New Lifestyle, New Basal Rates

Before I got pregnant, my basal rates were dictated by my schedule.  When I got up, how busy my work was, when I tried to work out most days, when I went to bed, etc.  So I had several basal rates throughout the day.  When I got pregnant, I stuck with one basal rate for the whole day, mainly because my rates changed so often that it was useless to try and nail down a change for every hour of the day.  

I ended up being way too aggressive with my rates, giving me a lot of lows, but I justified it with the little monkey growing inside me.  But now that my daughter is on the outside and it's been 5 weeks since my surgery, I'm finally starting to nail down some basal rates that actually mirror my new life.  

And what a life it is!  My new life revolves around this sweet little girl napping next to me.  Instead of going to meetings and spending most of my day in front of a computer, usually programming something in MATLAB, I go back and forth between changing diapers, feeding my daughter, burping her, and trying to do some housework while she naps.  And that changes everyday as she gets bigger and sleeps less during the day (but she's currently starting to sleep 6 hours at night, which I can function with).  

One disadvantage to being at home all the time is that there is an abundant source of snack food at my disposal, whereas when I went to work I would only pack what I needed to eat for lunch and a few snacks.  So I'm noticing that I tend to go high around the afternoons when my snacking tends to get the best of me and I may miss a bolus or two.  Plus, with breastfeeding I tend to stay hungrier all throughout the day.  It's like I have to eat right after she eats.  

Immediately after her birth, my endocrinologist instructed me to go back to my pre-pregnancy basal rate, which I tried to remember to the best of my knowledge.  But it looks like I need about 80% of that rate right now, which is mostly due to breastfeeding because I'm still +15 lbs from before pregnancy.  This rate is perfect overnight because I usually wake up around the 80s, but I definitely need more during the daytime.  

So now that monkey and I are starting to get into a routine, I'm finally starting to make some changes to even out my numbers.  Of course, I'm sure this will all change in a few months, because diabetes likes to do that just because.  Next week is my 6-week follow up with my OB, and that means I'll be able to released to exercise.  And that's a whole 'nother post altogether! 

Birth Story: Part 1

It's been a week since my daughter's birth.  And I finally feel ready to blog about it.  Partly because I've finally had time to collect my thoughts on it, but mostly because I've had time to deal with it emotionally.  Let's get one thing straight first:  I have a perfectly healthy little girl sleeping in my lap right now and that was always the priority.  But I want to be sincere about how things went, that's always been my goal with this blog.  If you wanted to stop by and read a pleasant birth story that ended in rainbows and unicorns, then I suggest you search on.  I also will not spare the gruesome details (Sorry, guys.) because I am writing this story as if I'm writing to myself from a year ago.  I wanted to know all the gritty details, emotions included.  With all that said, on to the story!

My doctor scheduled my induction beginning Monday night the 21st.  Trey and I went in to the hospital around 9 pm to check in.  My nurse K instructed me to lose all my clothes (but I was given the option of keeping my bra, which I took) and gave me a smock to wear that tied on the side.  Then she set up the fetal monitors on my belly that would keep track of baby's heartbeat and my contractions.  As soon as she set up the monitors, she could see that I was already having contractions of my own!  Really small ones, about 5 minutes apart, that I couldn't feel at all.  So that was encouraging to hear.  Because I was already contracting on my own, I was only give a half dose of cytotec to soften up my cervix (which was still at 1 cm, 80% effaced).  She put in my IV, which was the worst part for me to get through.  Trey held my right hand while she inserted the needle into my left vein.  My blood pressure rose during this part, but that was the only time it gave me any trouble.  

Finally, we were left to sleep for 4 hours until she would come back and give me the other half dose of cytotec.  At this point, I still have my pump on and keeping track of my blood sugars myself with testing and my CGM.  About 15 minutes before I was to get my second round of cytotec, I had a bad low blood sugar of 44 mg/dL.  The contractions I wasn't feeling were starting to have an effect on me.  I brought my own juice boxes, so I drained 2 and turned off my pump (it stayed off until about 9 am the next morning).  I took the second dose of cytotec and started feeling mini contractions around the time I woke up at 5 AM.  They weren't painful, just exciting because I was started to feel something.  

At 7 am on the 22nd, I met my day nurses W and M.  They would be by my side during the entire labor process.  They checked me again and I was now 2 cm but still 80% effaced, the goal of cytotec was to get me to 3 cm.  They went to consult my doctor to see if they wanted to administer another round of cytotec, which would delay starting the pitocin another 4 hours, or if we wanted to get the show on the road.  The result was to go ahead and start pitocin.  So by 7:45 am, I was on the pitocin IV drip.  I asked W when I would start feeling anything, and she said it usually takes about an hour.  At this point, things were not painful and, honestly, kind of boring.  I practiced breathing through the mini contractions that I did feel while listening to the radio on my iPod.  

The nurses contacted my endocrinologist about putting me on an insulin drip, but he made the call to let me keep my pump on and check myself every hour.  I was forever grateful that decision was made, because it gave me control in a situation where everything else was out of my control.  So I was checking myself every hour, and the nurses would record it.  I was cruising in the 150s for most of my labor, but my endocrinologist said that was fine as long as I didn't go over 200.  I think the risk of me going low during labor was more important than trying to keep a perfect 100 the whole time. 

At 9:30 am, my OB came in and greeted me.  He gave me the option of continuing with my labor as it was or going ahead and breaking my water.  I chose to break my water because I still wasn't feeling the contractions and I was still at 2 cm, so I figured we needed more momentum.  After my water was broken, I got on an aerobic ball and started breathing through my contractions that started to be noticeable.  Nurse W asked what would be the best care for me, and I said I just didn't want to stall out on my labor.  I wasn't afraid of the pain because I have  pretty high pain tolerance.  I was only worried about my endurance and being in labor for days!  So W wrote on the white board on my wall:  "Keep things going" as my goal for care.  

About an hour later, I hit active labor.  My contractions were coming in waves and becoming more intense, but still nothing I would consider painful or something I couldn't get through.  So far, Trey has just been hanging out with me and eating breakfast.  I told him I would let him know when he needed to come into the game.  All I said was "I need you" and he jumped in like a pitcher coming out of the bull pen.  He applied counter pressure to my back and hips through each contraction.  And in between contractions he rubbed my shoulders and feet to give me comfort.  The ball worked great for me in working through the contractions.  The best position for me was being on the ball, rocking back and forth, with Trey behind me on the edge of the bed or in a chair.  Also at this time, my contractions required all my concentration.  So when it was time to check my blood sugar, I would just stick my hand out and Trey would check it for me.  I know I wouldn't have made it through labor without his support.  

Around lunch time, my doctor came to check me again and I was at 4 cm.  I was starting to get a little frustrated with how slow this whole thing was going.  So M suggested that I labor on my sides for awhile to help the baby move down into my pelvis.  This was not a comfortable position at all, but it seemed to intensify the contractions.  Trey got out the heating pad we brought and applied it to my back during my contractions with pressure.  He eventually had to go eat lunch, so W and he rotated out during back compressions.   The pain was increasing, and I started low moaning.  I thought I would feel embarrassed doing this, but the nurses actually coached me through the breathing so I didn't feel so awkward. 

Sometime in the afternoon, M was keeping an eye on baby's heartbeat.  She was fine, but she wasn't responding to the contractions like they wanted.  So they gave me an oxygen mask to wake her up.  The mask was great because it gave me cool air to breathe and was very relaxing during this whole process.  At this point, I'm laboring on my knees on the bed, leaning over the back of the bed.  So imagine this picture:  a woman in labor, wearing a smock, low moaning every 2-3 minutes like a cow, with an oxygen mask on her face.  I had officially lost my dignity.  

Around 5 pm, things really picked up because I was at 7cm, 90% thinned out.  "Sweet!"  I remember sighing.  Trey laughed.  This meant I had made it.  I was at the point of no return for pain meds and it looked like I would be delivering my baby soon.  However, the contractions were increasing in intensity.  It took all my strength to moan and breathe through them.  Only once did I say, "I can't do this!" to which Trey quickly responded "Yes, you can.  You are doing it!"  I just had to get through each contraction and rest.  I felt enough relief in between each contraction to refill my energy tank.  

It seemed like I went from 7 cm to fully dilated within an hour, so the nurses went to call my doctor and have him come over for delivery.  Meanwhile, my contractions were stretching my pelvis to the max.  It felt like I had a 25-lb. medicine ball that was being stretched to a 50-lb. ball and deflating back down to 25-lbs.  I wasn't getting the full relief of the contractions I had at 7 cm.  Also, M told me that my doctor got called to an emergency surgery, so I had at least an hour before I could start pushing.  I went from low moaning to grunting/screaming during contractions, squeezing the bed rails like I was going through an exorcism.  They turned off the pitocin to hopefully give me some relief before my doctor could get there.  It didn't help.  My contractions went from every 2 minutes to every 3 minutes, but still no downtime from the pain.  

After an hour of being fully dilated, the nurses decided that the baby was coming soon and someone needed to be there to catch it.  So they got the on-call doctor and my room doubled in audience almost immediately.  I initially requested that Trey be the only family member in the room when the baby was born, and I'm glad because I'm not sure where anyone else would go!  I had my 2 nurses, the baby's nurse--who I would officially meet the next day--prepping the incubator table right next to me, and 3 delivery nurses (not sure, but I think one was an observing student).  They brought up the stirrups for me to start pushing.  I was so exhausted from being in labor for 10 hours, but I felt relieved that the end was in sight.  I just needed to muster the strength to push.  

The on-call doctor comes in and introduces herself while I'm fully naked (minus my sports bra) with my goods pointing straight out to the world, sweat pouring out from every surface I had.  "Hello, I'm Dr. P and I'll be delivering your baby." 

Part 2 . . .

38 Weeks: Ready or Not, Here She Comes

This week has been a real busy week in preparing for our daughter's arrival.  I had so much anxiety about my OB appointment on Wednesday because I was worried about her size and being induced earlier than I wanted.  This appointment would also be my last regular appointment before the 39 week goal that my doctor set for me.  I wanted to end things on a good note and go into my induction with hope and optimism.  I also had my last endocrinology appointment on Thursday, so I was rounding things out in my last week as a diabetic pregnant woman.  

My OB appointment started out with an ultrasound again to check on baby's size and fluid levels.  Last week, she was measuring around 8 lbs 10 oz, and my doctor was worried about her getting over 9 lbs and being too big for me to push out.  Thankfully, it seems my daughter has ceased growing and is just chilling out in there because she came back at 8 lbs 11 oz this week.  My fluid levels were still good, too.  My doctor still seemed puzzled by the fact that I was carrying a large baby when my diabetic control has been as good as it's been.  I explained to him that Trey and I were both 9 lb babies when we were born.  And it was as if a light bulb went off in his head and he exclaimed, "Oh, well that explains it!  You just breed big, healthy babies.  That's all!"  So it turns out that I'm a "big breeder", nothing more.  But it does give me more pressure to keep stellar control for other pregnancies since my kids will more than likely land on the larger side anyway.  

My blood pressure came back fine.  Not great, but it wasn't higher than last week, so my doc didn't seem worried about it.  Next was my first internal exam.  I have to admit that I was really worried about this.  I had read horror stories about how painful they were and they could accidentally strip your membranes and put you in early labor!  Well, it wasn't nearly as bad as I thought, just went to a happy place and counted the tiles on the ceiling.  Right now I'm 1 cm dialated and 50% thinned out, which my doctor said is very optimistic before being induced.  Looks like my dedication to walk 2 miles everyday in these last few weeks might have paid off.  

The plan is if I haven't gone into labor on my own by Monday at 10 PM (which I highly doubt), I am to go to the maternity center and check in to start the induction process.  They'll start with something called cytotec that will thin out my cervix even more overnight.  The nurse told me that sometimes it is enough to send some moms into spontaneous labor.  Then we'll start an IV of pitocin, the drug that kick starts labor, early Tuesday morning.  After 3 PM on Monday, I can only have clear liquids (water, sports drinks, jello, chicken broth, etc.) because the drugs can cause some nausea.  

Yesterday, I had my final endocrinology appointment before having my daughter.  The nurse checked all my vitals while my A1c was spinning.  I asked for a refill on all my prescriptions, just in case I might be close to running out and I wasn't coming back to the office for 4 months.  I have been spoiled a little bit by coming in once a month, I don't worry about checking my prescriptions before I come in for an appointment.  My A1c came back at 5.3%, which makes my overall pregnancy range 5.1 to 5.6.  I was quite proud of myself at this fact and feel confident that I did the best I could, diabetes wise, to give my daughter the safest place to grow.  My endocrinologist and I discussed the plan for me during labor.  I'll keep my pump on until they start the pitocin, and I'll keep it off until she is born.  "And I can put it on right after, right?"  I'm not a big fan of IVs, so I have this image of immediately ripping them out (a la the Hulk) right after I hear her first cry.  They will check my blood sugar once every hour while the IV is in, but of course I can check at my leisure as well as having my CGM.  Then I can reconnect the pump using my pre-pregnancy basal rates and bolus ratios, because once she's out and the placenta is delivered my insulin needs will dramatically decrease.  

So everything is set in place.  My daughter will be here by this time next week.  I got a little emotional leaving my OB's office after scheduling the induction.  I wasn't scared or anxious, just overall emotional from the culmination of "This is it!  She's coming!"  This weekend, we're busy doing last minute things and preparing for incoming family.  We're also planning a last date night that involves a movie trip (Battleship) and a trip to Babies-R-Us to pick up last minute things.  I've also been busy putting things in the hospital bag, most of it we may not need.  The car seat is in the car, along with the essential Boppy.  

I'm excited to meet her, but I'm more scared and anxious right now.  I'm mentally putting on my game face and getting ready for what the labor process will be like (and how long it will take).  I'm afraid I'm not strong enough to handle it.  But at the same time I have no idea what to expect, so I'm hoping I surprise myself.  I just keep imagining that moment when the doctor says "She's almost here!" and I hear her first cry and we get to hold her, finally.  That moment is my trophy that I'm running towards. 

High Risk Outcast

For the past month or so, I'm thankful to say that my pregnancy has been fairly boring.  My weight gain has plateaued (34 lbs.) and so has my insulin resistance (42 units basal, and 1:6 bolus ratio).  The last 2 OB appointments have gone very smooth; in fact, I've spent more time in the waiting room than actually seeing my doctor.  My blood pressure and urine have all come back fine, which I count as a huge blessing.  For most of my formerly-pregnant friends who ended up getting complications such as preeclampsia, the symptoms started showing by now.  So I feel like I've beat some personal goal by making it to 34 weeks and everything about me seems like a normal, non-diabetic pregnant woman. 

But I feel very at home with my OB, and he treats me as a unique patient and doesn't generalize me for my type 1 diabetes.  That hasn't been the case everywhere else.  For example, at our prepared childbirth class last weekend.  Initially, I was very excited about this class because I wanted to get an idea of what to expect during labor (either naturally or induced) and I was anxious to tour the maternity center where I would be giving said birth.  

The class started out great.  We went through the overall process of labor from early labor to transition to PUUUUUUUUSHing.  The morning teacher made me feel like I could handle the type of labor I wanted because it is 90% mental anyway.  Plus, she said regardless of how long ago it happens, every woman remembers the details of her child's birth.  So it's so important to mentally prepare yourself and fight for what you want.  We broke for lunch, and I felt great.  At this point, no one knew I was a type 1 diabetic or that I was considered "high risk".  

Then came the afternoon, and a different teacher took over.  Her job was to talk to us about medical interventions like inductions, epidurals, and C-sections.  I wasn't scared of this part because I figured some of these interventions might be in my future.  Before we got into the part on C-sections, the teacher threw out this random statistic because she had just got back from a conference on diabetes and pregnancy.  "Did you know that 85% of all diabetic pregnancies end in a C-section?"  And she starts the video.  

I lost it.  I looked at Trey and said, "Well, isn't that wonderful?"  Tears began falling down my face.  Snot was running down my nose.  And I had to muffle my mouth from the heaves that were coming up.  Really?!  85 percent?!  So even if I do everything right, I only have a 15% chance of having a vaginal delivery?!  I was distraught and could barely pay attention to the video.  It ends and the lights come on.  I calm myself enough to listen to the cord blood banking guy, the last talk before the maternity center tour.  

I tried pushing that number out of my mind while we went on the tour.  I reserved that I would deal with it later.  One of the reasons I chose the hospital I chose is because a) my doctor is right next door and b) they have these LDRP rooms where every process of labor is done in one room.  I wouldn't have to labor in one room and then be escorted to another room for recovery.  These rooms are great, they're set up like your grandmother's bedroom with a quilted bed, rocking chair, and warm decorations.  The same afternoon teacher told us that these rooms have everything that a typical LDR room has, but you get to stay here the whole time after baby is born.  "However, we typically only use these rooms for our low-risk patients."  I raised my hand and revealed myself to the whole class.  "So with me being type 1 . . . "  She responded, "Yeah, it's unlikely you'll get to use these rooms."  Again, I was shot down due to my category and nothing to do with me.  

Trey and I got in the car and headed home, and I felt like I had completely wasted the entire day.  I felt so defeated.  I don't care if I have to have a C-section or have to be quarantined to a room deemed suitable for high-risk patients if my daughter comes out healthy and safe.  BUT.  I feel like my story has already been written even before I'm there.  I want to have some say in how my body is dealt with, but right then I felt like I was just at the doctor's will.  I cried the whole way home, and that's a long 30-minute drive.  

Thankfully, I had an OB appointment this past Monday, and I basically told him everything that happened at the childbirth class.  I told him I felt very discouraged.  My doctor, always the sensitive guy, looked me in the eye and said, "That's not true.  That 85% MIGHT be true for uncontrolled diabetics, but definitely not for you.  And you have the choice to use the LDRP room, I'll see to it.  As far as I'm concerned, you have a good chance at a vaginal delivery."  I dried my eyes that had been wet for the past 2 days, and made my appointment for 36 weeks.  My endo even told me that given how good my pregnancy has gone, he would let me go to 40 weeks no problem.  

I know I shouldn't let these things get to me.  I should be used to people generalizing diabetics into some doomsday category.  My story is still unwritten.  I want every pregnant type 1 to know that they don't have to submit to anything that "should be" just because of our category.  We are high-risk, not "high maintenance enough that we don't want to give you a chance".  Several people have already asked me if they were going to take my baby early or if I have a C-section scheduled.  No and no!  If you take away this stupid disease and just look at ME, I am 100% healthy and so is my little girl.  Let's take off the vial glasses and look at ourselves as individuals.  Because as one of my good friends says, "Diabetes doesn't define me (!), it just explains me." 

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). 

19 Weeks: Double Doctor Duty

Well, it finally happened.  The stars and calendars aligned and I had an OB appointment as well as an endo appointment on the same day.  The festivities began around 10 AM with my OB appointment, followed by my endo appointment at 1 PM, with a light burrito lunch in the middle.  

OB appointment:  

This appointment was fairly boring, if there can be such a thing in this world.  I knew that the nurse would want my pee, so I drank a large decaf coffee before the appointment.  After waiting for 45 minutes, my bladder was nice and ready to give its supply.  Next, she took my weight, which has finally taken an upward trend.  So far I've gained 10 lbs total this pregnancy, which is right on track for what my doctor wants.  It seems my idea of adding a cereal snack at the end of each day worked to beef me up.  I just hope it doesn't start a landslide in the weight gain department.  Then she took my blood pressure, which was 146/74.  It's getting quite comical at this point because my blood pressure was absolutely fine yesterday at the gym and it was 110/70 at the endo's office; it seems I just get anxious at my OB's office--in a good and bad way.  

After all the vitals, I was escorted into a room where Trey was waiting on me.  Another nurse came in to check for little Ferbie's heartbeat.  What happened next is a story so funny that it's definitely one for the baby book.  She placed the wand over my exposed belly and was able to find the heartbeat right away.  "Good," I thought.  But then it disappeared.  So the nurse moved the wand to the other side of my belly where she was able to find it again, but it was there for less than a second before it disappeared again.  "She's trying to run away from me," the nurse said.  Ferbie was not liking having an intruder on her roof, and she began moving up towards my belly button causing me to giggle.  The nurse continued this routine for a few more tries:  find the heartbeat, it disappears, I laugh because I can feel her moving around, repeat.  Finally, she said, "Oh forget it!  She's obviously fine in there.  I just can't get her to stay still!"  I don't know why, but I was feeling quite proud of my daughter at that point and wanted to give her a high five. 

Next, the doctor came in and greeted both of us.  We went over the standard questions:  "Any bleeding?  Loss of fluid?"  No and no, thankfully.  Then he let me ask questions.  If I haven't said it already, my OB is great!  He'll let me ask all the questions I want to for as long as I want.  So I've started keeping a list of questions on my iPod that I reference before my appointments.  I asked him about some muscle cramps I've been having, especially at night that wake me up.  He recommended a magnesium supplement to hopefully relieve the cramps, although I'm enjoying the husband-hired back rubs everyday.  We also talked briefly about pediatricians, which we need to nail down soon before I . . . you know . . . go into labor (!) because they'll need to be there to check her blood sugar after she's born.  Then he measured my fundal height--22 cm.  My doctor was happy with that.  He said he wanted to see me again in 4 weeks for another appointment and ultrasound.  

I made a joke with him "So I don't have to do the glucose test."  "No, definitely not," he said, still clicking away on his tablet.  I smiled and said, "Yeah, I mean what are you going to do?  Put me on insulin?"  This comment caused my doctor to let out a laugh.  I like making fun of diabetes.  

Endo: 

This appointment was even less exciting than my OB appointment, except for this one guy in the lobby who kept staring at my belly.  I just wanted to say "Stare much?  It's not an alien."  But I kept my cool.  

I was called back, and the nurse took my weight (1 lb more than my OB, I'm guessing that was the burrito I had for lunch) and my blood pressure:  110/70.  I just started laughing because the differences between the two offices are quite comical.  I decided I quit on trying to figure it out.  Then the nurse pricked my left middle finger, but she couldn't get enough blood for a strip.  Dang calloused fingertips!  She had to prick another one to get enough.  I was nervous what this A1c was going to be because I had a horrible week during Christmas (just blood sugar wise, the rest of my Christmas was great).  After 5 minutes, my A1c came up:  5.1%  My jaw dropped open because I literally couldn't believe it.  The only rationale I have for it is that when you're used to keeping such tight control that any trend of bad numbers seem significant.  Obviously, my numbers in between these bad episodes were still pretty stable.  

My doctor came in and we looked over my numbers.  "22, huh?" he said, barely any emotion.  "Yeah, that one was pretty bad."  I'm glad he didn't freak out about it, I was done reliving that nightmare.  He changed a few things on my pump to help me keep some lows at bay and hopefully keep me at a more stable trend overall.  We'll see how things go.  I made another appointment for a month from now, but this time it is a week after my OB appointment.  

Overall, I learned that I'm actually doing quite well at this whole pregnancy and diabetes thing.  I need to stop beating myself up when things don't go 100% perfect.  These things fall in line with my only 2 New Year's resolutions:  1) enjoy the rest of this pregnancy to the fullest extent and 2) stop freaking Googling anything health related!!  I'm really serious about that last one, and I've made it 5 days so far!

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.

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. 

Pregnancy Update and Morning Sickness

First of all, I want to thank everyone for all the wonderful comments on my pregnancy announcement. I still go back and read all of them multiple times throughout the day. I definitely feel the support and love of the DOC. Now that I'm "out", I wanted to give you guys a quick update on my pregnancy so far these past 9 weeks.

When I first found out I was pregnant, I didn't really have any symptoms. I had some soreness and cramping, but nothing that was discomforting. But once I hit 6 weeks, it was like the plethora of pregnancy symptoms hit me like a ton of bricks.

I had heard about the pregnancy lows accompanied with a type 1 diabetic pregnancy, but I didn't realize that they were on a completely different scale. It's like my body wants to be at 60 mg/dL all the time without any symptoms. All I can say is THANK GOODNESS I have a CGM. The majority of the time, Constance catches my lows before I feel them. I honestly don't know how low I could be most of the time without her alerting me. The only problem with this is she seems to go off all. the. time! Especially when I (try to) sleep, she keeps beeping at me every hour that I'm below 70 mg/dL. And when she woke me up last night at 1 AM for the 5 millionth time, I busted out into tears because I just freaking wanted to sleep. I know these lows are manageable and it's better for me to hang out in the basement end of my range for the next few weeks, but I'm looking forward to getting back to the 100s as "normal".

Another symptom that hit me in the gut is morning (umm, all day) sickness. I've always had a pretty strong stomach. Even if I get a whiff of something that turns my stomach, I can usually hold it in and still eat like nothing happened. But it seems that pregnancy has turned my iron stomach into mush. And the main culprit that makes me run to the bathroom? Ground beef. Even just typing that makes me try to think of something else. But as it stands right now, I can't even look at a hamburger right now without turning the other way (towards the bathroom).

This pregnancy side effect actually caused me to lose 5 pounds the first three weeks I was pregnant. But it seems I have turned a corner recently because I can eat something larger than a tennis ball. The nausea is still there, mainly when I first wake up and if I go more than 3 hours between meals.

At my 2nd appointment with my endo since I found out I was pregnant (where my A1c was 5.5%! Woo!), I asked him what was the standard procedure with insulin and puking. Because I mainly worry about "eliminating" something I just bolused for and the oncoming low. He said the best thing I can do is either suspend my pump or put my bolus on an extended square for an hour or two to make sure I keep most of my meal down.

I've got roughly 3 more weeks of the pukes before it hopefully gives up altogether. Until then, I'll keep my diabetes supplies stashed with diet ginger ale and whole wheat crackers.

My new love.

The Day I Found Out I Am PREGNANT!!!

It feels weird to be writing this post since you guys probably won't see it for another month or so, but I know this time in my pregnancy is important and I need to get down every emotion and feeling.  This post was written on September 26, 2011.  

I'm 5 weeks!  It feels awesome to be writing those words.  I feel so incredibly blessed and excited with this pregnancy.  Trey is excited, too!  Every once in a while he'll just look at me and giggle--I don't have to guess what he's thinking about.

We found out I was pregnant last Tuesday, September 20th.  I knew there was a strong possibility I could be pregnant because I was 2 days late, and that never EVER happens to me.  I'm very . . . "on time"?

The dogs started their usual stirring around 4:30 AM, and instead of telling them to "Shhh, lay down!" to try and get those few extra minutes of sleep, I went ahead and let them out so I could take the test.  I did the test and put it on the counter to wait the instructed 3 minutes, but I didn't have to wait that long.  After less than a minute, the "Pregnant" line showed up clear as day, and after 3 minutes it looked like this:

The proof!

I woke up Trey and said, "Come look at this!"  My sleepy husband got out of bed and came to the bathroom.  He looked down at the test and said, "I told you so!"  He had guessed a few days ago that I was pregnant, but I wanted to wait until I was officially late to test.  We hugged and kissed, then looked at each other.  "So what do we do now?" he asked.  "I'll call my OB later and my endo to get the ball rolling."

I went to my OB that afternoon to do the initial blood work.  I got a call back the next day that my levels were right on schedule for someone who's 4 weeks, my hcg levels were over 500.  I did another blood draw on Thursday, which I'm still waiting for the results. My first ultrasound was scheduled for October 20th, I'll be 8.5 weeks and praying they find a good, solid heart beat.  (If you guys are reading this, then they did.)  ;-) 

I saw my endo that afternoon as well.  He congratulated me on my pregnancy and took my A1c.  To be honest, I was a little nervous about what the number would be.  We figured we had gotten pregnant while on vacation and I was CGM-less for a week, not the best environment for good blood sugar control.  However, I was astonished when I saw 5.6!  I actually asked the nurse, "Is that right?"  She looked back at the machine and said, "It's right.  Not gonna argue with it are you?"  "Not at all!" I said with a smile.  I texted Trey and said "A1c = 5.6! Hellz yeah!"  We set up my next appointment for October 24th, with blood work a week before. 

I haven't really been having any bad symptoms yet.  I keep having this nagging worry that something will happen before our first ultrasound; it plagues my mind all day.  I have made conscious efforts to keep those thoughts out of my mind, even to the point of writing down reasons why I shouldn't worry:  I'm a young, healthy female.  My numbers are solid.  There's absolutely no reason to be worried and every reason to celebrate.

I'm sitting with a smile on my face at that last sentence.  For the first 4 weeks of this pregnancy, I haven't really celebrated because I was so worried.  But now that we've seen the heartbeat and know there's a baby inside me and not a monster causing my morning sickness (more on that later), I can't help but smile . . . and freakin' tear up a tiny bit.  

I'll Take That A1c!!!

This morning I had my quarterly endo appointment.  But today didn't start out very optimistic and sunny, quite the opposite.  Severe thunderstorms were entering our region and causing power outages across the area.  It's really freaky to be driving on the road and watching the street lights go out!

Anywho.

I get to the parking garage, check my blood sugar (118 mg/dL), and head to the office armed with my Dexcom printouts.  I only wait 30 minutes (woo!) before my name was called.  The nurse takes my weight (I didn't ask her if it had gone down since last time, I didn't wanna know), my blood pressure (122/86), and my blood sugar (118 mg/dL, yay for accuracy!) and A1c draw.  I've written before that it is torture to get my A1c taken at my doctor's because I have the pleasure of watching the timer inch its way down from 5 minutes to 0:00.  My heart felt like it was about to jump out of my chest before I saw the number.

I'll take that. 

"Good job," the nurse said.  "The doctor will be in shortly."  I immediately texted Trey the number, to which he responded, "woohoo!"

My doctor walked in and excitedly said, "Hi, Holly!"  He was obviously pleased with my decrease in my A1c from 6.8% back in February.  He asked me how I thought my blood sugars were doing, and I said I was pleased with them but just trying to avoid the lows with working out.  We also discussed the possibility of me getting pregnant, and my doctor made the point that even though I'm doing well with my control now, that it's much easier to be in control when you're doing it for someone else.  That is so true!  There have been plenty of times where I SWAGed for a piece of cake or didn't wait 30 minutes after taking a bolus to eat because I didn't care about the consequences.  If I were pregnant at those times, I guarantee that I would think twice about SWAGing for the key lime pie.

I was also given a copy of my lab work that I had done last week, and this is the first time I've ever been given a copy of the results.  It's quite extensive, but my doctor said my results were stellar.  I can spend time deciphering all the codes later.  He scheduled my next appointment and left.  I grabbed my mounds of paperwork (Dexcom graphs, pump downloads, and lab work results) and made my way to the receptionist to checkout.

I started getting a little choked up thinking about all the hard work I've done, the hope of a successful pregnancy, and the peace that my body is perfectly healthy despite having a chronic illness. I celebrated my success my grabbing a caramel macchiato on the way to work.

Now, about that coffee addiction . . .

Doctors, Doctors, Everywhere!!!

Life has been insanely busy lately, from my crazy work schedule to keeping up with somewhat of a social life, I've been out of the social media/blogging loop.  Thankfully, my diabetes has somewhat behaved during all of this.  My current 30-day average on my meter has been hovering around 140 mg/dL.  (Thank you, diabetes gods!)  But I have several doctor's appointments coming up that make diabetes hard to ignore. 

Last Friday, I went to have blood drawn to look at all my levels including cholesterol, lipids, and (of course) A1c.  And my pathetically small veins made it hard for the nurse to get enough blood in the vial at first.  She had to squeeze my upper arm to make enough come out.  So this lead to having to keep the needle in my arm for half a second longer than I wanted it to.  Next time, I'll just take a jog up and down the hall to get my blood pumping. 

This weekend, I downloaded my latest Dexcom graphs, and it looks like my A1c should land around 5.8 (median) to 6.1% (mean).  I feel really good about this A1c, but I had similar graphs before my last appointment when my A1c came back at 6.8%.  Most people would probably be happy with this number, but I'd rather be below 6.5% before we get pregnant.  Even though we're not trying right now, I don't want to have to wait on diabetes when we are ready.  I've been trying to keep my A1c in the baby-safe range for the past year, so that all my doctors and company will give us the green light without hesitation. 

The other numbers that I'm not so excited about is my weight and consequent blood pressure.  I was really diligent with my diet and exercise until we were without power a for week due to some local tornadoes.  After that, work got crazy and all I could manage to keep up was a spinning class once a week and playing on my company's softball team.  Diet?!  Pssssht!  What diet?!  I've done more eating out and SWAGing this past month than I care to admit.  So I'm hoping that my physical exercise is enough to give me a normal BP reading, at least.  I've been testing on my own about once a week, and although I've been landing in a normal range, there's always white coat syndrome.  Weight-wise, I'm exactly where I was in February, even though my legs appear a bit toned thanks to spinning.  I'm trying to get back in the groove with exercise AND diet. 

Non-diabetes wise, I also have a dentist's appointment the week following my endo appointment.  And I also need to schedule an appointment with a PCP, and I'm still on the hunt for one I can be comfortable with. 

Such is the life with diabetes, it seems.  Just as soon as life gets busy enough to make diabetes the background noise in your life, you get an alert on your calendar to go get blood work done for your endocrinologist's appointment the next week.  Then diabetes comes back into full focus, exactly where I hate for it to be. 

At least I have a new toy (re: Nook) to keep me entertained in the waiting area. 

Something's Working

So 5 weeks have passed since my endo appointment where I was told to lose 10 pounds in order to help my elevated-but-not-high blood pressure issues.  The first week, I upped my workout routine and decreased my diet mainly be getting rid of snacks and alcohol, and I lost one pound that week.  After that, I was stalled, stuck, not moving, etc. for 3 weeks!!  I stayed at the same weight for 3 weeks, battling lows after workouts, and constantly adjusting my basal rates.  Luckily, I never gained, because I'm unsure if that would have made me give up. 

It finally seemed like I found something that worked, BG-wise, for my basal rates because I stopped having so many unexplained lows and tweaked temporary basals for workouts.  For example, for spinning class, I disconnect Arnold an hour before the class and don't bolus for my afternoon snack, which has to have a good combination of carbs and protein in it.  I was finally able to go a week without having a low after working out.  After that week, I broke my plateau and lost half a pound!  It may not seem like much, but after 3 weeks of no change, I was happy to see any change at all! 

This past week, I decided to change up a few things and do some different workouts via Netflix (other than the Wii.  sorry, virtual trainer.) and increased my intensity at spinning class by increasing my resistance on the bike.  And I did my best to maintain my diet during the week with some splurging on the weekend (I have to, or else I'll go insane!).  I figured all this would (hopefully) lead to another half pound loss, but when I got on the scale this morning I saw a loss of one pound!!!  A whole pound!  I couldn't believe it!  I actually smiled and said, "Huh," which is a lot of emotion for 5 AM in the morning. 

So since my appointment, I have lost 2.5 pounds.  But personally I have lost 4 pounds since the beginning of this year.  Some people might not consider that a big deal, but for a type 1 diabetic having to balance cardio with insulin it's a huge deal!  Plus, I'd rather not lose a whole bunch at once because I'll be more likely to bounce back up.  I would love to keep up a one pound/week loss, but I'd feel safer with half a pound/week.  Besides, it took me about 8 years to gain 20 pounds (hello, Freshman 15 plus five), so it's going to take some time for my body to get used to being lighter and stay that way. 

I still have a ways to go:  7.5 pounds to meet my endo's goal and 14.5 to my personal goal.  I really think the spinning class has a lot to do with it, honestly.  I burn over 300 calories in 45 minutes in that class alone.  One of the things that's a challenge right now is changing up my diet to keep my body guessing.  It's so easy, diabetes-wise, to eat roughly the same thing everyday because I know how my body reacts to it.  I'm slowly introducing different foods into my diet other than Greek yogurt, fiber cereal, and popcorn.  All of those are fine, but I have all of those multiple times during the week.  So I'd love any suggestions for changing up my food wardrobe if you have any. 

I'm feeling really good today, not just because of the weight loss, but because I've found something that I love doing even if my weight loss stalls.  I keep saying to myself, "Just keep spinning, just keep spinning.  Spinning, spinning, spinning . . . " 

"Please, sir, I want some more."

The past day has been a whirlwind for me with my endo and getting a new test strips prescription.  It actually all started on Sunday when I went by the pharmacy to pick up a new refill for all things diabetes:  insulin, syringes, strips, and glucagon.  The cashier hands me my bag o' diabetes and I double check the strips amount because a lack in communication has occurred before.  I peek in the bag and notice that I'm short 50 strips.  I asked the pharmacist why I only had 150 strips when my prescription was written for 200x/month.  Turns out my endo wrote in parentheses after 200x, "test 5x/day".  So my insurance company interpreted that to mean only 150x/month. 

I figured this was a simple glitch on my endo's part.  So I called his office first thing on Monday morning to ask the Rx to be rewritten.  I leave a message on the nurse's voicemail, "Hello, this is Holly, birthday eleven twenty-nine nineteen eighty-four, pharmacy is 'such-and-such' Pharmacy on 'blankity-blank' road, and I need Dr. Special (not his real name, but he has a 'special' sense of humor) to rewrite my prescription for strips from 5x/day to 6x/day.  Thank you!"  Well, the little voicemail message said to allow 48 hours for prescription requests.  So I (not-so) patiently waited until Wednesday afternoon to call my pharmacy to see if the prescription had been changed.  "Yeah, I don't see anything from your doctor," the pharmacist said.  So I braced myself for calling my endo's office . . . again.

This time I refused to be sent to a mailbox, so I optioned for the receptionist to get a live person.  "Hi, this is Holly, I'm a patient of Dr. Special, and I called on Monday to have him change my prescription for strips from 5x/day to 6x/day and that hasn't been done yet?" I inquired as if asking, "And why hasn't this been done yet?"  I get put on hold for a few minutes and the receptionist comes back and says . . .

"Well, his nurse said that 5x/day should be enough since you're wearing a monitor and only need to test 3x/day."  

I stumbled for words before I finally said, "Uhhh yeah, that's not going to work for me.  I want to have 6x/day."  Nevermind the fact that CGMs are not meant to replace finger stick tests, what made me mad is that I told my endo at my last appointment that I wanted 200/month and he didn't even blink!  I really didn't appreciate that he was changing my prescription without talking to me first.  Well the little receptionist said, "We'll need to talk to the doctor about this.  We'll call you back."  Yeah, OK.  This was about 2 PM yesterday, and I never heard back. 

I was steaming after that phone call!  Forget about lowering my blood pressure!  Every vein in my body was pulsing with rage, frustration, and sadness.  Three times a day?!  Sometimes I test that many times before breakfast!  I mean I love Constance and all, but she is not accurate enough for me to rely on her 100% of the time.  The fact that my endo would suggest this meant to me that he is ignorant of the purpose of CGMs and was abusing their purpose.  However, this information was being relayed 2nd-hand through his nurse and receptionist.  I could only HOPE this was a huge error in communication.  

I called again today after lunch (giving them plenty of time to call me back) to see if I was about to make the decision to change endocrinologists.  I get the receptionist on the phone and she said, "Yes, a new prescription for test strips was sent to your pharmacy for 6x/day, 200x/month."  "OK, thank you."  So I have my strips, for now.  But I hope at my next appointment in June that my endo doesn't allude to me needing to test less because I wear a CGM.  It's an extra tool, not a replacement.  It would be like trying to use a screwdriver as a hammer, it just doesn't work the same way.  But I should trust my endo to know that! 

As much as this infuriates me, the last thing I want to do is change endocrinologists.  The next closest options for me are another office 45 minutes away or a university hospital 2 hours away!  I know my endo is not the best endo I could possibly have, but he's honestly all I've got.  And I really don't want to go through the process of changing doctors at this time in my life (see also:  planning for pregnancy).  But right now I feel like Oliver in the orphanage asking for more gruel.  I feel like I'm being punished and put through the mill for wanting to take better care of myself than what 3x/day would result. 

"Yeah, I'm gonna need to see a copy of your insurance card first.  Mmmmkay?"

Overwhelmed

Yesterday's endo appointment didn't go very well.  I wasn't really expecting it to go great, but I didn't expect it to be as bad as it was.  I had suspected that my A1c was going to increase from last time, but I figured I would land around my usual 6.5 that seems to follow me without much effort. 

My appointment was at 8:30 AM across the interstate in downtown, so of course I visited the closest coffee shop on the way to grab an Americano for the hour-long drive.  Armed with my Dexcom software graphs and coffee, I took a seat in the lobby and snapped a pic of the freakishly-empty waiting room.  (For those who know my endo or go to him for his care, you know the waiting is usually very full!) 

Not 20 minutes later, my name was called and the nurse led me to my room.  She took my weight and my blood pressure.  She was putting the sleeve back in its holster when I asked, "What was it?"  "130/90," she said.  Another elevated reading, this was something I was definitely going to bring up to my endo.  She also took my blood sugar (168 mg/dL) and began spinning my A1c.  What kills me about the A1c machines at me endo's office is that you can see the timer!  I was tortured watching the 5-minute clock slowly make it's way down to 0:00 waiting for my number.  During that time, the nurse downloaded my pump data and made sure all my medications were the same.  Finally, the clock goes down to 0:00 and I see the number before she does:  6.8%. 

I felt defeated.  I couldn't help it.  I know most people would be content, even happy, with this number.  But for me, this number is way too close to that 7.0% threshold required for pregnancy.  I immediately started thinking of changes I needed to make, but I barely had any time before the endo came in the room. 

He shook my hand and took a seat beside me, and he starts going over my Dexcom graphs with me.  This really surprised me, because my endo has been reluctant to the whole CGM thing so far.  So it was nice to see him wanting to use the tool I wanted for so long.  He said it looked like I was correcting too many times after a meal, resulting in a lot of lows.  He thinks my overall basal rates were too low, so we increased my total amount by making my basal rate one rate for the whole day.  I'm not sure I agree with this right now, but I know my basal rates are messed up, so it's best to start over with a single rate for now.  He also wanted me to increase my IOB time by 2 hours and make my target BG 120 mg/dL.  I compromised by increasing it to 1 hour and keeping my range at 100-120 mg/dL; I don't mind being at 120 mg/dL, but I refuse to treat 100 mg/dL as "low". 

Then I addressed the elevated blood pressure reading with him.  I told him I had been having a lot of appointments lately with my knee, and each time I was having elevated readings.  He agreed that he doesn't like this trend, so he took a look at my history with his office over the past 4 years and notice another upward trend:  my weight.  I've never had a huge gain all at once, just a few pounds here and there.  But a few pounds over a couple of years can sneak up on you.  He said the best thing I could do to reduce my blood pressure was to lose 10 pounds, or else we'd have to do "something".  I'm assuming he means I'll get put on blood pressure medication, which wouldn't be terrible because they could also protect my kidneys.  But I don't like knowing that I didn't do all that I could to be healthy on my own. 

So to recap:  increased A1c, weight, and blood pressure.  I debated calling Trey immediately after the appointment, because I knew it would result in tears.  And it did.  My poor husband can read me like a book, even over the phone.  And when he said, "I know you're about to cry . . ." I lost it.  "It's not the end of the world, Babe.  You're still doing great.  We just need to change some things."  We agreed that we had been calling the local pizza place too many times over the last few months when we had no plans for dinner.  And even though I've increased my physical activity over the past couple months, I need to bump it up.  I've decided to give the spinning class a try (now that my knee is feeling better.  Thank you, physical therapy.), and softball is about to start up again.  Hopefully these things will help in the weight department. 

I really don't know how to end this post other than to say I'm feeling very overwhelmed right now.  Ten pounds seems so impossible, seeing as I'm struggling to keep 2 lbs off on a weekly basis.  I can log my food with some consistency and keep up a reasonable workout routine, but more than anything I need encouragement.  I need hope that this is not an impossible feat.  I just need to find something that works for me, but first I need to know that everything will be OK.  I need to stop freakin' crying about this and find some joy again. 

Sorry, guys.  I know this isn't how I wanted to end this post, but sometimes I need to be real.  And I hate this, period. 

Things on My Radar

Yesterday I had my yearly female appointment with my gynecologist.  Even though his office is labeled as OB/GYN, I like to invert the two and add an "O" making him my "GYNOOB" (pronounced "guy"-"noob"), cuz I'm mature like that. 

I know most women can't say this, but I love my gynecologist!  Of all my doctors, he is definitely the nicest and most encouraging one I have.  Yes, you may have to wait over an hour past your appointment time to see him, but it's worth it when he takes your time with you and treats you like you're the only patient in the world.  (And especially with this kind of appointment, sensitivity and patience is key.)

He always makes a point to ask me, with genuine sincerity, about my diabetes.  I usually tell him, "Fine," but I know I could say, "It's a pain in the arse," if I wanted to.  When he asked me what my last A1c was and I said 6.3, he looked up from his chart and smiled, "Good for you!  That's awesome!"  "Thanks, I just try to keep up with it," I shrugged. This (A1c) point led to an interesting topic between us:

Me:  "So, what would be your threshold for, say, pregnancy?"

Dr. (smiling):  "Oh that's a great topic!  I would want you to stay under 7.0, but that will be controlled by you and your endo.  Who are you seeing for that?"

Me:  "Dr. [insert name here], the one with the 'special' sense of humor."

Dr. (stomping his foot and laughing):  "That is so true, he's definitely unique."

Nice to know even another doctor notices my endo's dry personality.  Should make April feel better.  ;-)

So after this nice little chat and my *ahem* exam, he looked me in the eye and told me I was just as healthy as any other woman who desires children.  "That's what I wanted to hear," I said and he walked out the door.  And before I left the room, I paused and held onto his words like they were charms on a bracelet:  "just as healthy".  Even though we're not trying for a baby right now, I like knowing that we could.  Like the power of my diabetes is harnessed and chained, under my control.  I couldn't help feeling a little empowered, like some goddess of femininity wielding a pump and CGM.

Trey and I talk about having kids all the time, like they're already here or something.  And sometimes I forget that having diabetes makes that dream a little more of a nightmare.  I'm not afraid of the lab-rat-type testing I'll undergo, or even the constant warnings of complications due to high blood sugars.  The one thing I'm afraid of more than anything:  motherhood itself.  I know I want kids, and I desire them more than anything.  I get all teary-eyed at posts like this one and get chills thinking about someone calling me, "Mommy."  But I'm a little anxious about the 180 life-change that will follow.  It's the same anxiety I felt before college, getting married, buying a house, or adopting another dog.  It's the anxiety of not being prepared for something very important, only to realize there's NO WAY to be fully prepared to begin with.

It's so strange to desire something that you're terrified of, like WANTING to be bitten by a snake (who would want that?!).  To be responsible for a life, a soul, that will rely on you to know how to walk through this life.  Hoping that they find God's love, and praying you're not going to screw it up!  And wondering how can you love someone so much that you haven't even met!  (CC:  Facing the Giants)

I don't know, we're so far ahead of the literal pregnancy/diabetes stuff that I'm still focused on the big picture.  All I can say is that I'm excited and terrified, especially now that I've added a new label to my blog:  pregnancy.

Whoa!  Things are starting to get too real around here.  So to level things out, here's a picture of my dog gassing me with one of her rancid farts. 

Aaaaaaaand, we're back!  =)

Calgon, Take Me . . . to Low Blood Sugars?

Last night, I had the rare opportunity of having an hour of nothing to do (what?!).  So I decided to use the occasion to take a bubble bath using my lavender-scented body wash and bath salts.   I tuned my iPod to my favorite radio station, and cranked the water to one degree below boiling, just how I like it.  And I enjoyed having the hour to myself (oh and Elvis the cat, who decided to hang out on toilet next to the tub.  totally.  awkward.). 

After I was done, I went into the living room to catch up on a little Facebook stalking before bed.  But before I could sit down on the couch, Constance was bzzzzzzing from my robe pocket.  "Low BG.  70 mg/dL" with a southeast arrow.  Then I finally took stock of how I felt:  racing heart, maybe sweaty but couldn't tell from just getting out of the tub, kinda fuzzy in the mind.  So I made a glass of milk and grabbed some Elf Fudge cookies before taking to Twitter to discuss this phenomenon. 

This isn't the first time that a hot bath or shower has induced a low blood sugar.  It could be the temperature of the water, which is well above my body temperature.  So, I'm basically boiling myself like a lobster, causing my heart to race--possibly causing the hypoglycemia?  You'd think being disconnected from Arnold for over an hour would have the opposite effect. 

Like this?

When I was first diagnosed, my mom (a nurse for 30+ years) told me that hanging out in the hot tub helps my dad (T2) with his blood sugar.  So, guess where I was the first 3 weeks of my diagnosis?  Do you think purchasing a hot tub could be written off as medical equipment?  (A girl can dream, right?) 

So has anyone else experienced this hypoglycemia phenomenon or managed to harness its power for good?  Like taking a bubble bath when having a stubborn high?  Or hanging out in the hot tub while eating pizza instead of taking a bolus?  The possibilities are endless! 

But regardless, I like Dayle's response.  "still waiting for my endo to prescribe more bubble baths! ;-)"  Me, too, Dayle.  Me too.  

Just Blah

I wouldn't necessarily call it burnout, I'm not quite there yet.  But lately I've just felt like I've been going through the motions with diabetes (and life).  I'm testing, counting, bolusing, exercising, but I just don't have any emotion behind any of it.  The other night, Constance said that I soared to over 350 mg/dL before my insulin kicked in, and I just blinked at it.  And I'm waiting out my lows longer than I should:  I'll see that I'm low, wait the 30 minutes for the "snooze" to see if I will come up on my own, then correct if I'm still low. 

I don't know what's causing this "blah"-ness.  It could be the constant cold weather that's starting to wear on me and causing some winter blues.  It could be the fact that I've stuck to my resolution of working out at least every other day and I've oscillated between +/- 2 lbs.  It could be that college football is officially over (can I start the countdown yet?).  And it could be just because diabetes is a constant disease regardless of my ambition or spirit to keep it under control. 

Sometimes the blahs or burnouts can be a good thing.  I haven't stressed out over a blood sugar reading over 250 mg/dL because I know the insulin will kick in eventually.  But I haven't hooked Constance up to the Dexcom software since before my endo appointment back in October.  And honestly, I'm afraid to.  Between a sinus infection that left me cruising in the 300s and all the holiday snacking, I think my last A1c of 6.3% is long gone. 

I'm just in this weird in-between phase right now because it's too cold to go bike riding or play softball (or to at least enjoy it).  So I find myself going from home to work to home, trying to keep warm in the process making soup after soup (I'm running out of soup recipes), and working out with the Wii.  Trey cut up a cantaloupe the other day, and I got the sweetest hint of spring with its taste.  I'm so ready to see the sun and feel its warmth, rather than seeing my breath in the sky. 

I've got the winter (and diabetes) blues.  *cue jazz harmonica* 

Friday Five: Since then . . .

Tomorrow is my 4th anniversary since my diagnosis.  I was thinking about this the other day and reflecting on everything that's happened in 4 years.  So for this edition of Friday Five, I want take a look back at everything that happened since that day. 

1.  I graduated with a bachelor's degree in Physics with a minor in Mathematics.  My diagnosis happened at the end of my second to last semester in undergrad.  Several people asked me if I was going to take the next semester off to get used to being diabetic.  To be honest, the thought never crossed my mind.  I guess I never truly knew how serious this disease was until later, so coming back to college with insulin pens seemed to be just part of my life then.  I was too passionate about my education to simply give up.  

Just after walking across the stage. 

2.  Married the guy who's been there since day one.  I love him more now that I did on that day.  I can't imagine being with anyone else, and not just because of diabetes.  Trey is the strong, dependable Christian man I prayed for when I was single.  I respect him because he proves his love for God and me through his actions.  Being with him feels like "home". 

I look up to him, literally. 

3.  I became a MASTER . . . of atmospheric science.  Grad school was by far the most stressful thing I've ever gone through, but I felt so proud of myself on the day I defended my thesis.  I was the first female in my family to get a graduate degree, and it landed me a great job. 

Defending my research at a conference. 

4.  Helped remodel a house.  OK, my abilities kind of stop at sweeping and painting, but that's more than I've ever done before in my life!  Having a bulk pack of sports drinks at arms' length helped keep away the lows involved with sweat equity.  I love seeing how we've turned this somewhat trashed house into our family home. 

Proof that I painted.

5.  Preparing for children.  We aren't trying or anything, just doing some preparation work.  But I know that diabetes won't be something I have to wait on.  The fact that Trey and I can talk about our future kids without a worry about my less-then-stellar incubator gives me hope that diabetes will continue to be the background noise in our life. 

Even without diabetes, these past four years have included a lot of life changes that would make a normal person go "whew!"  I'm not sure if I would have taken stock of all of it if I didn't have an anniversary to celebrate.  I guess it's another reason I'm GRATEFUL for diabetes, it gives me a chance to sit back and be humbled by all the blessings in my life while managing this disease.  And whether I'm here on Earth for 4 more years or 40 years, I hope I always take the time to look back and see how far I've come.  It's like anytime someone says to me, "Oh you can't do that because you have diabetes."  I can say, "Oh yeah, watch me . . ."