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.

Carb Counting Challenge Results

So, to make things standard and therefore fair for everyone, I only used the CalorieKing.com website to gather the numbers.  Here's the final break down:

Thomas brand cinnamon raisin bagel - 58 grams carbs
3 oz cream cheese - 2.3 g
Starbucks blueberry scone - 61 g
Grande coffee with milk - 24 g
Two sugar packets - 8 g
Two medium slices bacon - 0.2 g
Two scrambled eggs - 1.5 g
Two slices white bread toast - 23.9 g
1 cup home-made hash browns - 54.8 g
One medium banana - 27 g
1 cup 2% milk - 12.4 g
1 cup multi-grain Cheerios - 24 g
Seven 4" home made buttermilk pancakes - 76.3 g
1/2 cup real maple syrup - 108 g
1 Tbsp butter:  > 0.1 g (not added to total)
12 oz fresh orange juice - 37 g

Total:  518.4 grams carbs

Pizza protest.

And so it starts.   I am officially facing irrational insulin resistance for the first time.  Dum dum dum! 

I've read about this part of pregnancy countless times and I knew this was coming, but it's still disappointing to have it begin.  One woman I read about would bolus for a full serving of oatmeal (roughly 25 g carbs for a cup) but would eat only a tablespoon of it and her blood sugar would surge so high that the rational carb:insulin ratio for everything else would be completely irrelevant and impossible to calculate for that particular food.  Scary....

Well, I've been on a serious Greek olive kick for the past couple months (I hated them previously, gotta love pregnancy cravings) and so HB and I regularly pick up this Greek pizza from a local pizzeria that scratches the olive itch and satisfies the quick easy meal when I am slacking and don't feel like cooking (Julia Child, please pardon me for this).  According to the pizzeria's nutrition information, each slice of this Greek pizza has 17 grams of carbs and, starting yesterday, no matter how much I bolus per slice - whether I double or even triple the amount of carbs per piece - I unavoidably shoot up into the 200s.  Dang.

Even with the cravings and ease of it all, such unpredictability isn't worth it and I'm bummed that this means pizza is out...

Back when I was pregnant with GW, I had pizza pretty much every day because it was just about the only food that didn't make me feel sick and we conveniently lived next to a fantastic Italian restaurant on Pentagon Row in Arlington, VA.  All I had to do was show up and sit down and this wonderful waitress named Monica would deliver to our table these amazing (pasteurized) goat cheese and spinach salads and one of these individual size pizzas with homemade sauce and ridiculously fresh toppings... yes, I was that predictable; yes, I was there that often; yes, HB was that supportive.

I guess I can say thank God that I live an hour south of that restaurant now and that pizza isn't my only source of sustenance this go around, but none the less it's frustrating to be diabetic, it is frustrating to be a pregnant diabetic and this irrational carb juggling simply sucks.  If it wasn't hard enough already, here's a new curve ball for ya! Boo hiss!

I hope someone out there - whoever you are - orders a pizza tonight and thoroughly enjoys it in absolute protest of my pancreas' tyrannical dictatorship and its cruel and unusual rejection of what ever it so capriciously whims!

Bon Appetit!

And that, my friends, is the Webster's definition of amazing.

So my endocrinology appointment on Monday came and went with next to no fanfare.  I anticipated the doctor to tell me that my numbers this past week were atrocious and that my body is obviously becoming insulin resistant, but instead she looked at my numbers over the past three months and decided that I actually need to turn my sensitivity levels down from 80 ml/dl per unit of insulin to 85 and that if I continue to see regular lows I should decrease it even further to 90.  Fair enough...  beyond that she had nothing else to say about my self care and asked to see me every three weeks until the baby  is delivered.

Unfortunately their office was out of the in-office HgA1C test kits and they were unable to tell me right away the most important information of the appointment.  HB, GW and I trotted down stairs to the hospital lab to have them run the test and I must say that I had the best phlebotomist I think I've ever encountered draw my blood with absolutely zero pain.  Maybe I'm getting too used to needles, but seriously this girl managed to get four vials of blood without even the smallest pinch!

Any way, I had to wait and wait and wait and wait and... wait before finding out what the number was.  But instead of eventually receiving a random phone call from the nurse's assistant, the doctor herself called to deliver the news. My HgA1C is down and that it is the wholly impressive number of 5.3!  Yes, people, that is in non-diabetic range and, yes, I have been doing that well with my blood sugar control.  Little party for me!

For the time being, I'm continuing as is until my next appointment with her on September 14. The reason she wants to see me every three weeks until delivery is to make sure that my sugars are in the range they need to be in for the third trimester of pregnancy.  It's particularly important that my blood glucose be under control now because if they are too high too often then the baby will grow larger than she ought to and that could lead to issues with delivery.  Furthermore, it is very important that my sugars are in control with regards to my other pregnancy complications because if Baby could arrive whenever it is extremely important that my sugars are normal so that the baby is born with normal blood sugars as well.  If my sugars are high, that glucose is transmitted via the placenta to the baby and causes her pancreas to increase insulin production to combat her resulting high bgs.  But if she is born while I am hyperglycemic and she is subsequently disconnected from the placenta (aka the source of extra glucose) she will be born hypoglycemic and will need to be put in the NICU until her sugars stabilize.  Which I, obviously, want to avoid to the best of my ability.

I'm planning to keep my sugars on lock down until she's out, but even during delivery I am planning to run my own diabetes management.  Typically most hospitals want to take over checking a diabetic's sugars and administering insulin via an IV drip for the patient, but I am not comfortable with anyone's standards but my own - so I'm going to do it.  Either HB or I will check my bg every 30 minutes and we'll keep my pump on so that we can fine tune as necessary to keep me at 120 mg/dl or under throughout labor.  If I have to have an emergency c-section, obviously that goes out the window, but in all other scenarios I'll fight anyone tooth and nail to maintain as much control over my body and my pancreas as I possibly can.  It's my responsibility, after all, to grow this baby and raise her once she's out, so while I am willing to accept outside help I reject anyone's suggestion that I hand over the responsibility for my baby daughter while she is encountering the world for the first time.

Yes, I am stubborn, but you probably noticed that already.  Ah well, this stubbornness is why my HgA1C rocks the socks off of my endocrinologist... pardon me while I keep it up!

Agh!

So there are points in each of our lives when we all have one of those moments/days/weeks/whatever that just aren't going in our favor.  You know what I am talking about - the day you wake up already late for work, get a speeding ticket on the drive in, have a fight with a friend over lunch and manage to drop a meatball down the front of your white dress right before an important briefing and then you get home to discover your pooch ate the heel off the left shoe of your favorite pair of heels - you know, those days.  I've felt like things have been going pretty well lately - nothing new to report with the pregnancy, grades came back from Middlebury and were where I wanted them, and HB and GW are well all things considered - and I have been fighting the good fight to good effect.  But then, out of the blue, diabetes struck again!

I don't know what it is about the last couple days, yesterday in particular, but my sugars have been all over the map.  One minute I am slightly low and my body is exhibiting major hypoglycemia symptoms (seriously, last night I could have been running a marathon in 150 degree weather given how fast my heart was pounding and how hot I felt) and the next my sugars are soaring higher than I've seen in I don't know how long. All I can figure is that one of the following has to be true:  A)  I've been off on my carb counting; B)  my insulin resistence is ramping up; or, C) my body just plain does not know what to do about the specific carbs I've been eating. 

It's probably a combination of all of the above at any given point, but it is frustrating none the less.  I mean to vasilate between correcting a low with my three (yes, repeat that, three) starburst and then rage bolusing (this means injecting extra "unnecessary" insulin to correct for a high faster than waiting for active insulin to work) to correct the unexpected high is simply obnoxious.  I'm sure there are those out there thinking some extremely useful thought like "well, just eat two starbursts, dummy" and while you might have a point, it's times like this that I'm sooooooooo not interested in commentary about what I should or could do better with my diet or diabetes management. No offense meant, but let it be known I beat myself up enough over abnormal blood glucose numbers for all of us thank you very much.

The cherry on top of my bad diabetes day yesterday was in the middle of the Sound of Music Sing-A-Long HB, GW and I went to (oh so much fun!!) my pump freaks the heck out and reads the stop-you-dead-in-your-tracks, armagedon-is-upon-us, you've-got-to-be-kidding-me error code: "motor error." AGH!!  So while the thousands of people around me were belting The Hills Are Alive while Maria is twirling on the big screen, I go into pre-panic mode and have to reset my pump all the while hoping to God that the mechanics of my pump really aren't failing.  Exposing my huge belly to the crowd to disconnect the infusion site, I removed the resevoir from the pump and held my breath as I watched the piston rewind back into the gear box.  It beeped - rewind successful.  I reinserted my old, still full resevoir into the pump and went through the key stoke commands to reset it and watched it intently for additional problems.  And - thank God - it worked fine.  I exposed my belly again to hook it back up and promptly joined in the chorus of nuns and would-be-nuns in "hallelujahs!" (Thank you to the male-mother superior sitting in front of us for the extra blessing, ha.)

Okay, so maybe that wasn't an actual cherry on top of that particularly bad bg day, but those heart-racing moments of concern that my plastic, artificial insulin life line had been cut off scared the boohockey out of me.  Granted, I have back up insulin in the pen form back at the house and I'm not completely in over my head if my pump does actually fail, but seeing as I'm not always home, I don't carry my insulin pens with me (they need to be refrigerated) and time without active basal insulin in my system is not healthy time for the baby, I would really rather not need to go there.  Further more, I've fine tuned my diabetes care to the point that my bolus doses are within 0.05 units of exactly where I need them to be at any given moment... with an insulin pen, you can only dose in whole numbers thus requiring too little or too much insulin.  Let it be sufficient to say that without the pump, I am pretty sure my diabetes management and my sanity would be out the window.

I know that Medtronic has a 24 hour emergency hotline for full on pancreas crisises like that and that they would have either fixed my pump or gotten a new one to me as fast as FedEx can move it, so it's not the end of the world to have it break.  But given the cost of replacing it, the efficacy of treatment on the pump and the necessity - at this point in the pregnancy in particular - to be as close to non-diabetic as a type 1 can get, I'd really just rather not go there. 

Needless to say I said several many more diabetes related prayers this morning at mass and increased my morning bolus ratio and my afternoon basal ratio to hopefully combat any resistance issues I'm starting to face.  From the other pregnancy and diabetes blogs that I follow, it seems to be pretty typical that things get a bit out of hand right about now and continue to deteriorate as the third trimester approaches and wears on.  Hopefully I'll get to expereince the frustration of third-trimester insulin woes for several many weeks and Baby will be delivered after wk 36, but we'll just have to see how all of this unfolds. 

I head into the endocrinologist tomorrow morning for my first A1C check up since early this summer and I anticipate that it will be a good number.  I've only had issues the last several days and the past three months have been solid, so we'll see where that officially puts me in the rankings...

Holy OW.

So I had a feeling that this might happen sometime soon since I'm not putting on too much weight and the baby bump is getting bigger and harder, but alas inserting my infusion site has become a ridiculously painful experience.  I went to reinsert the site at a new place on the left side of my abdomen and instead of only going into the subcutaneous fat like it usually does, the needle bounced off my abs or uterus or something and seriously hurt like all get out.

Don't get me wrong, I have a really high pain tolerance and I am used to the pinch of a two inch needle jabbing my stomach every few days, but having a needle hit muscle or something more tender than fat is SO uncomfortable.  I've had to switch my infusion sites from the parallel lines next to my belly button to my sides since Baby has oh so lovingly deposited extra cushion for Mama there... So far the swap seems to be working out, but it makes lying on my side uncomfortable and carrying a purse is a bit painful when it bounces on the site.  Oh the joys of being a diabetic!

In other news, I've been completely on the ball with checking my blood pressure twice a day, weighing in daily and checking my urine for protein to make sure preeclampsia isn't setting in.  So far things are all within normal levels and that is great.  I'm going to be talking with my perinatologist at my next appointment about whether his concerns are for "IF" preeclampsia sets in or "WHEN" it sets in.  I'm not sure what to make of this high risk pre-preeclampsia routine since preeclampsia is frankly much more intimidating to me than any of the other complications we're having with this pregnancy.

The Preexisting Diabetes and Pregnancy book I've been reading has several many stories of women who had similar combinations of complications that had their babies as early as week 30 (which, by the way, is only six weeks from now)... scary. But face it, week 30 is better than week 24 -- and week 36 is even better than week 30!!  I registered for delivery this morning with the Fairfax INOVA Women's Center and I am glad that is ready to go just in case.  I've pretty much resigned myself to the expectation that we'll likely deliver earlier than optimal and that the use of a NICU may actually be required, but that is all in God's hands and I can only hope for the best.

Week 23: Less pressure is good pressure

THANK GOD FOR PERINATAL ASSOCIATES OF NORTHERN VIRGINIA!! I am so glad to be back in NOVA for the quality medical care these doctors provide that I cannot even begin to articulate how relieved I am.  No offense meant to the people in Vermont that want to go to Fletcher Allen, but sign me up for comprehensive, careful prenatal care for this and all future pregnancies please!

So, as it is probably obvious, I had my first prenatal appointment back in VA yesterday afternoon.  They ran a second level-II ultrasound to double check what results were found in VT and were able to confirm with greater clarity that the baby is in fact a girl and that she is healthy.  They looked at my blood sugar logs and used the word "impressive!" to describe my self-care - GO ME.  Unfortunately, amazing diabetes control aside, the doc confirmed that there are several complications on top of my insulin dependence that makes the remainder of this pregnancy risky:  elevated Alpha Fetoprotein (AFP) levels, a partial Placenta Previa and very high risk of preeclampsia.  Let me explain:

1)  Each fetus creates a protein called Alpha Fetoprotein that is present in the fetal serum and amniotic fluid.  As a standard test between weeks 14-22, docs check the level of AFP in the maternal bloodstream to ensure that it is within normal levels (no higher than 2.0). Simply by being diabetic, the range for normal levels of AFP are lower and therefore more sensitive (no higher than 1.9) than non-diabetics; my level is 3.25.  Fortunately this abnormal number is not directly correlated with my diabetes and there was nothing I could have done to prevent it, but unfortunately it does present issues that need to be addressed on top of my diabetic-pregnancy care.

So what does this mean?  Well the initial assumption with elevated AFP levels is the presence of neural tube defects (such as Spina Bifida), which we have thoroughly ruled out through the comprehensive level-II ultrasounds.  Great right? Heck yeah... but we don't know what is causing the elevation now and that creates concerns about the structure of the placenta.  I'll be going into the doctor's office every three weeks for the time being so that they can check fetal growth and if she isn't growing at the appropriate rate for her gestational age (which she currently is) that means she isn't getting enough nutrients through the placenta and we may need to deliver her early.

2) Well the doctors in Vermont were wrong - I am not previa free.  The great news is that my Placenta Previa is in fact a partial and does have a possibility of sorting itself out between now and delivery, however the doctors here in VA are unwilling to say that it "will" move because it is much lower and closer to the cervix than it ought to be.   There is nothing that I can do to fix it and ultimately it is a wait and see what happens situation, so all I can do is hope for the best and work on damage mitigation. Between now and delivery I need to do everything in my power to make sure that I am not making the situation worse: no heavy lifting (anything over 10 lbs; btw GW weighs 36 lbs now), no exercise and increasing amounts of rest.

Keep your fingers crossed for me that the placenta continues to move up and reduces complications with delivery!

3) The new concern as a result of my diabetes mixed with both the placenta previa and elevated AFP is a higher risk for preeclampsia.  Preeclampsia is pregnancy hypertension or elevated blood pressure that results in extremely dangerous situations for both mom and baby.  If I am actually diagnosed with preeclampsia I will likely need to deliver Baby early, but for the time being I am in pre-preeclampsia mode.  So while my blood pressure is currently fantastic (yesterday it was 105/62) it can go up almost instantaneously and whatever great number I had before wont matter.  Unfortunately there isn't anything I can do to ward off preeclampsia, but I can keep an eye out for the symptoms of it and be able to respond quickly if and when it does set in.



So... the long and short of it is that my diabetes is under tight control, but that does not affect the presence or treatment of the other complications.  Worst case scenario, each individual complication is solved by emergency, early delivery so any hopes I had to make it all the way to week 38 are pretty much shot.  I'm taking things one day and one week at a time right now and trying to keep my blood pressure and stress as far down as possible.  I anticipate with HB's ACL reconstruction surgery on Friday, GW's upgrade to a real bed (buh-bye crib!) and my anticipated insulin resistance that it'll be a difficult task to keep my anxiety down, but I'm doing everything I can and the certainty of that at least makes me feel better.

Update amid chaos...

Sorry for the hiatus everyone - between final papers for class and getting back home to Virginia it has been a crazy week and a half.  I am hoping to sit down and have some time on Sunday to answer a couple questions people have sent in... so bear with me.  I will also be posting a new Baby update after I head to the perinatologist on Tuesday to actually get answers that I've been missing for the last six weeks.  At the end of the month I check in with my endocrinologist in person and should have an updated HgA1C at that point.

I have time for one quick funny story now though...  Last week, I was talking with my endocrinologist over the phone about my blood sugars and she asked me if I was having any trouble with resistance.  After week twenty in a pregnancy - I am almost to week 23 - insulin requirements go up and up and up because of the sponge like nature of the placenta, so her question is logical and will be increasingly more common until November.  Well, at that point, I was able to articulately answer that "no, things are just fine" and that "no fine tuning is necessary."  Knowing full well that God and my pancreas have a funny and sometimes sick sense of humor, the next day my sugars were all sorts of out of whack... a day early and a dose short, eh?

Let the reindeer games begin!

To my partner in crime

Do you know what the worst part of being a diabetic is?  Standing like a marooned, blubbering idiot watching your husband drive away.

Wait... that has nothing to do with diabetes... oh well, I'll write about it anyway.  

After two weeks of "vacation" in Vermont, HB left today to drive back to Virginia and get back to the working grind of our daily reality back home.  It was wonderful to have him up here - to share this new aspect of my life with him and to hold his hand through the last few weeks of medical appointments.  Admittedly I'm beginning to mentally check out of my classes for my own reasons and I am glad that school ends in just under two weeks, but watching him go today made me very sad.  I'm going to miss him with professional precision from now until then, from that second his car disappeared around the bend and down the hill to the moment I anxiously open the front door back home in August...

Your nose is blue.

I know many don't understand why or how our relationship works, but for whatever reason it does and for that I'm eternally grateful.  Especially over the last few months, I've found myself awe struck by the immense luck I've had in not only finding a partner I want to work at marriage with, but an honest to God best friend that makes my world better.  Between the care he's helped provide medically, the support he's offered emotionally and the encouragement he's given freely, I feel like any number of the hurdles I individually face in life are less high and more attainable than they ever were on my own...

I can't tell you exactly what it is or how he does it that makes my everyday life, even with diabetes, everything I could have hoped for.  Perhaps some HB-centric inversion of Maya Angelou's poem "Phenomenal Woman" would be appropriate here, but I've never been known for a mastery of rhyme schemes or appropriate use of couplets.  All I can say is that it is in the little things, like:

*  when he's standing over my shoulder watching the processing line go around on my BG meter, waiting with me to see how my sugars are doing.  And when the tight-number finally appears on the screen, I love how he cheers for me as if his favorite football team just won the super bowl. 

* how he measures out pancake batter on Sunday mornings to ensure that each pancake is the same equivalent size so that I can easily calculate what number of carbs I'm eating.  Of course he rolls his eyes at me when I ask him to tell me how many carbs are in the maple syrup he gushingly poured over his pancakes, but still... :)

* when he talks with me in riddles and puns, making a game out of the English language.  Just this morning he turned that horrid song "who let the dogs out?" into a sing-along about dairy cows for GW and made us all laugh with his "moo, moo, moo" interpretation.   

Sure, sure I know this is a post off topic (and sappy), but sometimes I just have to say exactly what is on my mind and HB deserves the shout out.  Many spouses of diabetics struggle with the impact disease has on their relationship - either as a result of their own apathy for it or, more commonly, with the diabetic's apathy for it.  Fortunately this isn't the case in our house and I am very grateful for his continued support, increasing love and invaluable friendship.  Diseased or not, I feel like a million bucks around him and nothing can beat that. 

That said, I miss you and love you very much HB.  See you not soon enough.