Monday, September 27, 2010

All I Really Want for Christmas

I love Minimed's Carelink program. I love charts, and graphs, and having a record of my blood sugars and insulin doses in one place. I think it improves my ability to care for myself. But I have a few gripes about it.

I really wish that Minimed would update Carelink so that it supported Macintosh's Safari internet browser. Anyone else with me? Currently, the only internet browser they support is Microsoft Internet Explorer. I would use it much more if Minimed would just make it a little easier to upload.

Also, there is something really annoying about having Carelink prepare "reports." It just seems like sometimes it takes 15 minutes for it to pop up with the .pdf. Isn't there a better way? Also, a way to customize reports so that you can pick and choose exactly which data points you want to see?

I have a good friend who wrote a proposal on these and other ways that Minimed might expand their Carelink software to make it more useful for diabetics and their care providers. For example: how cool would it be if your blood sugar meter sent your BG reading to your pump, your pump then sent it and all bolus information you enter to your cell phone, and then you could enter all the things you ate on your phone, and then your phone would send it up to Carelink?! That would be a dream. I have never been able to reliably write down everything I eat in a day, but if I had a way to enter it to my logbook at the same time I'm dialing up my insulin bolus, I would have a beautifully complete record.

If anyone wants to read this proposal, or try to convince Minimed to take it on, or do something similar themselves, let me know and I'll send it to you.

Friday, September 24, 2010

Late Third Trimester

It's been a wacky couple of weeks. As with my last pregnancy, my insulin needs increased dramatically at 34 weeks. Fortunately, last time, they remained fairly stable until delivery. I'm currently at 36 weeks, and feeling good, but it's been a wild ride!

This pregnancy, when my blood sugars spiked around 34 weeks, indicating increased insulin needs, neither my endocrinologist nor I responded with the dramatic changes necessary to counter them. That resulted in 7-10 days of high (150-200) 2-hour post-meal blood sugars that made me EXTREMELY uncomfortable (not physically, but psychologically). As a result of my anxiety, I ate very little and very infrequently, fearing that would only prolong the high blood sugar.

This instability in my BGs was the background for a massive migraine I experienced over the course of 5 days during my 35th week. I was unable to drink anything that didn't come back up for about 18 hours, and unable (and afraid) to eat anything for about 36 hours. The headache lingered for several days after I resumed mostly normal functioning. My doctor helped me rule out meningitis, preeclampsia/toxemia, and a brain aneurysm (yeah, I freaked out a little bit), showed me an acupunture pressure point on my palms to help relieve the pain, and recommended Tylenol.

My suspicion is that the high blood sugars and the headache were related, somehow. I think that the headache may have been the result of poor nutrition for the 7-10 days prior. I wasn't eating enough because I was afraid of high blood sugars, but I happened to be restricting my food intake at the very same time that my baby and my body were requiring extra amounts of food to support the baby's growth, an increase in amniotic fluid and blood volume, and so forth. My OB had mentioned some concern about poor weight gain during a few of my previous visits. My body's way of saying: pay attention.

The alternative diagnosis is that I had an incidence of ketoacidosis, resulting in dehydration and imbalanced electrolyte concentrations and a very severe headache. I have never experienced diabetic ketoacidosis, so I can't be sure on this one - also, my blood sugar was only around 300, which hasn't ever pushed me into DKA before. However, I don't put it out of the realm of possibility because I am pregnant and my blood sugars had been so unstable and tending high for the 7-10 days prior. The other possibility is starvation ketoacidosis, but it may be generous to describe my state as one of starvation. After all, I was still eating; just not enough to gain weight necessary for healthy pregnancy. Needless to say, the causes of ketoacidosis seem complex, so this may or may not have been at issue.

The last possibility is that the same hormonal changes that I was undergoing that raised my blood sugars and made insulin needs higher (progesterone increase? estrogen drop?) also placed me at risk for a headache. I know that migraines are more common in women, and are associated with menstruation and childbearing events for this reason. I haven't had them before in my life, but did have one or two mild migraines during my first pregnancy.

So what I learned from this experience, and will continue to do through this third trimester and that of any other pregnancies I have:

Pay attention when your insulin needs increase dramatically, and respond accordingly. Moderate changes work well most of the time, and prevent lows, but the changes I needed really were dramatic and involved massive adjustments to bolus ratios, basal rates, and insulin sensitivity.

Be prepared to eat every 2 hours in the final weeks of pregnancy. As a corollary to the above, I would prefer the risk of making dramatic changes and having my blood sugars run low because for me, highs are much more difficult to deal with psychologically. I'm happy to be tied to my food every 2 hours. Keeps the weight gain up in any case, which keeps me, my OB, and my baby happy (even if my postpartum self disagrees. We'll deal with her later). My 16-month-old son is my snack-clock. I make sure I eat every time he does, which is at least 5 times a day.

Try Gatorade rather than juice or water. I should clearly get paid for this plug, but I have decided that Gatorade is an absolute necessity for me from here on out. I get more fluid per carb than I do with juice, which is important at this stage. It seems to be absorbed as fast, if not faster than, juice, when I'm dealing with a low. I don't have to go to the bathroom as frequently as I do if I drink just water. And it helps restore electrolyte concentrations, which is an important part of hydration and avoiding headaches. I'm hoping it will keep the charley-horse leg cramps that wake me up at night away for the rest of the pregnancy, too.

Sunday, September 5, 2010

Cholesterol during Pregnancy, part 2

So I did a little research on elevated cholesterol levels during pregnancy, because I was curious to know why my blood cholesterol was elevated when it was checked a month ago. I also wanted to know whether I needed to do anything differently (while pregnant or afterwards). During pregnancy, it appears as though the long and short of it is: eat well and don't worry about it. Stress may actually increase cholesterol. In fact, most doctors don't recommend checking blood cholesterol levels during pregnancy until at least 6 weeks postpartum.

I did not do a thorough search, but I don't think there are any medications recommended for elevated cholesterol during pregnancy. That means my only option for managing elevated cholesterol is diet and exercise. Even still, though, some people believe that cholesterol-restricted diets may be harmful during pregnancy, since the baby needs cholesterol for brain growth (e.g., Dr. Sears).

This study determined that cholesterol increased in the second and third trimesters of most average pregnancies, and that it increased more in subsequent pregnancies. So it even makes sense for me to have high cholesterol levels during my second pregnancy. Interestingly, LDL and triglyceride levels (i.e., "the bad stuff") seem to rise more than HDL. The same study indicates that women experience lower HDL (i.e. "the good stuff") in their subsequent pregnancies. That seems unfortunate, and the authors of the study suggest that it may adversely affect long-term heart health (not a proven hypothesis). But my thought is that if it's a temporary change, it probably won't hurt me in the long run (but that just helps me sleep at night, so I wouldn't blame you if you're disinclined to believe me).

Another study indicates that diabetics aren't any more likely to have an excessive increase in blood cholesterol levels. The only caveat to this is that they may be more likely to start out with high levels from the beginning. The only thing this tells me is that if I didn't have a problem with high cholesterol before getting pregnant, I wouldn't need to screen for it in this or future pregnancies.

The apparent reason for a rise in cholesterol in pregnant women is that cholesterol is necessary for the manufacture of hormones, and plays some part in the development of the baby's brain.

I think my elevated cholesterol level is probably due to pregnancy, rather than because I have an ongoing problem, but I may get them re-checked after the baby is born anyway just to be sure. I read in a couple of places that breastfeeding may help get them back down, and we're big fans of that here.

Wednesday, September 1, 2010

Super Cool All Natural Birth Stuff

I wish I'd thought ahead to research more "natural" ideas about babies and birth than simply the labor itself when I was pregnant; but alas, I couldn't see past the Main Event ;) Thankfully, there are ladies who do, and I wanted to share this cool postpartum post on another blog I ran across today. I haven't read much of this blog at all, but this posting on how to make a homemade postpartum kit was very relevant to going natural with birth.

I was thinking about home births just a couple of days ago and wondering what you did if you birthed at home and didn't have a nurse tech to bring you one of those ice-packs and a "squirt bottle" like they do in the hospital (ps... if you haven't had a vaginal birth yet, this may make NO sense to you, but ask a friend who has, she will explain the ice pack and squirt bottle). :)

Anyhow, after reading Lindsay's post, I know what you do when you have a home birth to care for yourself! And if I give birth again, I think I might just prepare these remedies ahead of time for home or the hospital!