Happy Birfday to ME!

So today is my birthday, and I had an endocrinologist appointment this morning. I didn't exactly want to go to the doctor on my birthday, but my endo's office has very little wiggle room in their schedule. So I went with the hopes that my 8:30 AM appointment wouldn't ruin my first day on my 27th year here on Earth.

The one happy thing I got for waking up that early: SNOW!!! I don't know if we've ever gotten snow this early in Alabama, but it was a beautiful site to wake up to this morning.


I got ready and headed out the door with my thermos full of decaf coffee and freshly place antlers and red nose on my SUV (What?! It's Christmas season, right?). I knew today was definitely my birthday because I got a parking spot on the lobby level of the parking deck, which means I didn't have to travel the four levels, uphill on wet pavement to find a spot.


I signed in and took my spot in the very empty waiting room. Apparently, some patients canceled their morning appointments due to the snow. They called me back right at my appointment time and took my weight. So far, I've only gained 2 pounds since I found out I was pregnant, and I'm 14 weeks along. I'm not sure how I feel about that yet. I mean, I fear the overall weight gain and trying to lose it when the baby is here, but I want to make sure the baby is well-fed while he/she is being baked. My nurse assured me it will go up and I'll certainly be miserable about it by the end of my pregnancy.


Next came the blood pressure check, which I have come to absolutely dread. I've had "above normal" readings for almost a year now that I just come to expect it and justify it with white coat syndrome and move on. But to my surprise, my reading was . . . normal, on the low side: 108/72. "That's good," I said as the nurse put the sleeve back in its holster. Either I'm starting to master white coat syndrome or the lack of caffeine is having a positive effect on my blood pressure.


She started spinning my A1c while downloading the readings from my new pump. We made small talk about Black Friday and baby stuff while I watched the timer go down on the machine. Finally, the machine finished and I got my A1c:

I'm proud of this number, but I'll admit that most of that number has been from lows. I've been tolerating them for the sake of baby, but I don't know how normal diabetics (ha! that made me laugh) tolerate this number all the time. I can't wait until I can get back to the 6s without guilt. My endo agreed that I was having too many lows, even in the short number of readings from my new pump. So we increased my basal rates for now, but we're expecting it to go back up in the next few weeks when insulin resistance hits.

So to recap: snow, killer parking space, stellar BP and A1c reading. All of this before the snow melted. I think 27's gonna be a great year.

Blogging over at Diabetes Sisters

I am excited to announce that for the next 6 months, I'll be guest blogging at Diabetes Sisters as their pregnancy blogger.  You can check me out over there for a weekly update.  I'll still be blogging about my pregnancy here, and will include most if not all the same information for each post.  But my posts here will continue to have that "Holly flair".  

My first post is up, so check it out and let me know what you think!  

Twelve Weeks

Yesterday, I had my 12 week appointment with my OB.  I'm beginning to think I need to check out some apartments behind the doctor's building, seeing as how I will be living there soon.  We kicked things off by taking a look at our baby on the ultrasound.  He or she was doing great in there!  Their heart was fluttering away at 154 bpm, and they are measuring a little ahead for the size of a normal 12 week baby, which means they are probably taking after their 6'3" daddy.  Their size is strictly related to its length, not girth.  And has nothing to do with diabetes.  ;-) 

Next, I had to get my blood pressure taken and give samples (urine and blood) for testing for protein and baby-related stuff.  My blood pressure was a little high (not officially high, but just higher than normal), but I attribute that to white coat syndrome and the fact that they took FOUR (count 'em, 1-2-3-4) vials of blood from me.  Even though I'm diabetic, I hate LOATHE having blood drawn.  I don't know what it is, but the whole feeling of having a needle sticking in my vein makes my skin crawl.  I just sit there, my head turned and my eyes closed and try not to think about the needle getting loose and my blood spraying all over the nurse and the walls.  By the time the nurse was done, my whole body was shaking from the experience and the sight of 4 vials on the table.  

The final thing was the state-mandated vaginal swab for chlamydia and gonorrhea.  I understand it's something that they have to do, but there's something funny about having my husband sitting in the chair next to me and getting tested for STDs.  I think I was getting a little drained (literally) from the appointment, because while we were waiting on the doctor to come in, I started getting low.  I wonder how many other patients have sat on the same table, pants-less with a paper skirt, while chewing on tropical fruit glucose tablets.  Probably not very many. 

The doctor came in and we discussed my good ultrasound and my BP reading.  I explained that whenever I test my BP on my own that it's never that high and that it must be a doctor thing because I always get nervous at my appointments, to which my doctor said, "Yeah, stupid doctors."  He said he's not concerned about it at this point, but he would keep an eye on it for sure.  He was more elated with my last A1c (5.5%) and said that was the best thing I can do for a good pregnancy.  He said I was his healthiest diabetic pregnant patient in his office--I guess that's an award to be happy about.  We briefly discussed me getting to keep my pump on during labor, even thought that's a lifetime away at this point.  But he said he's more comfortable with my pump than an insulin drip.  +1 for the good doctor. 

I received a goodie bag with all the information about the maternity centers at each hospital and several baby magazines.  It was like a "Welcome to the 2nd Trimester" club package.  We scheduled my next appointment for 2 weeks before Christmas (holy cow, where has this year gone?!)  and I went to refill my blood supply with a steak burrito.  

Now that I'm about to enter the 2nd trimester, that means my expansion is coming on quick.  My pants are getting tighter and trying to button them requires some effort.  I feel like I'm walking around with a bloated, post-Thanksgiving dinner belly.  My engineering husband has taken on the project of measuring the outward growth of my belly on the baby's unpainted bedroom wall.  I've grown a half inch in one month, which surprised me for some reason.  The growth of my belly is a lot more progressive than I thought.  I'll find myself rubbing my belly at random times, which I'm sure is puzzling to strangers in the grocery store. 

Yeah, don't make fun of the pants.  They have pockets, hence their functionality. 

Besides the vampire nurses and feeling like a glorified lab rat, I feel absolutely blessed right now!  This is my favorite time of year with the holidays right around the corner and enjoying the food, family, and friendships.  And the other day I got a little teary eyed about doing it all next year with a baby on my hip.  And the fact that we'll have to buy another stocking to go on the chimney.    

I'd thought I'd end this post will a little photo of Ferbie.  Right now it looks like a little alien, teddy graham baby, but they look cute to me! 

"Hello there, DOC!"

Disconnected

This past weekend, my husband and I took advantage of the long, cool weekend and went camping. For us, camping means sleeping in a tent and cooking over a fire or a propane-fueled grill. It was the perfect weather with cool 30 degree nights and calm 70 degree days.

Each day we took a hike through the beautiful scenery. The first day was only a 1.5 mile walk that left me at 38 mg/dL and draining a can of lemon-lime soda. The second day we planned for a 3.5 mile hike, so I did a little more pre-planning before the walk. I disconnected my pump completely about 30 minutes before the hike and packed some granola bars and glucose tabs to have just in case.

About halfway through our hike, we found this ginormous oak tree! Pretty sure it was the biggest tree I've seen in real life.  Trey got a picture of me at its base for a nice perspective. 

Holy Oak Tree!!!

At this time, we took a break to split a granola bar and a mini-bag of pretzels. Still un-pumped, we continued our walk back to camp. By the time we got back, I had been disconnected for over 2 hours, with a granola bar and a handful of pretzels, and my blood sugar was 133 mg/dL. Seeing that number was almost as beautiful as the fall leaves. Almost.

There were some scary moments during the trip, too. Like getting my first ever "TEMPERATURE WARNING" on my meter after the first night of 30 degree temps. I had to keep my meter in my jacket pocket so it would keep warm. There was also the time I woke up drenched in sweat (at 31 F, that's a cool wake up) and finished off my jar of raspberry glucose tabs and a bar of chocolate that was reserved for smores. I woke up later at 95 mg/dL, thankful that I decided against bolusing for the chocolate bar.

Camping also seemed to agree with my pregnancy symptoms, or lack thereof during the trip. The relaxing atmosphere and fresh air pretty much ceased my nausea and fatigue. If I could live in the woods for the rest of my pregnancy, I would. So long as there's a fire.

A1c Thoughts

When I found out I was pregnant and excitedly told my endo, the first thing he did was increase my basal rates 0.1u/hr.  This increase made my daily total jump from roughly 16 units to almost 20 units.  This puzzled me at first, because I had only heard of the plaguing first trimester lows associated with a diabetic pregnancy.  So I thought my basal rates should decrease or at least stay the same.  My endo warned me that I needed to arm myself constantly with fast-acting carbs for these oncoming lows. 

For the first few days after that appointment, I followed my low-treating guidelines by the book.  I religiously corrected using the 15/15 rule with scary precision.  But I kept correcting, and kept correcting, and kept correcting.  Eventually, I got tired of constantly correcting with oh-so-perfectly measured glasses of juice or exactly 4 glucose tabs.  Especially in the middle of the night, low correcting rules go out the window.  My low treating method became something like this:  drink enough juice that gets rid of the shakes, eat a tablespoon of peanut butter, chase with more juice or chocolate milk.  I'll admit that this resulted in some scary rebound highs that left me crying and vowing never to go outside the rules again. 

Things seem to finally be settling down and my 24-hour window on my CGM doesn't look like the cutting side of a bread knife.  Part of the resolution is learning my limits when correcting lows (like filling a glass of juice is always less than drinking it straight from the jug) and maintaining a constantly grazing schedule (like every 2 hours or less, seriously!). 

I know that being friendly with lows is good for Ferbie at this point in my pregnancy, and I'm quite proud that my A1c is in the 5s for the first time since I went on the pump.  But I must admit I could not do this everyday for normal diabetes management.  I know that everyone's comfort zone for A1c is different, but I feel the best when I land between 6.0-6.5% for my A1c.  Higher than that means I am hanging out on my higher end too much, but lower than that means I am spending a good majority of my days being low. 

I am coming to the conclusion, though, that the A1c holds a lot more value than it should.  My endo might give me a "Good job!" with an A1c of 5.5%, but looking back at the past month in my meter log shows that my body is roughly 50% apple juice.  I really put more value in my quarterly blood work for my kidneys and cholesterol, my yearly eye exam, and my overall "feeling" of health.  As long as those things get an A+ from all the medical personnel, I don't think it should matter what my A1c is when they happened. 

What Makes My Heart Skip a Beat?

I had never been more nervous for any appointment than I was before our first ultrasound appointment.  I don't know why I was so nervous.  I suppose because up to that point, it hadn't been "real" yet.  Sure, I had been puking like a champ everyday for two weeks, but the idea of actually having another life inside of me hadn't hit me.  I was also worried that things weren't going to be 100% perfect--a product of living with an imperfect condition, I guess. 

The nurse called us back to the ultrasound room where I hoisted myself on the table and held my breath.  The entire room was dark except for the screen facing away from me, towards the technician and Trey.  I waited anxiously while she looked for the baby and, more importantly, a little heartbeat.  A few seconds later, she said, "Oh yeah, there it is."  She turned the screen towards me, and what I saw absolutely took my breath away.  It was the tiniest little peanut with a flicker on the left side.  Seeing the heart actually move at its own rhythm caused me to instantly break out some tears.  Instantly, I felt the need to apologize.  "You're probably used to this, right?  Pregnant women crying?" 

She printed out a few snapshots of the little peanut for us to take home (which now are proudly being displayed on our refrigerator).  While we waited on the doctor, Trey and I kept looking at the pictures and smiling at each other.  This was real.  This was happening.  Holy crap! 

The doctor walked in and said, "That's a good looking baby!"  He let us ask a plethora of questions, from who should take over cat litter duties (Trey gets to take it on for the next 7 months. *score*) to how long before the puke fest should subside.  The last question I asked him was the most important one in my mind, "Have you ever done a type 1 pregnancy before?"  I knew my OB was high-risk, but this question was important because it was personal to me.  I needed to know his experience with "my kind". 

He looked at me, one eyebrow up, "Of course!  I've been around for over 20 years, and have certainly seen my share of type 1s."  Actually, he said that type 1s are usually some of his healthiest patients because they're diligent about their health before they're pregnant.  I've always loved my OB, but seeing him that day made extremely grateful to have him as my doctor in this process. 

We got to see little Ferbie (yes, my creative nickname.  better than "it".) again yesterday, and the little teddy graham was dancing in there like it was doing hula hoops.  I'm already proud of this little squirt. 

Sounds Like a Dinasour

Because of my diabetes, I'm automatically put in the "high risk" category for pregnancy. Therefore, I get to enjoy all of these extra tests, beginning with blood work immediately after I find out I'm pregnant to see how "pregnant" I am. The two variables they check are hcg, which basically measures how the baby's growing, and progesterone, which measures how my body's supporting the pregnancy.


They did back-to-back bloodwork to make sure my levels were doubling or at least rising. I'll be honest and say I didn't know anything about these variables or what they should be during pregnancy. All I could think of was that "progesterone" sounded like a name of some dinosaur.


 

"Rawr, I make babies grow."

My first results were fine, right on schedule for where I should be. But my second results were less than stellar. My hcg levels were fine, almost doubling from 500 to 970. But my progesterone levels actually went down from 18 to 12.


The nurse prescribed for me to go on progesterone supplements to get my levels back up above 15. Even though she said it is normal for those numbers to go down, I was still freaked out. If this is normal, why am I being put on supplements? I googled progesterone levels and what they should be at this point in my pregnancy. Big, big mistake. Never ever google anything related to your health, especially pregnancy. I pretty much scared myself into stressing out and crying at random times (of course, that could be the pregnancy itself). I was also dealing with a weird complex of taking these supplements and wondering "Am I not woman enough to carry my own child?"

I went back in for more blood work the next week to make sure my levels were still rising. I had to wait 24 hours for the results: torture! I had less than a day's worth of supplements in me, so I was worried about the time between my last blood work that was 4 days ago. However, I got the best call the next day. "Hello Holly? Your results are wonderful. Your progesterone increased to 25 and your hcg increased to 9,000!" I was so relieved! The next set of blood work they took the next day made the nurse sing, "Your results are out-stand-ing!" Progesterone stayed the same at 25 (the nurse said that was fine) and hcg increased to 18,000.


These results made me so relieved! Also, the fact that my progesterone levels doubled in 4 days mostly from me (and not the supplements) made me feel a lot better. And the fact that the hcg levels (a.k.a the baby) increased out-stand-ing-ly made me feel like he/she is doing great regardless of my shortcomings.


All in all, I'm somewhat grateful to be placed in the "high risk" category because of my diabetes. It means I get the comfort of extra monitoring and testing that lets me know that the baby and I are doing OK. It can be stressful if there are any hiccups, but the doctors can do their thing to help me or the baby before anything bad happens.