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. :-)

~Layne