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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.


  1. Hi Maria!
    Thanks for sharing your *feelings* with us, not only BG and HbA1C numbers. Of course they're very important, but your doubts, fears and certainties make us feel closer to you (hey, Maria thinks exactly like me, I'm not alone, god!!)

    I'm 30 and relatively new to this diabetes thing - 2 years (I was first diagnosed as T2 during the "honeymoon", 5 years ago) - but I'm happy with my treatment. My A1C varies from 5.4 to 5.6. I'm still trying to reduce hypos, because I'm 20% of the time below 80mg/dL.

    I'm planning a pregnancy for the next year (in fact, I wanted it now! But I need to wait for some bureaucratic stuff in my job). My endo said my A1C is ok, although I need to work on those hypos. And she said I should use a pump. I'm really uncomfortable about it. I live in Brazil, a pump is very expensive and people "force" the government to give them a pump by judicial means. Also, it often lacks inputs for the pump operation, and they are very expensive to buy as well.

    As I could notice, you have a CGM but not a pump, right? You're the first blogger I found that is facing a pregnancy without pump and you're doing it very well! Here the CGM (only two companies options: Medtronic and Roché) suffers from the same problems as pump: high prices and unstable supply. But I've got a new solution: Freestyle Libre from Abbott. This company is well established here and I can afford the cost of two sensors each month. The sensor makes continuous scan, but the reader is manual (I need to approach it to the sensor to get the latest results). I'm and engineer and so is my husband. We're projecting an NFC-alarm to make automatic readings during the night =)
    Based on my current graph from Libre sensor, I don't have hypos during the night, but reading your posts I could notice the huge changes in insulin sensitivity and hormonal behavior during PG. So I decided to implement this alarm to help me during the night.

    I use Lantus and Humalog. Maybe my endo changes the basal to Levemir, not sure. But I'm relieved you are also on injections.

    My next step is searching for other ways of exercising. Currently I practice Kickboxing - not an option for pregnancy. And I need to find a reliable OB. I don't know if this behavior is Brazil-specific, but most of OBs here prefer c-section than natural childbirth, even for non-diabetic women! I don't like it, although I know there's a chance of macrosomnia even if I keep low A1C during the nine months...

    My biggest fear (during pregnancy or not) is to be unconscious and the hospital doesn't do the right thing regarding diabetes. There are lot of myths about it even among health professionals. My grandmother suffered a lot because of diabetes, and when she stayed in the hospital, nurses neglected her BG, which worsened her clinical condition. We don't have any diabetes-specific excellence center. I hope I find a good place for the delivery!

    A lot to thing about! Thanks again for sharing! Your posts are helping me a lot!

    I'm sending you good energy and positive thoughts from Brazil! ^^
    You're doing it very well regarding pregnancy + diabetes. Your BG control is exemplar! You know details of your body behavior and surely deserves to be heard by doctors. You need to work together. You'll succeed! A charming and healthy girl is coming... *-*

  2. Oh, it sounds like the pregnancy crazy is contagious! I've been blaming my doctors, but maybe it is just me. Stakes are high now that we're nearing the end, eh?

    I would hate it and would never allow them to manage my blood sugars for me! Gosh, I didn't even think that would be an issue at the new hospital where I'm delivering, though of course I have the advantage of being able to tell them that I've done it on my own four times at two different hospitals. If you want my doctor to talk to your doctor, let me know. My last OB was the director of the obstetrics department at the hospital where I delivered and was very well-respected.

    I will say that my last two deliveries were like picture-perfect as far as blood sugars go during labor and delivery. One baby had low blood sugar, the other one did not. So I don't know how much your blood sugar really matters during delivery, even though they *say* that a high blood sugar can make baby's low. Babies recover remarkably well from low blood sugar, and a little bit of formula given by way of a dropper will not make it impossible for baby to nurse if that proves to be necessary.