Category Archives: Pregnancy

Putting Diabetes Back Into My Life

Wow. It’s been 3 months since I blogged?! What?!?! I guess that’s how things go when you’re stretched at every end it seems between a baby, toddler, and a house to keep up with. I’m busy, but happily so. I’ve not had much time to think about blogging as it seems my day is full from the moment I get up to the moment I go back to bed. Some days are overwhelming but most are just full and things like blogging have taken a backseat.

So, if you are wondering how we’re all doing, we are good. The hubs is staying busy, baby A is growing (she’ll be 5 months old soon!) and E is quickly growing into a little boy rather than a toddler. Baby A is rolling over and already has 2 teeth (!!!), and E is in pre-k learning and filling his mind with all sorts of awesome things (Hey moma! Apples grow on TAAAAAAAAAAAALLL trees!).

Me? eh. I’m “here” most days. I get so wrapped up in what is going on around me that I forget “me” and, most of all, my diabetes. I’ve let things go so much that I don’t even want to remotely know what my A1c is right now. I realize that I can’t expect to be perfect with it, but I also know that I can’t let my control go. My husband and kids depend on me to be healthy, and I feel like I’m having more and more “episodes” and am not healthy any longer. My body is tired and worn out from the rollercoaster caused by my own “backburner” attitude I’ve had. I’ve just not had the time I had before baby A to sit down and upload. I used to think I would like to have a system of remote uploading for convenience sake, but now, it would be an absolute dream to upload everything with no wires, on-the-go, from all devices, and get instant feedback. That’s one thing I do love about Glooko’s updates to their app because while I can’t plug my pump into it, I can have my Dexcom data plugged into it from HealthKit and I can upload my Contour Next USB into my android tablet and at least get feedback that way by seeing comparisons between weeks, months, etc. I looked at it earlier this week – my average BG is almost 170. Yep. And while that may not be a big deal to some, it’s a huge deal to me since I usually keep a tighter, lower range goal.

I feel like I’ve let myself go too much and it’s time to get back. And what got my head back into the game after having E was blogging. It was my way of working things out in my head because rarely do I go back through and edit – I simply blog out what’s in my head and get better clarity of where I stand and what I need to do.

And this is the one, constant truth. As selfish as it may seem to put myself first, it’s really not because if I don’t it’s also not putting my family first. My health directly impacts them and my ability to take care of them, and I can’t take care of them if I am too sick to do so. So, putting me and my care first, is actually putting them first… and then you realize that there are no placeholders, only the ones we’ve created, and we’re all just one unit.. your family unit.

The time has come for me to put diabetes care back into my life and to stop “winging” it.

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Long time, no blog… The big update.

I promise it has not been intentional to not be consistent or to be absent in blogging. Things were becoming increasingly busy near the end of my pregnancy trying to prepare for the baby, which proved to be a needed thing because I actually went into labor on Father’s Day weekend.

Yep. Totally unexpected. I even had an OB check-up the Thursday before and there was absolutely NO sign of her coming early. I knew my pelvic bone felt as if she had shifted down, but my OB said he didn’t think she had dropped, and that labor did not seem to be any time soon. Yeah, right. My body thought otherwise. Late Friday night / early Saturday morning, I started having contractions. Not bad, but stronger than normal, and only a few of them. I went off to bed with no problem other than the usual hip/pelvic pain that I had all throughout my pregnancy. Saturday morning, we went shopping for the weekend and for things for the next week (food, etc). Halfway through the shopping trip, the contractions were very strong, but not consistent. I thought maybe it was the pelvic pain from walking as long as I had been. Activity was not something I could do without major pain anyway, and this was just over the top. All I wanted to do was to go home and rest in my recliner and wait for the contractions to ease too – because, ya know.. they just had to be Braxton-Hicks since I was no where NEAR ready for labor right?? Ha. They stayed steady all.day.long. And into the night. By that evening, I told my husband we had better go just to get checked since the contractions were then becoming about 4-5 minutes apart.

After a 2 hour stay at the hospital (SUPER strong contractions, but no dilation… only a half centimeter!!), I was sent home with a cocktail shot in my hip to make me sleepy and to ease the pain (which made me super drunk and sleepy, but did NOTHING to ease my pain)… and some juice, crackers and peanut butter because my BG was dropping… which wasn’t usual.

All day Sunday (Father’s Day), I had contractions. I stayed in bed or in my recliner and simply kept a watch on my contractions, and took warm baths to help ease some of the pain. We went to bed that night and by 1am, I was crying and moaning through the contractions. Something HAD to be happening. We went in and I had dilated to maybe 1 cm.

O. M. G… Seriously?!? Yes… Seriously. And they were going to send me home again. I fought against it. By the end of that two hour wait, I was so uncomfortable. I couldn’t sit any longer. Walking helped, but not much. The contractions made the pelvic pain so much worse than I felt I could stand. Finally, the nurse came in once again an hour later to tell me my options and insisted that she check me. I also believe she tried to ‘help’ the dilation along because I had gone from that measly 1cm to 4cm. She called my OB and came back  and said “Congratulations, you just booked yourself a c-section at 7:30am!”

I cried. I was so ready to not be in pain, but was so unsure if she was ready since I had JUST made it to 37 weeks that morning.

My section was bumped to 9:30 due to an emergency one. By then, I had no idea how much further I had dilated, but there was no going back. I knew it. The pain was VERY intense, and I shook, cried, and moaned uncontrollably through contractions. I wish now that I had an idea of how far I had dilated just for curiosity’s sake.

Funny thing about c-sections, once they begin – it’s super fast and over before you know it. I was wheeled in and being prepped at 9 and by 9:35, I heard the cries of my little girl. And this time, I got to see her because they took the blue sheet down far enough for me to see as the doctor suctioned her and cut the cord.

And just like that, I had 2 kids. One, so happy to be a big brother, and the other just as happy, content and healthy as could be to be out of her cramped living space and out in the world. She was perfectly healthy with only a dip in BG after birth that was brought back up with some formula while I recovered with no NICU time.

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As far as my BG the whole time? I owe a HUGE thank you to the Nightscout team – both for the push to get Dexcom to release Share and for them to have the Pebble app be able to get the info from my Share account so that I could be monitored VERY closely with just a glance by my husband at his watch, and my Dexcom and phone be tucked away in his pocket. Oh, and the medical staff was super impressed ( nurse: “hey, what’s her BG?” husband: “136” OB while cutting me open: “awesome!”… yeah… that’s pretty darn awesome!!)

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The D50W Experience

In a way, it’s sort of funny how the medication used to bring up a low if you ever have to go there is labeled D50W… sort of makes me think of the metal lubricant WD40 in a way – though it has no connection whatsoever other than the letters are the same and in different spots and one number is off.

BUT, that’s not what this post is about. It’s about actually having to go to the ER to get it.

Most of the time, a stomach virus is simply an inconvenience to most people. It sucks, no doubt about it. But when you’re a diabetic, it can be dangerous. Some people react with high glucose levels due to the sickness and can easily go into DKA (diabetic ketoacidosis) because you’re dehydrated from the sickness. That’s usually how I am in that I stay high for the most part because of dehydration, but I’ve never gone into DKA. I’ve also not had a situation where it had the opposite affect on me and made me low for an extended period of time… until this past weekend.

Saturday morning, I woke up feeling very queasy and knew I had caught my son’s stomach bug that he had the day before. Knowing that I usually run high, I didn’t turn my pump down at all, but also being pregnant, I didn’t want to assume that I would run high and turn up the basal unless my BG showed the need for it. And it was a good thing that I didn’t.

I was able to eat breakfast as long as I ate slowly enough. But, two hours later, I started trending down. I started eating glucose tablets and drinking juice as I could tolerate. Before long though, my stomach was full and not digesting anything, and my sugar was plummeting even more. I kept trying to eat glucose tabs. Eventually, upon smelling yet another drink, I lost everything. I could see that I had thrown up every bit of anything with sugar – glucose tabs, juice, my breakfast… all of it. So, as much as I didn’t want to, we had to get to the ER. I knew I wasn’t going to be able to hold down anything and I needed help.

It took 30 minutes to even get treatment, even though they took me back immediately. I had heard the doctor give the orders for half of the syringe of D50, but the head nurse was busy trying to find the billing code for it and apparently got side tracked. I guess because I was awake and not passed out they didn’t see it as quite the emergency that I felt it was. I knew before getting there, my BG was 52. By the time another nurse came in to start an IV of fluids, my BG as down to 45. I asked her about it, and finally the head nurse came in with the D50.

It wasn’t long and I began to come up again. However, it didn’t hold very long and they had to come back an hour later and give the rest. All this time I had been trying to find a good temp basal to set my pump at but that wouldn’t have me skyrocket and get sick from having no insulin at all. The last thing I wanted was to go into DKA straight from a low because I was dehydrated and now I was going to be cutting off all insulin… and from what I could tell, the staff in the ER had no idea of what to do with an insulin pump.

The ER visit

I was finally stabilized and set home around 3-ish, and I did okay the rest of the day. I will say it was one of the scariest things I’ve had happen in a long time. I hate when I am no longer in control of what happens with my diabetes for whatever reason and it makes me anxious, plus I was scared because it wasn’t just me that I was worried about but also this little person growing inside of me.

While I’m angry over how long it took to receive treatment and how some things happened while I was there (they were more worried about paperwork than treating me at all to begin with), I’m thankful that it wasn’t worse than what it was. My ultimate fear is losing consciousness and no one knowing what to do and how to treat me because they’re unfamiliar with how I manage my diabetes. That, along with being labeled as an uncontrolled or careless diabetic for letting it happen in the first place. I work my tail off to achieve the control that I do, but all it takes is one person giving into the stigma that only uncontrolled diabetics end up in bad situations (the ER, with complications, etc), which projects through their attitude toward me, to make me not want to trust them or feel like I have failed.

I know that I didn’t fail and that it wasn’t in my control, but it’s the emotional aspect that gets me every single time. I don’t know that I’ll ever be able to ask for help without that overwhelming sense of having failed and crying my eyes out every time.

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Until The End… At Least

Yesterday, I had my monthly appointment with my endocrinologist. I always look forward to my meetings with him – he’s always on top of everything to do with my diabetes, knows what a data nerd I am, and he fully trusts my decisions about my diabetes as much as I trust him to help me make decisions when I can’t.

He also knows that before my pregnancy, I switched pumps within my arsenal pretty regularly. He never had a problem with it. We even laughed about the amount of “backups” I have, even though all but one are out of warranty. When I received the second t:slim replacement in April of 2013 and started using it in January/February of 2014 after the cartridge recall and continued with it for a year until it was replaced earlier this month, he was impressed that I stayed with one that long. Last week, when I finally had enough of the craziness from my third replacement, he was willing to try to help because up until then, he (and I) was under the impression that I had found “the pump”.

So, when I went in yesterday, I told them about going to my Minimed once again (for documentation purposes), but this time I showed him the Dexcom reports between the two. He was floored just as much as I had been. Just as I had thought all along, he would expect to see that if I had switched insulin brands, not simply insulin pumps – because essentially they all should work relatively the same at delivering the set amounts of insulin. But the difference I had shown worried him. He told me not to use t:slim for the remainder of my pregnancy, and to stick to Medtronic. I had told him my husband and I discussed it and we had already planned to do that anyway, but hearing that from him validated it. And, in all honesty, it shocked me. He’s always been one to trust what decisions I make and go along with what I want to try, with the exception of ONCE telling me “no” to a medication I wanted to try, and this time I had the same reaction. He had stepped in and told me not to use a pump. Part of me is in shock, but partly not. It once again reassures me that he’s allows me to do what I want with my diabetes management, as long as it is within reason, and staying on a pump that would potentially cause harm would not be within reason, and he stepped in.

I will have add to all of this, though, that I did receive a call from Tandem at 10pm about replacing my t:slim once again. Since it is in warranty, that’s what I expect them to do. I went through all of the common questions they ask for record purposes, and the representative documented my answers. The replacement t:slim will be here next week, however both following doctors orders and for my own sanity, I will not be using it until the end of my pregnancy – or a bit later once insulin needs become somewhat predictable again. I’ll already lose some of my brain cells and energy to taking care of a newborn, and I won’t want to add switching pumps into the mix. He documented also that I wouldn’t be using the replacement until after August/September, so I wouldn’t be able to give feedback until then – and to my surprise, he didn’t try to pressure me into trying it any earlier. That made me feel very comfortable. I am glad that they reached out and were willing to replace the t:slim without hassle this time. I’ve only had a couple of sub-par experiences with their tech support, and the rest of the time it’s been good, so it does help to know that they are listening.

So, out of everything that’s happened this month, I am thankful to have an awesome Endo that I fully trust and that I know truly cares, and to know that Tandem does care – even at 10pm at night.

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Studying and Tuning

Usually, about once a month, I study my Dexcom trends and make minor adjustments here and there in my insulin needs (with permission from my endocrinologist, of course). This ritual then becomes a weekly thing during pregnancy, and this time is no different. And, later in the pregnancy, I tend to do this every couple of days or so due to all of the increased resistance and stuff.

Since I switched back to my Medtronic pump after issues with the t:slim last week, I wanted to get a good few days of data before making any changes since typically you do have to make some adjustments between insulin pumps. Not all of them deliver in the same manner (though relatively the same, but juuuuuuust enough to possibly need minor changes in insulin dosing). Here’s what I mean:

6 days on tslim 2

6 days on the t:slim I had been using during the first part of my pregnancy…

6 days on the *replacement* tslim... NO changes in rates as they're the same brand of pump so it shouldn't have made a difference...

6 days on the *replacement* tslim… NO changes in rates as they’re the same brand of pump so it shouldn’t have made a difference…

...and the last 6 days since being on MedT with practically the same rates.

…and the last 6 days since being on MedT with practically the same rates.

If you compare the first and the last picture, you can see that there’s not entirely too much difference, and the average BG between the two was only a few mg/dL off from each other. The replacement, however, was whacko.

Either way, I’m doing a lot better on the MedT and will probably stay on it. And since I have made that decision, it’s time to get down to fine tuning things. I’m dropping every night around midnight, and it’s taking longer to treat them, thus I over treat and go high. BUT, the thing is, I’ve not corrected those highs. I’ve been trending back down on my own. So that tells me I have some work to do between supper, bedtime, and overnight basals and other factors.

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I usually look at my trends on the computer and try to identify things. If I think I see something or have a hunch, I’ll print out the Daily Trends report so that I can see the days individually and not as an average, and I’ll write my basal rates below it. This time (for example), I noticed that I dropped an average of 57mg/dL from my highest average to my evened out number when I wake up, which, ironically, is close to my insulin sensitivity factor (55mg/dL currently). So, I took the 1u and divided it by the number of hours it had been dropping  before leveling out, which was 7hours, and it came to 0.14, which I interpret that to be a needed basal rate change of 0.15u per hour less than what I have it set at now.  It all may not be exactly right, as most of what I think I’ve figured out is simply a hunch that I try out and see if it works. If not, I have record of my information pre-changes and I go switch everything back to what I had before.

This the stuff that goes through my head while I’m examining my data. This is why having as much of my data in one place is as crucial as air to me, especially while pregnant. It’s such a pain in the butt to have to look at multiple reports and have to spend more time organizing it than actually analyzing it. So, I’ve also resolved to leave my beloved Verio IQ and use the Contour Next Link meter that works with the pump, so that all of my data from the pump and meter at least are in the same place. That, and since using the CNL meter, my Dexcom data more closely matches it whereas it hardly ever matched my Verio. I’ve done a lot of research over the past couple of days, and it seems that maybe the CNL meter is a bit more accurate than the Verio, and with the Dexcom using the more accurate 505 software, maybe the two are just meant to be… Or I could just be completely off my rocker. 😉

So, I’m off to my endo tomorrow for my monthly checkup and to share my observations and changes with him.

(What I do and write here are in no way medical advice that you should ever take as such. I have worked very closely with my endocrinologist over the years and he has helped me learn how to do these things. If you want to learn how to manage and fine tune, please speak with your health care professional, as I am not one.)

 

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Changes At The Half-Way

Typically, when one such as myself who is a device hoarder and who likes change becomes in a medical state where circumstances would favor more stable device use and more concentration on what is actually going on, one would stick to those devices no matter what and create a harmonious data record flow throughout the medical state.

My said state is, of course, pregnancy. A highly regulated and controlled medical state in those who are diabetic because both high blood sugars and wide variations in blood sugar control can cause damage to the developing baby. So, when I found out about this one, I resolved to stay on my t:slim pump, Dexcom CGM and Verio IQ meter – both because I was happy with my t:slim finally after having used it for almost a year without issue and for the sake of keeping consistent records. I had no concrete reason to switch back to another pump other than for my own sanity as I still didn’t 100% have faith in it. In all honestly, even though I had used it for the entire year without issues, I still -in the back of my mind- wondered when the issues would arise again. I held my breath with each cartridge change and said a prayer that it would work just fine. And it did… until earlier this month.

Granted, I know that being in the second trimester that insulin resistance would start to kick in, but there was a HUGE difference in my control after I had received my last replacement from Tandem on the 6th of this month. I was right back to fighting wild, crazy numbers from all ends of the spectrum without any rhyme or reason to them – and the only thing that had changed was the pump. And while I could call Tandem about it and have them replace my pump again, I just don’t have the mental energy to go through it again when even this last time was a bit challenging to get it replaced because the error I was getting was not a known problem and the pump had passed all other safety tests. I’m sure for other people, Tandem is a great company. I think they have a good product on their hands, but for some reason I just seem to not have luck with it for long.

Last week, when I had finally hit my breaking point – literally, I was sobbing Wednesday while contacting my Endo and letting him know I would be faxing records to him for help – I decided to go ahead and use my Medtronic pump. Crazy thing is, just for my own security of mind, I had just had it switched out from the 5 series (the 180u pump) for the 7 series (300u pump) to have as a “just in case” for the end of the pregnancy when insulin needs were going to be much higher. One of the issues with the t:slim seemed to be when I filled it up to 280, it would screw with the load sequence – thus the reason I had it replaced. Within a day, my BG’s became predictable again. I could bolus without skyrocketing and plummeting later – as if the insulin wasn’t being delivered. I could pre-bolus on a predictable schedule before eating again. And while I don’t like that now I can’t upload my pump and meter together so all of my data is messed up, I’m more at ease about my glucose levels overall. All from switching a pump.

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Saturday, I put my t:slim into sleep mode and packed it up and away. I do not plan to use it for the rest of my pregnancy, and even after that, I’m not sure if I’ll use it again. I’m absolutely torn about it because it was the first pump since my Disetronic way back in the day that I truly loved to use. But it’s like I’ve heard many other veteran pumpers say – I don’t care how fancy you make your pump, I just want it to deliver my insulin and work like it should. Especially right now.

Of course, this all is not to say you shouldn’t get the t:slim if you want it – there have been plenty of people who have used this pump since it came out without issue. I seem to be one of the lucky few who has had problems with it. Not every pump works for everyone, and you can’t go off of one person’s experience to assume what yours will be. 

And I know this is already a long post, but I want to give a shout-out to my Medtronic rep if he’s reading. He’s been so supportive of me through the past 4 years – no matter how many times I would switch pumps and go back to my Medtronic one, he was always there to help with whatever I needed. I can honestly say that I have never had a rep from any company be as good to me as he has, and I really appreciate that. So, a huge “Thank you” to Travis, especially this time for taking out a few moments on your day off (and on your way hunting, no less!!) to bring me a few sets that I needed until my order comes – you’re an awesome guy.

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Second Time Around

So my last post was about my little announcement and why I’ve sort of been MIA around blogging and stuff. As of today, I’m 12 weeks along and according to some places, I’m in my last week of my first trimester, and to some, I have 1-2 weeks more to go. Either way, I’m almost out of the first part, which I hope means I’m almost out of the whole morning sickness and fall-asleep-at-the-drop-of-a-hat part in the beginning.

The biggest difference so far between this pregnancy and the last one 4 years ago was that I am MUCH sicker this time around. I had a lot of morning sickness with E, but this time, it’s on a whole new level. It’s all day, which really isn’t that much difference, but it’s just much more intense. Chicken is my number one “no-no” food – I cannot bear to even think about it without feeling super sick, with any carbonated or flavored drink holding a strong second (yes, this mama has been without diet coke for 2 months now! shocker!). And, for at least one meal a day, I’ve resorted to having a Glucerna meal shake since the thought of any food at all is just not working out. I finally had to call and get anti-nausea medication because this time around, I’m very sick when I am below 70. And, since while being low, food is sort of important to keep down, I weighed the pros and cons and decided it would probably be more beneficial to be able to treat the low than the risks of taking the medication.

Other than that, my insulin levels by this time with E were dropping significantly and by the 16th week, I was at half of my usual dosages. This time my insulin requirements have dropped, but just not as significantly. In fact, they went up by 20% in the beginning and are now seeming to go back to pre-pregnancy levels. So, for the most part, that has been completely different.

My A1c came back at 5.8, after just a month before having it at 6.7. That was a welcomed result by both my endo and my OB. My OB had some harsh words at our first visit about how I am not the “poster child for a healthy pregnancy” (don’t worry, although I wanted to punch him, I refrained), but I think my endo may have had a hand in setting him straight about how OCD I am over my control, and our next visit was much different and his attitude had made a 180 toward me. My endo is just as attentive as he was last time, and we’re working on a weekly basis on my levels over fax and I see him once a month in person, with my next appointment being tomorrow. I have a feeling though, that with my cold that I’ve had over the past 2 weeks that my A1c won’t be quite so nice, but at least I have an explanation for it. I’m not too worried about it, but at the same time I am simply because I don’t want my OB to make some smart remark again.

Other than that, so far, things are going great. No issues or scares, and our ultrasound went great a few weeks ago. The baby was moving like CRAZY in there. E said it was “cute” and he wanted to hold it. It’s been an adventure trying to explain to him that there’s a baby coming next year. It’s also hard for him to understand why I can’t hold him right now too, which breaks my heart. We’re hoping that maybe once I start showing a bit and if he gets to feel the baby move himself that it’ll start clicking with him.

So, that’s my update for now. More to come later, I’m sure. 🙂 I hope you all have a great and happy New Year!

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