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Posts from the ‘Blood Sugars’ Category

Diabetic Pregnancy: Third Trimester.

Ten weeks left until the little man arrives, which means I’m in the third trimester and ready to fast forward through the summer.  FAST.  FORWAAAAAAAAARD!!

Swelling.  So far, so good.  I don’t have any swelling to speak of, which is a far cry from my first pregnancy, when I was in StayPuft mode starting around 28 weeks and stayed there until I delivered.  But thankfully, I’m a little more comfortable this round.  I can still wear my wedding rings, all my shoes, and my feet look like feet (instead of inflatable kayaks).

And I’m grateful to be back home from Utah, which was the scene of the swelling crime six years ago.  Something about being that far above sea level seemingly kicked off my incoming preeclampsia last time, and I’m glad Utah this year didn’t bring about any repeat performances.  (Also, I’ve only been to SLC twice, and both times I was seven months pregnant.  Weird theme.)

Blood sugars.  I still have them.  And they haven’t been entirely pleasant lately.  Some high numbers are returning in the evenings, which caused me to kick up my insulin : carb ratio for dinner as of this morning and I’m also side-eying my basal rate a little bit.  Still attempting to pre-bolus for as many meals as I can manage, which is working out pretty well.  I am aiming to keep my A1C in the same range it has been for as long as I can.

Some lows are back, only without symptoms at all, and those suck.  The other night, my CGM was screaming LOW for about an hour and I woke up the next morning with glucose tab dust all over the bedside table, a text message conversation on my phone that I have no recollection of having, and a low hangover that kicked my ass for hours.  Also, there was a missing burrito, which I can neither confirm nor deny responsibility for.

(Have I mentioned the Comfort Burritos that have lived in my freezer for the last five months?  Cravings were weird and intense during the first trimester, and there was a specific day when I NEEDED to have a burrito but didn’t want to eat so many carbs in one sitting, so I bought a frozen one and threw it in the fridge next to Animal.  It’s been in there since, comforting my cravings without having to be consumed.  I will plant it in the backyard after my son is born.  Perhaps a burrito tree will sprout?)

Baby kicks.  My daughter is strong and quick now, but I do not remember her being such an athlete in the womb.  However, her little brother is a storm of flying feet and hands at all times.

“Are you pregnant?” asked the lady next to me on my flight over the weekend.

“Yes, I am,” I confirmed, grateful for people who don’t assume/don’t say “WHOA! ARE YOU DUE TODAY?!”

“I thought so.   Your baby has been moving like crazy since we took off.  You have an active little one in there!”

Awesome.  You can see my son moving around through my shirt now.  And he clearly digs long flights.

Doctor’s appointments.  We’re turning up the dial on doctor’s appointments for this last trimester, moving to weekly appointments next week and then twice-weekly appointments until delivery.  My team at Beth Israel and Joslin are in sync and tracking me closely, in addition to keeping tabs on any eye disease progression (holding steady), kidney issues (none to speak of), and blood pressure spikes (still not back on BP medication yet, so feeling good about that).

I’m grateful to have so many medical professionals at the ready and tracking my baby’s progress.  (But I can’t lie; I’m looking forward to never seeing any of them again, post-delivery.  I’m emotionally done making that frigging drive to Boston.)

August.  We’re still working towards a late August escape date, with my body cooperating so far.  If the weather holds in this lovely 72 degrees and no humidity pattern for a few more weeks, I’ll be the happiest third trimester lady of all time.

Fifteen Minutes, Fifteen Grams.

I just needed fifteen minutes, after fifteen grams of carbs.

“I can’t go with you, because I need to eat something else and wait for my blood sugar to come up.  You guys can go without me and come right back, if you want?”

The sentences sounded soft and measured.  Sure, go for the bike ride around the neighborhood, dear daughter and trusted neighborhood friend.  I’ll just sit here and eat fifteen grams of carbohydrate, then wait patiently for fifteen minutes while the food works its magic.

Instead, I was shouting up at them from the bottom of the well, hoping my voice carried in a way that didn’t make my kid nervous, hoping she’s hearing the reassuring tones of my voice instead of the panicked inner monologue that was playing out:

“HEY!  Go on outside and play and don’t watch me mop the sweat from my forehead while I inhale two juice boxes and a packet of fruit snacks.  Ignore me while I fight back the urge to lie down on the kitchen floor and let this weird wave of unconsciousness wash over me.  Pretend not to notice that I’m looking through you instead of at you while I’m talking to you.  Go on outside and let mommy fall apart for fifteen minutes, after these fifteen grams of carbs.”

My daughter and her friend strapped on their bicycle helmets and took off down the street, enjoying the sunshine and almost-summer weather while I stuck a spoon into a jar of Nutella, not giving a shit if this was the best option or healthiest decision but mostly because I wanted to have something sweet on my tongue, reminding me that I was still here and capable of coming back from this low blood sugar and that I could start making dinner soon because I would be capable of standing unassisted, without fear of falling into the abyss, in just fifteen minutes, after fifteen grams of carbs.

t:slim with a Twist.

Several months ago, I switched insulin pumps.  (Here is the post about the switch, and please read this post about the disclaimer that initiated the switch.  My full disclosure page is here.)  My first impressions of the t:slim pump were drummed up over a year ago, after trialing one for a few weeks, but my real t:slim immersion came once I switched in full.

Funny thing is the timing of that switch.  When I packaged up my Animas pump in favor of a Tandem one, I had also just found out I was pregnant.  Which means that I was adjusting to life as a pregnant PWD and also to a new insulin pump.

tl;dr – There’s stuff about the t:slim pump I wouldn’t have appreciated so soon were it not for the baby-en-route.

Because dude, if I had switched a year ago, I would have been all, “Oh, it looks so cool and the touchscreen is badass, and the fact that it’s flat all the way across the front makes it easier to tuck into my clothes,” making the wearability the most important part of my switch.  Yeah, wearability matters, but not as much as ease of use and OUTCOMES does these days.

(None of the following is medical advice; remember, I’m not a doctor and currently can’t even see my feet in full these days.)

#tslim #diabetes

A photo posted by Kerri Sparling (@sixuntilme) on

Entering a bolus is stupid-easy.  And this matters, since every blood sugar counts double these days (for me and for my growing son).  It takes me a few seconds to unlock the pump and bang out a bolus, and only a few extra seconds to add crucial information like my current blood glucose and the carbs I’m consuming.  Part of my over-arching problem of diabetes management is keeping apathy from creeping in; the all day, every day tasks of type 1 diabetes wear on me in a way that prevents me from taking advantage of everything technology has to offer.  Oh, so an insulin pump can calculate my insulin on board (IOB) and the dose I need to bring down a blood sugar back into range, or what’s needed to cover X amount of carbs?  HANDY INFO!  The only thing I have to do is enter that information and it spits out a result?  ALSO HANDY.  But having to scroll forever to enter information is enough to keep me from entering that information.

It’s pathetic, how often I was taking 2u of insulin because it seemed “close enough” to cover what I needed, instead of spending the time calculating the proper dose.  Being able to input this necessary information in a matter of seconds makes me actually DO IT.  My endo is very pleased with this uptick in my management, and my A1C 100% reflects these efforts.

#tslim #diabetes

A photo posted by Kerri Sparling (@sixuntilme) on

Changing my basal rates is stupid-easy.  Being pregnant means that my insulin needs are changing rapidly.  First trimester brought about insanely sticky hypoglycemic events, which equaled out to dialing down my basal rates significantly and making frequent use of the temp basal option.  (Again, it’s about the button pushing – it takes me seconds to set a temporary basal rate.  Ease of freaking use FTW.)  Second trimester showed a steady climb in my weight and insulin resistance, with a marked rise in my basal rates and my insulin:carb ratios.  And now, at the beginning of the third trimester, shit is changing all over the place, with some basal rates going down a little bit and my insulin:carb ratio almost double what it was pre-pregnancy.  There’s a lot of math going on in my baby-building body, and being able to change my rates after reviewing my data on Diasend and t:connect makes for easier management.

Holding more insulin is stupid-easy.  The t:slim holds a ton of insulin (300u) and as my pregnancy progresses, I may need that cartridge to be filled in full, instead of the half-way filled I’ve been doing for the last six months.

#tslim #diabetes

A photo posted by Kerri Sparling (@sixuntilme) on

Seeing my status is stupid-easy.  One button push shows me how much insulin is on board, how long it will be active, shows how much insulin is left in the reservoir, the percentage of charge left in my battery, and the time.  Oh, and what day it is.  (This matters, as the day and time are bits of information that are being eaten regularly by intense pregnancy brain.)

Not everything is stupid-easy.  This isn’t a list of perfect moments with my insulin pump.  There are pros and cons, and the time it takes to change out the cartridge and infusion set is still cumbersome.  I also am not a fan of the luer-lock tubing bulge, as it takes on a “third nipple” appearance more often than I’d prefer.  And I’ve seen more occlusion alarms with the t:slim than I did in the past.  But I’ll these cons over the pros, especially when I review my lab work from Joslin and see how strong my numbers are.

Being more on-target through my pregnancy is not stupid-easy.  Let’s not make my successes as a pregnant PWD the product of an insulin pump, shall we?  I am working my ass off to make sure my body and my baby are healthy, with just over 11 weeks left to go before we release this particular Kraken.  But having a piece of technology that alleviates the bolus math angst, makes it impossible to forget whether or not I’ve taken my basal insulin, and being able to bang out a correction dose in a matter of moments helps take the pressure off, at least a little bit.

… even if the beeps and boops might startle my developing fetus.  (If that study has any truth to it, my poor kids are screwed.)

 

It’s Just a Blood Sugar Check.

Checking my blood sugar takes less than 30 seconds.  Truly – upcapping the bottle of test strips, inserting the strip, pricking my finger tip, squeezing blood onto the absorption pad on the test strip, waiting the five second countdown of my meter to see the result up on the screen, and then taking the strip out and turning off the meter.

Thirty seconds.

Great.  No big deal.  Easy-peasy, and other rhyming phrases.

Let’s add in the responsive elements.  First, I anticipate the result.

Have you ever had go force yourself to check your blood sugar because you don’t want to see the result?  You know you’re high, so you want to avoid confirming it because seeing that number adds to the emotional failure quotient.  Have you ever forgone checking your blood sugar because you know you’re low, choosing fast-acting glucose sources over the 30 second confirmation routine?  The process of checking blood sugar isn’t just the installation of strip, pricking of finger.  There’s oftentimes an emotional hurdle that needs to be leapt over first, forcing me to attempt to view data as data instead of data as self-worth.

Then I perform the glucose check.

Then I respond mentally.  What is that number?  Do I have insulin on board?  Have I exercised in the last hour or two?  Am I planning on exercising?  Do I need to correct the number, either with food or insulin or exercise, to bring it into range?  Am I okay to leave it alone?

Normal questions like, “Am I hungry?” come to mind oddly late in this hierarchy.

But before the mental response, I respond emotionally.  A blood glucose result of any kind stirs up emotions, even when I try to immediately squash them.  There’s pride built into a 100 mg/dL.  Anxiety built into a 50 mg/dL.  Guilt baked right the fuck into a 300 mg/dL.  This is what keeps me from viewing my data as simply “data,” because every number represents something I’ve done or didn’t do … and I need to remind myself more that the thing I’m honestly not doing is making insulin.  The rest is a basket of beady variables that spill out unpredictably.

Checking my blood sugar is important because it gives me a view of where I’m at and helps me set the pace for where I’m going.  But it’s never “just a blood sugar check.”  It’s more than that.  There’s so much mental and emotional real estate dedicated to a 30 second process.

 

The Thin, Red Line.

For the last few days, I’ve been sick.  Sicker than I’ve been in several years – a man cold morphing into a respiratory infection with an agenda, evolving into nausea that rivaled all my morning sickness put together, crashing into having to visit the doctor and cancel a trip to California this week.  (For the record, I’ve never had to cancel a trip.  Ever, in my history of self-employment.  This was not my proudest moment, but it was necessary, as I was the walking dead and have only been recently upgraded to walking mostly-dead.)

For whatever reason, the “sick day rules” that the Joslin Clinic warned my parents and I about back in the day haven’t ever fully applied to my diabetes.  I don’t often see ketones, or highs for hours, or need a 200% bump in my basal rate.  It’s weird; I just don’t get sick in that “affects my diabetes” way very often.

But this round was a bit different.  Aside from being decidedly real people sick, my diabetes took a nosedive in response.  I had ketones that required major insulin and hydration to kick out.  My blood sugar went stupid high for a decent clip and then spent the night in the trenches, coming up only after three juice boxes and two bananas.  (Two bananas!)

It was that thin, red line of hypoglycemia that really freaked me out, as I was having trouble keeping food down, so treating the lows became tricky.  In the beginning of this pregnancy, I had serious nausea for many weeks, and every first trimester-influence low blood sugar was very difficult to properly manage because eating something was a big NO THANK YOU.  This round of illness revisited that theme, leaving me low for hours and having a hard time effectively treating it.  (Thank you again, Tandem, for a pump with a quick-to-set temporary basal rate.  Saved my hypo ass.)  It’s a weird line to walk, not over-treating a low, and even weirder to not feel capable of treating it at all.

But relief is in sight.  This morning did not require anti-nausea tea.  My fever has broken.  I have no voice to speak of (or with), but at least that dulls my complaining down to a husky whisper.  And best of all, my blood sugars have stopped being illness-induced jerkfaces and are back to standard second trimester circus-ry.

Small victories.

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