Sunday, July 11, 2010

Feeling Low About Highs

May 4

Despite writing the effing book on pregnancy and diabetes, my blood sugars have still soared throughout the last eight weeks.

I just saw my Kind Endo and high risk OB on Friday, the first visit of this pregnancy. The OB did her ultrasounds, said I was measuring right on time (7 weeks, 6 days), and both she and the endo took a lot of bloodwork.

That morning, I printed out six weeks worth of Dexcom readings, and a day-by-day printout of the last week.

Things looked OK, but you could clearly see excursions. I tend to bolus now and bottom out later, so I’ve become more acquainted with juice boxes and such. I’ve started buying big jugs of juice to have on hand when I just don’t want to futz with poking the puny straw in the right place on the top of the juice box while I feel like my knees aren't going to support me.

This weekend, Kind Endo told me to stop bolusing before three hours were up, to religiously test my sugar before a meal, an hour after, and to NOT CORRECT A HIGH until three and half hours after that first (15-minutes-pre-meal) bolus.


I hated it.

My sugars soared and while they were in line a few hours later, I hated sitting there watching my CGM sit in the 200s, or the 300s, for more than an hour at a time.

Just now, I heard back from Kind Endo, and she wants me to reduce my breakfast and lunch insulin-to-carb ratios by one. Frankly, I will probably continue to correct post-meal highs, if they continue, immediately after a meal.

Despite my angst, my A1c dropped .4. It’s well in the fives now.

I don’t say that to brag, though, but to point out the obvious: what does it matter what your longterm averages are if you clearly see potentially-damaging highs at least once a day? Wearing a CGM has pointed this out even more obviously than pricking my finger 15 times a day ever did before. I've recommended the Dexcom to several others, but it certainly has added to my anxiety during this pregnancy as well.

I constantly think of the stat I cited in my book: conceiving with a high A1c means your chances of having birth defects are 30 percent. That means 70 percent of those people will deliver healthy babies. The irony is that my A1c was exactly where it should be, but I still have these daily highs.

I also think about one woman I tried to interview for the book. She carried several children at once and delivered all of them, but she told me diabetes was the least of her concerns while carrying that many kids inside. She did what she could, but she was very lucky because her sugars were crazy and her kids were all born healthy, so that she probably wasn’t the best person to interview for a book about healthy pregnancy and diabetes.

It’s not right to focus on this, but it comforts me when I see a high blood sugar that isn’t budging fast enough.

[Added on July 11 after I wrote this original post: It's also possible to get my sugars to drop faster when I can jump on the elliptical trainer we have at home immediately after I see a post-meal sugar rise. But that isn't always practical, and I usually need to stay on it for a good 30 minutes to see a drop. (Again, the reality of wearing a CGM.) Sometimes I'm driving in my car immediately after a meal, or have to deal with my kid, or have to do some work. Or something.

It makes me angry that insulin isn't instantaneous. This should be a much bigger issue, in my opinion, than other issues that diabetes advocates talk about. Where is insulin that works immediately? As in, doesn't need to be injected early to mimic the absorption of a meal with carbohydrates? Doesn't need three hours to bring a high down? Who out there is with me?]

ON the other hand, I think how awful it would be to have an unhealthy baby after I’ve just written this go-girl pregnancy guide.

Just by writing that makes me think I might be tempting fate.

I really, really hope I am not.


Rachel said...

That's one negative about CGMS, too much information, huh? Almost too much.

I suppose we all have our own wants and needs regarding diabetes care regimens. I don't find meter accuracy that important compared to fail-safe measures for insulin pumps or getting more endos on board with CGMS. (They seem to be all about it in more urban areas, but the further out, trust me, they're not - my husband's endo in Boulder doesn't think they're worth the insurance battles.)

But those are issues I directly deal with in regards to my husband. I also try to think wider in terms of all people with diabetes, rather than our little household, especially when it comes to the affordability of test strips. There are plenty who see meter accuracy as an important issue and I respect that.

I did struggle over Roche paying my way, but I honestly cannot see anything negative about what they've done since their last meeting with the online diabetes community - perhaps baby steps but better than nothing, right? Face-to-face communication with the rest of the online diabetes community was extremely valuable to me, something that would not have been possible given geography and economics without Roche, though. (Oh, and our insurance considers LifeScan their preferred product, so we don't even use Roche products in this house.)

Antropologa said...

You and your doctors are staying on top of it. You have a lot of knowledge and experience. I don't think you are tempting fate--just learning more. Good luck! Sounds frustrating.

Flmgodog said...

I feel your pain...

DiabeticType1 said...

Eurgh I totally agree with the instantaneous insulin point! I never realised how frustrating it was or how long the insuling actually takes o work until this year (when I started getting managing my diabetes a lot tighter to start trying to get pregnant). It makes total sense to have something that just works **like that** Hopefully one day eh?xxx

Annie said...

I'm sorry you're having a hard time, can only imagine the heavy burden you must now feel as the person who wrote the book on diabete and pregnancy, but as you know all too well, sometimes we can do everything in our power and still get numbers that don't make sense... I'm right there with you on that right now, and know how frustrating/scary it is!! I hope it gets better.

diabetic neuropathy symptoms said...
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Anonymous said...

I also totally agree with the instantaneous insulin point! I noticed while I was pregnant how long it takes to bring blood sugars down after a high. FORGET it if you are high AND you want to eat at the same time AND you are pregnant so you're hungry! But then there were the old day that were much worse (Regular insulin, need i say more).


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