28 Weeks: Dealing with High Blood Pressure and a Cute, Chubby Face

Yesterday I had my 28 week checkup with my OB. I was rather excited about this appointment because it had been over a month since my last appointment (you'd think I was missing the place) and this appointment included an ultrasound. I hadn't seen our little girl for 10 weeks when we found out that she was going to be a she. So regardless of my weight, blood pressure, or anything going on in my urine, I knew I was going to get some face time with my daughter. And that would trump anything else going on that day.

I was called back and Trey followed me into the ultrasound room. I've been very fortunate with my OB's office, even though he is a high-risk doc, that his office is small enough that I see the same people every time. So it's nice to see the same girl that showed me my baby's heartbeat a lifetime ago. I climbed on the table and she put the blue gel on my stomach. She turned on the screen and it amazed me to see how big my baby has grown! She doesn't fit on the screen anymore, but we got some great shots of her face. And her face! I can already tell that she has the chubbiest little cheeks. And she had her hand up by her head, like she was a fainting damsel or something.  Best of all, her stomach and head are perfectly in proportion with one another, so there's no worry about growing a big baby from my diabetes. She's also measuring ahead by 10 days, but those measurements can be off the further along I get. It looks like she weighs right at 3 lbs even right now. (So where in the world is my extra 25 lbs coming from?!)

Her cute little profile.

After my ultrasound, I began my "regular" appointment, which included the usual routine: pee here, step on here (weight), stick your arm out here (blood pressure). As I mentioned, I'm up a total of 25 lbs so far this pregnancy. And I definitely feel it after walking for awhile and I get a cramp on my side. I've never had a lot of weight in my middle (bottom, sure, but not middle), so I feel very unbalanced these days. Next, the nurse took my blood pressure that came back high at 140/90. Calmly, she told me that I needed to go lie down on my left side and she would come take my reading again. I didn't freak out about this, surprisingly, I just got caught up in her instructions and did what I was told. I know I've had normal blood pressure readings at other times, and there was little I could do about it at that point. So Trey and I waited in a room, me laying on the paper-draped table and him reading from his phone and cooing over our baby's pictures. I closed my eyes and nearly fell asleep, listening the sounds of feet shuffling past us. Fifteen minutes later, the nurse came back and took my pressure again: 122/74. Everyone was pleased with that number, so I was free to sit up at that point.

Finally, my doctor came in and greeted us, "Baby looks great!" I'm glad that was the first thing he mentioned, because it reminded me that's the priority around here.  He asked me how my numbers were doing, and I said I have my good days and bad days but the good seem to outnumber the bad. I asked about our baby measuring a week and a half ahead and if he would change my due date. He said he would not change my due date and would allow my baby to stay in there until a full 40 weeks. I was relieved. I know it's best for her to camp out as long as she wants to, and I don't want to force an eviction earlier than necessary. I mentioned the rogue contractions I seem to be having, and he said he's only concerned if I'm having more than 6 contractions an hour (right now it's about one a day). And lastly, he said he's not worried about my blood pressure because I wasn't spilling any sugar or protein. I just wonder how many high readings they'll allow me or if they're OK with it as long as everything else is OK.

I set my next appointment for 2 weeks from now, so I begin the expedited appointments until her arrival. I'm so glad to know that my daughter seems to be thriving in there, it gives me a peace that I'm doing a better job than I give myself credit for. Doctors are doctors, and I'm not sure I'll ever be settled with being there. I just wish they had more comfortable beds or something to watch.

Settling Out

I like this view.

Thanks to some recommendations that I received on my last post, this last week of blood sugar management has been a lot better. In fact, I went a whole day without crossing my high threshold on my Dexcom (160 mg/dL). So I want to thank everyone who offered great advice or simply said, "It's OK. You can do this."

The main suggestion that I'm following is keeping my old site in even after I put in a new one. I take the cap from my new site packaging, put it on the old one, and keep it on there for at least 12 hours. Ideally, I would like to change my site before bedtime to give it the most time to get "wet" before I try to bolus for a meal. But of course the units don't always line up that way. I have succumbed to giving myself injections when I have to change my site right before a meal, but I'm weary of doing this because I really like the "Active Insulin" feature on my pump. I like knowing how many units I have on top of my basal rates, especially before I go to bed. Because despite the huge amounts of insulin I'm taking compared to pre-pregnancy, I still struggle with nighttime lows.

Speaking of basal rates, I'm currently streaming over 32 units/day (my pre-pregnancy rate was 18 units/day). It seems I need a good increase in my rates at least once a week. So I've been increasing my rates by the lowest amount (0.05 units/hour) every 3 days. Combined with my current insulin:carb ratio that is set at 1:6, I'm going through cartridges every three days or less. I've learned to keep a site change set with me at all times because I tend to forget about it until I get my "Low Reservoir" warning, which doesn't leave me much time to cruise on the units I have left. I expect these increases to continue until the last month of my pregnancy, based on what I've read from other type 1 pregnancies.

On the regular pregnancy front (as if there is such a thing), I am getting bigger and definitely more uncomfortable. As of this morning, I broke the 25-lb. threshold from my pre-pregnancy weight. I told myself in the beginning that I wouldn't worry about the number as long as I and baby are healthy, but it is really hard to see that number (and to think about losing it all later, eesh). I have to sleep with a body hug pillow every night to ease the middle-of-the-night cramps that have plagued me for the past few weeks.  Also, I believe I felt my first Braxton-Hicks contraction last weekend. It wasn't painful or uncomfortable, but I definitely noticed it. I've got another appointment on Monday for my 28-week checkup that will include another ultrasound. And I'm very excited about this appointment because it's been 10 weeks since I've gotten a look at our little girl. After this appointment, I'll start going every 2 weeks. So I need to restock my Nook for all that time I'll spend in the waiting room.

I'm officially in the third trimester now. The home stretch, the light at the end of the tunnel, the final lap, etc. I'm getting less freaked out about this whole pregnancy thing, and more freaked out about the whole parenting thing!

High Days are Low Days

I don't know what's going on. But every three days, like clockwork, I keep having these extreme highs. Not coincidentally, these highs line up with my site changes, so I feel like there's some time that my body needs to get used to the new site area. The first meal that I have following a site change will have me soaring into the 300s like the insulin I gave was nothing. And I spend the next few hours either crying, frustrated, and rage bolusing or some combination of all three.

So I'm contemplating not changing my site immediately when I run out of insulin like I usually do. I'm thinking of changing the reservoir but keeping the site in my skin to avoid the time my body needs to get used to a new site. I know some people change their site every 3 days to avoid absorption issues, but I seem to be having the opposite effect. Pre-pregnancy, I could fill up my 180cc reservoir and make it last 5-6 days, and I've never had a problem with absorption on the last day. With my basal rates up to over 27 units a day and my insulin:carb ratio at 1:6, I'm barely making it three days. As for when I do change my site, I'm thinking I will switch to injections for the first 12 hours for meals because insulin always reacts more quickly to an injection. These are all just tentative plans. I have no idea if this will work.

I know that having rogue 300s now and then are not that dangerous in the long run, but rather the sustained highs for several hours. But it is so, SO hard not to feel emotional when I see that number staring back at me. It might as well have said, "You failed." The emotional aftermath of having type 1 diabetes and being pregnant was something I was not prepared to handle. Trey and I talked last night about spacing out our kids (if God-willing we're blessed with more), and I said I feel like I would need time to recover emotionally more than physically. The guilt, the shame, the frustration with each bad number has drained me. I can't help but feeling like each bad number is hurting her, and I want to fast-forward to getting her out of me.

In the meantime, I'm trying to keep my eye on the prize. I know she's in there because she kicks all the time! The nursery is prepared, and the car seat and stroller have been purchased. I want to know that she will be OK and that I will survive this emotional roller coaster.

I'm ready to put her in here and run away!

24 Weeks: Tunnel Vision

I am 24 weeks pregnant this week. And the cruel reality that I'm 6 months pregnant but I have 4 to go has hit me. Even though I'm over halfway through this pregnancy, I feel like I have a long way to go. Namely because I discussed my labor plans with my OB and endo this week, which means I have to think about her actually being here and that stresses me out because the only thing we've done is paint her room. (Actually, Trey painted. I'm banned from all paint fumes, and thus her room for the next few days.)  This post is rather long, so I'll try to break it up into each appointment to give any readers proper intermission breaks.  

OB: 

My OB appointment last week was filled with more questions on my part.  I'm pretty sure I talked more than my OB, but he's a patient guy and willing to indulge me for my sanity.  The appointment started out the same as all the others:  pee in this cup, step on this scale (I'm up 20 lbs total), sit here while we take your blood pressure (122/70).  This was the first appointment where Trey didn't accompany me, and it felt weird.  I told him he was welcome to come to any appointments he wanted, but he was busy with grad school shenanigans so I was flying solo this trip.  The nurse used the Doppler to find my little monkey's heartbeat, which was whump-whumping at 163 bpm.  She cooperated a little more this time, but I think she's running out of room to escape the intrusive wand.  

The doctor came in and he immediately noticed my list of questions on my iPod sitting in my lap.  "Go ahead.  Fire away."  The first thing I asked him was the plan for the rest of my appointments going forward.  He said the plan is to keep seeing me once a month until 28 weeks, then I'll go to every 2 weeks until 36 weeks.  After that I'll be going once a week to check my cervix (sorry, TMI) and baby's position for upcoming labor.  In addition, I'll also be doing non-stress tests 2-3 times a week starting at 37 weeks.  So for the last month of my pregnancy, I'll be camping at the doctor's office at least 3 times a week.  (I think I'm gonna go ahead and start my maternity leave then, because I'll be spending more time with the doctor than at my own office.)

The next thing I asked about was the plans for labor.  My OB said the current plan for me is to get to at least 39 weeks, but he will not let me go past 40 weeks.  He doesn't want me going into labor on my own.  Considering my mother didn't go into labor with me and my brother until 43 and 42 weeks, respectively (What were doctors in the 70s and 80s thinking, anyway?!), it's a good assumption that I will be induced.  His reasoning for this is that he wants to keep an eye on my numbers from start to finish.  I'm sure I'll do that on my own, especially with a CGM, but he'll be able to give me guidance on insulin dosage depending on what stage of labor I'm in.  He also wants me to keep my pump on during labor (thank you! thank you! thank you!), and I'll be allowed to treat lows at my leisure with juice or whatever to eat (so no glucose drip, yes!).  

At first, I was kinda "eh" about not being able to go into labor on my own.  I'm not a natural childbirth advocate or anything, and I've already said that is not the most important thing to me.  But I hate feeling like I don't even have the option.  But such is the life with diabetes.  Bottom line:  there are certain things I'll never be able to do because of this stupid disease like join the military, become an astronaut (even though my friend April is going to break that rule), and be allowed to have a granola experience with child birthing.  Now that I've had a few days to think it over, I'm at peace with this plan.  I'm more comfortable with things being planned in advance, and I know my doctor won't force my body to do something it's not ready for (I do trust him, by the way).  And I'd rather have time to get used to being induced and research it before that day arrives.  So it looks like May 28th is the absolute latest for my girl's birthday, or earlier depending upon induction date.  

ENDO:  

I also had an endo appointment yesterday.  I knew my numbers were still solid, but I didn't expect to hover around the 5.1% A1c I had last time.  In fact, my A1c crept up to 5.4%.  The nurse assured me that this is still a good number for pregnancy, but it's obvious that my insulin resistance is beginning.  I've increased my basal rates by 3 units this week alone.  But I also know that my number of lows has decreased dramatically.  So I'm taking this increase as a sign that things are settling out more than "OMG, need more insulin now!"  And I'm all for less lows.  

My endo and I discussed my numbers and my recent ER visit.  I told him my OB's plan for inducing me, and I asked him if he had any plans, insulin wise, that I should be aware of.  I was a little surprised, because my endo told me that once I start having contractions I should suspend my pump.  *insert confused face here*  He explained that the uterus is one big muscle, and once it starts contracting it's like going through one long workout.  And I always suspend my pump if I'm going to workout, so the logic makes sense.  I just can't imagine going through such diabetes maintenance for 9 (10!) months just to say "Goodbye, pump!  See you in a few hours!"  He said even if I suspend my pump, it's still possible for me to see a lot of lows.  I'm still wrapping my head around this plan, and a lot of it will be making decisions hour-by-hour.  But right now I'm still walking around whispering "No pump?  No pump?"  I'm sure people think I need a white jacket. 

FINALLY: 

And finally, I have one big concern that's bothering me:  my belly button.  I've always been sensitive about my belly button.  I don't like anyone to touch it because it feels weird, like a dead sensation where there's no nerve endings but I know someone's touching and I don't like it!  It drives Trey crazy because he thinks I have a cute belly button, especially now because it's pushing out into an outie.  Well, it's like a half-outie at this point.   The top part is pushing out, making my stomach look like a face with no eyes or mouth and a weird looking nose.  And so that dead feeling is a constant because my belly button is rubbing on my tight shirts and maternity pants.  I know that pregnant bellies are beautiful and people want to touch them, but I'm not liking this, not one bit. 

 

My (whoa!) belly with said half-outie. 

So to recap:  baby is still in there (she moves all the time!) and doing great, both of my doctors are aware of the plan for the rest of my pregnancy and potential labor, and my expanding belly is sporting an outie belly button.  I hope you've enjoyed this super long post, because I need a potty break (something I'm doing every hour I'm awake). 

Don't be Afraid to Pee

Well, this post is by far the most embarrassing post I've ever written.  It seems that everything is on high alert with a diabetic pregnancy, or maybe just in my mind.  But the two questions my OB always asks me at my appointments are "Any bleeding?" and "Any loss of fluid?"  I didn't really understand what "loss of fluid" was, so I asked a nurse to clarify.  "Oh, it will feel like you peed yourself."  Lovely.  So be prepared for an extremely TMI post. 

This past Sunday, I was sitting in church and listening to the sermon, which was titled "Do Not be Afraid".  We're currently doing a sermon series on trusting God and not being afraid of death, rejection, etc.  When we stood up to sing the last song, I felt this "gush" of liquid.  I turned to Trey and said, "I'm going to the bathroom".  I'm sure he thought I was doing the typical pregnancy thing of going to the bathroom every hour or something.  

In the bathroom, I checked but couldn't tell if anything was wrong.  I called the on-call doctor as soon as we got out, and he said it might be urine but said to keep an eye on it for the rest of the day.  If it was my water leaking, it would be continuous and not one time.  Having my water break this early is a scary thing because it means my baby would have to be delivered within 24 hours, not OK with me!  So I cautiously went about my day, cleaning the house for a Super Bowl party.  I also laid down for a nap later, and still no more "gushing", thankfully.  

I called my doctor's office the next day (yesterday) to see if he confirmed the on-call doctor's instructions.  And I wanted to at least let him know that I had this issue.  He said if it happened again to go straight to the hospital to be monitored.  I wasn't sure if I could take this as a relief or instruction to be more cautious and aware.  

Yesterday, I went about my day, trying to ignore what didn't happen the day before.  I took the dogs for a walk, and Trey and I went to dinner with some friends.  When we got home, I tried to decipher if things were more "wet" than normal.  It could have seemed like more from sweat from my walk or more pee or more whatever.  I finally settled to just go to the ER and have them check me out, since that was my doctor said to do if I felt that it occurred again.  

After being admitted, putting on a gown, getting hooked up to a fetal monitor, and answering the bazillion questions required to be admitted as a patient.  They took a swab to test to see if what I was experience was my water leaking or something more embarrassing but less scary.  

I hung out in my labor and delivery room (somewhere I didn't expect to be for very long time) and watched Castle while I waited for the results.  It was getting really late at this point, and I started to feel silly for creating an ordeal for something that is probably all in my head.  The nurse came back and said, "Well, it's not amniotic fluid."  

So they let me go home with instructions to come back if I felt anything like that again and assurance that I did the right thing.  That helped, because I was feeling extremely embarrassed for spending two hours in the ER over the fact that I simply peed myself. 

I Still Get Scared

You'd think being 23 weeks pregnant with a lively, kicking baby would make me feel like I'm "in the clear" as far as anything happening to her or losing her.  But I admit that I still get scared, of what I don't know.  I just never fully shook the feelings of the first trimester when I was in the "danger zone" until that first appointment.  I felt good after that appointment, until a few days before the next one.  The day and morning before an appointment, I'm a wreck.  I am so overcome with anxiety and worry.  "Is she still OK in there?  Is she getting too big?  Is she too small?  Why haven't I felt her move in awhile?  Is that stubborn high from last night going to do something to her?"  

But as soon as I hear her heartbeat, my fears are instantly eased.  My mood leaving the OB's office is a 180 degrees from coming in.  I'm good for a few days, feeling confident and less like I'm a high risk pregnant woman.  But then the cycle starts all over until my next appointment, which is tomorrow.  So you understand where this post is coming from now? 

The other thing that makes feel scared all over again is if I have a bad day with diabetes.  Like yesterday, I got to work and glanced at Constance before I ate my yogurt, and I also looked at my 24-hour graph and I had only gone high once in the past day (and just for the record, my high threshold is currently set at 160 mg/dL, tight control is a beast).  I was feeling pretty good about everything.  The little monkey inside me was extremely active the day before, my numbers were good, and I am sporting a nice baby bump that feels huge to me but everyone else says is "so little".  Then I went to lunch with my husband and a friend and we picked a Chinese buffet.  (You can see where this is going.)

I didn't go crazy at lunch.  The most carb-heavy things I had were some fried rice and some ice cream for dessert, other than that I stuck to my obsession when it comes to Chinese food--egg drop soup, delicious and low carb.  I SWAG bolused for the meal and added a few units that I call the "pregnancy factor", but I still ended up with a stubborn afternoon high that took me several hours to come down from.  I got scared, and the first thing I want to feel when I'm scared is her kicking me or jabbing me or anything that says, "Hey, Mom, I'm right here and I'm OK."  

It seems that I need to be on my game everyday to avoid these episodes.  Test my blood sugar, take my insulin at least 30 minutes before I eat, know the carb count, correct for lows without over-correcting, exercise.  I feel like if I slip in any one of these areas that everything falls apart.  I didn't get back on track until this morning, and I'm carefully watching my CGM like I did the first week I had it.  I don't like feeling like I can't handle one slip-up without a major emotional breakdown.  

I'm hoping my appointment tomorrow will put me at ease, that I can get back to feeling confident with this pregnancy and ready to do my victory lap of conquering a diabetic pregnancy once she's here.  Because after tomorrow's appointment, I can officially pack the hospital bag.  Not that I'll be expecting to use it for a very VERY long time, but her rate of surviving outside the womb goes up after 25 weeks.  Maybe once she's here I'll stop worrying . . . right . . . RIGHT?!?!?!?!?!!?

Meeting the Pediatrician

So per my OB's request at our last appointment, we started the process of trying to find a pediatrician.  The way we went about this was contacting our insurance company and getting a pre-approved list of pediatricians in our area.  It was really important to me to meet with a pediatrician first before I decide to go with them.  I had a ton of questions I wanted to ask, and I really didn't want to wait until my little girl is here before we do that.  Surprisingly, only one doctor on our list agreed to meet with me for a prenatal appointment.  I find this a little disturbing--that doctors won't agree to talk to new parents about their practice.  Apparently, it's not good enough to see me because I won't have to pay a copay.  Oh well, I just hoped that this one doctor would ease my fears and answer my questions.  

You'd think I would learn not to schedule an appointment for 8:15 AM, in rush hour, across town.  I was trying to follow the directions on my iPod while sitting in bumper-to-bumper traffic, trying not to stress out (too late).  But somehow, I managed to pull into a parking spot with 5 minutes to spare before my appointment time (after leaving the house 40 minutes earlier).  The place was extremely open and colorful!  It's been a long time since I've been to a pediatrician's office, but I couldn't stop staring at all the bright colors and crayons on the wall with the doctors' names on them.  They called my name (actually they called my unborn daughter's name, which was so weird and exciting to hear!), and they sent me back to a  waiting room. 

Of course, in my rush to get to the place on time, I forgot my list of questions in my car.  So I was praying that I could remember them all, or at least enough to make me feel confident in this doctor.  She comes in, extremely bright and cheerful.  I introduce myself and she tells me to go ahead with any questions I had, then she would tell me a little more about the practice.  I started firing off the questions as fast as I could because I wanted to get them out while I remembered them.  I hope the doctor didn't think she was on some rapid-fire quiz or something.  

I'm type 1 diabetic.  What, if anything, do we need to do for her?  Obviously, watching her blood sugars post-birth will be an issue, but the NICU pediatricians will do that if needed.  Other than that, we'll just keep an eye on her if any symptoms pop up (which I know by heart), but no blood screening for potential markers or anything like that.  She also said that her getting milk (either by boob or formula) for the first 6 months was very important, more so than when she starts any solid foods.  Having that good nutritional foundation is key.  I'm also glad she said either breastfeeding or formula would work, because I don't want any added pressure to be a good breastfeeder when it might not be physically possible.  Plus, I was breastfed and my brother wasn't, yet I'm the one with type 1 diabetes--it really is just a crapshoot.  I briefly mentioned tinkering with a gluten-free diet to add in that extra variable of protection, and she said she's fine with that but didn't say one way for or against. 

I got the feeling that my daughter would be treated the same as if any other child whose parents weren't diabetic.  I'm not sure how I feel about that right now.  On one hand, if we did do the blood screening early on and saw she was destined to have type 1, then there's not much we can do other than wait for the inevitable.  But I also don't want to spend her whole childhood watching her and following her around with my meter.  If she gets it, she gets it.  There's not much I can do.  I'm fine with this decision, for now.  

How do you handle frantic phone calls in the middle of the night or outside of office hours?  This was really important to me, because being a first-time mom is all about figuring this out and going "HELP!" at the same time.  Basically, there will always be someone at the other end of the phone, either a nurse or the doctor on call.  They like to at least talk with parents over the phone first before going to the ER, because exposing kids to everything in the ER is worse than just waiting for an appointment the next day.  I couldn't agree with this more!   But if going to the ER is necessary, they coordinate it for you so that someone is waiting on you when you get there.  

We are going to a couple weddings within a month after she's here.  I posed this more as a statement than as a question.  I didn't want her to think that I was considering NOT going to these (one is for a fellow DOCer, anyway!), but I wanted tips on what to do with taking such a new baby out to the "real world".  She applauded me for planning to go and said to just ask anyone who wants to hold her/touch her to wash their hands first.  So I'm going to be "that mom" at those weddings--armed with a gallon of hand sanitizer and bags under my eyes from very little sleep.  Party on!  

Overall, I felt really good about this doctor.  I still have the feeling that I'll be the one calling the shots on her medical care, which I prefer.  I can't stand pushy doctors.  I want to feel like we're all a part of a team, much like my plethora of diabetes doctors.  I want to feel like we can discuss things together, combining the powers of mother's intuition and many years of medical practice (getting a visual a la Captain Planet).  

As I was leaving the office, I was handed a goodie bag of diaper cream and formula samples.  Now I'm ready!