 mg/dl). If left untreated, hyperglycemia leads to DKA but it is entirely correctable with a bolus correction.

Hyperkalemia: a dangerous byproduct of DKA in which there is an elevated concentration of the electrolyte potassium in the blood. This causes arrhythmia and as such is potentially fatal. (Interesting related note: this is the condition that is intentional introduced by lethal injections cause in the US justice system).

Hypoglycemia: abnormally diminished amounts of sugar in the blood (below 70 mg/dl) due to too much active insulin. This can cause a diabetic to become disoriented or unconscious requiring an injection of glucagon.

Infusion Set: the port that is manually inserted (by me) into a diabetic's subcutaneous tissue and directly administers insulin to the body from the insulin pump. Diabetic supply companies provide different types of infusion sets to fit the needs and comfort of each individual person.

Insulin: a peptide hormone created by the beta cells of the pancreas that is central to regulating carbohydrate and fat metabolism in the body and removing excess glucose from the blood stream, which otherwise becomes toxic. (Brand name I use is Humalog)

Insulin Dependence: when the islet cells in a person's pancreas can no longer produce insulin, the person is diagnosed as "dependent" on artificial insulin and therefore type 1 diabetic.

Insulin Pens: a pre-measured, self-contained, multi-use syringe of insulin about the size of a large magic marker that you attach a disposable needle to for insulin injection. Pens also come with amylin for diabetics who require artificial administration of both hormones.

Insulin Pump: a medical device about the size of a deck of cards that is attached to the body via an "infusion set" that allows insulin delivery to occur automatically through pre-programmed settings rather than through multiple self-administered syringe injections a day.

Insulin Resistance: when the pancreas can still naturally produce insulin but is unable to use it effectively through metabolic irregularities, a person is diagnosed as insulin "resistant" and therefore type 2 diabetic.

Islet Cells: The pancreas contains clusters of cells, known as islet cells, that produce hormones such as glucagon (created by alpha cells) and insulin (created by beta cells). In type 1 diabetes, the body's immune system mistakenly destroys the beta cells of the islets and causes the pancreas to lose the ability to produce insulin naturally.

Ketones: an acidic product of DKA that are made when the body breaks down fat for energy. Normally, the human body gets energy from carbohydrates but the body produces ketones when there are either a) not enough carbs in your diet or b) when the body cannot use blood sugar properly (extreme highs).

Maternal Fetal Medicine (MFM): A branch of obstetrics that focuses exclusively on the medical and surgical management of high-risk pregnancies. These doctors are commonly referred to as "perinatologists."

Pancreas: A glandular organ in the digestive and endocrine system of the body that produces several vital hormones (like insulin) and secretes digestive enzymes that assist in the absorption of nutrients.

Postprandial: a blood sugar test that determines the amount of glucose remaining in the blood after a meal. In non-diabetics, the two hour postprandial will show bg levels back within normal ranges, but for those with diabetes it may still be elevated in abnormal ranges.

Type 1 Diabetes (previously known as juvenile diabetes, but also referred to as insulin-dependent diabetes): an autoimmune disease in which the pancreas fails to produce any insulin. It is currently incurable, but it is treatable with a rigid therapy of artificial insulin. This type of diabetes only represents about 5-10% of all diagnosed cases of diabetes.

Type 2 Diabetes (previously known as adult-onset diabetes): a metabolic disorder that results when the body develops a condition called "insulin resistance." This means that the person's body still produces insulin, but is unable to use it effectively. This form of diabetes is more common (90-95% of all cases) and is typically caused by poor diet and inactive lifestyle. If caught in early stages, the effects of type 2 diabetes are reversible with lifestyle modification.

Who said sugar is sweet?

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Wednesday, October 31, 2012

Week 34, part one

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Wednesday, October 31, 2012

Week 34, part one

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