So on Wednesday, I was frustrated by all the rules that I've been given by my OBs and endocrinologists over the years to (apparently) have a successful and healthy pregnancy. I've given a bit more thought to this question over the last few days, as I'm not one to simply reject rules just because I'm struggling to implement them.
Last night, I thought I was frustrated because my children were running into the kitchen, not cleaning up the house like they'd been asked and like we do at the end of everyday, and occasionally throwing things in my vicinity while I was trying to heat something up on the stove. (You know, like most days). But what shocked me was when my husband came into the kitchen, asked me what he could do to help get dinner prepared, and I simply exploded:
"I just can't do it all! I can't get my postprandials below 130, hit a fasting 60-90 target, walk for 30 minutes every day, and keep my weight gain between 25 and 35 pounds. She just needs to pick two! I can't do all of them!"
It turns out that having stuff thrown at me while I'm trying to sear meat at a high heat in a pan on the stove top bothers me much less than it used to.
So anyway, after identifying the real source of the stress in my life these days, I realized something. The problem with these rules is the complicated relationships between them.
For example, following walks, I tend to get unpredictable lows that last for long periods of the day. I can at least guess that they will probably last for a little while after the walk, but I don't know ahead of time exactly how long they will last, nor do I know how deep they will go. Setting a temporary basal, under these conditions, is total guesswork that's usually wrong. That means the most reliable solution is to keep eating small amounts all day long to keep my blood sugar up. But in that case, I'm just making up for calories burned by consuming those same calories at a later time in the day. If these walks are for the sake of my weight gain, it's a total fail. And it's occasionally setting me at low blood sugar levels that are rather debilitating for hours at a time.
Following walks, I also get unpredictable spikes in my blood sugar. They sometimes happen at lunch, sometimes happen at dinner, and sometimes happen at night. If the spike happens over night, then my fasting blood sugar will be off in the morning. If the spike happens between meal times, I have a hard time remembering what was a meal spike and what was a random glycolysis spike between meals when I look back over my graphs. And if I'm hanging out at a low blood sugar level for hours, and then I finally get sick of it and eat just a little more than the tiny bit that I normally eat to correct, then I can't tell if it's a meal spike, a random glycolysis spike between meals, or a rebound/low blood sugar correction error.
The final kicker is that none of these things happen in anything like what we can call a regular pattern. Believe me. I've been watching for it. Have I had three days these last two weeks in which a consistent pattern has emerged? No. Several different patterns have emerged (spikes between lunch and dinner, spikes after dinner, spikes at 1am, spikes at 4a, lows at 4a, lows at 1a, lows before dinner), but nothing that I can reliably change my insulin rates to accommodate. Because I just can't make a pattern to accommodate both lows and spikes at 1a, both lows and spikes before dinner.
Whether these walks my OB has prescribed are meant to control for weight gain or blood sugars, it's accomplishing neither.
I should probably be reassured by the fact that there is absolutely nothing wrong with me or this baby except that I am so absurdly anxious about these rules. And I've also had four healthy babies already. I still spend a good 12-18 out of 24 hours at or below fasting level, between the time spent with low blood sugars and those times when the spikes are not happening. The highs are never above 230 mg/dL, rarely above 200. I can only hope my A1C is staying where it's supposed to be. But the principle remains: the rules, as they've been communicated to me, are simply not working. They're stressing me out, and they don't work in concert with one another. Maybe it's more nuance that I need. How many postprandials below 130 mg/dL are expected in a week? What's an acceptable range of error? Once per day? Three times per week? How many mornings during a two week period do I have to wake up between 60 and 90 mg/dL to affirmatively answer the question, "are your fasting blood sugars between 60 and 90 mg/dL?" Is 10 out of 14 enough? Why are the doctors still wondering whether I'm handling this properly? And why am I still second-guessing the judgments that have gotten me successfully through four other pregnancies?