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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!

Wednesday, August 17, 2016

Work, pregnancy, doctors, diabetes etc.

I am eager to write some more before I start working and enter the third trimester when I will officially have no time for anything!

I start August 29th. I will be 27 weeks pregnant then. I left off last time mentioning that I wasn't sure if my new employer knew I was pregnant or not. Well, let me fill you in on how that went! Last Monday (at 24 weeks along) I went in to meet with the employee who was leaving and whose project I would be taking over. That same day, after we were done speaking, I went to my new boss' office and we headed upstairs to talk to HR and sign the offer letter. As the offer letter was being printed, she casually asked me "Are you planning to expand your family soon?". I said, "Yes. I plan to take off the least amount of time possible and return to work as soon as possible. I will arrange for childcare promptly and I have family in the area that can help so that will not affect my performance." She was very agreeable, at which point I said "I am happy you said something. I am due November 28th." I think she was a bit surprised it was so soon but she seemed happy, gave me a huge hug, congratulated me, and assured me that I should be able to take off as much time as I need (at least 8 weeks). So all in all, it went pretty well. I wanted to show you guys the difference between 22 weeks (when I interviewed, on the left), and 25 weeks (taken two days ago). If it seems like a pretty dramatic change, it is, and it's not just the difference in the fit of the shirts!

Pregnancy (& Doctors)
It's getting so real and suddenly so close to the end! I am less than 3 weeks away from the third trimester. This is the first piece of furniture we bought for our daughter ($20 at a flea market!). We bought it from a guy whose grandfather hand-made it in the 1920s, and while it could use a fresh coat of paint (something I may or may not get to accomplishing, along with all the sewing I have been meaning to get to lol) I thought it was a great deal!

I put together my registry for the new baby all in 1 day! My mother and mother-in-law are sweet enough to be throwing me a baby shower in early October. The funny part is it will be on my husband's 30th birthday! It just worked out that way because of people's travel schedules and so we are having a baby shower/ surprise party for him. Basically just a big family party to celebrate everything at once :) The main goals on my list currently are to find a daycare for her, as well as to find a name (we have had a short list for a while but I can't help but feel I am somehow cheating her by not thinking about it more). I am sure it will work out...

As far as pregnancy symptoms, the main one is weight gain. It seems so strange to just keep gaining weight. So far, I seem to have gained an appropriate amount but it's just so weird to me to have put on another 4 or 5 pounds in the last month! And more to go yet. Another not-so-fun symptom is sciatic pain, and I get that sometimes from driving too long or doing too much work around the house. Also, more recently (like this week) I have been having more trouble sitting up in bed or rolling from one side to the other - suddenly it requires a lot more effort than it used to, which is a little scary, because I have a ways to go and my belly is not getting any smaller! I am slightly concerned that my commute is almost 2 hrs (just over 1 hour of driving to the subway + 45 mins on the subway). It's temporary, as we will move closer next year at some point, but being pregnant makes me feel a little more annoyed about it (at least there is a public restroom at the train station - seriously, my least favorite pregnancy symptom is peeing. ALL. THE. TIME.) I will say the one really fun symptom is getting kicked. I have an anterior placenta (in the front) so it cushions a lot of her movements and it makes me nervous when she is having one of her less active days, but now that she is bigger I feel some good movements every day, which is great. Speaking of, I had my first apponintment at my new doctor's this Monday - let me tell you it was surreal to step into the Beth Israel Deaconness Medical Center and realize that my chld will be born in this building!

Last week, while waiting to meet with my new boss to sign my offer, I called Joslin and asked them who they would recommend I see (I was looking for someone flexible who would feel comfortable with a patient with type 1 diabetes, and would also be comfortable with that patient managing their own diabetes.) Joslin (and also Kerri) suggested Dr. O right away, but I ended up scheduling with someone else at the practice because Dr. O was so busy and it would be a while before I could see her. So two days ago I went in for my first appointment and it took 3 hours!!! Let's just say they were thorough lol. Although I have been receiving "high-risk" care in Ohio, they essentially repeated the entire anatomy ultrasound (four different people tried to scan everything, which took forever because baby girl was moving around so much and not cooperating at all!) They kept asking me if I was sure it was a girl, because she refused to reveal that to them for the duration of the appointment (she has been a girl twice now and they were sure both times lol). But at least they were able to finally find all the other important parts and were satisfied that everything looked great ("We just like to make sure for ourselves" they kept saying.) Everyone was very very nice and respectful to me. They said very nice things that almost made me cry, such as "Wow, your A1C is probably better than mine!", "Great job!", "You may be the lowest risk patient we have!". I have been working so hard and it was both nice and reassuring to hear those things. My daughter is tracking steady growth in the 30th% percentile still, so no changes there at all (we are not tall people, so that sounds about right!). My systolic blood pressure was high (but diastolic was 70). Of course, perfect at home, like always. They didn't care, and understood my stress of having to "prove myself to a new team of doctors". I had a small amount of ketones in my urine (low carb lunch of meat and zucchini that happened many many hours before the appontment) and of course noone was concerned because my blood sugar was perfect. "A little ketosis not ketoacidosis!" It was nice to be surrounded by such an educated team! And to have them appreciate the fact that I knew what I was talking about as well :)

Finally, they asked what they could do for me. I told them that I was looking for someone who would be comfortable individualizing my care. I understood that certain blanketed protocols exist for patients with diabetes, but I wanted things done my way lol. Actually, I said " I am not picky as long as I can dictate what happens" We laugh. "Seriously though, I understand that as the patient I can overrule whatever the physician suggests, but I would like to be with someone who will work together with me, instead of having to navigate an antagonistic relationship. For instance, I understand that there are complicatons that can necessitate, truly necessitate an early induction. However, simply having diabetes does not necessitate this in my opinion. I respect the medical degree but I also do not want blanketed protocols based on outdated research to be applied to me, barring actual comlications, including but not limited to pre-eclampsia, placental problems, macrosomnia, fetal distress, etc." They were agreeable and understanding that individualized care was best, and we all agreed that the best person for me to work together with would be Dr. O. And so my next appointment will be with her and we can work closely together to develop the best plans for the remainder of this journey. (If anything can be described as a long trip, it's moving cross-country with 3 dogs, and also pregnancy.) Amazingly, I will be almost 30 weeks pregnant by the time my next appointment rolls around (unless anything alarming happens), which is pretty crazy!

To be quite honest, starting to think about the end game has brought up a few natural fears. Mainly, it's the uncertainty. This pregnancy (knock on wood) has been going pretty smoothly. The most exciting/ crappy thing that happened so far was the food poisoning at 9 weeks. I know that things can change quickly. I know I could develop a complication, and I don't want to feel like a huge failure if that happens. I don't want my health issues to affect my daughter. I don't want my health issues to affect my ability to keep working right up until delivery. I don't want my health issues to burden my family. There - it's out there now. I can't help but be slightly apprehensive if not fearful about what's to come. I may have mentioned this but I have never done this before and I have no idea what I am doing. Or how well I will do once I am a parent. Or how good I will be at balancing family and work. And diabetes. And everything else.

Diabetes is still there and to be honest has been more difficult to control (than during the first half of the pregnancy). Overall, it is still going fairly well. But I can't help but feel like it could be going better. I always try to remind myself that treating a low is faster and easier than treating a high, and most of the time things are on track, but it feels like when things get off track they are difficult to fix in a timely manner. If I can't get to bed at a decent number, it seems the whole night is screwed (despite several correction boluses), which of course rolls into issues the following day. My plan is to remain vigilant and always make sure to: be in range before eating; pre-bolus, pre-bolus, pre-bolus; increase exercise consistency (which has been difficult, and perhaps is my biggest diabetes management "flaw" currently), and continue to be making changes when seeing a pattern (3 days) which warrants insulin increases. I should add "go easy on myself" but I guess that's not really my style. Boy, I never thought I would be this obsessed about my diabetes (to the point where my health care team seems to think I am doing as well as I possibly could be but I still seem to think I should/could be doing better...)

And now onwards.

Thursday, August 4, 2016

Second Trimester Adventures: Cross-Country Move, Insulin Resistance, and ... A New Job!

Let's pick up where we left off (and if this post sounds more like a diary entry or a bout of verbal diarrhea, I apologize in advance)...

1. The Move
We moved (about 800 miles NorthEast). With 3 dogs. And a cat. Two Cars & a moving truck (1 car in tow). What we did not consider is that what should take about 13 hours of driving (+ stops) would take about 18 hours of driving (+ stops) since the 18' moving truck really can't be pushed past 60 mph. But we made it, and it was fine. And my BG didn't go over 200 mg/dl, so that was good too (even though I ate a hash brown at the Waffle house as well as very questionable veggie chips from a gas station).

2. The Pregnancy... and Diabetes
It was good that I saw my MFM team exactly two days before we drove. I was reassured that our girl was growing perfectly, still in the 30% percentile, with steady growth and no red flags. I was also pleasantly surprised that my A1C came back at 5.4% (I thought it would be higher, although I knew it would be under 6%). I was told that I did not have to wear support stockings on the drive, which was also very good. Blood-sugar wise, the days leading up to the move were challenging. I was packing non-stop, and carrying the less heavy items to the truck, etc. so it was basically non-stop exercise that caused me to need to eat uncovered carbs to ensure I had no lows, but overall it was fine! (Shout out to B's mom aka my second mom, who stayed with us for a week and helped us pack and drive the truck. Seriously guys, thanks for not making me drive the truck - I feel much more comfortable driving my little Honda. Also a shout out to B, who defended his disseration and is now a doctor too).
Once we actually got settled, the insulin resistance kicked in (right on schedule I guess - hello 23 weeks!) For a few days I even entertained the thought that maybe all my insulin had slightly spoiled on the drive (aside: I used icepacks and styrofoam, ran the AC most of the time, and frequently checked for temperature as well as for any sign of freezing. So I am pretty sure that's not it). Finally, I started making some adjustments, increasing my Levemir TDD from 13 to now 15 U, and changing my I:C from 1:8 (1:7 at breakfast) to 1:7 for most meals (1:6 at breakfast). It seems to be a bit better. I also know that I am guilty of not waiting to eat until I am in the normal range always, and that I need to get into the habit of consistent exercise once more. But, maybe I should also cut myself a break - my A1C just two weeks ago did come back at 5.4% after all (my personal best since diagnosis). It's just that I really really want to keep it there and have definitely been frustrated by a string of days (or weeks now?) where I seem to be in the mid (or high) 100s waaaay more that I would like to see. Yes, I should cut myself a break, because these past two weeks also involved Dexcom-free beach time, and A LOT of eating out... Here is this morning - let's hope we can keep that (impending) breakfast spike at bay...
On the insurance front, we were happy to hear that B got to start his new job a day early so our benefits could kick in Aug. 1st (instead of Sept. 1st) meaning I don't have to be without health insurance this month, which is also very good... I have started the process of setting up medical care for myself here in New England.. I started up with a practice in NH, which I now have to start re-thinking because....

3. I GOT A JOB!!!!

.. In Boston! Well, actually I got two offers. At 5.5 months pregnant. Which I didn't really expect, but I can't help but be a little flattered (not to mentioned freaking out a little a lot)! Do they know I am pregnant? Who knows, they suspect I imagine. But I intend to come back promptly, and if I get fired - oh well I get fired (although I am pretty sure that's illegal?) Anyway, I have never done this before and I have no idea what I am doing!!! Anyway, I had my little back-up job offer in the bag for over a week now (part-time teaching at a small college). but yesterday afternoon I accepted a verbal offer from Brigham Women's Hospital/ Harvard Medical School for a full-time postdoctoral research position... I would be studying Multiple Sclerosis (which as many know is an autoimmune disorder). I was told that I could also come up with ideas for my own research projects in autoimmune disease (hello type 1 diabetes research?!) and they would fund my pilot experiments as the next steps (over the next 2-3 years) would involve gathering funding to start my own lab. Naturally, I couldn't not accept (Have I mentioned I will be across the street from Joslin?!). The only heistation is the pregnancy, and my dogs (as we now both have a very long crappy commute, which will probably change early next year, once we actually buy a house instead of renting!). However, I have a dog walker coming to meet us this evening, and although I have never done this before I hear people get pregnant all the time (it kind of makes the world go round), so solutions are in progress.. Hopefully I can prove myself quickly and they will understand/ not fire me for taking leave so soon after starting (aside: I really hope I can make it past the 3 month probation period to ensure I am covered by the MA maternity leave law, but I only have so much control over what happens next...)

So there. But the most exciting thing has been feeling my daughter kicking me. I have been feeling her since about 16 weeks, but I have an anterior placenta, which cushions the movement, so until this past week any movemenet I felt has been very very subtle. But for all four days of the month of August, she has been ACTUALLY kicking me (I can feel and see her from the outside!), which just made things feel so much more real....

And now I have to go write a bunch of emails. Alas, back to adulting.

Thanks for listening ;)