Sunday, May 29, 2016

Week 9: Finally Back in the Rhythm(ish)

I thought I'd done pretty well following my last pregnancy - postpartum, that is - in keeping tight control of my blood sugar. For me, this includes eating fewer carbs; eating less, period; skipping snacks or eating low-carb ones; eating much smaller amounts and waiting for my blood sugar to rise rather than eating a lot and subsequently spiking high. In the past, it's also involved scheduled nighttime alarms to check my blood sugar and more frequent finger sticks during the day. Now that I have a CGM it just requires continual attention to the receiver. As I mentioned, I thought I'd done pretty well sticking to the pregnant routine even in a non-pregnant state following my last baby's birth.

But the beginning of this pregnancy had me feeling like I hadn't retained ANY of my good pregnancy habits after my son's birth! I'm not sure whether it was little, minor deviations that pulled me far afield of the tight control I had during pregnancy, or whether it was just that I'd forgotten the feelings of pregnancy that make me hungry, tired, and feeling weak. During the first few weeks of this pregnancy, I really struggled to get back into those good blood sugar habits. My A1C was a bit higher at the beginning of this pregnancy (6.9). I think it's only this week I've had some success.

I suppose there's a temptation to resent the limitations and all the things I can't eat or can't do or can't enjoy, but somehow it doesn't feel that way. I feel a twinge of sadness every now and then that I can't enjoy a good meal with my husband or my friends in the same way, but the feeling doesn't threaten to overwhelm. It feels like, I think, what it is: a short period in my life that will eventually come to an end. Maybe it's also a function of my age: I've tasted enough of pretty much all the good foods there are to eat that I know I'm not missing out on the best of life by going without. And in view of what I'm trying to do here - that is, to create a healthy environment inside me for a little one - it just seems right to do it.

So it's not going without that leaves me bereft. The hardest part of this is learning the best way to tolerate the lows. Doctors want to avoid them altogether; I like that idea. Doctors also want to avoid highs altogether; I also like that idea. Enter diabetes reality, and there just needs to be a strategy for managing the lows that will inevitably come. So before pregnancy, I would eat a generous portion of whatever I wanted and then just give insulin if a high followed my quickly-treated low. But now, I have to take it slow to bring my blood sugar up, because my blood sugar has played ping-pong enough times for me to know that it's not a game I want to play anymore. So every time I see my blood sugar floating underneath that red line on my CGM receiver screen for more than 30 minutes, I begin seeing a stern doctor's face suggesting to me that my lows are too frequent and too long and she wants to make all kinds of dramatic changes to bolus ratios and basal rates that I have carefully adjusted based on close observations of my day-to-day life. But I've observed that bringing my blood sugar up during some pregnancy lows can take an hour or more. This slow rise keeps me from ping-ponging, but it freaks my doctors the heck out. In reality, though, I spend about equal amounts of time below the red line (that is, below 75 mg/dL) and above the yellow line (that is, above 150 mg/dL). (Thank you, Dexcom Clarity reports!) So how low is too low and how long do you have to be there before you worry? And which is worse, too high or too low? I don't know. Every day I fret myself into another forehead wrinkle with the wondering.

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