Hello, yeah it’s been a while. Not much, how ’bout you?

Hello, DOC!  I’ve missed you!  I know it’s been a while since you’ve heard from me.  My excuses/reasons for not blogging are kind of lame – busy at work, need a break from focusing on the D, busy getting busy, holidays, etc., etc.  I miss blogging, I just haven’t had the motivation to make it a priority right now.  But, I have some down time at work and thought I’d post an update on life.

Update #1.  Not pregnant.  Still trying to get a baby up in there, but no luck so far.  Not sweating it, yet, but I gotta say, it can be frustrating to do everything “right” and not get the results you want.  Kind of like how our blood sugars can behave one way one day and another way the next, despite doing the same thing.  I keep reminding myself that even with “perfectly timed” sex a healthy couple has a 20% chance of conceiving any given month.  Hopefully it’ll happen soon!

Update #2.  Holidays were not as hard with new robot parts.  Last Christmas I was still on MDIs, CGM-less, and felt like crap.  Between traveling 7+ hours to get to our hometown, eating dinner around 10pm on Christmas eve, and not having handy gadgets, I was nauseous most of the holiday last year.  This year was much better with my CGM and pump.  It was easier to make adjustments and I’m happy to say that I felt good and enjoyed myself!

Update #3.  Endo-conundrum.  I received a letter a few months ago that my beloved endo is reducing her hours and therefore will only be in the clinic on Thursdays.  Commence Panic.  How is this going to work?  Especially when I’m pregnant and have many more appointments?  After chatting with a few other patients of her’s I decided to see how it goes at my next appointment with the nurse practitioner before deciding if I wanted to change practices or stick with my current doc, despite her limited availability.  I had heard that the NP isn’t the greatest and rubs many people the wrong way, but I liked her.  So, for now, I’ve decided to stay with my current practice.  Hopefully when I do get pregnant, I will still receive excellent care.  If not, I’ll cross that bridge when I come to it.

Update #4.  A1c!!! My A1c has dropped from 6.8 to 6.7.  Woohoo!  I’m happy I stayed under 7.0.  My next goal is 6.5!

Update #5.  I have an annoying as eff coworker.  My cubicle neighbor has serious issues with his bodily functions.  He’s constantly snorting, snarfling, neighing like a horse, talking to himself, etc.  He drives me slightly insane.  There is going to be a day when I have the perfect storm of low blood sugar, PMS, and am having a shitty day where I go apeshit on him.  Thank goodness for headphones, but damn, he bugs.  Other than him, I love my job (Except for the whole keeping me away from the DOC thing).

Have a great week, everyone!

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High Risk OB Consultation

Doctors, doctors, and more doctors.  Sounds like I’m going to have to get used to this!

The hubs and I went to see my newest medical BFF, the high risk OB who will be holding my hand throughout future pregnancy.  On the urging of my endo, the husband accompanied me and I am glad he did.  He had an opportunity to get his questions answered and learned some medical stuff about Type 1s and baby building.

I had built up the appointment a lot in my head.  I expected a lecture about my weight (she said I’m “Only mildly overweight”, love her!), about my BG swings (“You swing, yes, but you stay in a good range, I’m pleased”), and I kind of thought there would be a physical.  (Luckily there wasn’t, yay!).

She answered all of our questions and gave us a bit of a “What to expect when I’m finally expecting” rundown.  A lot of info about why my insulin needs will increase and decrease, the risks of birth defects and miscarriage and one statistic that she provided that surprised me.  She said that our future child has a 1/10 chance of becoming Type 1.  However, everything I’ve read is that our child has a 1/100 chance due to me having him/her way after the age of 25.  I told her that is what I had seen on the interwebs and in some books so either she’s wrong or I need to learn how to use the google better.

Either way, it doesn’t change anything.  Yes, my pregnancy will be more risky.  Yes, our kid may have a higher risk of XYZ, but I am fully confident that with some discipline on my part, support from our friends and family, and careful guidance by an awesome medical team, we will have a healthy baby.

She also said that from 30-32 weeks on, I will be visiting her office twice per week(!!!) to measure the baby’s growth and progress and make sure everything is good.  Yikes.  Luckily I started a new job where I have a lot more flexibility (including Fridays off!) but this still was like “WHOA!”.  I wonder if they offer housing for their patients, seeing as I’m going to be living there?

That’s about it.  It was a good appointment and I’m glad we had it, however she didn’t really tell me anything I didn’t already know.  I would definitely recommend a consultation for those thinking about a pregnancy, if anything just to get you established as a patient of the practice so you aren’t scrambling to find a good OB once you get the positive pee stick.

So, now comes the fun part, right?

Friday Fives: August 9, 2013

Five things that (irrationally?) worry me about a future pregnancy with Type 1

1.  What the heck am I going to drink?  This makes me sound like a lush, ha.  Seriously, though.  My CDE said I can have 2 artificial sweeteners per day.  I use Stevia, which, according to my reliable resources on the interwebs, is safe during pregnancy.  Awesome.  I can have brewed Iced Tea sweetened with Stevia (right?).  Of course I don’t want my future baby born with 3 eyes or anything, so I will do my very best to eliminate/strictly limit all artificial sweeteners and caffeine.  *gasp*.  Bye bye coffee.  Hello….water?  Milk?  What else is there?  Should I ween myself now?  I have no problems with giving up wine and beer (although, nachos just don’t taste the same with water!), but I fear that giving up coffee will make me a nightmare to live with.  It’s going to be a long 40 weeks!  Sorry in advance for the crankiness, husband.  ♥ you.

2.  Is my job going to hate me with the 900 million doctors appointments I will have?  My Endo’s and future OBgyn’s offices are a good 30-40 minutes away and as far as I know, do not offer evening appointments.  However, I’m not willing to change because I love my endocrinologist and her team and I especially love my CDE.  Luckily my CDE is very responsive via email so I am hoping that maybe, possibly, she will continue to help me adjust my rates and answer my questions via email when I am pregnant.  Taking a lot of time from work to go to the doctor is something I already feel self-conscious of.  I really am nervous that my coworkers will be frustrated when the time comes and I have so many more doctor’s appointments.  However, I think that my direct supervisors will be more than understanding, as one of them recently herself had a high risk pregnancy.  But still, I don’t want people to think I’m a slacker.

3.  Working, period.  Diabetes is a full-time job.  My job is a full-time job.  Being pregnant will be a full-time job.  I’m tired.

4.  Keeping the secret.  The hubs and I have agreed that we don’t want to tell anyone until I’m 12-16 weeks along, however this may prove difficult.  I imagine I will tell my sister sooner since she lives close by and I see her frequently.  And I was the first to know (after her husband, of course!) with all of her pregnancies.  (Neener, neener Mom! Haha!)  But there are going to be challenges, depending on when we conceive.  It could be a non-issue, in that we wouldn’t see our parents for the first 12 to 16 weeks due to schedules, when holidays fall, etc.  Or there could be lots of time spent with parents in which I’ll have to lie my tender boobies off.  It is pretty important to me that we don’t tell anyone until after the first trimester so we will just have to do our best.  I’m looking forward to having a little secret with the husband.  ♥

5.  Guilt.  I’ve read about this on so many different blogs of D-mommies/mommies-to-be.  The guilt they feel when their BGs aren’t in range.  I really want to enjoy my future pregnancy and be as laid back as a pregnant PWD can be, but knowing myself and how much I already love our future baby, I just have a feeling I will be super hard on myself if I am out of range.  I hope I can find a good balance.

6. Judgement from others.  (OK, it’s friday fives plus a bonus!).  I’ve never been pregnant.  I am scared, nervous, excited for that day when I see two lines on the pee stick.  I have no idea what it will be like, how it will feel to hear my baby’s heartbeat for the first time, to feel the flutter of movement, etc.  I am researching pregnancy with type 1 as much as I possibly can in an effort to educate myself so I can kind of know what to expect.  I know that it’s going to be hard.  I know I’ll have to make sacrifices (see #1).  I know that there’s a decent chance I’ll have to have a Cesarean section.  I just worry that people will judge me based on their experiences and what they think is right.  I know my husband will have my back and I will just remind the judgey McJudgersons that although they may have been pregnant, they’ve never been pregnant with type 1 and I’m doing the best that I can for my unborn child.  And if all else fails, I’ll break out some kickboxing moves and show them who’s boss.

I am thinking about this stuff more and more lately as the day when we start “trying” doesn’t seem as far off as it did a few months ago.  I am so inspired by the type 1 women who have had successful pregnancies and know that my pre-worrying is a bit on the cuckoo side.  But I also know it’s normal as we PWD can’t just throw caution to the wind and have to actually really plan and work hard for our pregnancies.  In the end when I hold that little life, it’ll all be worth it.

My CDE is my BFF.

I had an appointment with my CDE on Friday and let me just say she is quickly becoming my new BFF of my Diabetes Team.  Like, I want to make her a friendship bracelet, ’90s summer camp style.

friendshipbracelet

I was never able to master the swirly ones!
Image from the Google.

Her awesomeness does not only stem from her coming to my Endo/PA appointment last week and giving me a hug, but she has been instrumental with determining my pump rates over the past 2 months since I’ve resumed cyborg living.  I’ve emailed her reports almost weekly and we make tweeks as needed to get me where I need to be to grow a human.  She is also totally relate-able and “gets it” as a PWD.  She makes me laugh and is super supportive when I’m annoyed with myself for not being a perfect diabetic.  I know I totally sound like I have a girl crush (my girl crushes are Megan Hilty and Jessica Simpson, TYVM), but I’d say it’s safe to say I have a definite favorite on my Diabetes Team.  Don’t tell my PA or Endo.  I know I’m supposed to love them all equally, and they can believe that I do, lest I’ll be subject to more finger pricks when I’m in the office.  (Seriously, am I the only one who hates when other people prick my finger?)

So, the appointment.  My graphs look goooood.  She pulled up some of my old graphs and the change in just a couple of months is remarkable.  Definitely happy that I’m back on the pump even after having the pump-cation blues.  For the first time since starting this “get body ready for baby” journey, I feel like I can actually do this.  It’s a good feeling friends.  And it’s motivating me to keep on trying my best to get myself in the best D-shape possible before growing our future little one.

We She noticed some patterns that we are working to correct.  I tend to go higher and stay higher with meals that are more than 60 grams of carbs.  So that means that I will try to limit my meals to less than that amount of carbs.  Easy peasy, mostly.  But if I do have the weekly occasional bowl of spaghetti, I’ll bolus as usual but try a temp basal of +20-40ish%, (depending on pre-meal BG) for 60-120 miutes post meal.  Trial and error.

Another trend is that I tend to stay higher throughout the morning if I eat breakfast earlier in the day.  So we changed my I:C ratio from 1:10 to 1:9 before 9 am and 1:10 after 9am (weekends).  I would’ve never noticed this – so happy for her trained eyes to see!

I do awesome overnight.  I average 147 from 11pm – 7am.  Good-ish number.  Would like it to be a smidge lower, but the thing I am most pleased with is that my overnight lines are typically pretty steady.  No real drops or jumps.  Sweet dreams for me.  This means naptime at work, no?  I have been pretty pro-active with setting temp basals at night when I go to bed on the higher end.  And I swear, it has nothing to do with me not wanting to hear my Dexcom all night.  It has everything to do with wanting to be all I can be with the D.  Or something.

We also changed my I:C ratio for dinner from 1:9 to 1:8.  My CDE was a little reluctant to do this because sometimes after dinner my numbers are great, however, I want them to be great most, if not all, of the time.  So I figure it’s worth a shot.

The best part of the appointment however was when she said that by looking at my graphs, she thinks my A1c is/will be very close to 7 if I keep this up.  This certainly motivates me to keep fighting the good fight.  High Five!

I kinda want to take her out for a beer.

Endo Appointment Round Up

Today I had an appointment with my Endo’s Physician’s Assistant.  Honestly, I kinda like him more than my endo (although she’s pretty awesome too!).  He’s young, very thorough, and never seems rushed.  In fact, he spent an hour with me today, which is just unheard of.  Unfortunately I wasn’t due for an A1c test (WAH!) as I had one within the last 3 months.  Kind of a bummer because I wanted to see how my new cyborg life has affected things.  But, I go back in August so I don’t have to wait too long.

We made some adjustments to my evening basal rate so my rates are now:

12 MN – 1.0
8 am – 1.2
2 pm – 1.0
8 pm – 1.6

Insulin to Carb ratios stayed the same:
12 MN – 1:15
7 am – 1:10
11:30 am – 1:9
5:30 pm – 1:9
9:30 pm – 1:15

Insulin sensitivity factor remains at 40 with my goal BG remaining at 120 +/- 10.

So, all in all, decent appointment.  I had emailed my CDE my CGM and Animas reports yesterday and told her about my nephew and that may account for some of the wonky sugars I’ve had over the past week or so.  She asked me when my appointment was and came over today to give me a hug and chat for a few minutes.  So nice.  I am really liking Duke!  My CDE and I have been in pretty close contact since I re-started pumping, I cannot say enough good things about her.  She’s awesome.

I had the PA write me a script for AccuChek test strips and he gave me a present of a shiny new AccuChek Nano.  I’m going to be calling my insurance company to determine exactly what I need to do to get my strips for free now that all of my out-of-pocket expenses have been met.  Hopefully what they told me last month about Accuchek strips being covered 100% is true.  And I have a good supply of one touch strips so should I ever need to use that meter for remote bolusing, I can.

On a personal note, I am muddling through with everything.  Staying busy helps.  My friends and coworkers have been so kind to me and I’m very happy that my sister and her family have such a strong community of friends supporting them.   

Diabetes Blog week – Day 1. Dear Doctor…

dblogweekBeing a new blogger I decided a great way to get more involved in the Diabetes Online Community was to participate in this year’s Diabetes Blog week.  What a neat idea!  I am looking forward to being challenged and to really have to think about the topics.  I am excited to become more connected with my fellow d-bloggers.  Let’s get started!

Day 1
Often our health care team only sees us for about 15 minutes several times a year, and they might not have a sense of what our lives are really like. Today, let’s pretend our medical team is reading our blogs. What do you wish they could see about your and/or your loved one’s daily life with diabetes? On the other hand, what do you hope they don’t see? 

This is a tough one for me.  I am generally a pretty open and honest person, including with my medical team (sometimes to their great dismay).  And, I really like my endocrinologist.  I am lucky that I live in an area that has some of the best medical facilities in the country and I have gotten in with an endocrinologist’s office that has a wonderful team approach.  I love this.  I love that everything is in the same office and every person I see knows my history.  I have had some not so nice endocrinologists in the past – whether they lack bedside manner or a personality.  I would try to crack jokes with my last endo and it was like talking to a brick wall.  I hated going to see her because she expected perfection and would get frustrated with me when my A1c wasn’t a perfect 5.8, or my fasting blood sugars were over 100.  She would act as if I wasn’t trying, when I was trying my best with the knowledge I had and really was looking to her to say “OK, we’re doing XY&Z and it’s not really working how we want it to, so let’s try AB&C and see how that goes.”  I got none of this with her, instead I received lectures about my blood sugars and weight, deep sighs, and I swear I saw her roll her eyes a time or two.  Let’s just say I was not heartbroken when we moved and I left her.

I think some endocrinologists think that in theory, diabetes should be easy to manage – it’s just a numbers game.  I understand you are a doctor and “science-y” and this is the stuff that you enjoy.  But, living with diabetes is much different than numbers on a paper.  With diabetes 2+2 does not always = 4.  I think it’s important for doctors to know how many variables go into caring for yourself.  How sometimes your sugar just does not want stay above 80 and how frustrating this can be.  How you can do one workout one day and your sugar will drop, while the next day it will go sky-high.  A lot of the care for diabetes is instinct.  Sometimes our instinct is correct, sometimes it isn’t.  We, as patients, know our body’s best and we know when something isn’t right.  Please don’t dismiss us if we have concerns.

Like I said before, I’m very happy with my current diabetes team.  I’ve never felt bad about having an A1c in the 7s (heck, it was 8.7 when I started there).  I like that they listen to me when I have concerns and ask me what I think we should do to improve my numbers and overall health.  I am an active participant in my healthcare.  I’m not perfect and they don’t get angry at me because of this.

I think that if I could send a message to all of the endocrinologists I would encourage them to let their patients be involved.  Don’t bark orders at us, don’t get angry at us, work with us, not for us.  Remember that there is much more to this disease than insulin to carb ratios, taking shots every day, testing blood sugars.  Diabetes is a 24/7 job and it continues for us in between those quarterly appointments.  And, for Pete’s sake, laugh at our corny jokes.

A love letter for my Endo’s office…

I am currently on a pump-cation.  (Got hitched, sick of being a cyborg, it’s ‘spensive).  I’ve been enjoying this pump-cation for about 8 months now.  However, since the Hubs and I want to create a small human, it’s time to get back on the pump.  I’ve decided to make the switch from Minimed to Animas as I’m a new Dexcom user and Dexcom and Animas are BFFs.

BFFs

Well, my Ping (I say this in my head like “BING!!” from “Friends”.  Oh how I miss that show.) is due to arrive today!  Yay!

However, my appointment to see the Certified Diabetes Educator to train me on my new pump is not until June 28th.  That’s, like, a million years from now.

So what does any pushy patient do?  I emailed my Endo and her PA asking for my last basal rates so I could get started pumping right away as I don’t want to wait 8 weeks to resume pump therapy.  I am so excited to see what results the Dexcom/Animas Best Friends Forever-ship brings me.

But, as well all know with diabetes, nothing is ever easy.  Doc responds to my email and does not give me my basal rates and says she wants me to wait until my appointment in June.

grumpy cat

I don’t think so.  So I call and complain and some how, magically, they are able to offer me not one, but TWO options for appointments this Monday.  Imagine that?!  So my homework for the weekend is to read over the manual and get intimate with my new Ping so I am fully prepared for my appointment on monday.  I’m mostly excited, with a teeny, tiny amount of sadness that I’ll now be attached to a pump again.  But, a wanna-be Mommy’s gotta do what a wanna-be Mommy’s gotta do.  Right?

However, I do wonder if the Endo’s office had these two appointments all along and it took me being a squeaky diabetic to get in sooner.  Squeaky D gets the new Pump?  Just goes to show that it can’t hurt to ask and those of us with chronic illnesses have to be our own advocates for our healthcare.

Also, side note.  I still need to figure out what to do for a pump case for working out.  I used to have a nice case that had a clip and zipped around the pump to wear while I worked out.  It was great because it didn’t bounce around (I wear compression capris so it holds firmly when clipped towards the inside), didn’t annoy me by riding up as I imagine one of the waist pouches/spi belt things would, and the fabric zipped around the entire pump protected it from moisture (I killed 2 pumps by sweating on them.  D’oops).  Of course, my awesome case is lost and it doesn’t appear to still be offered by Minimed.  Le Sighe.  What do you use for working out?