Archive for the ‘Diabetes (General)’ Category

It Hurts

My oldest daughter (a.k.a. “The Kid”) is three.  She’s at the age where likes to ask questions, watch, help, and do by herself.  My diabetes is no exception.  She likes to help me change the reservoir in my pump – pressing the buttons for me when I tell her to.  She likes to get things for me when I need them.  She wants to know about my infusion sets.  She even wants to watch me insert those awful CGM sensors.

Sometimes when I do the sensors she asks me if it hurts.  I try to be honest with her, but not make a big deal out of it either.  So I usually tell her that sometimes it does hurt, and sometimes I don’t like it, but that if I close my eyes when press the button (on my Serter, that is), it makes me a little less scared.  She seems to accept that and usually watches without much comment.

Yesterday I was changing my infusion set.  I use the Sure-Ts with a needle much tinier than the sensors, and I don’t use a Serter for them, but she still made the connection.  She watched intently while I pulled the new one out of its protective packaging.  I prepped the site and held it in my hand ready to insert.

Suddenly The Kid’s hands fluttered up to her face and she held them in front of her pinched-shut eyes, but only briefly.  Then, seeming to change her mind, she opened her eyes and covered her ears instead.

“Honey?”  I said.  “What are you doing?”

She pulled her hands away to answer me.

“I don’t want to hear you say ‘Ow’.”

And with that, I think my heart cracked.

I was so proud of her empathetic little soul, but at the same time sad that my diabetes would cause her any sort of discomfort.

After assuring her that this needle didn’t hurt at all, she seemed much more content and quickly moved on to other more interesting things, but it left me questioning how much of this disease, and the hurt and frustration surrounding it, I really want to share with my girls.  Maybe in this case being honest with them isn’t in their best interests after all.

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This Sh** Just Got Scary

Something very scary happened to me the other night.  I was woken up by my baby to discover that my bloodsugar was 1.8 mmol/l (32 mg/dl)!

Oh, you thought that was the scary part?  Not so.  Just wait…

Lately I’ve been very tired, due to an unusually restless baby sleeping in a bed about two feet away from me and waking me multiple times every night.  (She was such a good night sleeper, but not lately.  I digress…)  So I’ve been wearing earplugs to sleep.  They let me hear her when she really needs me and tune her out when she doesn’t.  I’ve also been using my short stints of good sleep to sleep extremely soundly.

One drawback to the earplugs and the sound sleep is that I haven’t been noticing my CGM alarms.  My pump is set to vibrate for alarms, and I have it on the waistband of my pajamas up against my belly so I’ll feel it.  (NOT between my boobs!!)  Normally the vibration wakes me.  But lately, between my exhaustion and my earplugs, my husband has been waking me quite often to tell me I’m sleeping through my CGM alarm.

This hasn’t been ideal because it’s meant that my pump has tried to wake me with vibration, then with an alarm, then resorted to waking my husband, who then wakes me.  It gives my bloodsugar time to drop further before I notice a problem – and the CGM already has the (approximately) 15 min. delay, so timeliness leaves something to be desired.  In the past, I actually used to wake up to nypos quite easily, but this has changed with the aforementioned exhaustion.  All in all, timely bloodsugar-related wake-ups are sketchy at best these days.

So when my baby girl woke me up, I realized I was pretty darn low.  My CGM said 2.3 mmol/l  (41 mg/dl), and must have been alarming – which is probably what woke the baby. I wobbled, bleary-eyed, into the bathroom to test and could barely stand up.  When the 1.8 appeared on my meter, I cursed, inhaled seven dextrose tabs (3g carb each) summoned all my energy and dragged myself back to bed .  In a case of bad timing, the baby wanted to eat at this very moment (she’s breastfed).  So I lay in bed and fed her (thank goodness for the side-lying breastfeeding position!), while my husband kept a watchful eye on us.

By the time she was finished, my BG was going up at a reasonable pace (quite quickly, actually), but I tacked on a few crackers with peanut butter for good measure. (Am I the only one who craves peanut butter when I’m low?) It was another 10g of carbs at most.  I was pretty impressed with myself for managing a wicked nypo like that with only 30g of carbs, since I’m just as prone to face-feeding during a nypo as the next PWD.

By breakfast time, I was in the 8s (that’s about 150 mg/dl), which was too high, but really not too bad considering what had happened overnight.  I had my breakfast of high fibre oatmeal/flax/etc. and proceeded to feel hungover.  By mid-morning, though, I was a whopping 17.8 mmol/l (320 mg/dl) – WAY higher than I usually see.

It was at that point (or, rather, after my BG came down to a more reasonable level) that I decided to start logging again to figure out what the hell needed to change in my diabetes management to keep this from ever happening again.

I sat down at my spreadsheet template (because I’m a geek).

I entered in my bloodsugar readings from my meter memory.

I started to enter in my boluses from my pump’s bolus history.

That’s when I saw this:

What the…..??

Something important to know at this point is that I was 8.7 mmol/l (157 mg/dl) when I took this correction bolus during the night.

Something else important to know at this point is that my regular correction for an 8.7 mmol/l should have been about 1 unit.  I would only ever take 7.4 units of insulin at night if I were eating a second supper of about 40g-50g of carbs.

Something else important to know is that I don’t remember taking this bolus.  I do remember fiddling around with my pump – trying to take a smaller bolus or calibrate my sensor or something – but the details are fuzzy.  Thankfully I do have a recollection of doing something or I’d be likely to blame my new pump and would be very afraid to continue wearing it.  But I’m quite sure this was human error.  My error.

Yikes.

I’ve never, in all my 30 years of having diabetes, done something like that before.

Presumably my liver kicked in to bring my bloodsugar up, because I don’t know how 30g of carbs, plus a bowl of oatmeal (with breakfast bolus), would have brought my bloodsugar up to 17.8 otherwise.  So it’s good to know that something was working – since I couldn’t feel the low, feel the vibrating pump, hear the alarming pump, or even think clearly enough to bolus properly.

This mistake has me very freaked out.  Lows like that are so dangerous, and I can only imagine the speed at which I must have been dropping after that whopper of a bolus.  I don’t want to think about what could have happened if the baby didn’t wake me.  Do I owe my life to her already…?

The question is, how do I keep from repeating this mistake?  My pump’s Max Bolus had been set to 12 units, and since this mistake it has been changed to 6 units.  If I ever want a bigger bolus than that, I’ll do it in two parts.  Also, I no longer wear earplugs to sleep.  I’d rather have a restless sleep than continue to sleep through my CGM alarm.  And I’ll be wearing a CGM 24/7 for the foreseeable future – at least until I’m less exhausted and easier to wake.  (Funny how even an unusual breath from my baby can wake me, yet a beeping pump won’t.)

Beyond that, I’m not sure what to do.  Will I do it again…?  I’m crossing my fingers that this was both the first and last time, because that was just way too scary.

Wordless Wednesday: Rough Night

Unexplained highs…3 set changes…default to syringe…then low. Whee!

Wordless Wednesday: Where Test Strips Go to Die

Time to clean out the old meter case!

3 Years, 10 Weeks and 2 Days

Today my oldest daughter (“The Kid”) is 3 years, 10 weeks and 2 days old.

So?

That’s how old I was the day I was diagnosed with diabetes.

I hate to consider the possibility that either of my girls will end up with diabetes.  I know we could handle it if they did – goodness knows we have plenty of experience with diabetes at our house – but I still shudder to think of the needles, the scary nypos, the parent-free trips to the playground, the sleepovers at a friend’s house, the potential complications…etc, etc.  In other words, I don’t want to put myself in my parents’ shoes, even if only in my imagination.  And I don’t want to find out how much I’ll blame my own flawed genes if they do.

My understanding is that my girls have a 2% chance of developing Type 1 diabetes since it’s me (i.e. their mother) who has the disease.  (The probability is different when the father has it.)  That equates to a 98% chance that they will be diabetes-free (Type 1, anyway).  Those are good odds.  My preference is to take comfort in these numbers rather than dwell on the negative possibilities, but it’s impossible to wipe out that worry entirely.  (PS – If I’m wrong about these statistics, please don’t feel the need to correct me.  This may be one of those “ignorance is bliss” situations.)

I often see posts written by parents with diabetes about their fears that their children will also end up with the disease.  Scott wrote a great post about it just the other day.  If you follow Scott, you may have seen my comment.  If not (you should), this was my comment:

“I can so totally relate to being scared of this. In fact, I choose not to think about it, and didn’t even read your whole post b/c of it. (I skimmed.) I can’t let these thoughts enter my mind or I’d go crazy. I was 3 when I was diagnosed. The Kid is 3 now…”

I liked his response:

It’s crazy how we tend to fit our own diagnosis ages into the probability equation. I keep telling myself that I was diagnosed at 7, so my kid’s got a couple of “free” years to go before he needs to worry about it. I also think that if he makes it D-free to 8, he’s in the clear. The practical side of me tells me that thinking is absurd (it is), but the thoughts still linger.

He’s right, of course.

But today still gives me the willies.

Pregnancy Update – 32 Weeks

It seems that blogging during this pregnancy has been easier said than done.  I was really hoping to keep on top of things and keep everyone up to date, but clearly I’m failing to do so.  Bad, busy, pregnant me.  Anyway, today I do have an update – complete with pictures (which you may have already seen if you’re Facebook friends with me).

Maybe I’ll start with the pictures.

First of all, this one is me, taken yesterday at 32 weeks, in the classic “bathroom mirror phone photo” (thanks to having nobody around to take it for me).

Next, these two shots are from our first Fetal Assessment ultrasound three weeks ago (i.e. at 29 weeks) – one of her profile, and one of her face.

And finally, this is a close-up of the lower portion of her face (nose/mouth/chin) from this past Thursday – one day short of 32 weeks.  We can hardly believe the resemblance to her older sister already!

And now to bring you up to speed…

1. Doctors Appointments

They are ramping up big time.  I’ve been seeing the endo every three weeks (but expecting to go to every two after this coming week’s appointment), and the OB every two.  I have had two Fetal Assessments that were three weeks apart, but I’ve now been asked to come every week.  I haven’t had any recent visits with the ophtho – only two so far during pregnancy – but I have one coming up in about two weeks.  I also have phone appointments with my diabetes nurse every 3 weeks to do some more detailed problem-solving than what we have time for at my endo appointments.  So it’s busy.

The good news is that everything is going great and everyone on my medical team is really pleased!  Yay!  My A1C has been hovering just above and just below 6.0% (which I am thrilled with!), my BP is consistently under 120/80 (last one was 118/73), my weight gain is approximately 23lbs (perfect at this point), no thyroid issues, very little swelling (only a bit every few days in my ankles), and generally no sign of any problems.  The baby is hovering right around the 50th percentile size-wise, so I can’t complain about that either.  My left eye bleeds a little from time to time, but always from the same spot it did pre-pregnancy, and never very much.

All in all, I’m almost the picture of diabetic-pregnancy health!  It’s been so much work, but so worth it to have come this far already.  We don’t have a c-section scheduled yet, but my OB is still aiming for the week of April 9th-13th (i.e between 37 and 38 weeks…hopefully closer to 38).  The more confident he sounds in those dates, the more confident I’m feeling that this pregnancy is on the right track!

2. Missing Out on Important Things

No, this isn’t about “important things” like donuts, burgers and Snickers bars.  This is about the fact that, in spite of all the good stuff in #1 above, my OB asked (read: begged) me not to take a trip to Victoria, British Columbia at my 31-week mark.  The “important thing” in Victoria: my best friend from childhood.  The “important event”: her wedding.  There are few things in this world that could have kept me from watching this woman I love so dearly marry her soul mate (who I also love dearly, by virtue of how dearly I know he loves her), but this was one of those things.

While there was nothing to indicate any current health problems, my OB was worried that any additional stress of travel, etc, could start to cause that dreaded increase in blood pressure that could start the downward spiral we saw last go around.  Since my health, and the health of my baby (including the amount of time she gets to bake in my womb) is the highest priority for me right now, and since I trust my OB immeasurably (he is a very reasonable doctor, and an expert at what he does…not to mention a saint, but that’s another story), I had no choice but to heed his advice and stay home.  It was the right thing to do, but it seriously sucked.  Seriously.

3. Comparing Pregnancies

When I was pregnant with The Kid (i.e. the first one), I kept a pregnancy journal, so it’s been really interesting to look back and see the similarities and the differences.  On the side of differences, last time at this point I was having major swelling in my feet (read: compression socks and an inability to tie my shoes), and quickly rising blood pressure.  I was also significantly heavier by this point.  (For comparison, last time I gained 50lbs during the entire pregnancy and this time it’s looking like I’ll come in around 30lbs total weight gain, unless something drastic happens between now and my c-section.)

On the side of similarities, I was having some major insulin resistance (check), bad infusion site absorption (check) and was waking up every 2 hours at night to pee and/or check my bloodsugar (double check).  I was also entering “indigestion mode” again (seems to be a 1st and 3rd trimester thing), which is pretty much right on target again this time around.

It’s interesting how two pregnancies really can be so different, yet have some very distinct similarities.  I’m not complaining about any of the “similarities” though when I see how lucky I am to have the “differences”.

4. Insulin Resistance

I mentioned it above, but I’m mentioning it again.  Insulin resistance is huge in 3rd trimester!!  My bolus requirements at meals are more than double what they were pre-pregnancy.  I’m moderating my carbs a lot more with this pregnancy than I was with the last one so as to avoid massive insulin doses with the still-unavoidable (for me) bloodsugar spike-and-drop combo.  It’s really making a difference and it makes me wonder how I managed last time on a carby diet!  I’ve learned so much about my diabetes since then…  Last time it wasn’t abnormal for me to have highs in the high teens and low 20s (that’s the 300-400 mg/dl range) – not every day and not even every week, but every now and then when things weren’t working right.  This time my bloodsugar ceiling has been 17 mmol/l (~300 mg/dl), and I’m happy to say that I’ve only been that high twice in the last 7 months (making me a much less guilt-ridden Mommy than last time).  I’m at the point now where I feel high (and talk in terms of being high) when I’m above 9.0 mmol/l (~160 mg/dl).  It’s nowhere near perfect, but I feel like I’m giving this baby a much better growing environment this time than I was able to with Baby A last time, and that feels very satisfying.

Anyway, away from that tangent and back to insulin resistance.  I have it bad.  And it’s mostly around meals.  In fact, with my superbolus strategy (i.e. borrow basal insulin to add to meal boluses, and then follow it up with a 2-3 hour significant drop in basals), I’m seeing my basals drop significantly because of how much insulin I’m having to take when I eat.  So it’s this weird balancing act these days – add to the bolus, drop the basal, add a bit more to the bolus, drop the basal even more.  I find I’m pretty much assessing and re-assessing trends every 3-4 days now.  I’ve said it before and I’ll say it again – how anyone who is not an analytical Type A personality does this is beyond me.  I’m the kind of person who thrives on numbers and analysis and control and even I’m burning out!

5. Looking Ahead

Now that the end is in sight (hopefully still in as close to 6 weeks as possible and not sooner), I’m starting to think more about the time after Baby B comes, including my diabetes/diet management and my maternity leave.  I’ve realized two things:

a) There are going to be some days where I eat what I want to in spite of what I know it will do to my bloodsugar.  I don’t even mean donuts, etc.  I mean a bowl of cereal with milk, a real sandwich (on something other than skinny slices of high-fibre Weight Watchers bread), chicken fingers and french fries…things like that.  And I don’t mean on a regular basis.  I do still plan to go back to the low(ish) carb way of eating that I followed pre-pregnancy (and that I’ve only slightly modified during pregnancy), but I also plan on giving myself the leeway to have some exceptions – something I’m not really allowing myself in any major capacity these days.

b) I’m hoping I can get myself a bit further immersed in the D.O.C. while I’m on mat leave.  I see so much good stuff out there that I’d love to participate in more fully, but it’s so hard to find the time when I’m juggling work and my family and the rest of my life.  If I have a relatively happy baby (which I didn’t last time, so I’m still crossing my fingers about this for Baby B), I’m hoping to be able to participate more in online chats, diabetes blog memes, and a LOT more reading of blogs by my fellow D-bloggers.

And hopefully it will also mean more frequent blog updates here!

New A1C – 30 Weeks Pregnant

I got my new A1C result yesterday (from a bloodtest done on Wednesday).  The result?

5.9!!

I’m back in the 5s!  Yay!

The timing is perfect because I’ve been so frustrated with insulin resistance lately and highs that just don’t make sense and just don’t come down.  (By “high”, I mean 10s and 11s in mmol/l, or 180 – 215 in mg/dl – so not brutally high, just too high for pregnancy.)  The old guilt was starting to settle in, even though I knew I was doing everything I could.  So this result was an absolutely fantastic reminder that I’m still kicking ass at being pregnant with diabetes!

On another note, I apologize profusely for my absence of late.  I’ve been lacking the technology to post properly, but we finally have a new computer, so I’m hoping for a longer post in the near future…

Stay tuned!