Friday, December 23, 2011

Week 12: Ctrl-Z

After all that I said last week about the big changes I needed to my insulin levels last week, I basically undid a whole bunch of it. I started waking up in the 40s and 50s again, so I took my pre-dawn basal rates down to normal overnight levels (0.65). I'm back to 1:10 for breakfast, although I am toying with giving an extra 2-3 units at breakfast to keep my 2-hour postprandial down. I'm back at 1:10 for lunch. I've actually lowered my afternoon basal rate to 0.60, and dinner is still at 1:12. Unfortunately, things are still a little weird, particularly in the morning, and I have a feeling that they are partly so because I've been trying to compensate for anticipated highs by giving manual boluses on the side.

Breathe, Beth. Blood sugars are important, but it's not going to kill anyone if you have a few 2-hour postprandials above 150.
In fact, it's significantly more likely that it WILL kill someone if you can't keep your blood sugar above 50. P.S. Try to stop eating cookies in between meals. I know the cookies you made to celebrate your son's patron saint's feast day are delicious, but it's seriously not helping.

I went to see my endocrinologist again this week. He was mad that I didn't call him sooner (today was the first news he had of the pregnancy). I told him that things were under control. He seriously doesn't believe they possibly can be without his meddling. He wants me to come in every month, which I gave him grief about. He gave me grief about the fact that he's "trying to take care of my baby." I wanted to smack him and tell him that no one - NO ONE - cares more about the health of this baby than I do. In my calculation, the marginal benefit to my health and the health of the baby derived from coming in to see him every month compared to the marginal benefit of me not having to stress about a babysitter, the risk of "discovering a problem" that isn't really there, AND my insurance company having to pay hundreds of unnecessary dollars for care that I don't really need...well, the marginal benefit actually favors fewer visits. If I can't find a babysitter for any given day, I just won't come, and I am not re-scheduling.

By the way, I am aware that it sounds like my endocrinologist and I are old friends and/or an old, unhappy married couple. He was my endocrinologist when I was first diagnosed with Type I diabetes, and I was actually an unusual case in his office (he isn't in the business of treating children). He lived in our neighborhood, and my mom knew him because she worked as an ER physician at the hospital just down the street. We all went to the same pool together in the summer. I moved away for college and then to St. Louis with my husband, but we're back now, so he's stuck with me again. Based on my last two visits, he has come to expect that when he gives me grief, I give it right back. I am now of the opinion that it's not entirely unhealthy, but also not without tension...

My A1C was up just a bit, from 6.0 to 6.2. Of course I'm worried about it, but of course I know that I'm doing the best I can and I really and truly don't believe that my endocrinologist will magically make these numbers improve. I've done this for two pregnancies already, and if I got it down to 6.0 by myself once (and below), I don't need a doctor to do it for me the second time. Contrary to what he believes about his own interference.

Also, I've gained about 3 pounds, which I consider a small victory. Victory because it's only 3 pounds, small because who wouldn't love to emerge from their first trimester saying they hadn't gained any weight? I'm pretty sure I had gained about 7 pounds by the end of the first trimester during my first two pregnancies.

I also got a call from Medtronic this week, and they told me it was time for a pump upgrade. What they really mean is that my pump's warranty is expiring, and insurance companies will now pay for a pump upgrade. I'm obviously skeptical about spending more money (even my insurance company's money) if it's not necessary, but what sold me on it is that I will be able to adjust carb ratios by decimal point! That makes a huge difference at the end of pregnancy. Being able to adjust from 1:4 down to 1:3.7 instead of jumping all the way down to 1:3 will be great. Also, I am upgrading to the model that holds larger reservoirs, so I won't have to change out my site every day. I used to be able to get away with replacing the reservoirs without changing out the infusion set, but ever since Medtronic had their infusion set recall two years ago, the site always gets blocked up when I try to do that.

Also in pump news, I tried again today to insert my new infusion set into my belly rather than my backside, just to see if it would work. It kinked, so I am really just not going to be able to use my belly until the baby is a little bigger and the skin is not so flabby.

The last event of the week was a visit to the OB who delivered my second son. This may be one of the first doctor's appointments I won't be griping to you about in months! It was a treat to see him. He looked at the blood work done before I conceived (mid-September) and said, "ordinarily, I would expect a young, healthy woman to have good numbers, but I always look them over just to be sure. You know what? Your numbers are extraordinary. Look [pointing to my hemoglobin value]. You have more blood than I do!" That was a good feeling. He also did a Doppler to check for baby's heartbeat and gave me a glowing smile when we both heard the sound.

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