Posted tagged ‘insulin resistance’

27 Weeks and an Ultrasound

March 30, 2010

This morning my husband and I visited the High-Risk OB for my 27 week checkup and for an ultrasound. Now that I am an old pro at navigating the crazy, unmarked streets in the “big city,” I had no problem arriving on time, even though I left after my husband. He, on the other hand, got lost and arrived late, despite the directions he printed out before he left (perhaps it’s time we finally join the 21st century and purchase a GPS …) The nurse admitted that even though she has lived in the city forever, she still gets lost from time to time.

The appointment took about an hour, all told. First I did the standard pee-in-a-Dixie cup-and-then-stand-on-the-scale routine. Let me tell you, it’s getting harder and harder to aim for that little Dixie cup. I won’t give you the gory details, but when the cup disappeared below my belly, I had to take it on faith that my sample would make it in there. Luckily I made it another week without any accidents.

Then the nurse checked my blood pressure, which was a little higher than usual at 126/86. She said we will just keep an eye on it. I mentioned to her that the blood pressure cuff I bought seems to giving me low readings, and she said I can bring it in so that we can figure out what the deal is. At the very least, we can see how far off it is from the one in the doctor’s office and then I will know what my reading really is.

The ultrasound went very well. Baby NoName was wriggling and bouncing around in there like crazy. The technician kept saying things like, “Now where are you going” and “He just wriggled right out of my picture!” Luckily we got two great shot of his face and confirmed, once again, that he is definitely a boy. Even though the pics are just fuzzy black and whites, I am already convinced that he is going to be a heartbreaker. He’s just SO cute! More importantly, he is measuring right where he should; Everything is at 26 weeks and a few days, which is just a few days short of his actual age. His tummy measurement is actually 27 weeks, but the doctor says that, while it’s slightly bigger than everything else, it is close enough that we don’t need to be worried. He weighs 2.2 pounds.

Diabetics are at a higher risk of growing bigger babies due to the higher level of glucose in our blood. This is why we have to try so hard to keep our BGs in the “magic” range during pregnancy. You see, when my BG is high, Baby makes extra insulin to compensate, which makes him gain weight (fat.) This weight is seen most obviously in the torso/tummy. Luckily, my awesome A1Cs seems to be paying off. I’m thinking his big belly is just genetic 🙂

The doctor is not at all worried about my swelling, so my worry-fest was pretty much for nothing. He says every pregnant woman swells, and what I am experiencing is just plain old pregnancy-induced swelling. He said the compression stockings were a great idea, though, and that I should keep wearing them if they make me more comfortable. They really do help with the achy, tired feeling, so I will keep it up. He also encouraged me to get back to the pool (this has been difficult given my aching hips,) and even said a hot tub would be fine as long at the temperature was turned down. Apparently the weight of the water helps push the fluid out of my swollen limbs.

We talked a little about my BGs, which seem to be pretty stubborn lately. Numbers in the 150s and 170s are hanging around a lot, despite my best efforts to bolus them down. He suggested an increase in my basal rates of .1 around the clock, and said that this is right about the time that he expects my insulin needs to start really creeping up. I see my Endo next week, which is good because I’m sure that some hard-core rate tweaking is in order.

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He’s Perfect

February 10, 2010

Today was the 20 week ultrasound, and our little baby was not bashful. He showed us multiple times that, indeed, he is a boy. A boy!

The technician took her time to inspect all of his miniature organs and limbs and everything is in tip-top shape. Baby has all of his arms and legs, all four chambers in his heart, a perfectly sized brain, a perfectly formed spine, and a beautiful mouth (no cleft palate.) What more could we ask for?

I would love to include a picture here, but my new doctor’s office does not do digital ultrasound photos. So all I have is hard copies. But I can tell you that they are just adorable. Of course, I might be just a little biased, but I doubt it 🙂

After the technician did her thing, we talked to the doctor, who says I am doing great. I asked about a couple of meds my other doctors have prescribed, and he said they were all fine. We also talked a little about my appointment with the dietitian. He warned me that the dietitians sometimes go a little heavy on the carbs in the diet plans, and that makes sense to me. She suggested 13 carb exchanges and 3 fruit exchanges, which is around 6-8 exchanges more than I normally eat. He suggested sticking with my normal carb count given my insulin resistance.

Now that my appetite is improving (maybe improving too much!), Things like proteins and veggies are starting to sound good again, so I am going to make an effort to shift back toward my pre-pregnancy diet. It is going to be hard to go back to being disciplined … these last couple of months were sort of like a diet vacation!

Speaking of insulin resistance, I’m pretty sure it is rearing its ugly head today. I have struggled to keep my sugar under 150 all day, even with extremely large correction boluses. I am sitting at 232 right now, likely a spike brought on by my lunch nearly three hours ago. I just shot in a rage bolus which should inevitably result in a rebound low sometime this evening. But what else am I supposed to do?

I usually send my BGs to my Endo every Friday, but I might send them tomorrow this week, especially if this keeps up. I’ve never seen anything like this before. And it came on so fast! Just two weeks ago I was still struggling with those continuous, crazy lows.

I’m sure this is just the beginning of my struggles with highs, but try as I might, I can’t squash that unnerving thought that keeps rolling around in the back of my mind … what if I’m hurting my baby?

And so the journey continues. I am trying to roll with the BG issues and just focus on the good news from the ultrasound today. It’s a boy and he’s healthy!

5 Month Endo Appointment

February 9, 2010

I had my regularly scheduled monthly appointment with the endo this morning and the verdict was positive. Here are a couple of takeaways:

The ketones are gone! Now that my BGs are starting to even back out (thank you, insulin resistance), I am no longer bottoming out overnight. This has cured my ketone issue and, perhaps more importantly, means that I can forgo the 2AM snack. Yay!

My A1c is even more awesome this month — 5.2. How is that even possible? I am suspicious, but the doctor is happy with it, so I’ll take it.

I have occasional slight swelling in my ankles now, but nothing to be concerned about … yet. My blood pressure is still good.
After a week of annoyingly high post-meal BG spikes, I adjusted my bolus rate yesterday. My endo is kind of weird about me making my own changes (something we disagree on), but he accepted it and we are leaving the rate alone for a week or two to see what happens.

He thinks my basals might still be a smidge too high, because I tend to spike too high an hour after a meal (160 range), but then drop to 90 or 80 at the two hour mark. This problem might sort of itself out as my insulin resistance grows, though, so we’ll keep an eye on it. Just for comparison purposes, and to show you that everyone’s diabetes is different, I just read that Kerri is now on a 1:6 insulin-to-carb ratio as she struggles with the later stages of pregnancy. In comparison, I was on a 1:6 ratio before I got pregnant (thanks again, insulin resistance!), and am now at 1:5.

My endo had lunch with the local Dexcom rep last week, and they are apparently more willing to do a trial of their CGM product now. I tried to get a trial a couple of months ago, but the rep in the corporate office would not do it. I had given up hope. I called the local Dexcom educator today and she is sending me a trial package this afternoon. She says it’s so easy that she can walk me through the set-up on the phone. So I might be sporting a Dexcom soon!

I picked the doctor’s brain a little about Metformin for Type 1s. I have been reading that more and more Type 1s with insulin resistance are using it to help with the weight gain and increased appetite that insulin can cause (See this post from Amy over at Diabetes Mine. I even read recently that they are using it more and more in the second and third trimester with pregnant Type 1s. We agreed that it is not really necessary for me right now because my insulin needs are just starting to increase past my pre-pregnancy levels and because I am not gaining too much weight (actually, I am gaining less than is expected.) But he seemed like he would consider using it during the third trimester or after the pregnancy depending on how things are going. I am happy that he was receptive.

It is snowing like crazy here again today. We are expecting another 10 inches or so before the end of the day on Thursday. Isn’t it time for spring yet?

Tomorrow morning we are off to the High Risk OB for the 20 week ultrasound and, hopefully, we will find out if this little munchkin is a boy or a girl. I can hardly wait!