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Monday, April 30, 2012

Tough Weekend with Arnold

In the 4.5 years that I have been on an insulin pump, I've had very few instances where the pump had a malfunction.  Usually, I can contribute any random highs on operator error.  But this weekend, I had several instances where I was so frustrated with my pump that I want to call my endocrinologist to go back on MDI (haven't yet, but I'm still considering it).  

I guess it all started when I noticed that my most recent box of infusion sets seemed to be made of flimsy plastic because I would have little bits break off when I would insert the cap into the reservoir.  It never caused any trouble with the pump working, so I brushed it off.  But Saturday morning, I woke up to a high BG of 219 mg/dL, which is a far cry from the 100ish average I try to maintain in the last month of my pregnancy.  I got up to confirm the high alarm, and noticed that the tube on my pump was dangling towards the floor and not connected to the site on my thigh.  "Oh, well that explains it."  I reconnected with a new infusion set, and bolused a correction.  

The problem was that I was never able to get back into normal range, despite dialing in correction after correction.  I feel into a heap on the bathroom floor because I was so frustrated.  Even rage bolusing wasn't working.  (And by rage bolusing, I mean 5 extra units "just because".)  I finally come down after 5 hours of being above my preferred line.  The rest of the day went on as normal.  

Then yesterday, I laid down to take a nap (random occurrence for me these days) and when I woke up I started going high like I just ate a cupcake sprinkled with sweet tarts.  But I hadn't eaten anything in 4 hours!  I got up to 297 mg/dL and three failed correction boluses before I finally gave myself an injection, ignoring all of my active insulin.  I finally came back in range 2 hours late to 125 mg/dL without a crash, which should have been inevitable considering I gave double what I needed.  

After 2 calls to Medtronic, we decided that I have a bad box of infusion sets.  So I changed my site for the 3rd time in two days with a new reservoir and infusion set from a different box.  I bolused for dinner after not eating for almost 8 hours and waited to see if my blood sugar would actually come down before I took a bite.  Thirty minutes later, I was cruising towards my low threshold, so I concluded that the new site was working.  

Even today, I'm still not happy with how quickly my insulin takes to work.  Everything with my site change yesterday was new, including a fresh, cold vial of insulin from the fridge.  But so far I've had to give 2 additional corrections following breakfast.  It might be that my insulin:carb ratio needs adjusting (again!), but I still am not happy waiting over an hour for my insulin to bring my blood sugar down.  

I feel absolutely hopeless when this vital technology fails me.  I don't want to go back to MDI, but the time it takes for insulin to kick in is considerably less than waiting on a bolus from the pump.  It may save me from lows, but I'm spending far too much time over 100 mg/dL to justify it.  Even thought my last A1c was fine (5.6%), I don't want to let up in these last 4 weeks of pregnancy.  I want to keep the same steam that I've had the whole time.  And I can't do that when I don't trust the technology that I rely on to keep me there.  

It's the final lap, Arnold.  Do we need to come in for a quick tire change and fuel up before we win this thing? 

Friday, April 20, 2012

High Risk Outcast

For the past month or so, I'm thankful to say that my pregnancy has been fairly boring.  My weight gain has plateaued (34 lbs.) and so has my insulin resistance (42 units basal, and 1:6 bolus ratio).  The last 2 OB appointments have gone very smooth; in fact, I've spent more time in the waiting room than actually seeing my doctor.  My blood pressure and urine have all come back fine, which I count as a huge blessing.  For most of my formerly-pregnant friends who ended up getting complications such as preeclampsia, the symptoms started showing by now.  So I feel like I've beat some personal goal by making it to 34 weeks and everything about me seems like a normal, non-diabetic pregnant woman. 

But I feel very at home with my OB, and he treats me as a unique patient and doesn't generalize me for my type 1 diabetes.  That hasn't been the case everywhere else.  For example, at our prepared childbirth class last weekend.  Initially, I was very excited about this class because I wanted to get an idea of what to expect during labor (either naturally or induced) and I was anxious to tour the maternity center where I would be giving said birth.  

The class started out great.  We went through the overall process of labor from early labor to transition to PUUUUUUUUSHing.  The morning teacher made me feel like I could handle the type of labor I wanted because it is 90% mental anyway.  Plus, she said regardless of how long ago it happens, every woman remembers the details of her child's birth.  So it's so important to mentally prepare yourself and fight for what you want.  We broke for lunch, and I felt great.  At this point, no one knew I was a type 1 diabetic or that I was considered "high risk".  

Then came the afternoon, and a different teacher took over.  Her job was to talk to us about medical interventions like inductions, epidurals, and C-sections.  I wasn't scared of this part because I figured some of these interventions might be in my future.  Before we got into the part on C-sections, the teacher threw out this random statistic because she had just got back from a conference on diabetes and pregnancy.  "Did you know that 85% of all diabetic pregnancies end in a C-section?"  And she starts the video.  

I lost it.  I looked at Trey and said, "Well, isn't that wonderful?"  Tears began falling down my face.  Snot was running down my nose.  And I had to muffle my mouth from the heaves that were coming up.  Really?!  85 percent?!  So even if I do everything right, I only have a 15% chance of having a vaginal delivery?!  I was distraught and could barely pay attention to the video.  It ends and the lights come on.  I calm myself enough to listen to the cord blood banking guy, the last talk before the maternity center tour.  

I tried pushing that number out of my mind while we went on the tour.  I reserved that I would deal with it later.  One of the reasons I chose the hospital I chose is because a) my doctor is right next door and b) they have these LDRP rooms where every process of labor is done in one room.  I wouldn't have to labor in one room and then be escorted to another room for recovery.  These rooms are great, they're set up like your grandmother's bedroom with a quilted bed, rocking chair, and warm decorations.  The same afternoon teacher told us that these rooms have everything that a typical LDR room has, but you get to stay here the whole time after baby is born.  "However, we typically only use these rooms for our low-risk patients."  I raised my hand and revealed myself to the whole class.  "So with me being type 1 . . . "  She responded, "Yeah, it's unlikely you'll get to use these rooms."  Again, I was shot down due to my category and nothing to do with me.  

Trey and I got in the car and headed home, and I felt like I had completely wasted the entire day.  I felt so defeated.  I don't care if I have to have a C-section or have to be quarantined to a room deemed suitable for high-risk patients if my daughter comes out healthy and safe.  BUT.  I feel like my story has already been written even before I'm there.  I want to have some say in how my body is dealt with, but right then I felt like I was just at the doctor's will.  I cried the whole way home, and that's a long 30-minute drive.  

Thankfully, I had an OB appointment this past Monday, and I basically told him everything that happened at the childbirth class.  I told him I felt very discouraged.  My doctor, always the sensitive guy, looked me in the eye and said, "That's not true.  That 85% MIGHT be true for uncontrolled diabetics, but definitely not for you.  And you have the choice to use the LDRP room, I'll see to it.  As far as I'm concerned, you have a good chance at a vaginal delivery."  I dried my eyes that had been wet for the past 2 days, and made my appointment for 36 weeks.  My endo even told me that given how good my pregnancy has gone, he would let me go to 40 weeks no problem.  

I know I shouldn't let these things get to me.  I should be used to people generalizing diabetics into some doomsday category.  My story is still unwritten.  I want every pregnant type 1 to know that they don't have to submit to anything that "should be" just because of our category.  We are high-risk, not "high maintenance enough that we don't want to give you a chance".  Several people have already asked me if they were going to take my baby early or if I have a C-section scheduled.  No and no!  If you take away this stupid disease and just look at ME, I am 100% healthy and so is my little girl.  Let's take off the vial glasses and look at ourselves as individuals.  Because as one of my good friends says, "Diabetes doesn't define me (!), it just explains me." 

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DISCLAIMER: I am not a doctor, nurse, certified diabetes educator (CDE) or any medical professional of any kind. (But I did stay at a Holiday Inn Express!) Therefore, please do not use any of my postings as medical fact. I am simply a blogger expressing my highs and lows (pun intended) with diabetes. For changes in your medication, exercise regiment, or diet please consult a qualified physician.

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My name is Holly and I live in north Alabama with my hubby, two cats, and a dog.