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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!

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