Blah A1C

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

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

I'm sure all of this will be out of date and need to be changed tomorrow (hoping and assuming my placenta is still working it's "magic"), but for the time being I should be on the right track.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

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

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

Week 31 Perinatal Appointment

Well, I had my first perinatal appointment this morning since returning home from the hospital just over a week ago.  And while I'd love to say that the doctors announced that I'm perfectly healthy and ready to go back to pregnant life per-normal, they, unfortunately, did not. 

It was an odd appointment - not like any of the others that I've had before.  Instead of getting another sonogram and then seeing one of the doctor in one of their cushy offices, we were taken into an exam room (I'd almost forgot what those look like) and asked how I was feeling rather than told what has new.  I explained to the doctor that I am continuing to get contractions, that they're worse and more frequent when I stand, that Baby's been moving about less than before and that I've generally been feeling like absolute blah.  Listening with an increasingly concerned face (never what you want to see), the doctor stepped out of the exam room and asked the sonographer to do the previously unplanned sonogram. And off to get sonogram #12 we went... 

Checking only the crucial bits and not doing a full examination of the baby, the sonographer admitted she was sad to see me on a week where she otherwise wouldn't have.  Reassuring me that she's there whenever I need her to be (and decreased fetal movement is a good reason to need her), she checked to see if I was effaced from the contractions (which I am not, thank God), she checked the amniotic fluid level (down from 28 to 17, so back to normal ranges) and she checked the injured portion of the placenta.  She showed us where the blood clot has formed under the membrane next to the placenta edge AND she found the source of the bleed... an undeniable partial placenta abruption.

At the hospital we'd been told they couldn't identify anything except a "dark portion" of the placenta edge where blood flow was no longer occurring (the clotted area) and that the hemorrhaging must have been from an injury to that edge.  Today, however, the sonogram clearly showed another dark spot a little ways in from the known clot that medically confirms a degree of detachment and bleeding between the placenta and the uterine wall.   While there is a bit of comfort provided by the fact that we have an answer for what exactly happened, it's definitely a more concerning complication than an abstract injury to the edge of the placenta because once you've had an abruption, they're more likely to occur again.  So that continues to be scary. 

Here's a visual for a couple of the complications with the placenta that
I have had with this pregnancy. The partial previa has fortunately cleared
itself up, but the abruption will stay "as is" due to my gestational age
(assuming it's not further injured that is).

The last thing that the sonographer checked was Baby's biophysical profile - which I am pleased to report Baby scored a perfect 8 out of 8 on.  Seeing as she only got a 6 out of 8 at the hospital on Sept 29 due to her limited practice of breathing, this was a comfort to learn because it means her lungs are continuing to mature for delivery.  Which, by the way, she apparently has decided to get ready for by flipping over (yay! vaginal delivery is a serious possibility!) and no longer firmly planting her head under my rib cage.  From what the sonographer could tell, it's this new position that Baby is in that is causing the decrease in the fetal movement I feel because she's not only behind the anterior placenta, she's also facing backward.  So any movements she makes either need to be quite large or lateral to translate into more perceptible kicks... though I must say her hiccups are far more obvious now than ever!

Reviewing all of this, the doctor was glad to see that Baby is still the resilient little toughie that she's been and that the contractions haven't been causing distress to her or further damage to the placenta.  She instructed me to continue to stay on modified bed rest and to call them immediately if the contractions increase to four or more an hour that last over a minute.  But seeing as I'm "only" (ha, that word is used oh so loosely) getting them every 15 minutes for 30 seconds when I stand or sit up, that's "just" (again, ha) a sign of significant uterine irritability caused by the abruption.  Because blood remains behind the placenta and in the clot, she said to expect the contractions to continue... lovely.    Beyond that, the doctor requested that I start weekly appointments the week after next and she expressed hope that I'll only need to do weekly non-stress tests rather than biweekly or more.  We'll see how that goes.

All in all, I guess you could say that it was an uneventful appointment in that we didn't learn of some new complication or problem we need to address. Baby and I are looking stable on bed rest and there is still a fair shot that I could make it into November before she is born.   I guess my bond with the couch will continue to grow and my slower weight gain will sustain (still five pounds down from before the hospital) - for better or for worse. I'll keep you posted.

Maximum Bolus

I had to reprogram my pump this morning.  Given my recent blog posts about new basal rates and new carb:insulin ratios, I'm sure that many of you are thinking "so what?"  And while I have to hand it to you that reprogramming my pump is definitely becoming old news, this particular change in set up is a big deal to me and an official diabetes first... I had to increase my max bolus rate.

I've probably explained this before and I know it's off to the right side here in the diabetes vocab column, but a bolus of insulin is what I inject via the pump to cover the number of carbohydrates that I eat during any given meal or snack.  Back before I was pregnant, I would typically bolus 1 unit of insulin for every 22 to 25 grams of carbohydrates depending on the time of day (it's not a stagnant ratio, our bodies aren't that simple).  So for an extremely large, carb heavy meal - say 100 grams for mashed potatoes, a dinner roll, a glass of wine and 1/3 a dessert (gotta share with HB and GW) - before pregnancy I might inject a total of 4 to 5 units of insulin.

Well, as I've perviously explained is due to dear old Mrs. Placenta, my current carb:insulin ratios are much lower than they were and now three out of four of them are actually below 10 grams per unit.  So to have a heavier carb meal (as I did this morning with GW's early-bday pancake breakfast) I am bolusing what I consider to be exorbitant amounts of insulin to cover what would have previously been "just" four or five units.  This morning I needed to bolus for 100 grams (three of HB's large pancakes with sugar free syrup) and my pump started beeping at me something fierce and the screen read "MAXIMUM BOLUS EXCEEDED."

I've never seen this screen before.

I went back into my pump and looked more closely at the numbers -- 100 grams of carbs at a ratio of 8.5:1 came to 11.75 units of insulin.  ELEVEN POINT SEVEN FIVE UNITS. Do you have any idea how crazy that is?!  Since 2011 I've been notorious with my endocrinologists for being truly insulin sensitive as a little goes a looooooong way.  But now, at just under 31 weeks pregnant, insulin sensitivity is a thing of the past and my 11.7 units now covers less than half of what it used to!  No longer is a maximum bolus of 10 units appropriate when I require more than that for a singular meal.

Sigh...

The whole point of a maximum bolus rate is to protect insulin pump wearers from accidentally injecting too much insulin at any given point.  Like when your toddler grabs your pump while you're sleeping and pushes the buttons to play the beeping noise and all of a sudden you've got 35 units of active insulin in your system to eat your way out of (happened to the type 1 medtronic employee who trained me to use my pump; scary).   Just to give you an idea, at my current ratio 35 units is just about 300 grams of carbs which is equivalent to: 5 slices of apple pie, 4.5 blueberry scones, 8 cups of Kemps Old Fashioned Chocolate Chip ice cream or 12 of HB's large pancakes.  I don't know about you, but I can't eat that much and that's exactly the point of the max bolus.

Long story short, I had to go into the bolus settings and increase the max bolus allotment - something I've never done before.  I only increased it from 10 units to 12 out of mere passive aggression toward my pancreas and placenta (what's up with me and malfunctioning "p" letter body parts?)... I'm guessing they'll retaliate sooner rather than later, but for the time being I'm relishing my effective, minor counter measure.

Take that.

A whole bunch of pregnancy firsts.

As many of you already know, I wasn't a diabetic when I was pregnant with GW back in 2009.  I didn't even have a hint of gestational diabetes let alone a full on type 1 dependence on artificial insulin.  It was a normal pregnancy in many regards with no complications and only a few quirks - namely I didn't realize I was pregnant until week 12 (nuva ring, baby!) and GW arrived "pre-term" by being two days short of 37 weeks.  But all in all, the pregnancy with him was smooth sailing and what I'd typically refer to as "all pop-tarts and rainbows."

Obviously this go round is quite a bit different.  I've got type 1 now, I'm having loads of non-diabetes pregnancy complications and I don't even want to attempt to go there with pop-tarts or rainbows because (lets face it) those probably have more carbs per serving than I have insulin -- especially if the rainbows we're talking about here are made of skittles.   But seeing as this is round two for me, I know what a little bundle of joy I'll get at the end of this and I'm grateful to my pancreas for at least providing me a degree of perspective by sparing my first pregnancy from it's wrath.

The thing is, though, despite my almost three years of hands on parenting experience, there are so many new and different things with this pregnancy that I feel in many ways I'm a brand-new mom all over again:

• My medical care is different and more complicated - leaving many new tests to research and understand.  
• My diet is more restricted and calculated - requiring more attention and proactive tracking.  
• My to go bag is ready to go much earlier (okay, it's been ready for several weeks and is actually re-packed after last week) - making me more anxious and nervous for labor to begin.  
• My expectations for delivery are more grey - causing me to unavoidably "what if" about before, during and after labor. 

So although I'm some how managing to keep calm and accept that the only thing I can really DO to help Baby is put my feet up, I find my experiences with this pregnancy far more resemble that of a first-timer than typical of a pregnancy-vet.  Don't get me wrong, I'm not back to absolute square one of trying to figure out which way the diaper goes on or what the heck a Manhattan Whoozit is, but there is something to be said about the difference between a straight forward, non-diabetic delivery of a baby and the complicated, ultra-sensitive (I mean you're even allowed to eat - yes, more than ice chips) delivery of a diabetic. Wrapping my head around the changes to my experience-based-expectations is turning into quite the task and emotional challenge.

On a completely unexpected note, one of the biggest differences that I've noticed this past week between this pregnancy and the last is contractions.  I know this probably sounds weird, but bear with me... When I went into labor with GW the only sensation I experienced was this sharp, unbelievable point pain that I quickly learned was caused by dilation.  The pain I felt with that was more than I expected and - as a firm believer in modern medicine - very much the reason I opted for the epidural.

Oct 12, 2009 - post epidural and much, much happier.
Hallelujah!

The past two weeks, however, I've had my first taste for what a contraction feels like and I previously had no flippin' clue there was a difference between "contractions" and what I felt in Oct 2009.  Contractions, unlike dilation, feel more like a solid, crescendo-decrescendo of pressure spread across your entire uterus that cause it to go entirely rigid.  I would not describe it as painful, it's just rather unpleasant -- and actually, if labor and delivery were confined to only contractions and not dilation I'd venture to say that natural childbirth would be quite within the non-medicated pain threshold I personally have.   But seeing as dilation is the bleepity-bleep-bleep that it is, I have no shame whatsoever in saying "yes, please" (or something to that effect) to a gigantic needle being rammed in my spine.

Perhaps I've developed too much of an immunity to needles?

Honestly, the biggest change I am scared of (well beyond any possible necessary use of the NICU) is the challenge maintaining healthy-range blood sugar creates with breast feeding.   As with any calorie burning activity, breast feeding requires a mother's body to burn energy - aka glucose - to the point that many diabetic-mommy's report that it is excessively easy to experience their worst episodes of hypoglycemia ever (click here for an example).   Not that these other changes or complications have been a walk in the park, but it's scary to think that the "high risk" of being a diabetic mother doesn't necessarily go away once Baby is born.

When I was expecting GW the only intimidating part about breast feeding was that I'd never done it before.  In trying to sooth my nerves, HB and I experimented with the Medela pump we bought and it made such an audible suction sound that I insisted he try it before I did.  As an extremely supportive husband and incredible good sport, he did and within the first weeks of GW's life I took to that sucker (ha, literally) with far more confidence because of his gallant courage.  But this go around, I can't just ask HB to test drive for me... it's my pancreas and my second baby after all and not some odd electronic that in any non-internet based forum would otherwise make me blush.  Obviously, I need to do some more research on this topic so as to understand the implications of my disease better and hopefully dissuade some of the fears that go along with it.  I'll let you know what I come up with.

Without wanting to jinx myself, I really must admit that I'm looking forward to baby #3 whenever he or she comes around.  Maybe by then I'll have wrapped my head around not only pregnancy, but pregnancy and motherhood with diabetes that I can finally go into the experience with the luxury of fewer questions and concerns than before.  Course, knowing me, there will be some other nuance that will change the situation and give me yet another run at pregnancy with an amateur status... but, by the grace of God, I've got HB and two amazing children that will help me get through whatever that challenge is when it arrises.  All I ask, Lord, is that if I'm allowed my druthers that next time the complication is something as straight forward and "easy" as twins!

TOF: The new PTO

Yesterday morning, while doing my daily pre-preeclampsia routine, I weighed myself and just about had a panic attack.  From the last time I weighed myself before going to the hospital my weight is down a total of eight lbs! That is an additional three lbs from Tuesday morning... While I'd normally be throwing a party about the scale showing a lower number, it's not exactly a trend a pregnant woman wants to see during the third trimester of pregnancy when multiple pounds should be added!

So I called and left a message for my doctors wanting to make sure that they weren't terribly concerned by such a dramatic drop.  After several hours I eventually got a call back with the nonchalant guidance that "don't worry, sweetie, such changes day to day are just water weight."

Okay, fine, I know that water weight can cause a few pound swing one way or another on any given day, but eight pounds over one week? The doctor then went on to explain that what I'm probably seeing is my body evening out after a week of full bed rest and hydration and that my body is finally showing the real numbers of atrophy induced weight loss... Sigh.  Eight.  Pounds.

Accepting that at face value (after all atrophy isn't a danger to the baby, only an annoyance to me), I asked him for further clarification about what kind of activity I am allowed to do post-hospital.  Initially confused by why I was in the hospital and thinking that it was because of a complication with placenta previa (which as you remember, has cleared up entirely) he said "just don't do heavy lifting or vigorous exercise."  Correcting him and explaining what happened at the hospital the doctor got quiet and asked:

"We didn't put you on anti-contraction medication?"

"No.  But I am having contractions when standing for long periods and after short stints of walking."

"Hmm."

Comforting, right?

Well, he explained that the fellow who discharged me made a mistake and should have at the very least told me to stay off of my feet for an additional two hours in the morning and two hours in the afternoon.  BUT that if my body was showing signs of exhaustion (aka contractions or physical weakness - both of which I'm experiencing) that I should listen to my body and do more bed rest than the minimum he would require.  He seemed comfortable with my next appointment being next Tuesday, but asked me to keep him posted if there were other problems that came up between now and then.

AS IF I WOULDN'T!

So... considering walking to the pharmacy from the car caused contractions, standing cooking dinner caused contractions, putting GW down to bed caused contractions... yeah... bed rest is definitely what the doctor ordered.  As HB and I have been joking lately that he's going to need another bonus of Paid Time Off (PTO) from the office for his spectacular work (yes, this is ANOTHER shout out for you - enjoy it!) given the high maintenance this pregnancy is requiring, he decided to give me a raise in my hourly acquisition of "Time Off Feet" (TOF).   Very generous, dear, thanks.

That said, I am going back to my comfy pillow and another episode of Dinosaur Train with GW.  We've recently been learning about the fact that all dinosaurs poop and that only some of them are nocturnal...  GW seems to think that they are all called "bigosaurus" and that the pretend, invisible dinosaurs in our house need to constantly be put in time out in the back yard because they can't use their indoor voices.

Too funny.

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.

Week 29 Hospitalization

So after six days of hospitalization, three extra sonograms, countless finger sticks and at least one too many hospital meals I am back at home. Given my last blog post I am sure that comes as a bit of a shock to some of you, but apparently things weren't going as smoothly as my appointment last Tuesday would have made me believe.  Let me explain:

Last Tuesday evening at 7 PM while helping HB sort things at our storage unit, I suddenly got a gush of bright red blood that scared the boohockey out of me. While starting the drive to our doctor in Fairfax I called my perinatologists and was promptly told to scrap the idea of driving an hour north and to get to the nearest hospital ASAP.  Pulling a tight right turn, HB got me to the Stafford Hospital within a few minutes and I was rushed to labor and delivery (L&D).


Upon getting to L&D, the nurses and doctor frantically hooked me up to the non-stress test monitors to check on the Baby and watch for contractions. Fortunately, the baby looked stable and unbothered by the excitement; unfortunately, I began preterm labor with regular, intense, every two minute contractions. They administered an antibiotic, the first dose of steroids to mature Baby's lungs if she would require delivery and an IV drip of 3 units magnesium sulfate to slow contractions. They did a sonogram to find where the bleed was coming from (the placenta), to see if the cervix was open or closed (partially open externally, long and closed internally) and to measure the amount of amniotic fluid (28 cm of fluid on the amniotic fluid index scale, shouldn't be more than 20 cm).

It was at this point that the OB on call explained that she and the Stafford Hospital were not equipped to handle a high risk case like this (yes, I found that scary) and that they would need to transfer me to either my hospital - Fairfax INOVA - or the local University of Mary Washington Hospital depending on how stable they could get me for ground transport. They needed my bleeding to lessen, my contractions to weaken and be less frequent - which eventually happened enough around 12 AM to allow for the shorter (aka less risky) transport to UMW Hospital.  So with every seven minute contractions and minor bleeding I was loaded into an ambulance and sent on to the next hospital.

For my first ambulance ride, I've got to say it was overwhelming and uncomfortable being the one strapped in to the speeding, bouncing (ouch!) vehicle that I usually watch go zipping by. But in 9 minutes and 42 seconds I was from one ER door to another and by 1 AM I was admitted to the L&D department at the local high risk hospital.

At UMW they gave me a second ultrasound, continued the magnesium for another three days, did continuous non-stress tests and administered the second round of steroids to mature Baby's lungs for delivery. I continued to have bleeding and slower, but regular contractions into Thursday morning and by Friday the bleeding subsided substantially and the contractions were sporadic enough for me to be transferred by ambulance again to Fairfax INOVA for longer term observation and care decisions.   GW helped the paramedics get me loaded up:

At the L&D triage at INOVA my doctors requested additional labs and a third ultrasound to actually diagnose the cause of the bleed and preterm labor. While I don't understand the medical nuances of the situation as well as I would like, essentially what happened is I somehow sustained an injury to the edge of the placenta that caused hemorrhaging and it was the bleeding that caused the preterm labor. In the sonogram the rupture seemed to be clotting (and Baby was "plugging" the area with her fingers - smart girl!) and the doctors expressed hope that by the following week I'd be able to go home.  They also said that throughout this whole ordeal Baby has looked stable and is extremely resilient, so despite my "irritable, sensitive uterus" (the doctor's words, not mine - fitting, eh?) she's been fine and that gives them comfort and confidence.

So on Friday night I was transferred from L&D to the High Risk Perinatal unit on the 6th floor of Fairfax INOVA. I was given daily non-stress tests and asked to begin kick counting for a general idea of fetal movement.  Baby continued to look beautiful on the monitors and responded promptly in her kick tests - which I thought was very agreeable of her.

And so begins the week 32 non-stress tests at week 29

Then, finally, yesterday morning the doctors announced that I could go home.  It's kind of bitter sweet to be back in my own space - I'm thrilled to be back with GW and to be causing less difficulty for my family, but I'd be lying if I said that being so far away from INOVA didn't scare me.  For the past many months I've been fearful of the day I might look down and see blood where it ought not be during pregnancy and last Tuesday the reality of what happened was far more terrifying than I could have even imagined (impressive, considering I'm a pessimistic worrier).   I'm definitely nervous that it will happen again and, considering I am still having sporadic contractions, I don't have much confidence that I'll make it to term (another seven weeks) let alone be clear of the NICU... I know God only gives us what we can handle and I managed to stay composed for the majority of the hospitalization (the paramedics actually asked what drugs I was on because they didn't believe I could be that calm on my own), but this has been a lot to take and I'm feeling far more delicate than I know how to deal with.

The doctors were quite murky in what they wanted me to do for the next several weeks, but I have a follow up appointment next Tuesday where I should have more comprehensive answers and new updates. I'm not exactly on bed rest, but I'm also not supposed to do much - and lifting is completely out.   For the time being I'm taking things easy and trying to prevent further muscle atrophy (lost 5 lbs in the past six days) by moving about the house.  I've got GW's halloween costume to make and a bunch more scrapbook pages for Baby because of this episode, so I think I'll be bonding with our couch.

Thanks to everyone who sent emails, text messages and flowers while I was in the hospital - your support means more than you know.

My source of hospital smiles.
What a good boy.

Week 29 Prenatal Appointment

Had my week 29 prenatal appointment this afternoon and I am happy to report that things are looking (mostly) good. The Sonogram shows that Baby is right where she needs to be size wise (a healthy 3 lbs flat) which means my AFP abnormalities are not presenting growth restriction issues and my blood sugar control is tight enough that fetal growth isn't excessive. The sonogram also showed my placenta is securely out of the way of the cervix and it's high enough now that the phrase "what previa?" is completely appropriate to apply to the remainder of the pregnancy. While this is obviously great news, that doesn't necessarily mean I'll get the vaginal delivery I've been hoping for after all – it appears that Baby is extremely content to hang out in a fully breech position and unless she flips over, I'll still require a c-section. For the time being I'm not going to worry about it since there are several many weeks left and I'll just be content to be annoyed with her use of my cervix as a trampoline.

We did receive one new bit of bad news that will require additional monitoring (yes, on top of what they're already doing) - the doctor said that the placenta is beginning to look "old." While I have yet to do my typical extensive research on what this means, it is my basic understanding that toward the end of pregnancy the placenta begins to calcify as it prepares to detach during labor. So when a doctor refers to an "old" placenta that typically means that it looks to be closer to 39 or 40 weeks old, which is not an issue at that point in a pregnancy, but obviously at 29 weeks that's not exactly awesome.

Having read of other diabetic mothers experiencing this complication I was not terribly surprised to have the doc introduce the issue, but I will admit it's frustrating to hear of yet another thing that could/is going wrong with this pregnancy. I asked her if there was anything we could do like an injection of botox or apply a prescription strength anti-wrinkle cream but apparently, much to the dismay of my sense of humor, there really isn't much that is doable about it. She said we need to keep an eye on it more closely by watching amniotic fluid levels for decreases, my blood glucose for unexplainable hypoglycemic episodes or drop offs in fetal growth from possible malnutrition.

So with that "I'm old" announcement, my placenta signed me up for every two week appointments a month earlier than typically necessary. While my life seems to be a revolving door of doctors appointments at least I can say that this little girl will have one very full pregnancy scrapbook with all the hoops they have me (gingerly - come on I'm 29 wks pregnant thank you) jumping through.

Peanut Butter

I don't know who I dislike more at the moment - Mr. Diabetes or Mr. Pregnancy. Those two (grumble, grumble, grumble) have a sick, sick, sick sense of humor and while you'd think that they'd be sworn enemies, oh no! THEY have to get together and play the not-so-funny-haha game of jokey-joke on me...

So get this: one of my favorite foods of all time has always been peanut butter. The smooth kind, none of that chunky boohockey.  I've grown up with it on everything - pb&j, pb and honey, pb and banana (thank you Elvis) and even pb on an otherwise classic blt.  Last week even, while waiting for HB's waffle breakfast to be ready I grabbed a spoon and the jar (okay fine, I have three jars in the pantry) of Skippy from the shelf.  He looks at me and asks what I'm going to put the pb on and I think my eyes must have doubled in size and my jaw must have hit the floor because, really, what kind of question is that?! 

Um... the spoon.  Hello.

Despite my efforts to convert him otherwise, HB is one of those on the fence kind of people who likes peanut butter as a sandwich option on a regular, but disbursed kind of basis.  You know, a freelance peanut butter-er, a non-connoisseur.  After three years of marriage you'd think I'd have made more progress, but alas he still asks the "cooking" questions with the obvious answers.  Maybe he'll get it next year?

Now I'm sure there are those of you out there that think that is crazy (don't knock the pb-blt until you've tried it!) or that peanut butter is "icky," but to you all I have to say is THANK GOD, MORE FOR ME.  If you don't grab the last jar from the shelf at the grocery store then I have a shot of getting it - and by God, I'm not going to let go of that sucker!!

Well... now that I've firmly established that I'm a bit of a freak when it comes to spreadable nut-paste, enter the excessively disturbing, horrifically mean world of diabetes and pregnancy:

So Mr. Diabetes and Mr. Pregnancy walk into the kitchen and take a seat at the breakfast bar.  They look around for the house head chef (aka ME) and, knowing the coast is clear, begin their clandestine rendezvous:

Mr. Pregnancy looks at Mr. Diabetes and says, "so, uh, you got the intel I asked for?"

Mr. Diabetes: "Yeah, I got it.  It's good stuff too... but if I'm gonna do this, I need more than basic tactical support to make it worth my while..."

Looking strategically ambivalent Mr. Pregnancy responds: "So what's the job?"

Mr. Diabetes:  "Get this, the target is totally digging peanut butter... and I've pulled some strings and managed to override her blood sugar to be non-responsive to it."

Mr. Pregnancy, looking very pleased: "Dang, that is good work... How about I have peanut butter make her neauseus?"

Mr. Diabetes:  "Perfect. Couldn't have planned that better on my own."

Mr. Pregnancy: "I know."

...

Thought you were going to read a joke, huh?  I wish.  Not so friggin funny in the end - peanut butter being a diabetes-friendly carb-filled food and totally not third trimester pregnancy kosher! UG!  I mean when I went off of kale after my morning sickness in GW's pregnancy I didn't feel like I was loosing anything... I mean it is kale for crying out loud! Just use chard or something, but PEANUT BUTTER?! Are you kidding me?! 

So.  Not.  Funny.

Humor & Coffee

So it seems that a reoccurring theme in my blog posts is that HB likes to poke fun at me and my diabetic habits. While some might view his sense of humor as unfairly coming at the expense of my infirm, unstable pancreas, I've come to appreciate his witty knack at highlighting what I could otherwise take far too seriously.

For example:

I love coffee.  I love that I can pre-program our coffee machine to have coffee made before HB goes to work and I wake up.   I love that my morning starts off right with the perfect concoction  of coffee, milk and sugar.  I love the way my favorite pooh bear cup fits in my hand and, how no matter what, coffee always tastes better when served in my Christmas china.  I love that GW called it "da-foof" for the longest time and that he still can't pronounce it correctly and calls it "da-fee."  I love that I have figured out exactly what to order at either a Dunkin Donuts or a Starbucks and come away pleased.

What I don't love about coffee is that regardless of how little carbohydrates I actively put into it with sugar, creamer or milk I still have to bolus to correct for the wonky things the caffeine does to my blood sugar.  Generally speaking I bolus for 20 grams and hope for the best... sometimes it works out perfectly and my sugars are dead-nuts where they ought to be; other times 20 grams isn't enough (usually those times DD or S-bucks put sweetener into it for me) and I go really high; and then there are times when it's clearly too much insulin and I drop low.

While the first two are relatively random and came about from trail and error practice, the third (unfortunately) is entirely expectable and makes perfect sense because: as much as I love coffee and as often as I pour myself a cup, this has no relevance what so ever on whether or not I actually get around to drinking the coffee.  More often than not, I'll bolus, make a cup and intend to drink it and then I'll get completely distracted by the world around me and (I must say, much like my Mother) forget not only where I put it, but to drink it.  The only reason I remember I forgot in the first place is my two-hour postprandial alarm on my pump, to which I always discover that my blood sugar is low and my coffee is sitting at an icky room temperature on the counter.

Well, yesterday morning HB made his very special waffles (28 grams of carbs per 1/2 waffle, 10 grams per 1/4 cup sugar-free syrup) because we had a beautiful, amazing and oh so very appreciated friend in town for the weekend (you know who you are and I love you).  Along with breakfast, he attempted to be extremely sweet by giving me my pooh bear mug with coffee since I haven't been sleeping much lately because of pregnancy-caused pain in my back.  So I bolus for breakfast and the cup of coffee and promptly eat my waffles with ravenous appreciation but leave the cup of coffee absentmindedly untouched on the table.  A while later my hands start to shake and I ask HB to retrieve the mug from the table and the following conversation happens:

HB:  "You haven't even had a sip of this yet! No wonder you're blood sugar is low - so TYPICAL!"
Me:  "Well... I meant to. Don't my good intentions count?"
HB:  "You know, hun, the road to hell is paved with good intentions."
Me:  "So, what you are saying is that the road to hell is paved with unfinished cups of coffee."
HB: "Exactly."
Me:  "That deserves a blog post."

And thus this post was born out of fully deserved flack and personality quirk.

Now, I could have taken his comment to mean that I'm not as on top of my diabetes as I'd like to believe I am (perhaps there is a skosh of truth in that, eh?), but I would much rather take the concept of the road to hell being paved with unfinished cups of coffee and run with it.  If hell is hypoglycemia, then fair enough he has a point, but if the road to hell is lined with charming coffee bistros then I think there is no amount of redemption that would save me from the pursuit of the perfect cup (aka the unforgotten cup) of coffee. 

Yum.

Endocrinology appointment blues.

Friday evening I went into the endocrinologist for my every three week diabetes and pregnancy appointment only to have her announce I need to come in every two weeks AND call her every few days. Thus far in this pregnancy when I've had issues with my blood sugars, I've just adjusted my own pump rates and rolled out without continuous help from a medical professional.  But now that the placenta is making me increasingly insulin resistant on a reliably horrid three-to-four day cycle the fine tuning that goes into making my sugars just right is requiring a collaborative effort.

I guess it's a positive thing that she wants to be more involved and to help make sure that my tight control continues to be tight, but, realistically speaking, you could say that I am both insulin and assistance resistant...   my independent, "I've got this" nature doesn't really serve me well in such situations.  I mean after 3+ years of marriage I am still learning to accept HB's assistance when he offers it and since I've only been diabetic for a year and a half-ish, it's just weird to be giving someone that kind of trust and input.

Okay, yeah, I know that is what I am paying her for and I appreciate that she is taking the initiative to push me, but it's a source of self-pride that I've done most of my diabetes care on my own with the help of medical professionals limited to writing necessary prescriptions.  Setting pride aside, I can rationalize and am working to accept that she's here to help limit the high bgs I don't want to subject Baby to and to prevent the low bgs that are increasingly dangerous due to the risk of falling in the third trimester. Makes sense, right?  And any way, since my endocrinologist isn't associated with the hospital I'll be delivering Baby at, I'll gain 100% of my diabetes independence back for game time any way and that's a fair trade off in my head.

On a different note, the big problem I had with my appointment on Friday was that it took almost a hour for me to get back in to see the doctor.  I was the last appointment of the day, so I understand that earlier delays in the day in combination with exhaustion makes for an expectable lack of promptness but when the office requires that all insulin pump users suspend and remove their pumps upon arrival so that they can download all of the data for their charts the delays can be irritating.  So while I was able to remain patient for their tardiness, I was surprisingly anxious and grumpy about my pump being disconnected so long.

HB couldn't help laughing at me for this because of my inconsistency - on one hand liking to take my pump off during infusion changes and on the other hand being visibly uncomfortable with my nakedness without it at the doctors office.  And while he has a point, I have to argue that it's completely different circumstances and reasons... at home, I voluntarily take off my pump and I make the choice to actively protest my pancreas; at the doctors office, I involuntarily take it off because of their data necessity.  The purpose of having it off is disparate and both situations introduce vastly different emotional mind sets... so, yes, I love not wearing my pump, but of course I feel naked without it.

Really, what else have you come to expect from me?

Any way, we'll see what my sugars do the next couple days and how the call with the doc goes on Monday.  I anticipate I wont be getting out of this an every few day phone call... ug... so God grant me the serenity to accept the things I cannot change and just move on.

Non-diabetic Nostalgia

The other night HB and I were debating the meaning of life (aka arguing whose turn it was to do the dishes) when my pump notified me of its depleted insulin reservoir.  As this is happening more and more frequently with my third trimester insulin resistance - about every other day or every two days - I absentmindedly grabbed my infusion change equipment and began to swap things out.  Amidst our deep, philosophical conversation, I went through every single step to reset my pump (rewound the piston, filled the new reservoir with insulin, hooked up and filled the new tubing, cleaned and prepped the new site and had the silserter charged for insertion) and only had one step left (actually inserting the new site) when HB started to uncontrollably laugh at me... 

Now, some of you might think it's cruel that my husband would laugh at me holding an almost two inch needle to my skin, but to be fair he does have good reason and here's why:  I have a new (admittedly somewhat ridiculous) routine when I do an infusion change. Typically taking five minutes or less to complete the whole process and move on with life, infusion changes now require a minimum of 30 - hopefully more - minutes to complete. 

This isn't because my uterus is too big to find a spot to put the new site or because the processes some how got more complicated.  Rather, it is because I am thoroughly enjoying the non-diabetic nostalgia that goes along with procrastination.  I looooove lying on the couch with my pump cast to the side, out of arms reach and pretending that I'm normal and don't need it to be attached to my hip (literally) 24/7.  I like that I can go to the bathroom without needing to coordinate my pump and my pants.  I like that I can put BOTH of my hands in BOTH of my pockets at the same time.  I like that if I wanted to be 100% in my birthday suit that I can be 100% not 98% dressed for success.  And I like that for those few minutes, I am completely free of the plastic shackles that bind me to a battery operated pancreas. 

Of course the end of my 30 minute trip down make-believe, dress-down lane ends with me regrettably whining for five minutes or so about having to come back to reality.  HB often asks me at this point if I want him to just insert it for me and the answer is always "no" because it is not that I need help or that I can't do it myself, it's just that it takes a bit to work up the desire to swallow that gigantic horse pill of "indefinite illness" that comes along with chronic diseases like this.  

I know the pump makes me healthy... I know being healthy keeps me happy... and I know being happy helps everyone around me be happy. BUT STILL, it'd be nice to just simply be happy and healthy without needing the pump.  

I miss being non-diabetic. A lot. 

Summer 2008:  Non-diabetic and simply self conscious.
(You try rocking a bikini and strategically wearing a pump at the same time!)

PS - I changed the infusion site that got this whole post topic started last night after a couple days of ultra sore, extremely sensitive to even the most minor touch pain.  Even before changing it I knew I'd have problems, but it turned out to be the ugliest, most gruesome site change I've had yet - gushing blood and unhappy ooze.  

Summer 2012:  my super sexy, you know you love it,
 ridiculously bloody infusion site.

So for anyone out there who has been diagnosed with pre-diabetes

 or has type 2, take a good look at this picture.  You have the ability to 

avoid this and - believe me - you want to.   

Carb-free cookies

I don't think I have mentioned this before, but I am currently going through the RCIA (Rite of Christian Initiation for Adults) program with the catholic parish that HB and I go to.  Having never been baptized or even remotely religious before, I've slowly but surely gotten my feet wet with the concept of faith and I'm actually really enjoying myself in the deep end of spirituality.  But that's neither here nor there for this post, just background mumbo jumbo.

Any way, over the past year or so that we've been attending mass weekly I've started to wonder: just how many carbs are in the Eucharist? While I am sure that my parish priest would be mortified that I'm asking that question (the vicar I'm sure would find it a bit more entertaining), I feel like it's at least relevant to point out that all bread - Holy or not - by definition contains carbohydrates and therefore is something that a diabetic ought to care about.  Right?  Right.

So I started doing some online research (you know, searching the hard hitting facts people reliably put in random forums) and have quickly come to realize that the consensus among catholic low-carb dieters is that - and I quote - "if you're Catholic, the carbs in the Eucharist don't count."

SWEET! (Do you hear the angels singing rounds of hallelujahs right now too?)

While I'd like to take this online wisdom as ordained fact, I have to rationally estimate that the Body of Christ has about 1 - 5 grams of carbs per serving.  Now, these forum-floating-sages may be right and maybe receiving Communion will do absolutely nothing to my non-pregnant blood sugars due to their limited number of carbohydrates and therefore can be treated as a "freebie" but I have to wait until next Easter to figure that one out for sure...

Until then, I'm going to pretend that the cookie plates the RCIA people put out each week are also ordained by God and covered under the auspices of the non-carb-carbohydrate policy of the google-gospel for the faithful... one can dream, right?

BOTH Obama & Romney to abolish pre-existing condition clauses!

A while back you all may remember my post regarding the impact of politics and health care reform upon the individual lives of people like me and my concern about the ramifications of the election of a Republican candidate.  As you may remember, part of President Obama's health care reform package is the abolition of insurance companies ability to deny coverage to those of us with pre-existing medical conditions which, as you may well know, is a policy that currently exists.

Well, good news: despite the Republican Party's overarching call to repeal all of Obamacare, Mitt Romney announced on Meet the Press this past Sunday that he will keep and promote aspects of it under his health Romneycare package if he is elected -- notably including the removal of the pre-existing conditions cause.  

Whether you agree or disagree with either of the party's plans for health care reform on a larger scale, that is your business and ultimately part of which way you cast your vote this November. But, as for me, all I have to say is thank God that regardless of who is elected people like me won't be stuck in ridiculous bureaucratic loop holes for the sake of political games.

To learn more about Romney's policy stance on this, and much more, click here to check out the Meet the Press website.

9-11 Memorial 5k

On Saturday HB, GW and I competed in the Arlington Police, Fire & Sheriff 9-11 Memorial 5K road race at the Pentagon.  Of course I use the word "competed" extremely loosely since HB isn't cleared to run for another four to six months (ACL reconstruction surgery three weeks ago), I'm restricted to the brisk walking pace of 140 beats per minute and, let's face it, GW only wanted to come for the fire trucks.

2011 9-11 Memorial 5k

This particular 5k has a very special place in my heart as the 2011 race was the first road race I'd ever signed up to compete in.  When I was younger, running was about the last thing you could pay me to do and that only changed about 3 years ago when I figured out that I love to pass other runners. So having spent the past couple years enjoying running around (literally) other people and wanting to honor those in our local community who were directly impacted by 9-11, HB and I signed up and trained to beat a 30 minute mark. Keep in mind that I'd never run competitively before and 30 minutes seemed remarkably reasonable for a first timer goal.

People always warn new runners to watch their starting pace coming off the gates because it is really easy to go out too quick... well, the 2011 race started and I definitely forgot all that boohockey when my feet hit the pavement.  Over and over again I put the next high-and-tight hair cut in front of me in my sights and tracked him until I passed him... Well, much to my surprise, my finishing time wound up being a 4 minutes faster than I'd trained for (26:10.8).  For my first time in a race and having trained at a 9 - 10 minute pace, I didn't think that was too shabby!

And so a running addict was born. 

2012 GW & HB waiting out
the rain pre-race

Well I've been out of the exercise loop for months now with these pregnancy complications and I was heart broken to have been benched from the Marine Corp Half Marathon last May, but now that I'm cleared for some level of exercise this particular 5k seemed to be the right race for me/us to get back on the horse.  Unfortunately, I underestimated the difficulty of walking a race I'd under any other circumstances be chomping at the bit to run in...

26 1/2 weeks pregnant and still
going at mile 2.5

HB and I held off to the side near the back of the crowd when the race began and started our self-pitying walk.  Fortunately, right near the starting line we came across a seven month pregnant woman and her husband with their 2 year old daughter who were stuck in the same boat... Banding together we waddled our way after the pack with our patient, supportive, amazing husbands in tow and practically a personal escort from the police cars marking the tail end of the race.  Even with most of the runners out of sight, it was very nice to have someone equality as impatient for November walking along side me and our two bellies brought on extra cheers and even some cow bell from the nice people on the side of the road who waited for us.

Needless to say, around mile 2.5 my competitive side kicked in and I wanted to at least not finish last. Motivated by the imminent arrival of dinner time and an escape from the drizzling rain, we spent the last leg of the race right at the Pentagon,  passing as many people as my swollen ankles and HB's knee would allow...

Ultimately clocking at the breakneck pace of a 18:12 mile, we crossed the finish line in 56:33 minutes with 23 out of 3069 other racers behind us.  My blood sugar was of course low (63 mg/dl) from all that "exertion" but at least we participated and went the distance - which, at this point in this pregnancy and HB's recovery, is definitely saying something.

I'm not planning to sign up for any more road races between now and Baby's delivery since so much with this pregnancy has been week to week and I've resigned myself to expect the unexpected, but I am really excited for race season next year.  I'm not yet ready to announce what schemes for post-baby body recovery I have up my sleeve, but God, Baby, GW and (grumble grumble grumble) diabetes willing it'll be effective, fun and worth the effort!

Ridiculous!

What you hear me say out loud: "Huh."

What you'd hear if you were in my head:  "What the bleep do you bleeping mean you bleeping stupid meter! Why the bleep is my bleeping blood sugar so bleepity-bleep-bleep-bleep-bleeping high?!"

The past three days have been absolute blood sugar hell.  I haven't been on track with my blood sugars nearly as often as my mental commentary has been inappropriately explicit in my opinion of them.  The last two nights in a row I've shot up into the 260s and even with active insulin in my system my body isn't responding to the "excess insulin" I'm rage bolusing to cover down on it.

Take last night as an example, I made this amazing poulet au porto rissoto a la Julia Child (yum) and I measured out my serving so as to bolus appropriately. Two hours later as my pump is reminding me to check my sugars, I see the numbers 186 mg/dl come on the screen of my meter.  Knowing that is high but will typically come down with the remaining active insulin, I let the high slide and decided to check again an hour later to make sure things were headed in the right direction.  So an hour later my meter reads 262 mg/dl and my jaw just hits the floor (probably making room for the commentary in my head to fall out my mouth).  The active insulin did nothing to fight off that high! So I rage bolused an additional 2.0 units of insulin to force my sugars lower sooner rather than later and set my alarm clock to wake me up in another hour to check on the progress... So off goes my alarm clock and I check my sugars again and they've barely moved down to 216 mg/dl. Frustrated beyond belief I bolus an additional 1.0 unit and set my alarm clock again, which I admittedly slept through until morning.  But when I woke up, my sugars were still above 100 mg/dl and my morning target numbers are between 60 and 90 mg/dl...

BOO HISS!!

As I've discussed before, such numbers are either indicative of carb miscalculations or insulin resistance as a result of pregnancy.  I've been really careful about my carb counting, so that means that the insulin resistance I've been expecting is off to an aggressive start... to fix this, I've decreased my carb ratios for almost all of my meals.  Pre-pregnancy my bolus ratios were roughly 22 grams of carbs per 1 unit of insulin, but now I'm down to 12 grams of carbs per 1 unit of insulin.  I've also increased my all of basal rates (the body doesn't need the same amount of basal insulin all the time for various reasons such as the dawn phenomenon) by several many tenths of a unit which has added up.  Pre-pregnancy my basal rates amounted to a daily total of 8 units of insulin and now I'm up to 11 units of insulin.

For those of you who aren't diabetic and aren't hypersensitive to the daily statistics of your life, such increases in insulin dependence are overwhelming (insulin:diabetics :: gold:pan miners).  The scary part is that I have somewhere between 8 and 12 more weeks of insulin resistance to work through, so these abnormally high glucose readings will persist and my increasing usage of insulin will continue until the placenta is delivered. 

Again, say it with me now: BOO HISS!!

The good news is that as of the appointment I had earlier in the week, I've been cleared to "exercise" again and that is another tool I can use to combat high glucose readings.  By hopping on the stair stepper and creeping along at a slow enough rate to keep my pulse at 140 beats per minute or lower, I can slowly but surely drop my blood glucose over the course of a half an hour from "exertion."  Unfortunately, with such high readings as the 260s, the risk is that I am spilling ketones and at that point exercise will only make my sugars go higher rather than helping me to correct.  So this additional solution is only helpful if I am at a lower high than the excessive numbers I've seen lately...

I am extremely relieved that I have another endocrinology appointment this next week to get some professional help to fix these issues.  From my understanding, I can pretty much expect my insulin requirements and bg numbers to be changing on a daily (or even hourly) basis, so at least one day this week I'll have exactly-exactly what the doctor prescribes. 

Diabetic Ketoacidosis

I was just surfing the Internet and came across an article that made me cry.  The title of the article is "People Dying of Diabetes Who Never Knew They Had It, Study Finds" and when I first clicked on it I fully expected the article to be about type 2 diabetes since it seems like everything in the media about diabetes is about type 2.  Much to my surprise, the article turned out to be about adult type 1 diabetics - like me - who die from diabetic ketoacidosis (DKA).

Check out the article here: http://news.yahoo.com/people-dying-diabetes-never-knew-had-study-finds-130911564.html

As you may remember from my diagnosis blog post (check it out here if you haven't seen it yet: My Diagnosis Post), DKA is what I was hospitalized for and within weeks from dying from.  It is an extremely serious complication caused by untreated diabetes and I wouldn't wish it on anyone.

Please, for your own information, read this article and recognize the symptoms of DKA.  If you or someone you  know starts to exhibit these kind of symptoms, get checked out immediately!  Even if you don't exhibit symptoms, please get an annual physical and blood glucose check just to be sure.  Diabetes doesn't have to be fatal if it is treated in a timely manner.

Week 26: Good bye second trimester

Week 26, the final week of the second trimester, began this past Tuesday with my second perinatal appointment since I've been back in Virginia.  As the past two weeks have been spent consciously (and unconsciously) brainstorming questions and concerns about the pregnancy, I arrived at the doctors office with a long list of topics to cover and completely full of jitters about what new complication or difficulty they'd uncover this week...

I dropped off what feels like the billionth urine sample (seriously, this is ridiculous, I'm doing one a day and one per doctors appointment) and we were immediately ushered into the ultrasound room.  Which reminds me -

I completely think a shout out is due here to the Perinatal Associates of Northern Virginia for their amazingly prompt and punctual service! At the OBGYN's office I used during my first pregnancy, Care for You OBGYN, all of us pregnant Mamas would be left sitting in the waiting room for hours after the "appointment time" started.  I always tried to schedule my appointments so that HB could come and wouldn't miss too much work, but every time my appointment would be scheduled for 3 PM I wouldn't even get seen by a nurse for my vitals until sometime between 4:30 and 5:30 - and they insist you show up on time!  It was horrible.  Even if I hadn't been diagnosed with diabetes and didn't required a perinatologist instead of a regular OB, I wouldn't have gone back to that office even if I'd been paid to go.  But that is beside the point, the Perinatal Associates of NOVA are on the ball and they deserve much praise for their amazing patient care!

Where was I? Oh, right!

- So the ultrasound specialist has me lie down, squirts the warmed (yes, ladies, they bother to warm the goo!) gel onto my protruding belly and begins to check things out.  This particular specialist isn't as chatty as the other one is, but she's got the kind of "shh-I'm working" demeanor that you don't really mind that she's engrossed with her work rather than asking what color you've painted the nursery (yellow by the way).  Any way, she clicks and clicks and asks me to roll over this direction and then lay back again and - oops! Baby moved - roll back this way again and ba-da-bing!  She announces the placenta has moved up by 3.5 cm and that the baby's weight is - exactly - on track for this week at 2 lbs flat.  After helping me wipe off the gel, she presents GW with yet another series of ultrasounds shots for Baby's already thick scrapbook and happily shows us down the hall to the nurse's station for my vitals check.

After learning that my blood pressure and pulse are still remarkably low (a good thing), my weight is increasing at an appropriately slow rate and that my son is adorable (well I knew that, but it was nice to hear the nurse say so), we were seated across the big mahogany desk from one of my favorite people on the planet - Dr. Barbara Nies. She took a look at my new HgA1C numbers, my sonogram results and my daily pre-preeclampsia logs and without a note of uncertainty in her voice pronounced that my sugars look fantastic, my placenta previa is no longer a concern at 3.5 cm and that I'm as fit as a type 1 diabetic Mama can hope to be at this point in pregnancy. Which means:

* I am not doomed to a c-section unless another problem arrises, but given my history with successful vaginal delivery the doctors are hopeful things will progress as they did last time.  (Ladies and gentlemen, get your stop watches ready, I'm gonna try to beat the 35 minutes active labor record from last time!)

* Pre-term labor is not as major of a concern at this point and they're hopeful that I'll make it at least to 36 weeks, but that'll probably be plus or minus two weeks given my pregnancy history.  Between now and then, they'll continue watching my blood pressure for signs of preeclampsia and Baby's growth rates for irregularities as a precaution.

* With the partial placenta previa out of the picture and just a normal low lying placenta to work with, the doctors have lifted my no exercise restriction and they're even allowing me to pick up GW if it doesn't hurt my back.

So all of that is fantastic news and I couldn't be more thrilled with the out come of the appointment!  I am relatively hopeful that my week 29 appointment in three weeks will go just as smoothly as this one did.  As we'll be signing on the dotted line for the property we are purchasing in VT (have I mentioned that yet?) at the end of the month, I am kind of banking on the doctors saying I continue to look fantastic (and what pregnant woman doesn't like to hear that?) and will let me travel back up to Middlebury for closing...

What did you expect?  You know me by now:  we keep things complicated!

Let the whacked-out labor dreams begin.

For those of you who have never been pregnant or have never spent a significant amount of time around a woman who is pregnant, news flash: pregnant women have crazy vivid dreams.

From the reading I've done out of sheer curiosity on the topic, the increased amount of hormones in a woman's body are partially to blame for these dreams when combined with the increased amount of sleep a pregnant woman requires and the increased number of times a Mama-to-be wakes up mid-dream because of (i.e.) fetal kick or needing to pee.  By waking up mid-dream, our brains are able to remember what we were dreaming about due to the recency of the experience.  And since we only sleep in 20-25% of a dream state, these factors create a prime environment for the wildest, weirdest, scariest things to happen every time we lie down to rest and the details of which rush back upon roused from sleep.

I've had several dreams lately that I woke up from wondering where the heck that line of thinking came from, for example in one I lived at high school, but my high school was actually the preschool I went to and in another I was roaming around New York City looking for a parade to lead.  Last night, however, was a first for this pregnancy:  I dreamed I was in labor.   It's my understanding that the baby-related themes pregnant women dream about are generally about what is currently going on in real life or about anticipated events - like what gender the baby is, what he/she will look like or what a wonderful/horrible parent the Mother will turn out to be.  But as the transition into the third trimester begins, which I do in just over one week, the big day becomes an ever present possibility with waking each morning and anxiety about uncontrollable factors seems to drive dreams about what could happen.

In my dream, mid-week 26 (this next week) I started to exhibit serious signs of pre-term labor.  I had regular contractions (which by the way, Braxton Hicks this go around stink since I know and remember what actual contractions feel like) and I began to bleed (a serious sign of complication with placenta previa).  So I went to the hospital and my doctors (who weren't actually my real doctors, but some shmucky dream doctor) didn't believe I had the symptoms I reported, refused to do an exam and promptly sent me to the labor and delivery waiting room where crazy women, like they thought me to be, were put to wait it out until actual labor began.   Rounds and rounds of horrifically young looking medical students were sent in to "check on my progress" but after the first three sets of them, I quickly realized they were there not to care for me but to practice their bed side manor... I was not amused.  Eventually, the doctor did come in and asked me to lie on the middle of the floor in the hallway because of the "proven expediency" this tactic had - had with what is a question I never got an answer to.  It was only after significantly hemorrhaging on the floor did they begin to take me seriously, but it was at that moment of unadulterated panic that I woke up... 

Charming, yeah?  I agree... not so much.

Of course HB was all sorts of reassuring that what happened in my dream would never happen in real life and that he and my doctors have me covered for the worst case scenarios, but I tell you what, that is not the introduction to labor related dreams I had hoped for.  I so enjoyed labor (admittedly after the epidural) last time and I so want this time to go like the first because of the sense of accomplishment and connection I had with the physical act of delivering my own baby.  But with the complications this go around, I don't know when or how delivery will go and frankly that increased degree of the unknown with Baby just makes relaxing into peaceful sleep all that much more difficult.

I remember a dream I had when I was pregnant with GW about how I heard a baby crying some place in our house but I had no idea where it was coming from.  I know I felt lost before becoming a mom last time - I had no idea what I was doing and I had all sorts of concerns about my ability as a woman to emotionally connect with this tiny being.  Retrospectively that was the most ridiculous concern to have given the wonder of mommy-genes, but for me at that point such anxiety was perfectly real and unfortunately relevant in my sleep. With this pregnancy, however, I know I'll connect with her and that we'll adore each other, but the search for quality medical care and the ever present reality of diabetes et. al. as complicating factors makes my pre-birth protectiveness of Baby all the more intense.  In my waking life I'm doing everything I physically and emotionally can and I am working with the best people possible, but in sleep the "what if's" I don't let myself ask creep in and scare the boohockey out of me...

I know it is perfectly normal to have nightmares and for dreams to color outside the lines of reality, but I've got a request for you, Mr. Sandman:  try bringing a dream about Baby that is all pop tarts and rainbows next time.  Go ahead, man,  turn on your magic beam and Mr. Sandman bring me a non-crazy, non-scary, non-complicated dream!

If you are interested in the topic of pregnant-dreams and want to read more, click here and check out this fascinating article.