Midnight Low Etiquette with/as a Houseguest

Late night lows are no fun.  They make me lose sleep, I consume extra calories that I don't want to, and I worry afterward about over-correcting.  My usual routine for late night lows is to shift out of bed, stumble down the hallway to the kitchen, drain some juice until I stop shaking, and follow it with some peanut butter (the only tasty saving grace from a low).  This stumbling routine is fine with just me and my sleeping husband in the house.  However, it's a whole different game when we have guests at our house or we're guests at other people's homes.  

We normally have guests sleep over about once a month, usually out-of-town family members.  Most of the time, guests stay in our guest bedroom that is closed off from the hallway and my stumbling ways.  However, we sometimes have enough guests that a few people have to snag a couch in the living room, right in the path to the kitchen from our bedroom.  So handling lows during this situation requires a little more thought, something that's hard to do with low brain.  

First of all, I have to remember to get appropriately dressed before I walk through the house.  I don't like pajamas, never have.  But I try to remember to wear . . . something . . . when we have people over, but it's hit or miss.  But that's why God (and The GAP) invented robes.  But putting on a robe is exactly what I want to do when my body is drenched in sweat (/sarcasm), but I do in case I happen to wake anyone sleeping on the couch.  I also have to be careful about turning on any lights, which I tend to do at each turn when it's just me walking through the house.  This is where that trusty light function on the pump comes in handy.  And to avoid that bright refrigerator light, I will go for a banana sitting on the counter top instead of juice.  Then I stealthily grab the peanut butter from the cabinet and a spoon from the drawer and head back to my bedroom.  Thankfully, I've never woken any houseguests (that I know of) or they haven't mentioned it the next morning.  

The other side of this scenario is when we're staying at someone's house as a guest.  Most of the time, this scenario is either at my or Trey's parents' house.  In both cases, the guest room is closest to the kitchen.  So I do the same SEAL-like operation but in somewhat unfamiliar territory.  And I usually settle for whatever I find to treat my low--cranberry blackberry juice cocktail with a granola bar?  Sure!  One time, I was looking for a piece of bread to munch on after drinking some juice at my in-laws.  I happen to wake up Trey this time and he walked into the kitchen, sleepily looked at me and said, "What are you doing?"  I was trying to open a pantry with no handles.  "I'm trying to open this thing but there's no handles and I'm really low and want to sleep where's the peanut butter sad face."  He helped me open the magic pantry and we found some bread on the middle shelf. 

Now, some people may ask why I don't just resort to glucose tabs in these situations.  Here's the thing:  those chalky tabs don't work well enough for me.  Even if I can get up from a low with those things, I still need some good protein to follow them to keep me from crashing again (hence, peanut butter).  I have a jar of those in my purse, but I save them only for when I'm trapped somewhere without juice or money and access to a vending machine.  There are truly a last resort treatment option for me, and it's worth the risk of pouncing through the house in the middle of the night in my underwear to avoid them. 

30 Weeks: More of the Same

Things are starting to speed up on the pregnancy front these days.  I've began going to my OB every two weeks, and I'm still seeing my endo once a month.  So that means I have an appointment every week for 3 weeks out of the month.  But my appointments are as quick as going through a revolving door.  It seems that each appointment is simply checking for any problems (blood pressure issues, protein in my urine, weight check) and sending me on my merry way.  Thankfully, nothing is sending up any red flags, so I'm in and out very quickly.  

Endo:  

I had my 7 month endo appointment last week.  I wasn't that worried about my A1c because my numbers had been pretty stable over the past few weeks.  I've got into a groove where I'm changing my site every 3 days or less, leaving my old site in for a few hours to prevent any highs, and steadily increasing my basal rates once a week.  I've been in this groove since about 25 weeks, and it seems to be working.  Even though I have my bad days, I wasn't worried about the result because I had had an ultrasound the week before and I knew my little girl was growing as she should be with no evidence of diabetes on her.  So even if my A1c had crept up a little bit, my baby was not suffering for it.  

After waiting the excruciating 5 minutes watching the machine count down to 0:00 for my A1c, I was surprised to see that it actually went down to 5.3% (from 5.4% a month ago).  And considering that this A1c is mostly the 2nd trimester when my insulin resistance started to kick in, this A1c represents less lows and more control.  A major win!  My endo was, of course, pleased with this number.  He made some recommendations for changes to my pump, but to be honest I'm taking them all with a grain of salt.  He always wants to prevent lows for me as much as possible, but I'm not going to worry about it with that A1c.  That might make me a non-compliant patient, but sometimes I trust myself more.  Kids, don't try this at home (see Disclaimer below).  I made my next appointment with him for a month from now, which might be my last appointment with him before my little girl's arrival!  

OB:  

Yesterday, I had my 30 week appointment with my OB.  Due to some changes for me at work, I switched from morning appointments to afternoons.  So my wait was considerably longer due to the domino affect of previous appointments getting behind, but I don't mind when I know my doctor will give me as much time as I want.  Sign of a great doctor!  

The appointment started out with my usual "deposit" in the bathroom.  And I was surprised when the little cubby hole where I put my sample already had another cup in it!  Now I know why the nurse always asks me to label my cup before I fill it.  I mean, could you identify your pee if you had to?!  

Next was my weight check, which is getting more depressing each and every time.  I'm up a total of 31 lbs. so far, and I originally wanted to cap my entire weight gain at 30 lbs.  I still have 10 weeks left, so I can only hope that my weight gain at least slows down.  I told myself in the beginning that I didn't care what the number was as long as my baby was healthy.  But man that's hard when you see that number on the scale and require help getting off the couch (or at least a beginning roll to get some momentum).  Either way, as long as baby girl gets here safe and sound on the outside, I'll deal.  

Finally was my blood pressure check, which I loathe each time because it's always high at this office.  I have selective white coat syndrome because it's normal at my endo.  This time it was 140/80, but the nurse didn't make me lie down on my left side like last time.  That's only if the lower number goes over 80, so I was allowed to stay vertical until the doctor got there.  

The doctor comes into my room and greets me.  He asks me how my blood sugars are doing, and I gave him my report from my endo appointment and he was all smiles with that number.  He measures my fundal height, which came in at 33 cm--thank you, 5'2" stature--a little ahead but right on target.  He did make a note that my blood pressure has climbed a little bit over time, but he said he's not worried about it since my blood sugars, urine, and growth measurements are all fine.  If anything else was going awry, we might have to take some action.  But right now it seems to be a normal part of a high-risk pregnancy.  Huh?! 

I mentioned to him the swelling I've been experiencing in the past week or so.  I don't know if it's the summer-like weather or pregnancy or both, but by the end of the day my feet feel like they're going to pop out of my shoes and I have to move my wedding ring to my pinky.  He said it is simply a normal, annoying part of pregnancy that will go away after the baby is born.  The best I can do for now is to try and put up my feet as much as possible (yay!) and decrease my salt intake.  So I'm taking advantage of the weather and wearing flip flops as much as I can.  

I also brought up the fact that I have been having some contraction-like feelings throughout the day.  I really can't tell if they're Braxton-Hicks or not because I have no idea what "real" contractions feel like.  He said not to worry unless I'm having more than 6 contractions an hour, or one every 10 minutes.  I'm not sure if this will be the same rule when I get to full-term because my doctor has made it clear that he doesn't want me to go into labor on my own.  We'll see, I guess.       

Less than 10 weeks left to go, and I feel like I just want to hold my breath until she's here.  It seems like there's so much left to do (childbirth classes, showers, more and more appointments).  Being pregnant has become a full-time job, and one I'll be glad to give my two weeks' notice when it's time.  I'm so excited to have her here on the outside, I can barely wait. 

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!