The bi-weekly diabetes process

I post a little update every time I blog about what's going on with my diabetes, but I have never actually posted what the 'medical' side of it looks like... I'm sure everyone knows I have more doctors appts than the average pregnancy, but what actually goes on with the diabetes side? SO - why not post about that?

 

I have appts with the 'diabetes in pregnancy' clinic at the hospital where I'll be delivering every two weeks. I've been seeing them since early 2011, when Jamie and I started seriously talking about having a baby in the future. There is a lot of preparation that goes into a diabetic pregnancy and my endo thought it was best to start the process early so I would know what to expect and make sure my health was where it should be before I got pregnant. Granted, we put off TTC so many times and it took a little while, I didn't actually end up getting pregnant until November of 2012 - when I hadn't been to the clinic in about 6 months. My A1C (or average over the past 3 months) was at 6.1 though, so things were still looking pretty good! Anyways, here's my routine!

 

I try to keep myself fairly organized by recording my blood sugars every few days in my small little logbook. I used to be awesome at recording ALL the time (actually recorded everything from 2009-2011 as it was happening) but now I'm pretty bad with writing stuff down as it happens. I like to keep it as current as possible though, because it helps me notice trends quickly. Step one - make sure I have everything written down in this logbook.

Don't mind the bloodstains, haha.

Once my logbook is up to date, I transfer all of those numbers onto these wonderful charts (from the 80's) that I need to complete for the diabetes nurse. They are these giant pieces of paper that need to be folded over a bunch of times to fit in a binder, and they use terms like PC and AC (I think that's right) for before and after meals instead of just 'before breakfast' or 'after breakfast'. The charts don't really allow for enough readings, so I need to improvise and put in extra numbers where you're 'supposed' to put carbs/ insulin etc. I have never written down my carbs or insulin on these forms though, oh well. They have a spot at the bottom for averages, and I think that's the main point of the entire thing - it works for me. It would be easiest if I did these weekly, but of course I don't even pull out my binder until about 10PM the night before an appt.

Lots of writing!!!

Once the written part is all done and complete, I have to download everything from my pump and meter to bring with me. I think that they can download my pump at the appts, but they use the old Animas EZ something or other (which was awful) where I use the new and greatly improved website www.diasend.com. It used to literally be a 45 minute ordeal to download my pump, because the program would freeze constantly and the dongle would never work properly, but now it actually works pretty well. It's still a little time consuming, and the dongle can be very finicky - you need to hold it a certain way in order for it to download from the pump without losing the connection, but it is a HUGE improvement from before. You need to suspend (stop delivery) on the pump too, and one time I forgot to turn back on the pump for about 1.5 hours, which led to a little bit of a high afterwards, not too fun. But that was just me being stupid. Don't mind my (successful) thigh infusion site in these pics! I'm now running on my third thigh set in a row - so far so good!!

 

 

Here's what the diasend site looks like as it's downloading - along with a pic of my computer background of cute little Holly before she got hairy and fat. She is long overdue for a full strip! Next week, that's my plan. :)

Cutie patootie!

Okay, so once I have everything downloaded, I usually spend some time going over all of the results. Diasend is awesome because it can give you SO MUCH information! I am a big information person, and like to have all the numbers and stats organized in different ways and review them all. Over time, I've learned which specific reports are relevant to me (because they aren't ALL relevant of course). I am now primarily using the report in the photo below, which I love because it ALMOST looks like I have a CGMS (continuous glucose monitoring system) with how often I test my blood now. It is really great to see where I have highs or lows, and how it relates to how much insulin I am taking at the time. A couple weeks ago I noticed high numbers almost every day at a certain time, and also noticed that my insulin was decreased around that same time. It was pretty easily fixed with a correction to my basal rates! Of course it still isn't perfect, and I don't expect it to be. But I'm glad that I can at least have stats to try to help me through it all.

 

Then.... It all gets printed off. I print my pump settings, a form with all sorts of averages and whatnots, and two separate forms that show what my blood actually looked like over the past week or two. Lots of paper, haha. My file at the clinic is HUGE because they put all of these in there every time I see them. I would probably just throw them out after a few appts, but they have them alllll stored in there.

By now it's usually well after midnight (I get distracted easily so this whole process takes FOREVER) so it's off to bed. Jamie used to help by doing all of my averages, but now that I have much more free time than him, I've relieved him from that duty. At my actual appts, it always starts off with a weigh-in and then a urine test to check for protein, ketones and glucose. I've had traces of protein a couple times, and 2 weeks ago I was apparently spilling glucose into my urine, but apparently it's not a big deal and just 'happens' sometimes. Never had ketones so far, so I'm happy with that. I also test for ketones at home if I have a high that won't budge for a couple of hours. I suck at what it all actually means now, but I'm pretty sure ketones are when your body can't handle the amount of glucose in your blood and starts burning fat and other important things. I can't remember exactly though, and too lazy to google. I just know that they're bad news bears.

I meet with the nurse first, and she writes down all of my averages/ basal rates/ total daily doses, etc into my chart. We talk about where I'm having issues, and what kind of things I want to talk to the endo about. She also checks my blood pressure, which has actually been GREAT through pregnancy. I sometimes have higher blood pressure during Doctor's appts (which is pretty common), but lately it's been awesome. Hoping it stays that way. After the nurse I get shuffled back into the waiting room until it's my turn to see the dietitian. The dietitian part is usually pretty short now. It was longer before when I couldn't keep anything down, but now it's mostly just 'are you eating well?' 'yep' and again we talk about where there are some highs or lows and if it's related more to basal rates, correction factors or crappy carb counting. Because I'm on insulin (instead of just a diet based plan like with gestational diabetes) there isn't really too much to discuss as far as what I 'can' or 'can't' eat. Shuffled back into the waiting room.... Until it's time to meet with the endocrinologist (diabetes doctor). There are three (well now two, because one is on maternity leave) endos in the clinic and they all trade off weeks. Now that I'm further along, we measure my fundal height and go over mostly the forms I printed from diasend. Working together, we adjust the basal rates (how much insulin I take per hour), ISF (insulin-sensitivity factors ie: how much insulin is needed to correct a high blood sugar) and my I:C ratios (insulin to carb ratios, which is how many grams of carb it takes per unit of insulin). This is for sure the most important part of the appt, and I usually leave with a new set of things to try. Granted - it's a moving target. What worked at 23 weeks doesn't work at 24 weeks because I suddenly have more insulin resistance or whatever. It's frustrating, but all I can do is try my best and be diligent about it.

Lastly - the most important part.... Dashing out to the parking lot because my appt ran over a couple minutes and hoping I didn't get a parking ticket!!!! The appt's usually run just under an hour, so I only buy one hour of parking. The next option is a full extra hour, which just seems like a waste. I should buy impark stock, those a-holes take a lot of my money!!! I've been good at not getting tickets, but it is unbelievable how much it costs to park at the hospital. It's not like I'm parking there to go to a concert or transfer to transit or something, crazy!! Also, you have no way of knowing if your appt that is normally 50 minutes will run over for some reason.

So... That's my diabetes routine! Of course every day consists of testing 12-15 times a day, and constantly adjusting/ calculating as I go. It's a big job to be diabetic in general, and even more while pregnant! But it will ALL be worth it in the end. :)

Feeling positive

Flowers from our lilac tree

I am officially at 25 weeks, 4 days pregnant! Things are still going pretty well, but carrying these little guys is still pretty hard on the body. I wouldn't change it though, and love having them in there. This will likely be my only pregnancy (because Jamie and I only want two kids... at least right now) so I'm trying to just enjoy it as much as I can! Let's see, what's new and exciting? Well, SPRING is officially here in the lower mainland! Jamie and I put out the patio furniture this weekend, and had dinner out in the backyard on Saturday night, which was great. The dogs loved that we shared, of course. It's been sooo warm, so I've been wearing lots of skirts and shorts, and loving the sunshine! I need to buy more summery pregnant clothes, I am not prepared. I feel kind of stupid buying like 8 pairs of maternity jeans off of Craigslist, but I'm sure we still have lots of cold days left - spring always likes to leave right when we think it's actually here to stay. The babies have been pretty active, and I love seeing my stomach move so much! It's distracting though, I try to watch TV and usually just sit with my shirt up over my stomach watching the babies dance around in there. Jamie has hockey a couple times a week out in Richmond, so I've started swimming while he is there, because there is a pool right next to the hockey arena! I take it veryyyyy easy, and just slowly slowly kick with my legs while keeping my upper body afloat with a couple of those 'kick board' things. I get a lot of Braxton Hicks contractions if I go too hard, so I don't leave the slow lane, haha. It's really helping my back though, my upper body is completely supported and afloat so I can relax my shoulders and it's great.

Diabetes.... has been pretty awesome! Knock on wood. I have accepted that my insulin to carb ratios are not what they used to be, and am no longer afraid to give myself more insulin. (I'm always a chicken with trying out new pump settings). I am getting into a routine where it's more 'proactive' rather than 'reactive' and that's helping a lot. Don't get me wrong - there are still times where it's stupid and doesn't work properly, but that is usually due to crappy carb counting on my part. Tonight was one of those nights, but my blood came down within an hour or so (from a not too high level) and I'm happy with that. I'm starting to run low in the middle of the night, but don't want to cut my basals. I'd rather wake up at 4AM and have a juice box (because I'm up to pee anyways!!) instead of possibly running high all night long. There is no worse feeling than waking up with a high blood sugar, knowing that it was there all night. I've asked a lot of questions about complications from diabetes to the Doctor I am seeing every few weeks, and everything seems to be okay. There can be a whole bevy of problems if you get pregnant without having a handle on your diabetes, but none of those signs are showing up in everything they've seen so far. The boys have little hearts with all the proper chambers and flow (and they are always so kind to keep their arms wide open during ultrasounds to show off their hearts... Although they do the same with their legs, LOL) At this point, we can start to see problems if the babies are getting 'fat' essentially. They always measure them to percentiles, and we're watching to make sure that their skulls aren't suddenly in the 40th percentile, while their stomachs jumped to the 90th percentile. So far so good, and I'm just hoping and hoping things stay that way. I know there still can be complications, especially with them being twins - and the potential of them being preemies, but all I can do is the best I can and hope it all works out. I'm trying to get an ultrasound report from a little over a week ago, because I hate not knowing anything. Hopefully I'll get that one tomorrow and I can do my usual over-obsessive research on how the results look, haha. Good ol' Dr. Google!

Ooh! And after a terrible experience with a thigh site a little over a week ago, which I accidentally ripped out only a few hours after placement, I had a great experience the past couple of days. I think it's been helpful because I've been wearing 'baggier' clothing, and chanting to myself 'infusion site, infusion site' every time I walk into the bathroom (Thigh sites get ripped out while pulling down your pants to pee, sorry for the TMI) I put in a new one this afternoon, and hoping it goes as well as before. I can't use my stomach anymore, and my hips have just been getting a little bit beat up. I find sites look a little bit worse after pulling them out, which is maybe from the increased amount of insulin running through them in a day? Either way, I'm excited to have a new spot, and the absorption seems to be pretty good too! YAY.

Roxie, the boys and I enjoying the sunshine!

Okay, survey time :)

How far along? 25 weeks, 4 days
Total weight gain: I haven't weighed myself in a day or so, but I'm up about 13-14 lbs now.
Maternity Clothes? Mostly, yep! I tried out a skirt Jamie bought me a few years ago (non maternity obviously) and it fit pretty good. I can fit most of my old shorts etc under my belly, although I am really planning on getting a couple more summery maternity shorts/skirts. Shirts are a different story for the most part. Normal T-shirts are no good (except for a mens large) but some of my empire waist tank tops from Abercrombie are working pretty well for me! I would say I'm wearing mostly maternity clothes though for sure.
Stretch Marks? Fingers crossed, still okay. I have a red mark on my belly button, but I think it's scarring from my bellybutton ring, boo. Other than that, they seem to be staying away... I'm not sure for how long though, I don't see how much more my skin can really stretch!!
Sleep: Meh, not great again. The body pillow is helping, but I'm finding that my hips are really hurting in the morning. So I tend to shift to lying on top of the body pillow somewhere in the middle of the night, which is uncomfortable in its own way. Of course, I also have a second 'pillow' which is Holly! She has started sleeping in between Jamie and I (usually on a part of my body pillow) and she takes up a decent amount of room. She also likes to sleep right next to my head, and she smells like white cheddar popcorn for some reason, LOL. I love the cuddles though, so I don't kick her out. She keeps my spot warm while I pee every few hours too, what a nice girl.
Miss anything?  Same as before - no back pain, rib pain and I would LOVE a drink. I saw the chiropractor a couple times, but haven't decided if it was making a difference so I haven't gone back. My regular days are okay, as long as I'm not stuck in a doctors office chair, because it's sitting that kills me. Other than that, I spend a lot of time either on my feet, or lying down which really helps. I've started actually tightening a belt around my ribs when they're sore, and that's been a lifesaver, haha. And booze... I miss booze. I was out this weekend buying some for Jamie and got some dirty looks at the liquor store, sheesh!!
Movement:  Yep! Every week I think 'wow, they move so much more than last week' and it's still continuing. I'm sad for when they run out of room and can't move as much - my OB thinks that'll happen around 30-32 weeks.
Food cravings: I love food! I got my Costco pizza last week (which was amazing, and I bolused PERFECTLY for) and now I'm on a big white cheddar popcorn fix (maybe why I think that's what Holly smells like in the middle of the night?), along with apples and peanut butter, and raspberry/blueberry mixes. I'm spending a fortune on fresh berries, but it's sooo worth it. But yeah, food is great. Jamie also made us hamburgers last week, yum! I love BBQ season.
Anything making you queasy or sick? Nope.
Best moment this week: Ahhhhh, success with my thigh infusion set!
Labour signs:  Just BH contractions if I do too much, my stomach tightens up really easily now, and it doesn't take much. I have another ultrasound on Thursday and hoping everything is still looking good in there and no symptoms that they're moving down too much or anything.
Symptoms: Still issues with my back, and I had my first bout of heartburn today - ouch!! Oh, and it's a mission in order to get off of the couch now, haha.
Bellybutton in or out? Flat, and starting to pop at the top!
Wedding rings on or off? Still on! They're a TINY bit tighter than before, but they were usually pretty loose. I think it has something to do with the hot weather too.
Happy or moody most of the time? Happy! Although I know I've had many 'moments' in the past week or so - Jamie would know that. According to me right now, I think I've been in a lovely mood 100% of the time :)
Looking forward to: Seeing the high risk Doctor on Thursday for another ultrasound. My Mother-in-law is coming along and I can't wait for her to see her Grandbabies in 'person'.... well, kind of! Hoping Jamie is able to make it too.

Comparison Pic!