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Thursday, December 22, 2016

Postpartum adjustments. aka taking care of a baby... and diabetes too

If you scroll back a few posts (back to 39 weeks) you would see in my Dexcom report that I used to calibrate my Dex about 5 times a day while pregnant. I also tested about 10 times a day on top of checking Dexcom obsessively. In fact I made diabetes the biggest priority of my life (as in a bigger priority than my job or anything else). I would bolus down a BG of 110 or 120 while driving, I would stash my insulin pen in my back pocket for quick access during work lunches. I would check my BG and bolus in public if needed. I would eat one smartie at a time to treat a 55 BG to ensure I did not shoot up too high. I would eat the same two options of breakfast and lunch each an every day to ensure I met my targets. Not to mention the part where I would download my two-week Dexcom history in preparation for every prenatal appointment. As a result, I stayed in the non-diabetic BG range aout 90% of the time throughout my entire pregnancy, achiving non-diabetic A1Cs in the low 5% range consistently, and generally felt very accoplished about my management. The work was worthwhile. I delivered a healthy baby girl at full term and experienced exactly zero complications related to diabetes during my pregnancy. In fact, my diligence (or obsession) paid off so much so that I felt I had a relatively normal and overall quite easy pregnancy and I can't wait to do it again. Overall, it was a very positive experience. Also, if I can do it, anyone can - I really believe that.

Now, almost 4 weeks after giving birth, things are quite a bit different. Let's back up to the day of the surgery. Within a few hours of delivery my BG was registering in the 80s and 70s consistently, which prompted the gradual lowering of insulin infusion in the IV drip. This escalated, and the insulin was shut off altogether (while the Dextrose drip remained) and my BG stayed in the 70s for hours without additional insulin (as the Levemir from the previous day was still doing its work I presume). These developments prompted my decision to go to 5 and 5 units Levemir split for my initial "return" dose instead of the 7 and 7 I originally planned upon. I also set my I:C to be 1:15 at first. Within the next day and a half - promptly after surpassing a BG of 200 for the first time in months, I re-set my doses to be 6 and 6 for Levemir with a 1:10 I:C, which was where they remained for a few weeks. (Aside; the hospital staff was excellent - just excellent - at letting me do whatever I needed to do, including using my own meter [which as I learned reads about 20 points higher than theirs] and insulin pens.) Currently, I am doing 8 and 8 Levemir and a 1:8 I:C, although I am now planning to lower the evening Levemir dose back to 7. Whew.

In the past 4 weeks there were night-time low battles - the only pattern I can identify is that sometimes I drop low after baby cluster-feeds and my milk supply is being replenished. All I can do is eat Pizelles, drink Capri Suns, or (my favorite!) eat giant sour patch kids to fix these lows. There was one night where I consumed about 30g or 40g of carbs uncovered and did not go high. There was last night where I only had to consume about 15g overnight to stay stedy in the 80s and then wake up at 62, but 15g is still too much for me to keep my basal dose. Things do not have as much of a pattern as they did during the pregnancy, which is annoying. But another reason for this lack of tight control is that I am not as diligent as I was during pregnancy at identifying the patterns, perhaps. I no longer freak out about a BG of 140. I certaintly do not calibrate 5 times a day. Seriously, I am lucky if I test two times a day! I have not downloaded my Dexcom history since the week before delivery. Also, after the past year of excellent control I never thought that I would be so relaxed about bouncing between 60-180 on many days, but.. I am. My food choices are well... not as strict as they were during pregnancy. And to be honest, I am ok with that.. for now.

I am still happy that I am not really hitting 200s ever. I haven't had serious lows.. yet. I am pretty sure any endo on the planet would be happy with my A1C right now (even if I would personally consider it too high). So it's not like I have completely gone off the control train - in fact my control is still much much better than all the years leading up to preparing for pregnancy. I guess I have just come to expect a lot of myself if you know what I mean.

Now, when it comes to taking care of my baby girl, I am much more diligent. Sometimes I have to put her down to check BG or take my insulin, or eat when I haven't in hours, but let's be serious - she rules the show and I wouldn't have it any other way (have I mentioned that I lucked out and it seems she is an easy baby? that I actually am getting enough sleep? that I am probably jinxing myself by writing this? that I am so freaking happy she is in my life?) I also feel that re-assessing my food choices and becoming more stringent in my control goals again is on my radar in early 2017, because I want decades of health for myself and for my family (which I definitely plan on expanding on).

Happy holidays everyone - best wishes for a very happy new year!

Monday, December 5, 2016

The Birth Story

11/24 - Thanksgiving

I spend the evening at my sister-in-law's enjoying good food and (gasp) a half a glass of red wine for what I think was the second time all pregnancy. I declare that I have absolutely no signs of going into labor and that the baby would definitely arrive by scheduled C-section on the 30th.


It is the day of my last prenatal appointment and before driving into Boston for the 3pm BPP and prenatal I spend the morning at home trying to clean but dragging my feet. I feel an intermittent but painless tightening of my abdomen at seemingly regular intervals, and at one point I start using an app to time these "contractions" but quickly stop and laugh it off because while uncomfortable I did not consider them painful. But they were somewhat on my radar as they did not go away after drinking water and resting. Another new and intersting symptom was that every time I used the restroom (which was a lot of times at almost 40 weeks pregnant) I felt the baby drop. It was a sudden sensation that I can only equate to a sudden stop when you are on an elevator, experienced only in your pelvis. This was indeed interesting, and I wondered if I should bring up these developments to my medical team at my appointment...

As I drive in for my appointment (about an hour and a half drive), I experience probably six or eight of these "fake contractions", this time accompanied by some lower back discomfort (or dare I say mild pain), which I attribute to the discomfort of the driving position. As I drive, I enjoy what will be my last snack as a childless person (diet Pepsi, almonds, and pork rinds).

I arrive at Beth Israel and we pass the BPP with flying colors. Although Dr. H is not there the day after Thanksgiving, Dr. S is (I like him too). My blood pressure is actually OK and we discuss some details of the scheduled section. He asks about labor symtoms and I casually mention the baby dropping sensations and tell him that I have been experiencing "fake contractions all day". He asks how many and I estimate about 20. He seems slightly alarmed by this information and suggests (my first) cervical check (which sucks by the way) before sending me home to New Hampshire for the weekend. "I am sure I am not dilated - these contractions don't hurt at all!" I declare. (Famous last words). He determines that I am 2 cm dilated and I get hooked up to the monitor to see if I am contracting. After about 15 minutes, the nurse encourages me to drink water to check if the contractions they are detecting might be an artifact of dehydration.They are not. In fact they are coming at 3-5 minute intervals and are starting to feel very uncomfortable, especially in my lower back. An hour passes an my cervical check comes back at 3 cm dilated. I am not going anywhere.

At this point the doctor and nurse are laughing at me because apparently I both have a high pain tolerance and also I am apparently in severe denial of the fact that I am actually in labor. I feel like I am in a strange dream when Dr. S decrales that I should definitely make my phone calls, head to L&D, and we are having a baby today. I oblige. We discuss vaginal breech birth. It is not recommended for first time moms. "It is not a good time to test your pelvis Maria. If this was your third the conversation would be very different". He also tells me that it is actually more difficult to deliver a smaller baby breech than a larger one. I am ok with the section - I could never forgive myself if something went awry because I did not do what (as far as I can tell) is safest for *her. As I go to the garage for my hospital bag and to make phone calls before checking into the hospital, the contractions pick up. They feel exactly like strong period cramps, they come at regular intervals, and I feel OK about it as long as I am pacing. I am still in disbelief. I take half of my regular Levemir dose and correct the adrenaline-induced BG of 130 mg/dl with a unit of Humalog.

I check in and we wait out some hours for the food to clear my system and for the insulin/ D10 drip to get me to the "sweet zone" (no pun intended). It takes some time to stop flatlining at 130 and get BG under 110. As a result baby's birthday is delayed until early next morning. Labor progresses meanwhile. Strong/painful contractions (I feel them and the monitor shows as such), increasing in length and intensity, although from time to time becoming irregular, but also some as close as 2 minutes apart. A lot of blood in the toilet. It is a good thing I did not drive home today.

I have them check one last time that baby is breech. "Nothing but a butt down here". I am only slightly upset that I am having a c-section. It is what it is - baby's position is not in my control I tell myself as I take my last look in the mirror that day.


Midnight. I am led into the OR while B waits to be brought in after they set up. (I should mention that the plan was for B to sit by my head at all times so he doesn't have to see anything.) I am suddenly very anxious and terrified as I am brought into the OR and I take my position for the spinal. I verbalize this. Thankfully the anesthesiologist is a pro and gets it in on the first try. As I lay down I don't feel much at first, just a little numbness, but that quickly escalates. Like a wild trip, I feel out of control of my body. I tell myself that since I am talking, I am breathing. The catheter going in tickles like crazy and I can't stop laughing. And then I think I panicked but only for a little while. I remind myself, as I lose control of my body and feel a lot of pressure on my chest that this too shall pass and surrendering the need to control is best for now. I hear suctioning. "Have you started? Where is B?" B arrives and sits by my head. He walked past the whole picture as they were cutting me open. This small oversight is the last thing on my mind.

It is around 12:20 am now. I don't feel anything, just pressure (as promised) and it is freaking me out that my left side is much number than my right. The sensation of trying but not being able to move my leg freaks me out a lot (for the record, it felt like my left knee was bent, and I tried to straighten it because it felt so damn weird, as the doctors assured me that my left knee was not bent at all). Shit shit shit. I say that a few times at least. "What is my blood sugar? I feel low" (Aside: I did have to pull Dex after all because they wanted to make sure it didnt interfere with their machines). It is 81, then 105.

Finally they are close and the spunky anesthesiologist grabs B's phone and takes pictures of Audrey's arrival. "There is the first poop!" the doc announces. The moments between the "baby is here" and the crying take forever. B is encouraged to go see (not part of the plan people!) and after the seventh suggestion he obliges. (B was a champ throughout by the way and 9 days after our daughter's birth I am more in love with him than ever before).  He shows me photos of her as I lay there and all I can say is "Oh my God. She is so so little".

11/26/2016, 12:47 am, 6lbs 11oz, 19.25 inches

"How is my placenta? Does it look good?"
"Yes, it looks good."

She gets a 9 and a 9 on the Apgars... Her blood sugar is normal during all the checks. (She never leaves my side, during the entire stay at the hospital.)

"When can I hold her?"
"About a minute."

And then I do. And nothing will ever be the same again.

It is incredibly hard for me to describe how surreal it is to be awake during your own surgery. They say about long trips (whether literal or figurative) that it is not the destination but the journey. I feel so proud of myself for everything I did before and throughout the pregnancy to have such a happy outcome. I still can't believe I am here. But the journey is just beginning I am finding.