Archive for October 2009

Chili for Halloween and a Truce with the Endo

October 30, 2009

Just a quick post today as I’m putting the final touches on my chili for the third annual chili cook off at work. Every year, we have a Halloween party complete with a costume contest and chili cook off. My company is not exactly the best place to work on a day-to-day basis, but they really do know how to throw a good party.

My Endo finally called yesterday evening. We ironed out a few things and we’ll reassess at my appointment on Monday. Basically, he does not want me to increase my basal rates, even through a temp basal. Instead, he wants me to use boluses to treat out-of-range numbers. I am also going to have to buckle down and log all of my insulin and carb intake, because my insulin pump does not do it for me (long story, but it does not communicate with the Medtronic reporting software.)

He also encouraged me to think about a CGM, which I have been thinking about, but I am leery of yet another hole in my skin. Also, he is pushing the Medtronic, and I have heard that it is not as accurate as the Dexcom. I also don’t look forward to the insurance fight to get coverage. So I guess I am still on the fence on this one.

Does anybody have any experience with any of the CGMs? How accurate do you find them? Did your insurance company make you jump through hoops to get the supplies covered? How are the insertion sites? Those sensors are so long!

Thanks for any advice you can offer! Have a wonderful weekend and a great Halloween.

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What’s Up, Doc?

October 29, 2009

I have been a little unhappy with Endocrinologist for a while now.

I just moved  to the area a little over a year ago, and  one of the first things I did was find a new Endo. My husband and I had been wanting to start a family, but were  waiting to get settled, so I was anxious to find a good doctor.

In the first appointment, he seemed quite knowledgeable, but made me a bit uncomfortable. I can’t quite put my finger on it, but it was sort of like an authoritative or egotistical vibe that he seemed to be giving me.

In one, rather shocking example, I mentioned that I was concerned about weight gain and increased insulin needs over the course of the last three or so years. I said that I thought this was probably insulin resistance (something that my last two Endos have agreed with). He said, it was probably that I was still making some insulin until the last three years. I pointed out that this would be quite amazing considering that I have had this disease for 27 years.

He also tried the shock-me-into-compliance attempt when telling me about what I needed to do to prepare for pregnancy. Of course, I knew that I had already accomplished most of the items on his checklist, but his tone made me anxious anyway.

Having relocated three times in ten years, I have gotten to know a lot of Endos. The ones that seem to be the best for me are the collaborative, supportive ones. I am hard enough on myself; I don’t need someone telling me that my feet are going to fall off if my blood sugar spikes occasionally. My irrational mind goes there on its own.

Anyway, he told me that I needed to send my BGs in every two weeks and that he would call with changes to my basal rates, etc. Then, when  I became pregnant, he would want me to send them in every week and I would need to visit him once a month.

The every two weeks BG faxing seemed a bit extreme considering that I was not even pregnant yet, and my A1C was 6.2, but I was willing to comply. I am always eager to get tweaks for my rates, it just makes life easier. So I started sending in my numbers.

The problem now is that he never responds. Often, I have to call in a week later to see if he even received the fax. And I never actually get to talk to him, just his office assistant, who simply reads off a list of changes he has noted in my file.

So how am I supposed to learn anything here? And often, due to the lag time between my fax and his response, the changes he suggests just don’t make any sense any more once I finally receive them.

Now that I am pregnant, this is really concerning me. I sent my first “confirmed pregnant” BGs on Monday. Here it is Thursday and still no response. I have been using temp basal rates all week to try to keep my numbers in range. I swear, my numbers are bouncing all over the place all day; I assume this is a result of first trimester hormones.

I’ve decided that I’ll give him one more chance. I have an appointment scheduled with him for Monday, and an appointment with my OB on Tuesday. If Monday’s appointment is just more of the same, I am going to ask the OB if he knows of someone who might be a better fit for me and for my baby.

Have any of you had similar experiences? Were you able to work it out with your Endo, or did you have to move on to someone else?

My Favorite Resources

October 28, 2009

I’ve been spending a fair amount of time combing the internet for information about Type 1 Diabetes and Pregnancy. Sadly, there are still not a lot of directly related resources. Nevertheless, I have found a  few good ones that I have been visiting pretty regularly. Here they are, in no particular order:

Blogs

The DOC is just awesome. I have been lurking for several years now, and I guess it is about time to come to the surface. These are the sites I have been pouring over for the last month or so:

  • http://sixuntilme.com/
    If you have been keeping track of the  DOC for any length of time, you are probably aware of Kerri’s blog and her advocacy for diabetics, especially those of us who live with Type 1. Well, she is pregnant now, and I am once again amazed at how closely her life has paralleled mine. Could we have been separated at birth?
  • http://thesweetnesswithin.blogspot.com/
    Lyrecha, aka Cheryl Alkon, told us all about her journey to motherhood, complete with her struggles with Type 1 Diabetes and infertility.  I have been  avidly reading her archives. Her most recent post tells us that she is working on a book (how cool is that?!). Her pregnancy was a complete success and she is thinking about baby number two. What an inspiration!
  • http://thisismysos.blogspot.com/
    Suzanne at Facing New Life as a Born Again Diabetic, is 16 weeks pregnant. Her story from non-compliance, to healthy and happy, to pregnant and still healthy, is another inspiration to me.

Websites

Most of these are not directly related to both Type 1 and Diabetes, but they cover either one or the other.

  • http://www.americanpregnancy.org/index.htm
    The Website for the American Pregnancy Association has become one of my favorites for explanations of symptoms and side effects. When I wonder “Is this normal?,” this site gives me the reassurance I’m looking for and the information that explains “Why?”
  • http://www.jdrf.org/index.cfm?page_id=103524
    The Juvenile Diabetes Foundation provides a fair amount of honest, straight-forward information about diabetes and pregnancy. In particular, I am most impressed with their information about the odds of passing this disease on to my child.

Books

I haven’t found any books about pregnancy and type 1 yet, but I am pouring over these books that just cover pregnancy.

  • What to Expect When Your Expecting
    Written by Heidi Murkoff and Sharon Mazul, this old standby was revised in 2008 for the modern mom. I am really impressed with the wealth of information and the down-to-earth, conversational tone. I am checking into this book at least once a day lately!

Those are the resources I have found useful lately. Do you know of any others? I’d love to hear about them!

Sweet Dreams and Deep Breaths

October 27, 2009

I have been SO tired during these last couple of weeks. This baby making process sure takes a lot out of me. And when I sleep, it a is hard, dead-to-the-world kind of sleep. This morning, I almost slept through my alarm. That is very unusual for me!

I have taken to sneaking off to my car during my lunch break for a cat nap. I tell my coworkers that I am reading. Hopefully that are not on to me!

Even with the mid-day  nap, by mid afternoon, I am struggling to keep my eyes open at  my desk. I have never fallen asleep at work, but I have come close in the last couple of weeks.

And the dreams. I am having all kinds of weird dreams. The night before the second HCG test, I dreamt that the test came back negative. It was a sad, painful dream that went on seemingly forever. I have also had dreams that my belly is huge and I can’t tie my shoes. And even some crazy, seemingly unrelated dreams. I don’t remember them all, but basically, I am dreaming most of the night.

I did go to that yoga class last night. It is the first time I have told anyone that I am pregnant. It was a weird feeling. My doctor wanted me to tell the instructor so that he could give  me some modifications.  I was somewhat uncomfortable being singled out during the class. I mean, I certainly don’t LOOK pregnant (maybe a little more flabby in the tummy pooch area, though), and I don’t really feel the pregnancy in my belly yet. Or at least I didn’t until about halfway through the class.

The instructor kept showing me how to support my belly. This seemed silly because there is no real belly yet, but the doctor tells me that my muscles are all soft now, so they might not support the bundle growing in my uterus. About halfway through the class, as we were practicing our breathing, though, I finally got a really deep breath into my stomach area. And then I felt a sort of resistance to the breath deep down in my lower belly. I am assuming this is some sort of wall of muscles, or else the actual uterus. I am not sure, but I’ve never felt it before, even when doing yoga. This morning, if I really concentrate, I can still feel it. Weird.

Also interesting, I had been dealing with a headache all afternoon, and it got significantly worse during the class. I was really light-headed and dizzy. I am thinking that it has to do with those expanding blood vessels, and all of the breathing. Basically, I think my blood vessels were just expanding too far and too fast.

Some of the things my body is doing are just amazing. I am in awe of its ability to adapt and change. I am just trying to keep up with the changes and to enjoy the ride!

Digestive Woes

October 26, 2009

Ugh. Who would’ve thought that pregnancy would lead to such drastic digestive issues? I think I’ve experienced them all…

One minute it’s constipation. The next it’s diarrhea. Complete with gas, cramping and pain. Then it’s indigestion, burping, and hiccups. And then there is the on-again-off-again nausea. And to think most of it will probably only get worse from here.

I assume this is associated with my everyday digestive struggles which were most recently diagnosed as “probably a little bit of gastroparesis, a little bit of IBS, and a little bit of constipation.” Really. That was the professional diagnosis from the most respected gastrointestinal specialist in the area. Even more impressive, he said there wasn’t really anything he could do to help.

Nothing seems to help the intestinal issues, but the nausea does get better if I eat snacks every couple of hours.

The struggle, of course, is to find something healthy to eat for that snack that doesn’t make my stomach turn. Most proteins sounds just repulsive right now. And if it’s not covered in salt, it doesn’t exactly sound good. So I am eating a lot of pretzels and crackers. Not exactly the best meal for a diabetic with insulin resistance, right?

Speaking of insulin resistance, my basal needs went through the roof yesterday. It is amazing how fast these things change. I am using a 130% temp basal rate this morning, and still struggling to stay in range.

In other news, I’m hoping to try out a new yoga class tonight. I am not very good a sticking with an exercise routine, but I am going to really try to keep with it during this pregnancy. I have fought insulin resistance and “flab” for the last couple fo years, and I am concerned that the hormones and cravings of pregnancy could put my weight over the edge.

Yay HCG!

October 23, 2009

And the number is … 120!

The quantitative HCG number in my bloodwork, that is. It turns out that my number more than doubled over the course of the last two days, so the nurse can no confirm that I am definitely pregnant!

OMG.

It looks like I am 5 weeks along. The nurse was really not sure what to do with me, though. They are not a high-risk practice, although they do deliver diabetics regularly, and I was concerned that I should be doing something now because of my diabetes.

She checked with the doctor and they decided that there is really nothing special to be done. I should just wait until the standard 7-8 week exam. So I  made an appointment for that.

Unlike most of the other pregnant DOC bloggers I have been reading, we don’t seem to have a well structured program for pregnant diabetics in my area. Apparently, around here, they only send you off to one of those programs if you are experiencing problems of complications.

I also called my endocrinologist. I made an appointment for the first week in November. They will want me to send blood sugars weekly, and I will have to go in once monthly.

I have a ton of questions for my doctors, but they don’t seem all that anxious to see me. This is making me pretty nervous. I am concerned because my blood sugars are already starting to fluctuate. I am really struggling to keep them in that safe baby range (70 – 120), and have even seen a few low 200s. The other day, after a site change, I nearly had a heart attack when, in just an hours time, my sugar went from 200 to 318 in an hour. Like any sane diabetic, I punched in a “reasonable” range bolus on top of the already high level of on insulin on board. About an hour later, I was down to 192 … then 54 … then 41. Ugh.

What kind of distress is this causing for that rapidly expanding bundle of cells in my uterus?

Slightly Pregnant?

October 22, 2009

Warning: This post might contain TMI. Boy, I’m throwing it all out there right away, huh?

Monday morning I was supposed to start my period, but, I swear, I had felt pregnant for going on two weeks. I know, all of the Web sites say this isn’t possible. Tell that to my body. And my nauseated stomach. And my swollen uterus. And my headache. And my dizzy head.

So I did a home pregnancy test. Those three minutes were pure anguish. As the nearly imperceptible pink line appeared in the little window, I wondered it was wishful thinking. But no, it was definitely there. Just barely, but it was definitely a pink line.

I called my husband who was already on his way to work.

“Um … I think we might be pregnant.”

Silence.

“I peed on a stick. The line is really faint, but the box says that’s positive.”

He had been kind of pacifying my “I feel pregnant” comments over the course of the last ten days or so, but this announcement seemed to get his attention.

We were both admittedly shocked. We’ve only been trying for two cycles, and given all of my health conditions (all Type 1 related), we were sure it would take us quite a while.

We decided I would call the doctor when they opened.

I struggled to concentrate on getting ready for work. I actually pulled the test out of the trash can a couple of times to reassess the line. Yes, it was still faintly pink.

After getting lost in the doctor’s phone mail system several times, I finally got through to the nurse.

“Well, we can do a blood test to confirm. I’ll send the requisition to the lab. If you go tonight after work, we’ll have the results in the morning.”

Sigh. Another wait.

I went to the lab after work. Tuesday morning came after little sleep. I slept with the phone by the bed. By 11:00, I couldn’t take it anymore, so I called the doctor’s office.

“That’s interesting,” the nurse says. “It looks to be slightly positive.”

Slightly?! What the heck does that mean?! My mind is reelling.

“Your quantitative HCG is 29. Normally, we are looking for 50 to confirm the pregnancy. So it could be really early …”

Right. Exactly what I expected. She leaves out the part I read on the internet, though … it could also be an early miscarriage.

“Why don’t you come back tomorrow and we’ll do the test again to see if the number is going up?”

What? Wait another TWO DAYS?! “OK. Sounds good.”

I had the blood drawn again last night. The girl who drew it recognized me.

“Weren’t you just here?” She checks the requisition and then she understands. “Ah, you need another one.”

Apparently this is standard procedure to confirm that the pregnancy is successful. Your body starts to produce this HCG hormone when the egg implants, but it is not uncommon for you to miscarry the egg early on. Most women who experience this don’t even know they were pregnant. So they want to confirm that the level of HCG is growing. It should double every couple of days.

So this morning we are still waiting. The symptoms are still here, and the period is not. Come on, HCG!