Friday, December 30, 2011

Week 13: Post-Breakfast Spike

I have very little to say about this last week.

My blood sugars are fine, although post-breakfast spikes have been somewhat unpredictable. One day, I gave an extra unit or unit and a half, and I was still high 2 hours post-breakfast. Another time, I was at 33 a mere hour and a half later.

I'm trying to eat fewer carbs in the morning, and my mother suggested that my cortisol levels may rise more on days when I haven't slept enough.

I feel a little sick in the late morning and a little sick in the evening still, and quite tired all the time. One night, though, I managed 9 hours of sleep. It was incredible! I hope to repeat it many, many times.

Sunday, December 25, 2011

For Unto Us A Child Is Born

Merry Christmas to all, wherever you are!

When my husband and I were preparing for our confirmation in the Catholic Church (Easter 2010), I was just learning how to pray the rosary. I made praying the rosary daily my Lenten sacrifice, and I have done my best to continue that practice ever since. In addition to preparation for our spiritual conversion, I had also just barely found out I was pregnant, somewhat unexpectedly, and only 9 months after our first son was born. I was overwhelmed.

Meditating on the Joyful Mysteries of the Rosary gave me more consolation than I can tell you:

I pondered the 7-months pregnant, elderly Elizabeth greeting her teenaged cousin Mary with such joy and tenderness as befitted the king and queen who came to visit. After an extended life of infertility, she was only carrying the greatest prophet (John the Baptist) in her womb, who was unfit to remove the sandals of the babe in Mary's womb, and her husband had been struck mute. But she bore no envy towards her cousin. And if I know anything about the end of pregnancy, she probably felt a hundred other reasons to grumble. But there was still no bitterness in her greeting. I asked her to be my patron saint for our confirmation, to seek God's grace for me to bear the physical and psychological pain of the pregnancy I had just begun.

I imagined Mary and Joseph's poverty of spirit, as well as the physical poverty of the entire Holy Family, at the moment when the God of the universe was born as an infant. At the moment when she might have suffered terribly, Mary loved God with her body and soul and was delivered from death. And she held the baby God. She reminds me that the weakness that doubles me over with pain and grief, offered to God with love and humility, returns to me in glory. I asked her to teach me the way of physical and spiritual poverty, as my husband and I prepared to leave the potential for a full-time salary behind and commit to 5 more years of school.

I wondered at Mary's presenting her son to God, dutifully returning to that Father what came from him but was also truly hers, her flesh and blood. I sought to give all that I have - even my very flesh and blood - to the God who gave His so willingly to me.

I remember these mysteries, and that precious season in my life, to such great effect during Advent, Christmas, Epiphany, and beyond. The season is rich in blessing for those who seek the Christ child. May he be born to us again today as we welcome him to our world!

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.

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.

Monday, December 19, 2011

Week 10: How are you doing?

When I think about answering the question, "how's it going?" these days, it makes my heart beat a little faster. Of course, my honest answer is that my life is difficult right now. "Are you excited about having another baby?" Well, I haven't actually felt good about much of anything except eggnog, snuggling on the couch with my children, and asking my husband to do favors for me for several weeks, so no, not really. But I do think that having a baby is a good thing, even if it costs me a lot of discomfort, if that's what you mean.

I probably worry about this more than I should. No one has flown off the handle at me. But here's what I worry that other people are thinking. The first is just a general discomfort with the suggestion that having a child is anything but a blessing. I can understand this one, particularly from people who don't have children, or from people who are particularly sensitive to our culture's complex relationship to childbearing. The other response, which is more likely to be accompanied by hostility, is a complete lack of sympathy. "You chose to have a baby, now you have to suffer the consequences. Don't ask the rest of us to listen to your griping." So, I'm trying to find the middle way between these two extremes, for the sake of my mental health.

Also, after I listened to this Gospel reading in mass on Sunday (Matthew 25:37-40): Then the righteous will answer him, saying, 'Lord, when did we see you hungry and feed you, or thirsty and give you drink? And when did we see you a stranger and welcome you, or naked and clothe you? And when did we see you sick or in prison and visit you?' And the King will answer them, 'Truly, I say to you, as you did it to one of the least of these my brothers, you did it to me.'

I finally understood the meaning of this verse (1 Timothy 2:15): Yet she will be saved through childbearing—if they continue in faith and love and holiness, with self-control.

If I had known - really known - what a sacrifice it would be to have children, I probably would not have chosen it. Fortunately for selfish people like me, in a Christian context, the cultural imperative for married persons to have children is so powerful that I could not help but surround myself with hungry ones who need food, thirsty ones who need drink, naked ones who need clothing, the least of Christ's brothers - in short, these, my baptized children. Jesus states very clearly that only those who fed, clothed, and visited him are to sit at his right hand in heaven, so I am certain that this path, childbearing, is my gift from him, and my way to salvation, if I continue in faith and love and holiness. So, no more griping...at least for the rest of the day.

The last of my news this week is that I felt the baby move! I know, it's super-early, but I promise, promise, promise it wasn't gas (which "Your Pregnancy: Week by Week," assures me that it is). Let me ask you this: does gas ever feel like someone is tapping you from the inside right where (and only where) your uterus is? The correct answer is no.

Friday, December 16, 2011

Week 9, again: Adventures in Pregnancy Dating

On Friday, November 11, I went to see the doctor again. It was a frustrating visit, for a few reasons. I felt horrible, first of all. Late morning is always the worst. I was also anxious because my mother-in-law said she dreamed we were having twins (!). I had no reason to believe I was pregnant with twins, since they don't run in our families, I'm still pretty young, and we didn't use any infertility treatments, but I was freaked out at the possibility of having to buy a new car on a (putting it mildly) modest graduate student income.

Then, I asked if they would do an abdominal ultrasound rather than an internal one. My doctor in St. Louis always did abdominals from 8 weeks on because, he told me, usually women complained that they were uncomfortable. Here, however, my request was neither considered nor heeded. The nurse said, "I don't think the doctor will do that...," and as far as I know, she never even mentioned it to her boss, because the doctor didn't address it when she came in the room. So much for patient advocacy. I let it slide, figuring it wasn't something I cared enough about to make a big stink about. The kicker was when she shoved the probe even further up to look at my ovaries, though, which she had no reason to do. And that part hurt the most! When I winced, she did not even look at me again while she moved the probe out of the way to (ostensibly) make it more bearable. Desired effect not achieved. It still hurt. When I asked her why she looked at the ovaries, she told me that she was looking for masses, and "for practice."

HOLD IT. First of all, you knew or should have known that a transvaginal ultrasound is uncomfortable. If you didn't, it's because you're not listening to your patients. I did, in fact, try to tell you that I don't like them, but apparently the nurse that works for you is too afraid of you to even pass on the message. Second, there was no indication whatsoever that my ovaries were causing me or anyone else problems. And finally, if I was content to be subjected to additional discomfort during my pregnancy for the sake of your education, I would have told you (or you could have paid me).

The last frustrating thing about the visit is that, instead of 10 weeks tomorrow, I am 9 weeks today (and no, I'm not going to try to blame that one on the doctor :). It just means I am about to do the worst week of pregnancy over again. Boo. That means my due date is June 15, about two weeks after my first son turns 3. In the end, I know that its more of a psychological wound than anything else, but it stings. Especially because I almost vomited at the zoo yesterday.

The doctor (who will no longer be my doctor as of my next prenatal visit) gave me a prescription for Zofran, but when I asked her about whether it seemed to make her patients feel better, she answered me with a statistic about rates of hyperemesis gravidarum being reduced after Zofran was made available to pregnant women. Totally not the answer to my question. I am not in any danger of inadequate food or liquid intake. I have not had ANY symptoms of dehydration. I just don't feel good. I haven't gained any weight, but I haven't lost any, either. I have really not shown any danger of becoming a statistical victim of hyperemesis, so why quote me statistics about how much Zofran helps said victims? I re-phrased the question slightly and asked again and she said, "Well, I have had some patients for whom it just never worked..." So, what it sounds like is that the only people you've ever heard back from told you that it didn't help. Do you even ask your patients whether the Zofran helped the next time you see them in the office? I picked up the prescription, but kicked myself for doing so after I looked at the cost. Only $20 to me, but another $80 to my insurance company. Not to mention - isn't it probably a good idea to avoid unnecessary medication, even when it's been proven "safe"? Because it seems like 40 years from now someone could come out with a huge meta-analysis saying that approving Zofran in pregnancy was a horrible idea.

Some of you may notice that I am drowning in contradiction here. I hate statistics, then I quote them. I want relief from discomfort, and then I reject pills. I don't even know what I want any more. I just don't want other people assuming they can quantify risks and benefits for me without my input, alright?

The rest of the week passed in mild nausea and fatigue and self-pity.

The upside is that my blood sugars have been fantastic - truly fantastic - for the last several weeks. I'm hanging out between 70 and 110, reliably, with only a few blood sugars here and there outside the range. I'm having some lows in the morning, and a few blood sugars just a tad high (150-200) after dinner. Not too shabby! My bolus ratios are 1:12 for breakfast and dinner, 1:10 for lunch. My basal rates are 0.5 over night, 1.15 from 4:30a to 7:00a, 0.6 during the day.


Just to prove that I'm not making this up.

Wednesday, December 14, 2011

Week 9: Food Cravings

When I was pregnant with my first son, I spent a lot of time being sick during week 9. I think it was the worst of all my sick weeks with him, so I am bracing for the worst this week and hoping we can manage somehow. My schedule has almost entirely cleared, since I haven't felt energetic enough to plan much of anything over the last few weeks.

Saturday, I forced myself to get out of the house with the boys so that my husband could work. Every time I've done that, I've kept myself from vomiting. Unfortunately, I still felt terrible when I got home. Fortunately, we went to a friend's house for dinner and she served a.maz.ing. enchiladas. This got me out of dinner prep AND into some delicious food. I stopped myself, but definitely could have eaten three.

On Sunday, I made white chicken chili and I've had the strangest recurring memory about a single bite of the chili with monterey jack cheese. On the one hand, I can't wait to put it in my mouth, and on the other hand, I have this very strong sensation that I will vomit it right back up again. Really, I've been re-living this experience all week. So weird.

Tuesday was a busy morning. I muscled my way through it, but it was not very pleasant. And I had a very powerful food craving for - of all things - eggnog. There it was, on the grocery store shelf, right next to the milk I was putting in my cart, and I thought to myself, "I have to have that." Sure enough, I had finished off the quart in less than 8 hours. Don't worry, it was low-fat (but so much for avoiding dairy).

Also, as I was preparing dinner, no joke: I ate about a half a pound of the ground beef I was preparing to put into my pasta dish. Right out of the frying pan. Fortunately, I had some frozen meatballs I could throw in instead. Sheesh. Eggnog and ground beef. What a strange combination.

Wednesday saw me lying around on the couch a whole lot. Random food craving of today was avocado and mixed frozen vegetables with butter (if only it were like that every day!). It was a beautiful day, so I forced myself to go outside with the boys after their naps.

Staying up late is morning sickness no-no for me. It seems like eight o'clock on and I'm done for the day. Looks like that 80s party I was invited to on Friday night will go on without me.

By the way, my blood sugars have been pretty reasonable this whole time. The eggnog made me go a little high, but nothing extreme. I am using a little less insulin for meals (1:11 or 1:12 bolus ratios) and my morning dawn phenomenon basal rates are pretty modest (for me) at 1.15 from 4:30 to 7:00a. I haven't been eating a lot, so that may explain why my blood sugars haven't been anything to blog about.

Monday, December 12, 2011

Week 8: Miscarriage Milestone

The OB that delivered my first son said that weeks 8 and 12 are big ones for the risk of miscarriage, because it drops at both of those weeks. So, this week, I celebrate the milestone of a reduced risk of miscarriage.

On the other hand, the first trimester is really, really lame:

Saturday, October 29: My brother and sister-in-law come over to celebrate my son's first birthday. It takes a lot of effort to avoid vomiting into the bowl of bratwurst, cabbage, and beer soup that I make for dinner. I also completely forgot to make or buy anything resembling a cake, or a birthday gift. Poor second child.

Sunday, October 30: Right before communion, I excuse myself from mass to run to the bathroom. I was rather surprised by it, but did actually hurl once I got there.

Monday, October 31: I think I might vomit when I get out of bed. I think I might vomit about an hour after breakfast. I definitely feel worse when my blood sugar is 40 (as it was when I woke up this morning, and about and hour and a half after breakfast), but not exclusively (because I felt sick when my blood sugar was at 164 before lunch, too). I lowered my early-morning basal rate once more, to 1.35 from 4:30a to 7:00a.

Another impact of this fatigue and gross feeling is that where I used to be able to hold the next four things that I was planning to do in my mind (two diaper changes, two coats on, go to the bathroom, go outside with the boys), now I can barely hold one (one diaper change. Hope second child doesn't get a rash?).

Tuesday, November 1: Running as a morning habit is long gone. I made it through mass with the boys, and even squeezed in a trip to the grocery store. Somehow, today is better than the others, and I go on a cooking rampage to use up the vegetables that will go bad and to prepare the meal I've promised to bring our priests on Thursday evening. Chili is always better leftover, right?

Wednesday, November 2: In pondering today's feast, All Souls' Day, I wonder if purgatory will feel like this, and I hope that if so, I don't spend much time there. I offer my pain to God as penance.

Thursday, November3: My 2-year-old must think mommy being pregnant is either the best thing in the world or the worst. Between-meal snacks ALWAYS involve tortilla chips (yay!), but I spend a lot of time lying on the couch trying to avoid eye contact.

Friday, November 4: Today was OK. Not great, but OK. Blood sugars have been fine this week. I think I've got my bolus ratios and basal rates down...for now, anyway. I'm having fewer high highs and fewer low lows, and while I worry that they are trending higher than average, I think that may just be me worrying.

Friday, December 9, 2011

The Week After That: Breaking the News

This week we broke the news to our families. I didn't want to do it while we were at the wedding in Florida, since I didn't want to distract from the bride's big event or from my sister-in-law's baby news. My husband wanted to wait until his conference was finished, to avoid casting a pall over his work, in case anyone responded badly to the news that I am pregnant for the third time in three years. Fortunately, our families are pretty great, and I think we've spent a lot of time grooming them for babies in rapid succession.

Saturday, October 22:
The morning starts out horribly when my birthday boy (second son, one year old) pulls out my insulin pump's catheter. Post-breakfast reading is 313. Ugh. After a correction bolus and 2 hours, my blood sugar is 419! I FREAKED out. My new site was kinked, too! This has happened at least 3 or 4 times in the last few weeks since I found out I'm pregnant, and I now think that belly sites are definitely not working. Maybe the skin and scar tissue are stretching, or the muscles are too loose, or something is making them kink up. I'll stick to the backside for now.

In the meantime, I decide that if my blood sugar is going to be excessively high, I might as well go for a run without any danger of dipping too low while I'm out. After a very sluggish run, in which I spend the entire time praying for protection for our child from the harm these high blood sugars may be causing to him (or her), I finally eat lunch at 2pm.

In other news, this is the day my cousin got married! I don't often hear people talk about the bearing and raising of children at secular weddings, but this one did. I was very pleased to hear the justice of the peace include remarks about the couple's preparation for children.

Sunday, October 23: At a brunch held in honor of the newlyweds, my 94-year-old grandmother tells me that I have too many children. My cousin thinks that may be because she can't tell which of the four toddlers at the party are mine. I'm not sure what to think, because my grandmother had four biological children and seven total after a second marriage! In any case, it was a little hurtful, but I think she means well. She had three children very close together, and her husband was often absent both emotionally and physically. She remembers it being very stressful.

Monday, October 24: Before we pack our things into the car to drive back to the airport, I am chatting with my grandmother. We will miss her dearly, and despite her general confusion, we and she know that we may not see her again before her soul departs her body for its eternal life. Once again, she confuses me with my sister-in-law, who is also newly pregnant. Since my husband and I are still trying to keep our news under wraps, this confusion has been unnerving.

"And you're having another."
(Silent gasp, and a moment's pause to figure out how I can avoid lying to someone who is already confused about how many great grandchildren she has.)
"Do you mean Hillary? Because she's pregnant now."
"Oh, is she?"
"Yes, she's due in May."
"Well, what about you?"
(Another silent gasp. But seriously, I'm not even sure why I need to bother hiding it from her. She won't remember in a few minutes.)
"Well...um...we are hoping to have more, but it probably won't be in May."

The travel day is uneventful, except for some pregnancy-related nausea and fatigue. The boys hold up like troopers. We all get to see daddy before the boys collapse into bed.

Tuesday, October 25: Wave after wave of pregnancy nausea and fatigue hit today. I don't know how much longer I'm going to be able to keep this a secret, particularly from my parents. So we decide to let the cat out of the bag and we tell my dad. We also call my husband's mom, and she is so excited. She is convinced it will be a girl, and unbeknownst to us, she's been stocking up on little girl clothes.

I also had a doctor's appointment this morning. I was disappointed for a few reasons, not the least of which is that when you go in before 8 weeks, they don't actually do anything. Not even a Doppler to hear the baby's heartbeat. They bill your insurance and tell you to come back when you're 8-10 weeks. For real, people, I could have saved my babysitting credits! Also, I think I will probably return to the doctor who delivered my second son. I know he'll want to induce me at 38 weeks, but he also knows I won't want it. If I'm going to have to put my foot down either way, it might as well be with someone I know.

Wednesday, October 26: So this (nausea and fatigue) is apparently just how it's going to be for a while longer. I remember this happened before...but not very well...and eventually it was over...but man, it sure saps the life out of you. I'm not sure what's going on metabolically, but I can't seem to keep my blood sugars up and there's a definite correlation between sickness and low blood sugar.

We call my sisters and brother today. They are all excited. My mom comes home and we break the news to her, too. Her lack of enthusiasm is conspicuous, and I can't tell if she is worried about me, worried about my kids, worried that life in her house will become even more unpleasant than it already is, or all three. I think it's safe to say she thinks it's unwise. She subtly implies that I have slyly timed the birth of our next child so that I can feed off the federal government (Medicaid) for assistance with my diabetes expenses while my insurance won't cover it. Ouch. (Mt 5:11-12).

Thursday, October 27: Seriously, forget everything I said about what I was going to do differently next time. There is no way I can avoid juice and dairy (no juice and no milk for low blood sugars? Impossible). Also, I'm not even sure I can avoid sweets like cookies, cake, candy, and so forth altogether. Because I can only drink so much milk and juice in a day before I vomit it back up. I need some low blood sugar alternatives, and a soft, chewy chocolate chip cookie works really, really well.

Friday, October 28: The Cardinals win the World Series in Game 7, baby! For those of you who don't know, Jenn and I met in St. Louis. Our husbands were in school together there for 3 years. Good times, and good memories of our time in a great baseball town.

Wednesday, December 7, 2011

The Next Week: Feeling Pregnant

I'm definitely feeling pregnant this week. A headache here, a little can't-keep-my-eyes-open there, and a little please-put-that-away-or-I-might-puke-on-you. I am terribly worried about my blood sugars, but as I recall, it wasn't much different the last two times I did this.

Saturday, October 15:
I was reminded today that I am pregnant because when I sat down my belly bubbled up over my waistband and into my crossed forearms. Also, I had a pump problem in the evening. I think my site was kinked. Putting the catheter in my belly may be a problem throughout pregnancy. I do remember it being an issue for a few months after the other two kids were born, and early on in pregnancy with my second son.

Sunday, October 16: As a result of the pump problem, my blood sugars ranged between 40 and 270 over night and into the morning, and didn't finally stabilize until after mass. I like to call this my diabetic hangover. You know, since I'm not allowed to drink alcohol now. It makes me feel cool...or something.

Monday, October 17: No news today. I'm glad I don't feel very sick, and even though I'm tired from getting up early in the morning to run, I resolve not to take a nap in the afternoon so I can actually sleep when night falls. I love collapsing exhausted into bed, and I love sleeping hard all night.

Tuesday, October 18: I eat my words about feeling sick and not napping during the day. Today I had a mild headache, bout of nausea, and extreme fatigue, and I felt like I couldn't stand up. I absolutely had to take a nap while the boys had theirs. We leave for the wedding tomorrow. I spent the rest of today packing and searching for outfits to hide my bulge.

Wednesday, October 19: Sure enough, I slept poorly last night, no doubt from my afternoon nap. Today is our travel day. Travel days are always hard on my blood sugar, particularly hard when I'm pregnant.

Thursday, October 20: Travel day wasn't too bad for my blood sugars, though I did feel more fatigued and more nauseated than usual. We have fun on the beach today.

Friday, October 21: I'm doing a pretty good job keeping the BGs under control. Feeling good about this. We have more fun on the beach today, and my boys' cousins show up (along with my sisters and brother and their spouses). The only thing that would make this vacation more fun is if my husband were here!

Monday, December 5, 2011

Week 1 (or 5, or 6, or something)

The next few posts will contain my reflections from the first few weeks of pregnancy, to catch you up on the first trimester. I don't know how long I'll keep this up, but I'm hoping I can pen a few reflections about my pregnancy each week, all throughout, focusing on how to manage my blood sugars and how to navigate the world of extra testing during pregnancy that Type I diabetics experience. I'll try to avoid telling you stuff you don't need to know or that everyone else on the internet has already commented on (like dealing with hot flashes and heartburn. Seriously, it's my third time, and I have no idea).

We had our positive pregnancy test on a Sunday night. Here's my very first week.

Monday, October 9, 12:30 AM: I am still not asleep, two hours after taking the test, and my blood sugar is in the middle of one of those mad spikes. Curses. Remind me next time to take the flippin' test in the morning. I give 5 units to cover it, taking a giant leap of faith and hoping that I don't wake up in a sweaty diabetic coma in the middle of the night.

Monday, October 10, 7:00 AM: Commence freak-out-every-time-my-blood-sugar-goes-over-170. Begin to notice that I have, indeed, been experiencing pregnancy symptoms. It probably wasn't my husband's bad driving that made me sick in the car on Saturday night. I probably had not simply eaten too much when half a bowl of butternut squash soup made me feel as though I might throw up in my mouth.

Tuesday, October 11: When I woke up in the middle of the night, my blood sugar was 88 (at 1:30a), but by the time I got out of bed at 5:30a (back on the bandwagon!), it was 206. I adjusted my morning basal rates earlier and higher.

Wednesday, October 12: I called some doctor's offices today, not sure I wanted to remain with the doctor who delivered my son last October and not sure they would still take Medicaid. As I learned, however, hardly anyone takes Medicaid these days, and even fewer will see high-risk patients like me. No one wants to take care of the sick AND the poor, I guess. That work is left for saints. I called at least 25 OB/GYN practices and only 4 accept Medicaid. We settled for a new practice and I have an appointment on October 25. The receptionist estimated that I will be 6 weeks on Saturday. And my news is out of the bag in this house, after I asked my dad to babysit the boys for a "doctor's appointment." Since I see doctors all the time, I didn't think he would ask, but...

Father: "So what doctor are you going to see on the 25th?"
Me: "Um, well, it's just, I have a...crap, dad. Don't ask that question."
Father: (awkward chuckle) "OK, question withdrawn."

I also reduced my bolus ratios today because I was having some lows 2 hours after meals. The higher morning basal rates worked (at least last night). As I dialed up an extra 5 units to cover my high blood sugar (269) before bed time tonight, which is way more than I would usually take to correct that number, I thought to myself how stupid it would be to ask someone else to manage my blood sugars for me during pregnancy. If my endocrinologist had been there, looking over my shoulder as I made that decision, he would have said, "You're crazy! You'll never wake up in the morning!"

Thursday, October 13: Fortunately, my endocrinologist would have been wrong. With five units before bed and a basal rate of 2.0 between 4:30a and 7:00a, I roused at 7:15a at a very comfortable 77. I am SO GOOD AT DIABETES.

Friday, October 14: My blood sugars have actually fallen to levels below normal. I'm not needing many (if any) 5-unit boluses for spikes. I gave one yesterday and one today in anticipation of spikes that never happened, and was stuck in a low rut for a few hours each time. My confidence from yesterday gives way to humility in the face of the ever-changing realities of diabetes during pregnancy.


The end of the first week finds me fully adapted to the idea that I am going to have another baby next June, that people may think I'm crazy, that I'm going to have to go through pregnancy again and pregnancy is hard. But the emotional upheaval is resolved...for now. At least until I remember (really, really remember) that I will have to go through labor again.

Friday, December 2, 2011

Running

During the first week of October, I made a resolution to get up early in the morning with my husband, at 5:30a, as a show of solidarity and maybe to squeeze in a run. After two days of the new schedule, I noticed my blood sugars were spiking at odd times, and way higher than I would expect. I assumed I was probably losing some weight on the new regimen, and I hoped that they would regulate once my weight stabilized.

By Sunday, I/we had fallen off the bandwagon big-time. Friday, Saturday, and Sunday involved zero running. But my blood sugars were still spiking at odd times. The spikes were happening right after breakfast, sometimes in the afternoon before dinner, and over night. I needed about 5 extra units to cover them.

On Sunday morning, I made note of the high blood sugars to my husband. "The only thing that makes this happen to me is pregnancy or weight loss." And then, refusing to consider the frightening alternative, "Maybe running is just bad for me..." After dinner, my husband stepped outside to say good-bye to some friends that came over. I decided to take a pregnancy test while he was outside.

Seriously, I have the worst timing ever.

Five minutes later, he came back in.

"The line is pretty faint. Are you sure?" "Yes."

We decided that I am probably only 5-6 weeks pregnant, based on our NFP charting, and came up with vague but truthful answers to awkward questions that I will no doubt face at my cousin's wedding in two weeks. ("Are you pregnant?" "Geez, I have been trying so hard to lose the weight!" And, if they ask, "No, seriously, are you pregnant?" "If I was and I wanted you to know, you would know.")

I am about 12 weeks along now, due in June. That means there will be about 20 months between these two, and if all goes well, I will have a barely-3-year-old, a 1-year-old, and a newborn. Lest you pass out on my behalf, please note that we have been living with my parents and they help with everything except carrying the unborn baby. I often feel like I am cheating on these early childhood years, because this would be a lot harder without them! And since there are not even 17 months between the first two, I have an inflated sense of personal heroism. Maybe it will help.

I always say my husband and I have never tried to have a baby. How it's possible to conceive three children without trying is something you may need your parents (or, if you live in our school district, your KINDERGARTEN TEACHER) to explain to you. So, although we have never actively tried to have a baby, we have gone through periods of not not trying. Those periods account for exactly three months of our marriage. Natural family planning does work. We used it to successfully delay childbearing for two full years. I am just always a little surprised at how well marital intimacy works for us. Having a baby is never a guarantee, even when you time it perfectly with ovulation, so I have to stay humble by reminding myself that fertility is a gift that God has always given to us very, very freely.

In all honesty, despite the "surprise" of it, I have never been more prepared to give everything I have for my baby, right from the beginning this time. I don't care if I need a c-section (though I hope not to have one) to do that (and that doesn't mean I trust my doctor to make the call without my input!). I wish I could rewind in time and give this gift, my whole self, to my first son, right from the moment of conception. I can't, but fortunately he has a spiritual mother, the Mother of God, who has been lavishing gifts and storing up treasures for him in heaven. I pray that he (and all of my children) will one day join her there, in perfect blessedness, where they will never lack any of the love they deserve.