Wednesday, December 21, 2011

Week 11: Big-time Changes to Insulin Levels

I remember well the day that I turned 11 weeks with my last pregnancy, our second son.

It was the weekend of Easter. My husband and I attended the vigil mass at the Cathedral Basilica in Saint Louis, Missouri, where we were confirmed in the Catholic Church and received the body and blood of Jesus for the very first time. It was amazing.

I hadn't been feeling well, as might be expected during that first trimester. My husband's parents and my father came into town for our confirmation, so we were hosting house guests. We stayed up late on the night of the vigil partying (and by late, I mean really late: our confirmation sponsors hosted a party for us at their house and it lasted until almost 3:00 in the morning). On Sunday, for dinner, I cooked three legs of lamb and we hosted a small army of very dear, Christian neighbors to dinner at our house (30+ people).

After dinner, most of our guests had cleared out. It was about 8:00 p.m. I was expected at work the next morning, which was Monday. The house was a mess. Under any ordinary circumstances, even apart from pregnancy, I probably would have said, "I'm too tired to clean up right now. It can wait until the morning, or Wednesday morning, or my husband will do it. Eventually."

However, on that Easter night, much to the surprise of everyone left in the room (including myself), I got up from the table, without so much as a groan or a moan or an achy sigh...and started to clean. Sweep, put tables and furniture back in order, pick up trash, and wash dishes. For the first time in a while, I actually felt like my old, non-pregnant self! I will always smile when I remember The Night I Felt Like Cleaning Up. It was a relief to know that the old woman (something of the good part, anyway), was still under there, despite the huge physical and spiritual changes happening in our lives.

The 11th week of this pregnancy, however, began much less pleasantly. I have decidedly NOT made peace with my fatigued state, and my grumbling is increasing in pitch. I apparently have not truly learned the sheep and goat lesson from last week.

It began for me on the Friday after Thanksgiving. Unlike the previous day, I was barely able to choke down half an avocado at breakfast and a protein shake at lunch. Fortunately, shrimp fried rice for dinner was tolerable.

Also notable was that throughout the week, my insulin needs changed. I had a few post-dinner blood sugar spikes (the same ones that I needed 5 units to cover during the very earliest weeks of this pregnancy). My 2-hour post-dinner was a little on the low side, but after a modest something to raise it, they were continuing to go up dramatically towards bedtime. So for the time being, if I notice the BG seems artificially high before bed, I give a slightly-larger-than-average correction bolus and set an alarm to check during the night.

Previously, my BGs had been trending low upon waking. I forgot to tell you all that some time last week, I lowered the rate to 1.00 because I was tired of waking up at 50. Well, suddenly, I'm waking up at 120-130, so it's time for the pre-dawn basal rate to come back up. I raised it back to 1.20, will keep my eye on it over the next few days, and may need to raise it further, especially if my post-breakfast BGs are still up.

And finally, because my post-breakfast BGs were up even after a day or two on the elevated morning basal rate, I also raised my breakfast bolus ratio from 1:12 to 1:10. I raised my lunch bolus ratio from 1:10 to 1:9. Dinner bolus ratio is still 1:12.

I also raised my non-morning basal rates from 0.60 to 0.75.

I talked to Jenn this week and she and I commiserated about how the late first trimester blood sugar changes are difficult to manage. I noted that my eating tends to be undisciplined when my blood sugars are constantly trending low, and she noted the ping-pong effect of constantly bouncing between 50 and 220. Her doctor is keeping her targets a little higher, and I decided that I would try getting my eating under control to see if I could bridge the gap. One notable way for me to do this would be to eat modestly (a half a glass instead of a full glass of juice, for example) in the event of a low blood sugar, rather than over-shooting to correct the low. I think I've mentioned that before.

On Monday, I realized that I have lately been spending an inordinate amount of time lying on the couch AND thinking about meat. I also noticed that some of my cravings, like ground beef, share a common feature: Iron! So I said to myself, "Self, you have been pregnant or nursing continuously for more than 3 years. Despite your ordinary prenatal vitamin, it is entirely possible that you are iron-deficient. Besides, despite the fact that your recent blood levels were normal, you weren't pregnant then and I don't even know if your endocrinologist would even run a test on your iron levels. You are way more tired this pregnancy than you were either of the last two. So, let's eat some meat - and a lot of it." I had a bowl of beef stew AND a hamburger for lunch and boy, was that good.

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