Studying and Tuning

Usually, about once a month, I study my Dexcom trends and make minor adjustments here and there in my insulin needs (with permission from my endocrinologist, of course). This ritual then becomes a weekly thing during pregnancy, and this time is no different. And, later in the pregnancy, I tend to do this every couple of days or so due to all of the increased resistance and stuff.

Since I switched back to my Medtronic pump after issues with the t:slim last week, I wanted to get a good few days of data before making any changes since typically you do have to make some adjustments between insulin pumps. Not all of them deliver in the same manner (though relatively the same, but juuuuuuust enough to possibly need minor changes in insulin dosing). Here’s what I mean:

6 days on tslim 2
6 days on the t:slim I had been using during the first part of my pregnancy…
6 days on the *replacement* tslim... NO changes in rates as they're the same brand of pump so it shouldn't have made a difference...
6 days on the *replacement* tslim… NO changes in rates as they’re the same brand of pump so it shouldn’t have made a difference…
...and the last 6 days since being on MedT with practically the same rates.
…and the last 6 days since being on MedT with practically the same rates.

If you compare the first and the last picture, you can see that there’s not entirely too much difference, and the average BG between the two was only a few mg/dL off from each other. The replacement, however, was whacko.

Either way, I’m doing a lot better on the MedT and will probably stay on it. And since I have made that decision, it’s time to get down to fine tuning things. I’m dropping every night around midnight, and it’s taking longer to treat them, thus I over treat and go high. BUT, the thing is, I’ve not corrected those highs. I’ve been trending back down on my own. So that tells me I have some work to do between supper, bedtime, and overnight basals and other factors.

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I usually look at my trends on the computer and try to identify things. If I think I see something or have a hunch, I’ll print out the Daily Trends report so that I can see the days individually and not as an average, and I’ll write my basal rates below it. This time (for example), I noticed that I dropped an average of 57mg/dL from my highest average to my evened out number when I wake up, which, ironically, is close to my insulin sensitivity factor (55mg/dL currently). So, I took the 1u and divided it by the number of hours it had been dropping  before leveling out, which was 7hours, and it came to 0.14, which I interpret that to be a needed basal rate change of 0.15u per hour less than what I have it set at now.  It all may not be exactly right, as most of what I think I’ve figured out is simply a hunch that I try out and see if it works. If not, I have record of my information pre-changes and I go switch everything back to what I had before.

This the stuff that goes through my head while I’m examining my data. This is why having as much of my data in one place is as crucial as air to me, especially while pregnant. It’s such a pain in the butt to have to look at multiple reports and have to spend more time organizing it than actually analyzing it. So, I’ve also resolved to leave my beloved Verio IQ and use the Contour Next Link meter that works with the pump, so that all of my data from the pump and meter at least are in the same place. That, and since using the CNL meter, my Dexcom data more closely matches it whereas it hardly ever matched my Verio. I’ve done a lot of research over the past couple of days, and it seems that maybe the CNL meter is a bit more accurate than the Verio, and with the Dexcom using the more accurate 505 software, maybe the two are just meant to be… Or I could just be completely off my rocker. 😉

So, I’m off to my endo tomorrow for my monthly checkup and to share my observations and changes with him.

(What I do and write here are in no way medical advice that you should ever take as such. I have worked very closely with my endocrinologist over the years and he has helped me learn how to do these things. If you want to learn how to manage and fine tune, please speak with your health care professional, as I am not one.)

 

Changes At The Half-Way

Typically, when one such as myself who is a device hoarder and who likes change becomes in a medical state where circumstances would favor more stable device use and more concentration on what is actually going on, one would stick to those devices no matter what and create a harmonious data record flow throughout the medical state.

My said state is, of course, pregnancy. A highly regulated and controlled medical state in those who are diabetic because both high blood sugars and wide variations in blood sugar control can cause damage to the developing baby. So, when I found out about this one, I resolved to stay on my t:slim pump, Dexcom CGM and Verio IQ meter – both because I was happy with my t:slim finally after having used it for almost a year without issue and for the sake of keeping consistent records. I had no concrete reason to switch back to another pump other than for my own sanity as I still didn’t 100% have faith in it. In all honestly, even though I had used it for the entire year without issues, I still -in the back of my mind- wondered when the issues would arise again. I held my breath with each cartridge change and said a prayer that it would work just fine. And it did… until earlier this month.

Granted, I know that being in the second trimester that insulin resistance would start to kick in, but there was a HUGE difference in my control after I had received my last replacement from Tandem on the 6th of this month. I was right back to fighting wild, crazy numbers from all ends of the spectrum without any rhyme or reason to them – and the only thing that had changed was the pump. And while I could call Tandem about it and have them replace my pump again, I just don’t have the mental energy to go through it again when even this last time was a bit challenging to get it replaced because the error I was getting was not a known problem and the pump had passed all other safety tests. I’m sure for other people, Tandem is a great company. I think they have a good product on their hands, but for some reason I just seem to not have luck with it for long.

Last week, when I had finally hit my breaking point – literally, I was sobbing Wednesday while contacting my Endo and letting him know I would be faxing records to him for help – I decided to go ahead and use my Medtronic pump. Crazy thing is, just for my own security of mind, I had just had it switched out from the 5 series (the 180u pump) for the 7 series (300u pump) to have as a “just in case” for the end of the pregnancy when insulin needs were going to be much higher. One of the issues with the t:slim seemed to be when I filled it up to 280, it would screw with the load sequence – thus the reason I had it replaced. Within a day, my BG’s became predictable again. I could bolus without skyrocketing and plummeting later – as if the insulin wasn’t being delivered. I could pre-bolus on a predictable schedule before eating again. And while I don’t like that now I can’t upload my pump and meter together so all of my data is messed up, I’m more at ease about my glucose levels overall. All from switching a pump.

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Saturday, I put my t:slim into sleep mode and packed it up and away. I do not plan to use it for the rest of my pregnancy, and even after that, I’m not sure if I’ll use it again. I’m absolutely torn about it because it was the first pump since my Disetronic way back in the day that I truly loved to use. But it’s like I’ve heard many other veteran pumpers say – I don’t care how fancy you make your pump, I just want it to deliver my insulin and work like it should. Especially right now.

Of course, this all is not to say you shouldn’t get the t:slim if you want it – there have been plenty of people who have used this pump since it came out without issue. I seem to be one of the lucky few who has had problems with it. Not every pump works for everyone, and you can’t go off of one person’s experience to assume what yours will be. 

And I know this is already a long post, but I want to give a shout-out to my Medtronic rep if he’s reading. He’s been so supportive of me through the past 4 years – no matter how many times I would switch pumps and go back to my Medtronic one, he was always there to help with whatever I needed. I can honestly say that I have never had a rep from any company be as good to me as he has, and I really appreciate that. So, a huge “Thank you” to Travis, especially this time for taking out a few moments on your day off (and on your way hunting, no less!!) to bring me a few sets that I needed until my order comes – you’re an awesome guy.

Happy 2015!!… with some bullet points.

HAPPY NEW YEAR!… 13 days late….

So, apparently I have a thing now for only blogging twice a month? Well, rather than overwhelm with a very long post, I’ll just use some bullet points to bring out the most important things.

  • Diabetes is being rather weird. Some days, it seems I’m very insulin resistant, others I’m super sensitive. I don’t know if it’s simply diabetes being itself, or if pregnancy has a hand in it, or if my thyroid being wildy off recently plays a roll. Or it could be all three.
  • Speaking of the thyroid thing… my TSH came back above 5 on New Year’s Eve, up from a usual 1.3-1.5’ish. Not sure of the reason other than being pregnant, as this happened when I was pregnant with E, but either way, my Synthroid has been upped yet again, and we’ll recheck in a few months.
  • I’m now 14 weeks, 2 days today. Baby bump is in blooming, and while I’m excited, it’s also freaking me out. The whole going from one to two kids… The further I go, the more freaked I get. I’m sure it’s just a thing I’ll get past soon as my emotions are EVERYWHERE. We’ve also decided to go for an early gender ultrasound, so we’ll (hopefully) know on the last Saturday of this month. I’m excited.
  • School started back this week, and it will be my last semester. I have 3 classes left, two of which I’m taking this 8 weeks. After that, it’s one more 8 week class and I’m dooooooooooooone! Yay!
  • Lately, I’m getting frustrated with my Dexcom being really off. I didn’t have this problem before the new 505 upgrade, but it’s been more and more inaccurate. And, after reading Stacey’s post, I’m beginning to wonder if I may need to change meters. After all, it’s not a secret to me that the Verio isn’t very consistent when tested back-to-back. So I’ve ordered a Contour Next USB meter, which is supposed to work with Diasend (though not the Medtronic Link version of this), so I’ll update as soon as I know something… or at least within two weeks of testing and finding out things for myself.
  • Oh, and the news of Tandem’s t:flex gaining FDA approval this week was also pretty awesome as well. It’s their larger pump, the only one that can hold 480u per cartridge (but knowing what I know about my t:slim, I wonder if you’ll only have 430u available for use per cartridge since I tend to average about 50u loss per changeout). I think it’s great as I do love my t:Slim pump and have had a pretty good relationship with it over the past year or so since getting the whole bad cartridge thing behind me. I still hate the insulin waste, but on a daily basis and for my needs now, it fits perfectly into my “diabetic” life, and I’m happy with it. I can only be that much more excited that others who have needed a much larger capacity pump (some type 2’s, teens with type 1, and some preggo people) will now have an option to help them be able to use a pump without having to change out so frequently.

So, that’s about it. Not much going on, but a lot at the same time. I hope you all are doing well and are enjoying your January.

Considering?

Okay, so remember yesterday I talked about being on all these loops?? Well, I was thrown for another one this morning.

Last night, my OB called to tell me that all my blood work and my 24hr urine collection results came back great, and that he was actually shocked given my history with diabetes and renal disease (I had kidney problems about 10 years ago which from my understanding, had reversed itself with tight bg control), and that the protein levels were no worse than someone who was a healthy, non-diabetic pregnant lady…. all to which I was elated. So, the ruling for the swelling and random star-flashes is that it can be normal in pregnancy and I need to deal with it. (And no, he didn’t say it like that, but that’s the gist of it.) Then, this morning, I get a call from his nurse. She wanted to be sure he had called me back last night. She went back over the results, but said it in a slightly different way. She said that the results came back good considering my diabetes and renal history.

Considering??

What is THAT supposed to mean???

So, I go from feeling wonderful about this pregnancy.. that somehow I had done something good and that my body really was able to handle pregnancy just like any other woman and that it didn’t affect me that bad and I may actually be around a long time for this kid,  to feeling an instant rush of panic. “OMG, so I’m just in the good range for a diabetic? I’m not in the good range for a normal, healthy person? So that means I actually do have raised levels? I’m probably at risk for having to go back on pills for my kidneys once again not because of lack of control but because I decided to have a baby in the midst of having a body-wrecking disease????”

Then she tells me my A1c… 6.9. The highest since becoming pregnant. I swear, if anyone had walked into where I work at the time, they would have seen a 9 month pregnant woman doing everything she could not to lose what little bit of hope and happiness she had. Everything seemed to pile on me at once, and I felt like I had been a failure somehow. Had I gone through this pregnancy trying to do everything possible to keep this baby protected from what my disease could do to him just to have it all slip away in the last month?

I know a lot of this has to do with the hormones and just the general uncomfortableness and wanting this baby out of me. The pregnancy is coming to an end and I’m going through the transition of loving being pregnant to, well…. NOT loving it, dealing with the worry of how things are going to go and how I’m going to protect him on the outside, and the realization that I’ve only got less than two weeks until this transition occurs. The overwhelming knowledge that very, very soon, there will be a baby – my baby – in my arms.

After having my little down-fit, I called the OB office back and requested that the results be sent to my endo’s office. I know they usually do, but I wanted to be sure he got them because I trust his judgment of my diabetes care over my OB. I wanted to be sure he had them so I could discuss them with him when I go for my appointment Monday.

I am also going tomorrow morning for my 37 week (well, almost 38 week) OB appointment. I’m going to see if they’ll go ahead and schedule the induction date then so we can have a definitive date to mark on the calendar of BabyK’s arrival… that is unless he decides it’s time to come before then and I magically go into labor between now and the date set. That way Erik can know when to take off from work and I can schedule a few days off before to make sure I have everything ready for the hospital stay and be sure the house and BabyK’s room is 100% (or as close to it) ready for him to come home with us. I’ve said since the middle of the pregnancy that I felt sure he was going to be a July baby… and we still have 11 days left for that to happen. But with the way my primary OB sounded last night, the induction is still going to be set for the week after I turn 39 weeks (I’ll be 39 weeks on Saturday, July 30th). I’ll be sure to update tomorrow as to what the on-call OB says.

Marshmallows

What resembles marshmallows on sticks?

But with baby marshmallows on the ends of the big marshmallows??

………….

……….

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…

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MY FEET!

From Beach2011

Now granted, my legs aren’t the skinniest around either, but they’re also a bit swollen.

But with all the swelling and uncomfortableness, I am still enjoying being pregnant.

That or I’m really trying to convince myself of that. I really just want BabyK to bake as long as needed to be sure he’ll be as healthy as can be when he comes.

It’s also said that “a watched pot never boils”… so if I keep dreading it and wanting it to be over, he’ll never come.

So I’m going to try to keep my mind off of “labor” things and just keep watching the calendar for August 6th, not before.

Winking smile

Nearing the End

35 Weeks 5days

35 weeks and 5 days. We are getting close to the “end”. Saturday, (by the pregnancy calendars), I’ll be 9 months pregnant, and will have yet one more month to go. BabyK will be technically “full term” on the 16th… which there is a full moon on the 15th, so we may have a baby in the middle of this month, or he may hold out a little longer. My next OB appointment is on the 14th, so I guess we’ll see if the moon’s increasing gravitational pull is having any affect on him!

BabyK is still rolling and squirming at times, and even has his own pattern going. He stretches in the mornings, pushing his butt up into my ribs and his hands into my lower side. Then his feet go pushing my upper side under my rib cage out. Then he’ll squirm a little more and he’s still again. He’s not as active during the day as he used to be, but when I’m at home at night in my recliner, he rolls and twists and does whatever acrobatics his little small room will allow him to do. I love feeling him move, but boy! Being short-waisted also makes it a bit more uncomfortable since when he moves, he doesn’t really have far to be able to move or stretch up and down. If I could, I would grow two or three inches to give him some room, but I know that’s not possible. It would be nice though!

Things are getting uncomfortable. I feel like a huge watermelon myself, not just the belly. My feet and ankles (and sometimes, hands) resemble something out of a fun mirror house where things are made to look either super skinny or really fat…. mine being the really fat one. There’s no shape to them at all… just two big balls of water with little tiiiiny appendages that I used to call toes not too many weeks ago. And while it seems gross, and it is but I’m kinda weird this way, if I press on my foot (that is when I can reach it), a huge dimple stays there for a while. It’s kinda cool looking but horrifying at the same time… “Is my foot really that swollen that I can press a 1/2 inch dimple into it?? Wow!”.

Infusion sites are starting to react weird. Not sure why, but really are hit and miss now. The ones that are misses, are ones where I can place it, do a bolus, and it will leak. I’m wondering if I’m swelling that much that it’s affecting them. I’ve even resorted to not only utilizing the slow-delivery function on my pump, but also doing a combo bolus for every single bolus that will deliver the insulin over 0.1hrs (I’m assuming that means it will take 6 minutes to deliver? 1/10 of an hour…? Right?) to see if it will help. So far, it has.

The Guardian gave me my first really-off reading this morning. It said I was holding steady in the 90s, but when I checked, my actual bg was 235 (stupid Hardees breakfast!). Now, I have had this “off”ness with the Dexcom, so I’m not saying it’s a bad system. Then again, what bg monitoring system is a perfect one? NONE. My thing is if you don’t expect perfection, you’re not going to be as disappointed, and you actually appreciate and rejoice more when things do work out to be just the way it should be. Crazy, I know, but that’s been my way of thinking almost my whole life. I get too stressed and depressed otherwise.

I know that we are nearing the end of this pregnancy, and while it will be a relief to not be on as much insulin, I am starting to worry about how things will go after he comes. As with this whole pregnancy, my diabetes has been a whole new ballgame. Diabetes is a baby itself… one that never grows up. I know countless numbers of you out there have been down this road before, and that gives me some peace of mind. So, while I am so ready for this pregnancy to be over in terms of I really want to hold him and hug him and kiss him and all that stuff, I’m also not wanting it to be over because I’ve finally gotten comfortable with knowing what pregnancy does to me as a diabetic and knowing how to handle certain situations. But as with everything in the diabetes world, nothing is constant. Nothing is easy. It always changes – pregnant or not. And rolling with the punches one day at a time is the only way you can do it and stay sane.

Hormones are Evil

bottle

See this bottle? It’s a free one I asked for through a special offer on the internet. To be honest, I had forgotten about it really until this morning when I checked the mail and saw the box…. then the next thing I did was cry. Yup. I cried because I got a bottle. Our first baby bottle. The first one I had ever held that would be for my baby.

Or so I thought… Then I remembered the Christmas baby stuff I had bought back when things were going on clearance – bottles, bibs, onsies… And cried again.

Not to mention I had already been crying anyway because when I woke up this morning, I realized it was the day I would get to pick up Erik from work after a week of not seeing him.

And I cried again when I looked at my desk calendar and saw where I have in big, balloon letters “4D Ultrasound” marked on tomorrow’s date. We’ll get to see our little boy tomorrow…. albeit it will be from a monitor screen, but I prefer it that way right now. He’s still baking in there.

As far as blood sugars go, I’ve had a rough week with lows (20’s and 30’s again!) and then some highs.. like this morning, I woke up at 198… WhatThaFructose??. (Thanks Mike * @mydiabeticheart * for getting that stuck in my head!)

All of which make me a crying, mad, moody mess on top of being pregnant. As if either one needed a sidekick. It’s as if they have meetings while I’m asleep…

Hey PGH (pregnancy hormones), wanna really mess with Sarah today? –DBH (diabetes hormones)

Sure, let’s really sock it to her today. You make her mad, I’ll make her cry, k? –PGH

Got it. – DBH

So, I’ve come to the conclusion. While we do need them, I do believe hormones are evil.

Confusing

Pregnancy so far has been pretty good. From a “normal” person’s stand point, the baby is growing right on track, I’m gaining weight as I should be, and am in full awe and love with the kicks, punches and rolling around this little kid is doing inside of me. All clothes (save one dress) are now too small in the belly (so this means all shirts, and pants must be either maternity or regular with a belly-band device to cover the wide-open fly area). Diabetes aside, I am loving being pregnant. I know what most of you are thinking though… “Yeah, yeah, yeah, wait til that third trimester and we’ll revisit how much you love being pregnant”.. and you’re probably right. But just thinking back to when I never thought I would be pregnant or the worries that something would go horribly wrong before I could even feel the first kick, I am completely in love with how things are going. This is, with no doubt in my mind, due to all the thoughts and prayers of all of my friends and family all during this pregnancy so far.

 

24 weeks

So, what’s so confusing? as the title of this post refers? Blood sugar. Yep. That thing that all of us diabetics have to deal with monitoring. But this is what is truly confusing to me. I kept decreasing insulin needs so fast at the beginning of the pregnancy – less than half of my normal dose within the first 6 weeks, and it stayed that way until week 20. Now? It’s been 4 weeks, and I have met, if not exceeded my pre-pregnancy basal rates in my pump, and mostly done within the past week and a half. It’s like “BAM! Destination Insulin Resistance.. FULL SPEED AHEAD!!”.  Numbers that I normally would never have seen on my meter are coming up, and worrying me. Yesterday’s average? 150-160 range, at every check. I even went to bed with 5 units still active (or so said my pump), and stayed at that 150-160 range until this morning. Yes, I could have corrected, but I was worried it would all hit and I would bottom out.  I am going to fax my numbers into my endo’s office first thing tomorrow, but at the rate my numbers seem to be jumping up, it almost scares me to wait for him to get back with me. I mean, what if by then I need yet another increase?? Can you see the visual I have playing in my head of me at the 9 month mark with a smoking, worn out pump clipped to my side, with an army of backup needles and insulin pens in hand yet???

I mean, like, right now, BG is 215… 2 hours after I have eaten. To me, this is NOT acceptable. And I hate it. All I can think of is the illustration given by Dr. Oz on that sorry Oprah episode where he talks about how to imagine a high bg as nails in a mason jar, swirling around. The nails are the blood sugar level, and the mason jar is the blood vessel wall. The more nails, the more damage that can be done in a short amount of time verses having fewer nails (lower blood sugar) in your system. And thinking of that illustration leads me to wondering if my high nail content blood sugar is doing the same damage to my little boy? It’s all overwhelming, and very mentally taxing.

It’s all so confusing because it’s not a gradual shift from pre-pregnancy to insulin sensitivity to insulin resistance during pregnancy… It comes in spurts or all at once it seems (or for me it does). There’s no rhyme or reason to it. Just a guessing game and battle every day. Like, what am I going to encounter today?? I swear, if it weren’t for this little one, I’d already be gone to the crazy house.

But would I trade any of it to go back to before?

Nope.