Monday, October 25, 2010

Good news/bad news

I had an appointment with my Endo last week (and with my OB and I saw my perinatologist the week before . . . Holy crap, these doctor's appointments are really starting to get to me!) Anyway, I found out that my last A1C was 5.3. I couldn't believe it!

The honeymoon period that was my first trimester and part of my second trimester had definitely worn off. I started seeing numbers in the 200's again (such a bummer) and I wasn't having nearly as many lows. I was sure that my A1C had gone up and I was worried. So, in some ways having a 5.3 A1C staring back at me felt like a small triumph.

But in other ways, I knew it was not. Even though I'm not having a lot of lows, I do still have them several times a week and some are very, very low. I also know that just because my A1C was 5.3 doesn't mean that those 200's didn't happen. They did. And they are still bad for me and the baby. I had to remind myself that A1Cs are an average. If you take the average of 20mg/dl and 200mg/dl, you'll get 110mg/dl. And that sounds like a good blood sugar, but the truth is those numbers aren't good. So, while I'm happy that I'm having more good days than bad days and that so far the baby and I seem to be doing really great, my most recent A1C just confirms that as far as my blood sugars go, I'm doing too much bouncing all over the place. I really need find the happy medium.

But, for me, this pregnancy has been the opposite of a happy medium! (Just diabetes-wise, on every other pregnancy front I really can't complain!) My first trimester my blood sugar was in the toilet constantly. It was all I could do to stay above 70mg/dl. Literally, my averages were in the 60s every day! And I was treating constantly to keep my blood sugar up! Before I got pregnant, my total daily doses (i.e. how much insulin I get everyday from my pump) ran around 70 units. (I have a feeling this is on the high side from what I've read on other diabetes blogs but I've always been pretty insulin resistant. My carb ratio is 1:5 for crying out loud! Anyway, this is what works to keep me in control.) Well, during my first trimester, I dialed my basals WAY back and my total daily dose dropped to around 50-55 units. That's almost 25% less insulin! And I was still low all the time!

Around 17 or 18 weeks along, I started noticing that I had a few blood sugars that were creeping up. I waited it out a couple of days to make sure I wasn't making changes too hastily and sure enough, it looked like the insulin resistance was starting to kick in in earnest. So I've been dialing up my basals ever since. Last week I even had to bump up my carb ratio because my insulin just isn't working as well to cover my meals. It sucks! I'm up to a total daily dose of around 90 units! Which means I'm changing out my site and cartridge every other day! I'm blowing through insulin and supplies and it really sucks. The one consolation is that I can tell my efforts are making a difference because after a couple of weeks of playing with my settings, my numbers have finally have settled down.

But they still aren't great. I'm having a way easier time hitting my post-prandial and fasting goals and I'm seeing WAY fewer numbers above the 100's. But the 200s are still there every now and then and so are the 30s and 40s. So my Endo and I have decided that I should wear the CGM for a couple weeks before my next appointment so that we can get a clear idea of what's going on with my trends and really tackle the highs and lows.

I think the most frustrating thing about this whole mess is that I have this irksome feeling that as soon as I get everything worked out, my pregnancy will throw another curve-ball at me and my numbers will get wacky again! I'm starting to feel like I'm chasing my tail. THIS is the time in my life when I want my control to be better than EVER, because it's not just for me it's also for my child! There's more pressure than ever. And, ironically, THIS is also the exact time when it's so hard to get good control because my hormones are throwing my blood sugars all over the place.

I think overall I am really happy with the way I've handled my diabetes during this pregnancy. And I'm ecstatic that my little girl is doing so well!! She's right on target in the 48th percentile in weight gain (50% is average and closer to 90% is too big and closer to 10% is too small), no heart problems, kidneys are working great, diaphragm is intact, she's just perfect in every way. (Okay, I may be biased.) My husband tells me constantly that he's so impressed with how well I'm taking care of myself and our child. It's a huge relief to me to know that he sees how hard I'm trying. I'm working so hard to stay on top of things and at the same time, trying NOT to beat myself up when things aren't perfect. But I'm almost 7 months into this and the constant state of vigilance and worry is starting to wear me out.

I don't really know what my point is or if I really have one. I guess I just needed to vent. Hopefully, happier and less-intense topics will be forth-coming. :-)


Sunday, October 10, 2010

Hard day at work

So last night at work, at about 1 o'clock in the morning, I went to the delivery (and resuscitation) of a 26 week old baby. He was exactly 5 days farther along than my little girl. And he did not do well. And it was difficult.

I knew that it was bound to happen. As my pregnancy progressed toward the point where my baby was viable I knew that it was only time until I attended the delivery of or took care of a patient that was the same gestational age as my baby. And that just that in and of itself would be hard. It was.

We got him stabilized and we'll see where it goes from here. But it started how it always starts with extremely premature babies. It will be a few days before we know how his brain is affected from the delivery and resuscitation. It will be several hours before we know how/if his kidneys are working. He will be unable to "eat" for several days to weeks and until then we will deliver protein, fats, electrolyte and the rest of his nutrition via IV fluids. When he is fed, it will be through a feeding tube inserted in his mouth that goes to his stomach because he is too little to know how to eat by mouth (that will come later). And he already has several issues pretty typical of a baby delivered this early (extreme hypotension, respiratory distress requiring a ventilator, etc).

Like I said, this is all pretty typical of babies delivered at this gestational age. And they are all a waiting game to see 'just how bad" it will be. I hate to say it like that, but for these babies it seems to be that we expect the worst and hope for the best. Rather than be hopeful in the beginning and simply brace for the worst. We try to be realistic with parents but most can not take much in at this point. This usually has come as a huge shock and they are mourning the loss of their "normal, healthy" baby. Some are realistic, some are very anxious, some refuse to accept the truth of the reality that their premature baby has been born into. And they are all finding their way through a world they know nothing about.

Except me. I know. And I can't decide if that makes it less scary or infinitely more so.

Last night, I resuscitated this baby. I took him back to the NICU and placed umbilical lines into a very small umbilical cord with even smaller blood vessels. I prayed, for his sake, that they went in smoothly and were in proper position so that we had the access that this baby will so desperately need in the coming days and weeks. They did. (Score!) I looked at his xrays, wrote orders for medications, made changes to his IV fluids and followed his labs.

And the whole time I thought of my daughter. I willed her to stay put. To grow and get stronger. I want so desperately for things to go right for her. And it's not that all of the babies that I take care of don't deserve this. Unfortunately, some babies just don't get it. But how could I not want the best for my daughter? How could I do what I do every day and not wish and hope with all my heart that she doesn't have to be put through that? Isn't that what makes a parent? Wanting the best for your child?

So even though I knew last night would eventually come, it was still hard. It made me think thoughts I've been trying to suppress for a long time. It put my worst fears for my child right in front of my face. And this morning I couldn't wait to go home, with my child still healthy in my belly and get some sleep.


Wednesday, October 6, 2010

Random Updates (plus 25 week belly pics)

I love fall. Mostly because it signals the start of the holidays and I'm a holiday freak. I pretty much love any reason to decorate the house and get excited! I start with Halloween, then fade into Thanksgiving and then go ALL OUT for Christmas. It's seriously my favorite time of year, the holidays.

The other reason I love it is because I live in Florida. Florida, where summer doesn't mean light breezy days in the sunlight. Oh, no. Instead it means miserable oppressive heat (we're talking 95-105 degrees FARENHEIT!) and sticky, gross humidity for at least 5 months (May thru September), maybe more. But THIS year, the weather gods have been kind. It seems as though someone knew that it was October and no longer appropriate for the heat to be stifling. Instead for the last week or two I've been waking up to *gasp* 70 degree mornings, even a few 60-degree mornings!! And even during the peak of the day it hasn't really been much above the mid-80's. I even broke out some light sweaters! (Completely unnecessary but I'll take any excuse to sub-out the summer wardrobe for a bit since it's getting pretty tired.)

Anyway, I took the liberty of decorating the house on the early side this year, to my husband's horror. He thinks I'm a bit silly when it comes to the holiday decorating and festivities. BUT he also always goes on and on about how great the house looks (and feels) after I'm done with it. I even decorate with seasonal smells and I busted out the pumpkin candle and the "Autumn" scented wall-diffuser. YUM! I think mostly the reason he's not a fan is because he doesn't love his part of the job, which entails climbing up on a ladder in the garage to get the decorations down and then going back up on the ladder to hang them outside the house (I usually take care of the inside decorations myself). He even had to drill another hole in our concrete house (not an easy job!) for a new decoration I found. Since he really hates his part, he refused to do it before October. So this weekend we'll finally get our outdoor decorations up.

Here are a few pics of the indoor decorations, I'll post yard pics once everything is set up!

Our Halloween "Welcome" sign! ;-)

My favorite part of any holiday decorations, the dining room set-up. Still need place settings, though.

Since we don't have a fireplace, our entertainment center serves as our "mantel" and holds some holiday greetings and decorations!

Fall-themed kitchen towels, not very exciting.

My pumpkin candle that smells SOOOO yummy!

In other, random updates, I went to see the Ophthalmologist again for my second trimester eye exam. And I passed again with flying colors, well, normal retinal blood vessels anyway. Whew! My nurse also mentioned on my way out that she was also a Type 1. Wait?!? What?!? Of course I tried to fire up a conversation and ask her some questions but I didn't get too much out of her. I have a feeling she's one of those "my-diabetes-isn't-a-big-deal-and-I-don't-like-to-talk-about-it" types. Obviously so unlike those of us in the DOC who crave fellow diabetic company and conversation. Oh, well. I gave up (a little bummed) and moved on.

I'm 25 weeks pregnant today and so happy to be so far along! The swelling has started in earnest, but only in my feet and only after being on them all day. I hate the way it looks and it's not very comfortable but at least it always seems to go away with a night's rest with my feet propped up. Also, I got the go-ahead from my OB for foot massages from the hubby, so YAY! (FYI: certain places on the ankle and calf have been known to induce labor if stimulated so I felt the need to ask before we did it.) I'm tired off and on but not too bad. Other than that, just sore and achy, mostly in my lower back. Again, not too bad.

But she is moving like a MANIAC!! I love it! And you can even can see her kick and jump and squirm from the outside now! She even kicked the OB's Doppler as he was trying to listen to her heartbeat. At first she was just squirming and messing up his signal and then at the end she kicked it and made that whole side of my belly jump and poke out! The OB actually jumped a little and raised his eyebrows and said "I guess I'm done now!" She's so feisty, I love it!

And finally, here is a belly update:

Again, this is me from today at exactly 25 weeks. I promise I wear different outfits, I just decided to stick with this one for consistency and comparison's sake. Although I have found some cute maternity outfits so maybe I should post a few pics of those!

And this is what I see when I look down. Well, not really because I see more boobs, but you get the idea. And I still don't have problems seeing my toes, I just need to lean over just a tad. (To be honest, I had to do that before the pregnancy anyways, thanks to the boobage. Sorry, TMI.)

That's about it. Hope everyone has had a good week and is enjoying the change in seasons as much as I am!


PS: Since it's finally cool enough (relatively speaking) for some good ol' fashioned comfort food, I posted a recipe for a really hearty spaghetti sauce. We had it earlier this week and it was awesome! But I don't know that any pasta qualifies as diabetes-friendly so I didn't consider it a D-Feast Friday recipe. The full post is here if you wanna take a peek.