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Monday, October 17, 2016

34 weeks

Well I have made it to 34 weeks and things are going pretty well I think. The problem I am having still is that the baby is breech. I am doing all the exercises that may or may not help her flip head down short of standing on my head and scrubbing all my floors on all fours (next weekend, maybe). I also haven’t tried the icepack to her head advice, but I am thinking I might as well. (Aside: my dogs get pretty excited when I am doing my inversions with my elbows on the floor and my butt high up on the couch, or laying on the floor with my pelvis elevated. At least *they are amused)… If she doesn’t flip I will be offered a version at around 37 weeks, which is a decision I am dreading making because with an anterior placenta and being a first time mom the odds of success are lower and the risks (although unlikely) freak me out. I haven’t decided if a guaranteed scheduled c-section freaks me out more than attempting a version first in an effort to attempt vaginal delivery.

My doctor’s appointment last Friday went much better than the last one – I was more agreeable to ceding control of my diabetes management (whatever, if they mess it up it’s one them!)  and he seemed pleased that I was going along with hospital policy and also with the twice a week biophysical profiles (BPPs) starting this week. I hope they don’t take long – so far they haven’t – she is always very active, practice breathing, and my amniotic fluid is and always has been “average”, which is great. I also had my first growth scan in over a month last week, and was very pleased that babe was still consistently in the 30th percentile. I only get one more growth scan in 4 weeks and that’s it for that!

I am keeping an eye on my blood pressure at home and was pleased to find it at 110/65 this morning. I also have zero swelling. So far so good. My blood sugar management continues on its own curve of running averages in the very low 100s with a tight standard deviation (of less than 20 mg/dl), translating to a normal A1C in the low 5s. My morning I:C ratio is now up to 1:2 with other meals at 1:2.5, and I am up to 26 units of Levemir daily. Crazy! I am doing what needs to be done and also fearfully dreading the postpartum insulin adjustments to come. With lows under 60 mg/dl reported as less than 1% (according to Dexcom) I really can’t complain.

My baby shower/ B’s 30th birthday went great – we got so much stuff and it’s really starting to feel real. My living room was temporarily transformed into a fortress of cardboard boxes (again, more amusement for the canines).  I promise I will post some pictures soon. Gotta run, meeting calls …

Monday, October 3, 2016

32 weeks: let the crazy begin

Well, here we are: 32 weeks along and 8 to go (give or take).

While I have been very lucky with pregnancy symptoms overall (no serious pains, heartburn, nausea, exhaustion, swelling, etc. *In fact sometimes I forget I am pregnant until kicked), I have to say that the third trimester hormones have been messing with my emotions (sorry B).

Also, sorry Dr. H. What can I say – I have recently turned into a bit of a control freak. The 40-minute discussion about whether all those twice a week appointments are really necessary for me (although I was relieved to hear that they are recommended after 34 weeks and not 32) did not amuse him. Nor did my obsessively strong desire to manage my own insulin during labor and delivery (apparently that is against hospital policy). I must say the latest “discussion” was not so much heated but just kind of antagonistic and repetitive (on both of our parts). We came to some agreements without much discussion at all: no early induction unless actual complications present (including going past due date, within reasonable limits), scheduled C-section only if baby remains breech (actually he said they do have limits on estimated fetal weight when it comes to vaginal delivery in diabetic patients but he seems to think that is a moot point considering my level of control and that the baby has been tracking in the 30-comething percentile). Looking back, I think maybe I am just over-reacting about giving up my own blood glucose management in the hospital. I am sure they can do a good job, and he said I can move around for most of the delivery (until the end when they do the Dex10/insulin drip to “clamp” my BG in the normoglycemic range for delivery OR if I have pain management, whatever happens first.) I guess that’s OK. I hope they listen to me when I tell them what I have been doing to stay in the normoglycemic range (92% of the time, according to the latest Dexcom download, translating to a 5.2% A1C). I know I am over-reacting, but something about not having a say in my own management protocol (which has been working so well) makes me a crazy pregnant bitch (maybe it’s just that I expected this would be a non-issue, since I have heard of other women being allowed to do so in labor, but where I am it’s a “non-starter according to hospital policy”). And I understand that it is policy and this doctor is not just trying to piss me off for no reason. I really do. But it just wasn’t what I expected. I was also hoping she wouldn’t still be breech (but she was). They will offer an external cephalic version at 37ish weeks to try to turn her if she doesn’t comply on her own. If she stays breech, it will be a C-section. Some things are just out of my control – might as well get used to it, I hear parenthood is full of that shit (and worry).

The good news is her first biophysical profile (BPP) took all of two minutes. She was doing all the things she was supposed to, and the fluid level looked great. My at-home blood pressure readings remain excellent, and Dr. H is not concerned about the spikes at the office (I guess when your pulse is 120, one can deduce a systolic high reading is an artifact of anxiety J

So, where am I/ What’s the point of this post? Oh yeah, I have to give up some control (a good lesson for impatient control-freak me). Also, after talking to B (who is very laid back and the perfect balance to all my crazy), I have decided there is absolutely no reason to not just go to the routine monitoring appointments. I am stubborn but not that stubborn? (read: I would never forgive myself if I went all apeshit AMA and something bad happened).

Until next time.

Friday, September 23, 2016

In the wild..

Walking to the train after work I see a little kid (maybe 5?) and his babysitter walking to the train as well. "Eat your snack" she instructs. "You better eat your snack."
"Haha, what if I am 40?" Laughs. "What if I am 12? Hahaha" The kid is having a good time as he waves around his zipplocks of goldfish and fruit snacks. "What if I am one? Hehehe !!"
"Well if you are 1 I think we would have to stick that medicine in your butt! Or maybe you will just eat a ton of those fruit snacks."

I pause and look at them closely as we cross the street together and we make eye contact.
"Glucagon?" I inquire.

Her eyes widen. "Yeah!"

She first assumes I have gestational diabetes (since I am wicked prego these days) and tells me how his mom had it with him and his older brother. Sounds like mom is trying to ease the sting of diagnosis for him by relating to her own experiences managing BG.

"I have type one too" I say. She gets excited. I am also but cannot help but feel an overwhelming feeling of sadness for the young boy. He is just fine though. "You?! You have type 1 diabetes too!!?" "I do!!" We bond. He can't believe it. Just recently diagnosed. Can't believe he is not the only one.

I chat with the babysitter as we walk together. He will be starting on a CGM soon. I pull mine out and show them. They are both so excited! "It doesn't even hurt" he brags about the injections. He is getting a pump soon. They are newbies - trying to figure out the intricacies of balancing insulin dosing and the unpredictability of childhood. I tell them to go for the Dexcom, how much easier it will be.  I wish I had time to tell them so much more. "Did you have it your whole life?" She asks. "No actually I was diagnosed at 18." We continue to talk and walk and bond. We talk about how rare type 1 is and how exciting it is to just meet another type 1 "in the wild". My train is there, I have to go. I regret not exchanging numbers (is that weird?) I feel like I could have should  have told them so much more. Perhaps we will see each other again (it was right after 3 and I assume she picks him up from school so quite likely.) If there is a next time I will tell them more.

I can't help but pause and think about what if it was my child. The kid was a happy kid. He was not in the least bit sad or bitter. I reflect about a recent social media post inquiring if those diagnosed as adults feel more bitter because they remember life before. I am thankful that I don't feel bitter. Although my heart broke for him I could not bring myself to feel bad for him as he skipped away to the other side of the tracks.

Thursday, September 22, 2016

Third Trimester Reflections

Hello and welcome to another ramble & update post J I am about 30.5 weeks pregnant. I am finishing up my fourth week at my new job. It’s going pretty well. The commute is miserable. And diabetes? Well, it’s getting more and more difficult to manage.

To sum up my life M-F, I get up at 4 am, feed my dogs, eat, commute for 2 hours, work for 8 hours, commute back for 2.5 hours, feed my dogs, eat, crash on the couch for 2 hours watching TV, sleep, and then do it all over again. The weekend always involves hiking with the dogs, cleaning, cooking for the week, and more often than not visits from family and friends (which I don’t mind at all but have also been relieved to have a couple of “free” weekends recently, now that it has been two months since we moved and we have caught up with all the family and most friends). We are excitingly looking at houses that will bring us closer to work so we can have a nice commute (anything is nicer than what we are doing now), and working out our financial situation to make that happen as quickly as possible (hopefully before my maternity leave ends). Maybe I am supposed to start preparing for the arrival of my daughter somewhere in between?

The rest of my life pretty much involves being preoccupied with being pregnant and having diabetes. I will briefly sum up the doctor visits (actually there has only been one more so far) and also BG management.

After the longest break in between appointments (almost 5 weeks) I find out a few days before I am scheduled to see Dr. O that in fact there has been a mstake and she cannot provide care for me since I am not being managed at the Joslin Diabetes Center concurrently. Big bummer. They apologize for telling me the wrong thing. I ask them to schedule me for the same day and time with someone (anyone) else who is able to be my OB even though I manage my own diabetes care. They do. Enter Dr. H. I like Dr. H. We talked for a while at my 29.5? week appointment last Friday. Below is the snapshot of the summary (I guess we all agree to be reasonable and we shall see what exactly that will entail considering how the pregnancy progresses). I actually don’t mind being monitored extra “just because diabetes” it’s totally fine with me, but given my stressful commute, new job, and deductible (and not the very best insurance plan), I would prefer to alleviate some of those stresses by perhaps opting for a few fewer BPP appointments after I hit 32 weeks. I want to be respectful and as agreeable as possible while still advocating for what is best for me and I think I got that across…

Honestly, I can’t believe I am in the single-week countdown, so to speak. Time has sped up (and also somehow slowed down) if that makes any sense at all. Oh about the baby – she looked great - 38th percentile for growth, practice breathing, average amniotic fluid, good-looking placenta, etc. etc. etc. I hope this trend continues. I has a bit disappointed that she was in the breech presentation last week (after being head down every other time), but sounds like there is plenty of room to turn so I hope she does. I look forward to the appointment actually – it does provide peace of mind (and I really need to get on top of discussing plans for labor etc. although I know that those plans will likely go out the window because life and childbirth in particular appears to be quite unpredictable).

My baby shower is two weeks from tomorrow. Crazy. It will also be B’s 30th birthday. Equals huge family party at my mom’s J

I am experiencing some pregnancy discomforts but overall it’s not too bad. I miss being able to sprint full speed to catch the train. My steady (if not accelerating) weight gain surprises me but I guess it’s fine – the doctors did not say anything… I had one evening where I had heartburn so bad that I almost threw up and that never happens to me. I did eat a lot of crap food that day though and it hasn’t happened since. My energy levels are either very good or meh. I like the good days. My favorite thing about pregnancy is by far feeling the baby move. It is nice to connect with her as she kicks and flutters about on my long commutes or when I am laying down at night. It is more surprising when she has a dance party in the middle of a work meeting. 

Emotionally, I am doing pretty well. The third trimester dreams are kicking into gear as my subconscious psyche explores labor fears. I do still worry about what-ifs and what may go wrong, and although there are no guarantees I am doing all I can to produce the best possible outcome and I try to accept that not all is under my control. It is just very hard to believe that I am going to have a child soon and that everything will just work out OK (I sure hope that it does though).

Finally, about diabetes – the insulin resistance is no joke and I am making constant adjustments. Based on my latest Dexcom stats, my A1C is holding at 5.5% but I won’t lie – it is a fight to stay there. My total daily dose for Levemir just hit 22 units, and my breakfast I:C sits at 1:3 (with most other meals looking like a 1:3.5). I am doing the best I can and that’s all I can do – I remind myself frequently. I feel guilty about the days when I bounce from 80-150 instead of 80-120, but I move on, telling myself that I am adjusting based on those higher numbers, and that every day is a new day, and diligent and consistent effort will (and it does) pay off.

That ‘s all I got for now ;)

Thursday, August 25, 2016

Funny thing..

Well sort of.. You know how I wrote/ complained about the insulin resistance and drastic Levemir increases in the last post? I forgot to consider all the variables. After I switched out my Levemir pen and took 11 units for my evening dose, I spent the night eating smarties. So my Levemir went bad on me.. Switched to dosing 9 units twice daily, went  to bed around 100 mg/dl and woke up at 88 mg/dl this morning. Again, thankful for Dexcom for alarming when I was low all of the previous night... Sigh, don't forget to question the integrity of your insulin!! I am kind of relieved though to know it was that and the insulin resistance was not as drastic as I was starting to think :)

Monday, August 22, 2016

Week 26

Today I thought I would take a closer look at the diabetes management aspect of pregnancy - in particular the constant adjustments. Aaaand also do a pregancy questionnaire :)

While I did have to shuffle things a bit during the first trimester (with my basal doses ranging from 12 U Levemir daily to 15 U and my I:C oscillating between 1:8 and 1:10 for the most part), the latter half of the second trimester (e.g. weeks 22-26/now) has been marked with such insulin resistance that has made me say "Whoa" and prompted changes that seem so drastic that it felt scary to make those changes but I have to do what I have to do when I see depressingly high trends on my CGM... Case in point: over the last week I have increased my basal TDD from 16U to (what will be as of today) 20U, and my I:C is now 1:5 or 1:6 depending on the time of day, which sure feels like an enormous jump from what I am used to, but it is what needs to happen.

This last week has been nuts in particular overnight, when when I wake up to pee and find that I have to correct almost every time :( Waking up in the low to mid 100s is just not working and neither is the 2+ U of Humalog needed overnight just to keep me from skyrocketing higher than what is already too high. I seem to have finally hit a stride with the daytime numbers (well, at least during breakfast and lunch, I am thinking dinner needs more tweaking because that's the time my morning Levemir dose is wearing off) after settling on 9U of Levemir in the morning. However, 10U of Levemir for my evening injection is not working out so well (Last night I had to take about two units of Humalog overnight just to stay steady, and that was after correcting the high from dinner - see below)

Now, this is not a horrible graph in my opinion, but the problem lies in all the stacked correction doses after having dinner, and then also more corrections overnight. So, this evening I will be increasing my second Levemir shot to 11 U, and I think I may test a 1:5 I:C for dinner (which is what I use for breakfast) instead of 1:6. That and doing everything I can to make sure that I am not above like 100 mg/dL when I go to bed. It is a bit unnerving to make so many changes in such a short period of time, but I really want normal blood sugars (all the time please :)

I keep reminding myself of the advice I received from my endo when I saw him back in June. "You know what you are doing Maria. Just remember, small, gradual adjustments." And so I have to remind myself that small and gradual is the way to go, which is precisely why despite all the extra corrections over the last few days I am increasing the evening Levemir dose by just 1 unit (and not more than that for now). I just really hate playing catch-up but I also don't want to end up on the other side, constantly chasing lows. We will see what happens next!

In order to get  better picture of everything (as I never log anything into my CGM), I have been doing some old-shool logging. It has felt necessary and has helped me be more confident in making these adjustements:
Fun Huh? And isn't my handwriting chickenscratch fantastic?
Finally, due credit must be given to Dexcom. I don't know what I would do without it. I certaintly would not be nearly as comfortbale making all these basal adjustments and then going to bed with a blood sugar of 100 mg/dL or lower (I guess I would still wake up to pee though, Dexcom or no Dexcom, and then I would test my BG anyway)... On that note, Dexcom has thrown a few curveballs my way as well. For one (since I prefer my CGM out of sight) I tend to use my stomach a lot in the summer-time. Last week I realized that wasn't going to work anymore. After a bloody site, followed by a gushing bloody site (never had that happen before, SO MUCH BLOOD) and a failed sensor, I deduced that perhaps my tummy was now just a little to big and the skin was stretched a bit too tightly over my baby bump to continue to use it as a CGM site. (I am still injecting into love handles or back fat for the most part). So a few days ago, I tried my thigh for the first time ever and I am loving it so far! Other Dexcom woes are not pregancy-related, such as constantly producing values that are 10-20 points below my fingersticks (read: Grr I thought I was 105 but I am actually 125!), and also just the general unsticking issue. For the latter, I have been using GrifGrips:

 My favorites are the flower ones, because you don't have to specify a vertical vs. horizontal cutout, they will work either way :) They have a ton of different colors and designs and not only do they make the site stay on longer, but they also (in my opinion) make the whole wearing a medical device thing (pump or CGM) feel a little more intentional and festive as opposed to purely medical-looking. They look especially good when you first put them on (see how this site is days old and the edges are lifting ever-so-slightly? That will happen). And for the record, I do not have any kind of relationship with GrifGrips (although feel free to send me free stuff if you'd like guys :D
On that note, I am going to go jump head-first into my last week of not working before I start working again. Also, have I mentioned that it's getting harder to move around and bend over and that I seem to be approaching the whole "Whoa I am uncomfortable now" part of pregnancy? Yep, leave it to me to start a new job at almost 7 months pregnant, but you know, life ;) But first, this:

How far along?
26 weeks

How big is the peanut?
According to my apps, she is about the size of a butternut squash or kale

Total weight gain/loss?
 + 18 lbs I believe

Maternity clothes?
Yes, I broke down last week and bought all the things (mostly on sale) at Motherhood Maternity. I actually spent $120 (marked down from $299) on two pants, 1 short, 2 sweaters, and 4 shirts. I also went to Savers and found a used pair of Motherhood Maternity jeans and a few tops. That and my mom bought me a pair of Maternity jeans from Target. Now I have clothes to wear to work that don't look ridiculous. 

Getting up to pee at least twice every night. So not great. Throw lots of vivid dreams in there (a wonderful combination of erotica and nightmares - take your pick) - and that pretty much sums it up. 

Best moment this week?
Kicks, kicks, kicks. 

Feeling like a whale, being out of breath easily, feeling quite hungry/ thirsty all the time, difficulty getting out of/ sitting up in bed, restless leg syndrome, insomia, sciatic pain. Eww. 

Food cravings?
I am not craving particular things, but I am hungry or thirsty constantly. I try not to eat snack more than every 3 hours so I can have a good idea as to whether or not my insulin doses are set correctly but it's not easy to follow that rule. And then I am all like - eww I ate too much...

Food aversions?


Labor signs?
That's a big no and I sure hope it stays that way for a looong time.

Belly button in or out?
It's well on it's way to being fully out. Weird.

What I miss?
I miss the refreshing feeling of a cold beer on a hot day. And being able to drink as much iced coffee as I want. And being able to be the energizer bunny that I am without feeling like I am going to pass out! And not peeing all the time!

What I'm looking forward to?
Getting into the swing of things with a new commute, job, dog walker, etc. Hopefully, any kinks will be worked out smoothly. Also looking forward to making headway in figuring out the whole childcare options thing, and also Labor day weekend, when I will get to see some old friends I haven't seen in years. 

Does feeling huge count? I like seeing my stomach move from the outside - very alien. 

Definitely - see last post!