24 weeks

On Monday I made the bi-weekly trip to “the big city” for my appointment with the high-risk OB.

I am starting to get the hang of the whole thing. I’ve not gotten lost for a couple of weeks now, and I’m finally starting to remember which level of the parking garage to park on for the quickest access to the office.

Except for the excruciating hip pain I told you about yesterday, the appointment went according to plan. According to the nurse, my blood pressure was “beautiful” and the heart rate was “perfect.”

The doctor observed that my weight is good, and when I commented that I am always starving, he said, “Don’t starve, eat!” I don’t think he knows what he’s saying … he may have unleashed a monster. Some days I feel like I could eat everything in the refrigerator! He reminded me for a second time that my insulin needs will probably triple over the course of this whole journey, and that the increase is totally normal and it’s not because I am doing anything wrong. It’s just a consequence of those pesky pregnancy hormones and the placenta that makes them.

He asked if I was having any other problems aside from the hip pain. I mentioned the swollen feeling in my pelvis and he explained that this is also normal. He says the ligaments are stretching to make room for my huge uterus. As an aside, I mentioned that my heartburn seems to be making an occasional appearance again, but that this was the least of my concerns given the fact that the hip pain is keeping me up at night. We tabled the heartburn discussion for now.

The appointment ended with the now standard hug and a smile. In two weeks, we are scheduled for another ultrasound.

This past weekend we also did a little baby shopping with my husband’s family. Our baby gear collection now includes a pack and play and an umbrella stroller, and finally the little guy has a couple of t-shirts and a sleeper. We also looked at cribs and bedding, but we didn’t purchase any. We are so indecisive! A special thanks goes out to the in-laws for their generosity this weekend! We had a nice time, and are really happy with the gear.

16 Weeks

Today I met with the High-Risk Ob for my 16 week check-up. His office is in a larger city nearby and while I am typically pretty good when it comes to directions, this city really seems to give me a hard time. People who live there admit that the street signs are pretty much worthless and that you really need to “just know” where you are going. So it is no surprise that I got lost on my way back to work. I’m not 100% sure where I lost my way, but goodness knows I’ll have plenty more opportunities to figure it out over the course of the next 5 months.

The good news is that everything checked out well. The heart rate was strong (oh, that sound!) and my blood pressure was good. We talked about my blood sugars and he suggested a few tweaks to my basal rates to help with these crazy lows.

I asked him about the ketones, and he was also concerned about them. He advised me to eat at least 15-30 grams of carb every three to four hours. He said protein was not really necessary at this point and that if it does not sounds good to me, I do not have to force it. In fact, he said that when I needed the protein, my body would self-regulate and protein-rich foods would start to sound and taste good again.

He also said that eating a small portion of carb more often would help keep my sugar from dropping into that crazy low range so often. Finally, he suggested that I try more complex carbs and I mentioned that I have had to avoid my typical fiber-rich carbs, but that I have had good luck with pasta.

He recommended Dreamfields pasta. He says it will not cause as drastic of a spike in my sugar, but does not have the fiber that my digestive system cannot tolerate right now. However, I see on their Website that Dreamfields has 5 grams of fiber per serving. That sounds like too much for my delicate digestive system these days. Have you tried Dreamfields? Did you have digestive side effects?

He also started the ball rolling for me to talk with a nutritionist. I am really happy about this. I have to admit that I am overwhelmed by all of these new eating challenges lately and I am concerned that my baby might not be getting all of the nutrients he or she needs.

My next appointment is in two weeks and we will review blood sugars again then. In four weeks I will see him again for an ultrasound and we will hopefully find out if this little one is a “he” or a “she.” Wow!

Consult with the High-Risk OB

Last week I had an appointment with the high-risk OB. My regular OB practice sent me for a consult. Originally, my OB told me that he felt comfortable taking care of my pregnancy, unless anything unusual happened, at which point he would refer me to the local high-risk OB. But then, the message got mixed up. You see, my OB works as part of a larger practice, and despite my attempts to see only my doctor, I managed to see three different doctors and a nurse practitioner over the course of my first few months. And each of those practitioners had their own opinions about the best strategy for a healthy Type 1 pregnancy.  It was confusing at best.

As a result of all of this confusion, I ended up at the high-risk office for a consultation. The high risk OB works alone, without partners. There are obvious advantages to this set up, but also disadvantages. For example, when we went for my consultation, the doctor was delayed because a C-section he was scheduled to perform was bumped from the OR. When there is only one doctor in the practice, there is no partner to share the load. On the plus side, there are fewer conflicting opinions and more consistency. But there are fewer ideas and fewer minds working on my “problem.”  There just isn’t an easy answer, is there?

At the appointment, he was practically dumbfounded by my record A1C (5.3 — Yay!!!), but he did pour over my BGs and suggest a few tweaks to my basal rates. I liked that he seemed open to my opinions, and to  a  more collaborative approach to managing my sugars. He said that I probably know more than him about the disease given my 27 years of living with it. He might be right, but it sure is nice to have a professional opinion every now and then!

On the down side, it seems that he wants to manage my endocrine issues throughout the pregnancy. This is not necessarily a bad thing. Afterall, he did make good suggestions. But I am just now getting this relationship with my Endo worked out. And he does have my A1C down to record lows. I hate to abandon that relationship.

My OB from the regular practice called the next day to say he thinks that the high-risk OB should manage my entire pregnancy. He feels that I would get the best care that way. I can still have some of my run-of-the-mill appointments at my regular OB’s office so that I don’t have to spend so much time on the road (the high-risk OB is in a neighboring, larger city), but the high-risk guy will be in charge and he will deliver my baby.

But there is this nagging feeling in the back of my mind that maybe this is not the best solution. Sigh. I don’t know what to do. I just don’t want to screw this up. My baby is depending on me.

I have an appointment with my Endo in early January, so I expect to ask him  for his advice. I think he may be a bit miffed that he is sort of  being forced out of the equation by the high-risk guy. But maybe my Endo knows another high-risk guy who works more closely with the Endo. As a third alternative, I asked my mom to ask her Endo for advice. Her Endo recommends a hospital system in another surrounding city, but it is even further away from home. However, that hospital seems to be “the place” for pregnant diabetics in the area. And it has had that status for quite some time. In fact, it is the same place that my mom delivered me 31 years ago.

So what should have been a settling appointment has left me with new questions and few answers. Maybe I just need to relax a little and go with the flow? What would you do?