Happy Belated Diabetes Blog Week

So I totally dropped the ball on Diabetes Blog Week last week. I only managed to write two days all week, an all time low for me. Unfortunately, life just keeps getting in the way of my blogging.

Case in point: things at work are getting busy. I work as a Technical Writer for a software company. We have a new release coming out in a couple of weeks, and that means A LOT of work for the Technical Publications department. I spent all day Saturday at work – so not my idea of a nice weekend.

And the doctor appointments just keep coming. Between the non-stress tests, the physical therapy visits, and the “meet the pediatrician” appointments, I feel like I am spending more time in doctors’ offices than I spend in my own home. I’m pretty sure my High-Risk OB sees me more than my husband does.

I finally finished the spring semester of my Masters program at the end of April, but I quickly had to enroll for the summer course, too. It is the final course in my degree, and the professor has agreed to let me finish the course in the fall as an independent study project, but I still have to attend the first couple of classes. So that started up again last night.

The good news is that Baby NoName is doing great. I had an ultrasound last week, and he was weighing in at just over 4 pounds – right on target. I’m so proud of him! Last week, he “dropped” into my pelvis, so I can finally breathe a little bit again. He is definitely getting stronger and more active, too. He spends most of the day twisting and kicking and punching at my internal organs. Things must be getting tight in there. On the outside, my belly feels tight and stretched to the limit. Occasionally, I see a stray limb or rump poking out of my belly before he swims off to the other corner of his home. Oftentimes, I catch a glance of my belly bouncing all around as he continues his dancing and maneuvering.

My husband and I have now visited three pediatricians. We have one more to interview. We are nothing if not thorough! So far, I am leaning toward one who is affiliated with the Children’s Hospital in the “big city” nearby. They have a Pediatric Endo who services their office and would be available to answer my never-ending questions about things like diabetes triggers and formula and vitamin D drops. Plus she seemed like she had a nice mix of a friendly bedside manner and a down-to-earth, tell-it-like it is approach.

I’ve also contacted four daycare providers and I have one more on my list. Some work in their homes and some are large daycare centers. We won’t need anyone until I go back to work sometime in October, but I’ve heard that the “good ones” book up fast, so you have to reserve your spot in advance. I’m learning that interviewing daycare providers is a difficult task. It’s hard to even know what to ask them. I’ve found that the phone calls have allowed me to weed out a few, but I am nervous about the actual visits that will help me make an ultimate decision. For those of you with children in daycare, how did you decide on a provider? What questions am I forgetting to ask?

My husband keeps hounding me to pack my hospital bag, so I started a pile of things to pack: Test strips, insulin pump supplies, insulin, juice boxes, robe, bathroom essentials, etc. What am I forgetting? I’m sure we will get there and I will have forgotten something really obvious like my toothbrush. Is there one thing that you wished you had packed that you didn’t? Or something that you did pack that turned out to be indispensible?

Slowly but surely, we’re inching toward the finish line of this journey. I am full of emotions; I’m ready, anxious, excited, scared, tired, and energized all at the same time.

A Day in the Life of a Diabetic Mom-to-Be

In response to Karen’s great Diabetes Blog Week idea, and also in response to Saffy’s question about how I fit in all of the pregnancy-stuff around work, here is my contribution. The topic is “A Day in the life . . . with diabetes.”

5:45 AM: Can’t wait any longer. Have to pee. I’m dancing in front of the toilet while I fight with the vial of ketone strips. Finally.

6:00 AM: My husband stumbles into the bedroom headed for the shower. Seeing as I have been up at all hours of the night for months now, he usually sleeps on the couch. One of us might as well get a little sleep, right? “Are you done in bathroom?” he asks. I mumble “yes” from under my pile of pillows. I can’t believe it’s time to get up already.

6:30 AM: My husband leaves for work. I do a test: 97. I crank up the laptop and upload my BG readings out of my pump, then print them for my doctor.

7:00 AM: Into the shower. A frantic hour of readying myself for the day ensues: shower, hair, teeth, breakfast, packed lunch.

8:15 AM: Another test: 98. I’m late. I throw everything into my laptop bag and rush out the door. Along the way, I discuss this BG reading with my inner self: “It’s only been an hour since breakfast. Will I be low at the two-hour mark? Maybe not … I did have peanut butter with breakfast. I stuff my meter in my coat pocket and pull out of the garage.

9:05 AM: I’m late for my non-stress test. I roll into the parking garage and make a mad dash for the fetal evaluation center. They hook me up to the monitors, and Baby NoName sleeps. We give him a little jiggle, I drink a glass of ice water, and we use the “alarm clock” to try to wake him up. Finally he startles and starts dancing in there. The peaks and valleys are recorded on the red and white graph paper. A half hour later, the nurse is satisfied. She permits me to move on to the next appointment of the day.

9:45 AM: I arrive on the other side of the hospital at my High-risk OB’s office. I am making good time. Sometimes the non-stress test takes an hour. The office manager smiles and calls me by name from behind the sign-in desk.  I sign in, pee in a cup, and weigh myself. It turns out that the Ultrasound Tech is ready for me already. I do a quick test while I’m sitting on the exam table. The Ultrasound Tech has to wait for me and I feel guilty. 156. Damn peanut butter. I ignore the “insulin on board” recommendation of my pump and dial in a .7 unit correction. Let the ultrasound begin.

Baby NoName is doing great, although the tech discovers for the first time that the umbilical cord is a two-vessel cord, not a three-vessel cord as we originally thought. The doctor assures me that it is nothing to be concerned about, but I make a mental note to google the difference later.

I realize that I left my BG readings on the kitchen counter … or somewhere. Pregnancy brain again. I will have to fax them in tomorrow.

10:45 AM: I finally arrive at work. Another test: 93. Much better. On to e-mails and meeting preparations. I sneak in a quick glance at a couple of DOC blogs between projects. I’m starving, so I eat my mid-morning snack.

12:30 PM: Lunch break. BG is 115. I head out to my car for a thirty-minute cat-nap. I am absolutely exhausted.

1:00 PM: Back in the office, I get back to work, and nosh on my packed lunch. Sometimes it’s one of those “healthy” frozen dinners. Today it’s a ham and swiss sandwich and an apple. Due to digestive woes, low blood sugars, and cravings, my pregnancy diet contains a lot more carbs than my non-pregnancy diet. BG is 62, a little low, so I take a little less insulin than the pump suggests.

4:30 PM: The office is starting to clear out. BG is 55. I peel an orange and start to munch on it while I work on one of many never-ending projects. For whatever reason, my BGs have been plummeting in the evenings, so the 4:30 snack has become a normal part of my pregnancy routine.

6:30 PM: One final test before I hit the road: 83. Afraid that my sugar might be dropping, I grab a handful of M&Ms from the office candy dish. I pack up and leave because the “late shift” support rep is locking up, even though I don’t have all of my hours in for the day. This means tomorrow will be an extra long day.

7:30 PM: I am at home, collapsed on the couch. My husband and I are trying to think of something to eat for dinner. All I want to do is sleep, but my BG is low AGAIN. We settle on grilled cheese sandwiches. I am delighted because he is doing the cooking AND the cleaning up. We watch a little TV while we eat and catch up.

9:00 PM: I can hardly hold my eyes open. I get ready for bed, do a test, take my pills, and double-check my stash of juice boxes and gum drops on the nightstand. Satisfied that I have enough sugar to make it through the night, I fall into bed. Because I under-bolused for dinner in fear of another low, I am at 180 now. I take a small correction bolus and settle in under my pile of pillows.

11:00 PM: My husband is on his way to bed. He wakes me up to test. 105. The number barely registers before I roll over and fall back asleep.

2:00 AM: I have to pee. Again. And my hip is killing me. While I’m up, I test. 65. Eyes closed, I slurp down a juice box and then drop it on the floor in the general vicinity of the trash can. Close enough.

4:00 AM: Again with the peeing and the testing. Luckily, my BG is in the “safe range.”

6:00 AM: My husband stumbles into the bedroom … another day begins!

There are a bunch of other D-bloggers participating in Diabetes Blog Week, too. Check out the list on Karen’s blog here.

27 Weeks and an Ultrasound

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.

His heart is in the right place

This morning I drove to the children’s hospital in a nearby city to have a fetal echocardiogram. The children’s hospital is just around the corner from the hospital where I see my high-risk OB, so you would think that I would have no problem navigating my way around the area, but as usual, I got lost. It took me an extra 15 minutes to get out of the city and onto the highway. I somehow managed to drive all the way around the hospital twice before I found an (unmarked) road that led to the highway. If you’ve read my previous posts about driving in this city, you’ll remember that this is a reoccurring theme for me.

On the plus side, I managed to arrive on time, despite a struggle with the ticket machine in the parking garage and an overturned semi on the highway. Also, on the way out, the parking attendant was walking away from his little hut and waved me on out without paying the fee. Yay for small victories.

The fetal echocardiogram is a specialized ultrasound where a pediatric cardiologist examines the heart to look for abnormalities including congenital heart disease and arrhythmias. The cardiologist also told me that high blood sugars often lead to thickening of the heart walls on the left side, so this is one thing that they are particularly looking for.

The nurse was astounded that I have been having lows in the 20’s and 30’s. I showed her the Dexcom I am trialing, and she was pretty impressed. She’d never seen one before. The doctor nearly fell out of his chair when I told him that I’ve had diabetes for 27 years. I don’t think they get many Type 1s in there.

Thankfully, baby boy came through with flying colors. The doctor said his heart is “perfect.” The doctor also took a ton of pictures of the heart, including some with lots of colors on them (mostly red and blue.) I think these are to check for blood pumping through the veins, arteries, and chambers, but honestly, I am not sure and I did not ask. After he told me that everything was fine, I finally started to breath again and just lay back and enjoyed the views of my little one bouncing around in there.

Afterward, I scheduled a follow-up appointment for 10 weeks from today. The doctor will take another look then and will want to check things out again when the baby is born. Seems kind of like overkill, but I guess it is better to err on the side of caution. Besides, who knows how the blood sugar fairies will treat me and baby boy over the course of the next couple of months?

He’s Perfect

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!

12 Weeks

Baby says, "Hi"

Today was my 12 week OB appointment. The purpose of the appointment was twofold: To set me up as an “official” pregnancy patient and to start genetic testing.

The day started out with an ultrasound. Part of the 12 week genetic testing, called Nuchal Translucency, is to measure the amount of fluid in the baby’s neck. This measurement, coupled with some blood work, assesses the baby’s risk of having Down syndrome and some other chromosomal defects.

This whole genetic testing thing is complicated. As parents, you do not have to do the testing, it is just an option. Also, the tests are known for producing false positives, which can cause a lot of worry and heartache. It was hard for us to decide whether or not to do it, but we finally decided that we would rather know what the odds are, and to be prepared for the outcome at delivery.

The ultrasound was somewhat uncomfortable. Because the baby is so little at this stage (something like 2.5″ – 3″!,) you need to have a full bladder to push your uterus forward so that the ultrasound wand can pick up the sound waves. I dutifully drank my 20 ounces of liquid 1.5 hours before the exam. As anyone who has been pregnant before can probably tell you, there is a lot of pressure in the bladder area. Even when your bladder is not full, it sort of feels like somebody is trying to wring it out. I am in the habit of peeing every 1-2 hours, even when I have not had a whole lot to drink. So maybe you can start to understand the pain I was in when I walked into the doctor’s office.

Luckily, I did not have to wait long, and the ultrasound experience, as usual, was mesmerizing. Hearing that heartbeat (171 beats per minute this time!) and seeing a “real baby” in there is just amazing. This time it looks even more like a baby, less like a fish. Baby looked like s/he was posing for us, with his/her right hand in the air as if to wave “hello”. The ultrasound tech also instructed me to leave a urine sample, which was not problem at all!

Afterwards, we spent several long minutes trying to draw my blood. They need something like 6 vials of it for this genetic testing, and my veins are apparently still weak from my dehydration and hospitalization. So we finally gave up on that. I have strict instructions to rest and drink tons of water. On Tuesday I have to go back for another try.

After that, the nurse practitioner recorded some of my genetic history, and then took some cultures. And then I was free to go.

All in all, a tiring visit, but I am so relieved to hear that baby is healthy and growing as expected.

Zofran, I think I love you

Our visit with the OB was relatively positive yesterday. The heartbeat is up from 97 to 119. I still have to go back in a week to make sure everything is growing.

We got another ultrasound picture … a white blob with a blinking black center suspended from a white yolk sac. I’m sure that it doesn’t look like much to the outside world, but it is beautiful to us. We hung the picture on the refrigerator. I am getting less and less nervous with each visit.

One of the highlights of the visit was the prescription for anti-nausea medicine. The doctor prescribed Zofran and I am actually starting to feel human again. Don’t get me wrong, I don’t feel normal, but this stuff is definitely taking the edge off and I am preparing for a day at work (and out of bed) for the first time in almost a week.

Of course, it makes me a little leery that the drug is not actually approved for use during pregnancy, but there is a lot of good anecdotal evidence out there, so I am just hopeful that everything works out. And for the first time in five days, the scent of my own deodorant (powder fresh?) is not making me gag.

A Peanut with a Heartbeat

I broke into tears of relief when the technician showed us the little blob on the screen. “There is definitely a baby in there,” she said “And there is the heartbeat. Do you see it?”

I nodded through blurry eyes. Yes, the little blob was blinking: in, out, in out.

Next she focused her attention on the mass. “This looks like a pedunculated fibroid. It is on the outside of the uterus near the ovary. It doesn’t look like it is bothering anything. I think it will be fine.”

More relief.

We saw a different doctor this time. She confirmed that the fibroid is nothing to be concerned about. We’ll just keep an eye on it to make sure it doesn’t grow into anything problematic. She was a little concerned about the heart rate, though. At 97 beats per minute, it was a little low, but she said this is not so unusual in such an early pregnancy. So I need to go back on Monday for another ultrasound to confirm that the heart rate  is increasing. She said the age is 6 weeks and 2 days and that my due date is June 29.

She was also mildly concerned about my HCG level. She thought it was slightly high for the age of the embryo. Nothing to be too concerned about now, but she suggested genetic testing when it’s time. We had planned to do that anyway.

So I finally got some sleep last night and life is returning to its normal rhythm.  A peanut. With a heartbeat. Inside me. Amazing.