Tough Weekend with Arnold

In the 4.5 years that I have been on an insulin pump, I've had very few instances where the pump had a malfunction.  Usually, I can contribute any random highs on operator error.  But this weekend, I had several instances where I was so frustrated with my pump that I want to call my endocrinologist to go back on MDI (haven't yet, but I'm still considering it).  

I guess it all started when I noticed that my most recent box of infusion sets seemed to be made of flimsy plastic because I would have little bits break off when I would insert the cap into the reservoir.  It never caused any trouble with the pump working, so I brushed it off.  But Saturday morning, I woke up to a high BG of 219 mg/dL, which is a far cry from the 100ish average I try to maintain in the last month of my pregnancy.  I got up to confirm the high alarm, and noticed that the tube on my pump was dangling towards the floor and not connected to the site on my thigh.  "Oh, well that explains it."  I reconnected with a new infusion set, and bolused a correction.  

The problem was that I was never able to get back into normal range, despite dialing in correction after correction.  I feel into a heap on the bathroom floor because I was so frustrated.  Even rage bolusing wasn't working.  (And by rage bolusing, I mean 5 extra units "just because".)  I finally come down after 5 hours of being above my preferred line.  The rest of the day went on as normal.  

Then yesterday, I laid down to take a nap (random occurrence for me these days) and when I woke up I started going high like I just ate a cupcake sprinkled with sweet tarts.  But I hadn't eaten anything in 4 hours!  I got up to 297 mg/dL and three failed correction boluses before I finally gave myself an injection, ignoring all of my active insulin.  I finally came back in range 2 hours late to 125 mg/dL without a crash, which should have been inevitable considering I gave double what I needed.  

After 2 calls to Medtronic, we decided that I have a bad box of infusion sets.  So I changed my site for the 3rd time in two days with a new reservoir and infusion set from a different box.  I bolused for dinner after not eating for almost 8 hours and waited to see if my blood sugar would actually come down before I took a bite.  Thirty minutes later, I was cruising towards my low threshold, so I concluded that the new site was working.  

Even today, I'm still not happy with how quickly my insulin takes to work.  Everything with my site change yesterday was new, including a fresh, cold vial of insulin from the fridge.  But so far I've had to give 2 additional corrections following breakfast.  It might be that my insulin:carb ratio needs adjusting (again!), but I still am not happy waiting over an hour for my insulin to bring my blood sugar down.  

I feel absolutely hopeless when this vital technology fails me.  I don't want to go back to MDI, but the time it takes for insulin to kick in is considerably less than waiting on a bolus from the pump.  It may save me from lows, but I'm spending far too much time over 100 mg/dL to justify it.  Even thought my last A1c was fine (5.6%), I don't want to let up in these last 4 weeks of pregnancy.  I want to keep the same steam that I've had the whole time.  And I can't do that when I don't trust the technology that I rely on to keep me there.  

It's the final lap, Arnold.  Do we need to come in for a quick tire change and fuel up before we win this thing? 

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." 

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!

High Days are Low Days

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

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

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

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

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