Wednesday, March 17, 2010

Update

Someone asked if I could make sure to let everyone know how the change in insulin is going since the blood-sugar debacle last weekend. Well, it's hard to say what the cause was, whether it was just the change to Humalog from Apidra or if it was because the bottle was expired. The reason it's hard to tell is because after all that mess, I just switched to Apidra rather than mess with another vial of Humalog. Plus my last vial of Humalog also expires 03/2010.

Anyway, I still have my theories. My blood sugars have been dramatically better since the switch back. Hugely better. I had been having minor issues with my numbers even before the ridiculousness that was the other night. Just little things, like slightly elevated morning numbers and stubborn sugars after meals. It was stuff that wasn't happening when I was first on the pump and the only two things I could think of that could be related was my period and a cold I was fighting a couple of weeks ago. But then they both came and went and the bad sugars were still hanging on. I was stumped.

Until the other night. It was then, in my troubleshooting haze, that I realized it could all have been related to the insulin. The soft signs up front could have been the first indications that maybe Humalog was not the right insulin for me. And Humalog worked for me for years so I'm not saying that I can just never use it. But I think that it would take some fiddling with my basals and maybe even my sensitivity factor to make it work like the Apidra was working. My body just seems to love that stuff!

So I've thought about it and Google'd it and heard from other T1's moms who have gone through a pregnancy on Apidra without incident . . . and it seems like my Endo may have been overly cautious when she recommended stopping Apidra during pregnancy. And I totally get that. I would even prefer that kind of attitude when it comes to medicine. However, in my case, I think it's obvious that Apidra just works better for me. And maybe 2-3 weeks doesn't prove anything but ultimately the chances of a baby being hurt by the kind of insulin I'm taking are much, much lower than the chances of a baby being hurt by chronically high blood sugars.

So I think I'm going to talk with my Endo at my next appointment and see if she'll give me the okay to use Apidra during pregnancy. I'm hoping she'll be as convinced by the numbers as I am. Until then I'll finish up this bottle and then start back on a fresh batch of Humalog. I'll let you know how it goes.

~Layne

Tuesday, March 16, 2010

Life

I seem to have posted more about diabetes and work-related things recently. I think that's mostly because those are the things I tend to need to vent about. Which is great and all but doesn't really make for a thorough blog of my life. There has been something brewing in our house recently and I thought I'd let y'all in on it . . .

Okay, a really quick update on work . . . sorry I can't help myself! I have stopped my days schedule and I no longer have to stay in Jacksonville 3-5 days a week! Thank the Lord! I have switched to the schedule that will be my regular schedule from now on, which is all 24 hour shifts. Before you freak (like my mother, who just about had a heart attach!) I really think this is ideal. It's bad enough that I found my dream job 2 hours away but the part that makes it bearable is that the hours are flexible and allow me to work really long shifts several days apart from each other. For example, I leave my house around 5:30am to get to the NICU in Jacksonville about 7:30am. I work until 8am or 8:30am the next morning and drive back home.

And, yes, it can be miserable. If I don't get any sleep? If the babies don't stop rolling in? If there are really sick babies already in the unit? It can be awful. But it's only 24-25 hours and then I go home. If I didn't sleep I can always grab a few hours in the call room after my shift before I hit the road. And the best part? I only do that 3 days every two weeks!! I get 3 to 4 days off in between my shifts. How awesome is that? Last Friday was only my second of these types of shifts and it's been rough. But I can already tell I'm getting used to it and it's really nice to be doing what I love (babies!) and still get to live in the city I love and have enough time off I actually get to see my husband!

Speaking of my husband, we actually have some big-ish news. No, I'm not pregnant! (That's what our families have been asking us for the last several years every time we say we have news!! Geez, desperate for grandkids much?) But this time that's not too far off! We are officially trying! That may not be exciting for anyone but me but I've been waiting my whole life to be a mom and I work with ridiculously cute babies all day long . . . knowing I'm that much closer to having one of my own just makes me grin!

We have done a lot of preparing for this moment. Brad's preparation has mostly been mental. C'mon, he's a man and I think they are genetically predisposed to get nervous when the subject of babies comes up. But over the last year, Brad has become more and more excited about the whole idea and it's been so much fun for me to watch. My preparation has been more physical. You already know that I went on the insulin pump in hopes that it would give me the best control of my blood sugars during pregnancy. I already had a great A1C but my doctor thought I'd be able to keep on top of my sugars more easily with a pump during pregnancy. It was a bumpy road getting used to a different way of managing my diabetes. But I think most (*most*) of the kinks are worked out and I recently had some lab work done which came back looking beautiful so I think my oven is about as ready for a bun as it's gonna get!!!

I probably won't announce my pregnancy super early on the blog or to anyone else. I've been working in the NICU for many years now and I've seen what can happen and it's made me more than a little superstitious. So I'll just let everyone stew a bit and go on thinking we are still trying until I'm sure that little bugger is stuck. (I can just hear my mother now. . . "OMG, I'm going to be a grandma! . . .Wait, y0u are HOW far along??")

Anyway, that's my big life news. We are trying to make a baby and we are SO happy and SO nervous about it at the same time. I'm 27 years old but some days I still feel like a kid playing at being a grown up and the idea that I could be a mom soon is bananas.

Other than that, I have a fun family-filled week planned ahead. My brother, Adam, and his fiance, Lacey, are going to be in town this weekend visiting. They live in Ohio and I never get to see them so I'm so happy that they'll be here. Coincidentally, Brad's family is also coming into town this weekend because is cousin (an amazing artist) will be participating in the Winter Park Sidewalk Art Festival, an art festival featuring artists from all over the country. It's held on Park Avenue, a beautiful part of Orlando and we went this past fall and had a blast. Now we get to go and support a member of our family!!

I love getting both sides of our crazy family together so I can't wait for this weekend. Plus, Michael and Megan (Brad's cousins) just had a baby last year who we haven't met so I'm excited to see him! Which will NOT help the baby fever but will be fun anyway!

~Layne

Monday, March 15, 2010

Last night. . .

. . SUCKED! I'd been having issues with my blood sugars all week and last night was the boiling point. It made me want to scream but instead I decided to vent. . . on to the post!

To start, since going on the pump my morning blood sugars tend to be on the low side (50's-70's) but over the last couple of weeks they've been higher (high 100's-low 200's). I thought maybe it was my period . . . maybe it was the wicked cold I was fighting (NOT FUN, btw) . . . the new work schedule. But as the days went on it didn't seem to be any of these things.

Then over the last couple of days, I have been fighting off some nasty highs. When my blood sugar goes high, it usually means it's in the 200's. I feel awful when I'm high and when you combine that with the fact that I'm pretty well controlled (uh, minus this week) it never really gets into the 300's or 400's. Well, in the last 2 days I've had 2 blood sugars in the 300's and several in the 200's. Work was crazy Friday night and I thought it was just stress and maybe some lazy carb-counting on my part. Again, this persisted into Saturday and no amount of strictness would bring these suckers down!! And in the last couple of weeks, even when my blood sugar hasn't been terribly high it has definitely been more stubborn about coming down after meals or high-corrections than it usually is. There were a couple of times when I thought it might be my site but when I took them out, they all looked great! Hmm. ::insert puzzled look here::

So finally, yesterday. On Sunday I woke up to another crappy blood sugar (207). It was a beautiful day so Brad and I went out to lunch on Park Avenue (a wonderful section of town where you can eat at bistros that have plenty of outdoor seating). I ordered a light lunch and only ate half. Then Brad dropped me off at a friends house for the afternoon. There were several girls there and loads of snacks and goodies so I was grazing all afternoon. But I did my best to stay on top of my boluses. By the time I got home I felt like crap and my blood sugar was 331!! My cartridge was running low and so I just changed out my cartridge, insulin, site, everything and hoped that would help. I also took a huge bolus to correct and felt nauseous for the rest of the afternoon.

By dinnertime I still wasn't interested in food but we had dinner plans with friends so I went out anyway. All I ate was a salad and picked at the appetizer that the table was sharing. After dinner I checked my blood sugar and it was 162! Hooray! Maybe it was finally going down. Then why did I still feel like crap?

We called it an early night and I changed into my pajamas and plopped on the sofa with a big glass of tea. I was thirsty and peeing every other second but I figured that was a hangover from my highs early on. I tested again and I was 191. Wha? So I bolused and then tested again before bed 230! Double wha?!? I took some more insulin and decided that I had had enough and it was time to trouble shoot (not that I hadn't been doing that already but I was serious now!)

I had Brad take a close look at my site (it was on my hip in the back where I can't see it very well). He said it looked great, dry, etc. I double checked that I was actually infusing insulin and not a giant air bubble. Check! So what the hell was it? Then it hit me.

Here is some background: I have been on Apidra for the last year and absolutely friggin' love it. It's the insulin I've been waiting my whole life for . . . well, the last 19 years for anyway. I've always been pretty insulin resistant yet at the same time I tend to process it faster than most. Meaning, while most diabetics still expect some effect from their Humalog 3-4 hours after taking it, I know that it has done all it will do for me within an hour and a half or 2 hours max. So Apidra was heaven sent because it was fact acting and all it's energy came in the first hour or two and there was no more waiting around for my insulin to work on meals or high blood sugars.

Anyway, when I spoke to the Endo about getting pregnant she said that I would have to change back to Humalog because Apidra has not been tested in pregnant women. Or:

Apidra has not been adequately studied in pregnant women, so it is not known if it is safe to take this medication during pregnancy. Apidra does not appear to increase the risk of any problems in the fetus when used in animals. Apidra is pregnancy Category C.

Pregnancy Category C is the category they place a medicine in if they don't think it does any damage to the fetus during pregnancy but they don't have empirical proof that it doesn't. I poo-poo'd her concerns but really I ended up playing it safe and switching. As much as I hate being wrong, I would hate it even more if something I did hurt any future pregnancy.

So a couple of weeks ago I dug the few remaining Humalog bottles out of the butter compartment and started using them. I couldn't refill my prescription for Humalog because it had expired and I decided to wait until I saw my Endo (last week) to get another one. Well, the bottles were on the older side and expired 03/2010. I started using them the last week of February thinking I'd be ok and that they'd last me until I could send a new script in.

Fast forward to this weekend . . . um . . . I may have been wrong?? It's weird, though because the first bottle I used was relatively ok. But this last bottle (that I started middle of the last week) seems to have caused me issues. But I can't tell if it's just expired and gone bad. . . or if I need to change my pump settings because Humalog works so differently in me.

Either way, I switched back to Apidra last night and woke up with a beautiful blood sugar this morning (109). I'm going to rush a refill of Humalog and try this again. If it works, I know that I cut that whole expiration date thing a wee bit too close. If not . . . I may have to go back to the drawing board with my basals and sensitivities while I'm on Humalog. We'll see.

But last night I threw a royal fit because I was so uber pissed about my blood sugars. I was sick of being high, I was sick of not having anything I was doing work and I was sick of feeling sick!! And it reminded me all over again why I used to hate the pump. When it works, it's fine but when it effs up there is just so much to trouble shoot! And I had to change the entire set again before bed (site, cartridge, insulin). . . twice in one day?? That's friggin' expensive!! And because those set changes are kind of an ordeal and pricey to boot, I try to hold off and only do it as a last resort. . . which means it's taking that much longer to get my sugars fixed!! And that long process is rough when you don't feel good and you're tired. With shots, if my needles went in, I knew they were good, so the only options are that the insulin is bad or you need to take more. The end.

I'm not ready to give up on the pump. Not at all. But these kinds of things frustrate the ever lovin' snot outta me. Maybe I'm just less patient than all the other diabetics out there on the pump. Maybe those other folks don't mind as much when stuff like that happens. Or maybe they love their pump so much that it's not a deal-breaker. But for me, these kinds of days tend to momentarily erase all the good things about the pump and just leave a bitter taste in my mouth for it. Granted, it was partly my fault, but if I was using bad insulin and I was on shots I would have figured it out much sooner (because with shots there are only two things to troubleshoot: quantity and quality.) And I wouldn't have had that sense of protection over my brand new set of supplies that I had just put in a few hours before.

Sorry to rant and ramble over this. Last night was a rough one and we didn't end up in bed until after 1am. My blood sugar ended up spiking at 280 and then coming back down to 168 before we decided to be done and just hit the sack. Poor Brad stayed up and helped me with everything, listen to me gripe and was just generally awesome even though he had to go to work this morning. I felt so bad after it was all over and apologized for being in a huff and being impatient because I didn't feel well. I said I was sorry that he had to deal with all this crap just by association and I asked if he stopped to think about how other folks don't have to deal with this and how he wouldn't have to if it weren't for me and does he ever wish he didn't have to go through all this? He said, "No, I just wish you didn't have to go through all this." Ugh. After all that, the little turd made me cry! I love him so much and I'm so lucky to have someone like that in my life. Makes all this junk a little bit more bearable.

~Layne