24w4d Viability and Type 1 Diabetes control

If you are more interested in reading an update about Tiny Fish then please skip down a bit :)

Diabetes and Pregnancy at 24 weeks:

I am starting to think that the first whispers of insulin resistance may be appearing.

My last two weeks - CGM data

Although in general, my blood sugars are averaging right on target (7.5 mmol), there are now some worrying patches where it is going too high for my liking (above 10 mmol). It's still brilliantly wonderful compared to the pre-pump, pre-pregnancy results, but now that I get tired so easily that little additional couple of mmols really makes me feel like crap. Tired, dry mouth, lethargic, and fuzzy-brained. What's more, if I sit at 10+ for more than 2hrs then I start to get a headache caused by the additional dehydration. Boo.

So here you can see the actual CGM readings from the last two weeks:

The raw CGM data plotted with each day as a different colour.

I was getting higher and higher reading overnight, even though they held pretty flat. Of course, nothing is guaranteed to last more than 3 days in Diabetes Land so I've started having 3am lows (note the red line) in the last 2 nights. Sigh. And I was just about to raise the overnight basals! Must be another growth spurt for Tiny Fish?

My Diabetes Nurse Educator (DNE) likes to tinker with insulin to carb (I:C) ratios first, as these are quite a quick tool to see if they are working. I think the breakfast I:C ratio is doing ok, by looking at that graph above, but it doesn't show you that I've been having to add 30%+ temp basal increases to claw my blood sugar back down during the morning for the last several days. I believe a gentle strengthening of that I:C ratio is in order. (Changed! It was 1:7g and I've just moved it to 1:6g - that may not sound like a lot but I would prefer to adjust things gently as low blood sugars/hypos really tire me out and I seem very sensitive to insulin changes.)

Lunch is definitely my nemesis. Look at that awful peak! Every colour goes up (with the exception of purple, whatever day that was??) meaning the I:C ratio is probably quite shot. I have just changed it from 1:6 to 1:5, and although I expect it will need to go further I still get very nervous giving a bolus of 5 units or more... so I will adjust the basal rate for lunchtime as well to provide a bit more of a gentle boost. Basals should start about 1hour before your want to see the result, so I will look at altering the basal from about 11am onwards thru to 3pm. I've just put it up from 0.675u p/hr to 0.7u p/hr. Not a great increase, but I will see how it goes and keep doing gentle increases every 3 days as needed.

Dinner is a bit of a moveable feast with the actual eating occuring anywhere between 5pm and 8pm. I don't really want to tinker with anymore basals or I:C ratios considering the changes I've made to earlier in my day, so will leave this chunk of the day until the next download. Best to change just a few things (or one! But I'm too impatient! lol) and know which change affected what.

Tiny Fish update:

Hooray for 24 weeks and "viability" - whatever that is. I take it to mean that should I (heaven forbid, touch wood, throw salt over shoulder etc etc) go into early labour then the medical folks would have a crack at saving the Tiny Fish. I very much like the idea that the outside world now considers Tiny Fish worth saving. I have thought him/her worth it since I knew she/he existed for us. It is interested now that I am Showing with a capital S how people react differently to me. My pregnancy has felt very real to me for a long time now, so it is strange to see how other people are just starting to catch on with the idea. I am now well over half way there, and I have been rather full of mirth this week when colleagues and students react in surprise when they ask "am I pregnant?" get a "yes, over halfway now!" in response. Hehe.

I have a nearly-flat belly button. This intrigues me, as my belly button has always been quite sensitive and now it seems to have lost a lot of sensation. I still have a waist, but only just. I can no longer wear normal pants and have been in maternity jeans since the day I bought them.

There is a little bit of reflux, but this is more from the fact that my stomach is getting compressed and I can no longer eat a huge meal. Even though I feel like the cookie monster and have an appetite that could crush mountains. It's a cruel irony that now I am "allowed" and even encouraged to eat more, I can't fit it in without reflux or terrible painful indigestion. My weight is now about 64Kg, give or take, and I still get a bit worried when I see it plateau or drop. Nearly 10Kg+ from my original weight of 55Kg.

The biggie is my leg. I have tried physio (4 sessions) and that seemed to help a tiny bit, but not really. Honestly, they don't seem to be able to help. When I went last week the physio suggested I try a stretchy type of maternity belt thing to try and hold my belly up and off the nerve in my hip. This works for about 15 mins, or until I move, when the stretchy band will roll up and try to cut me in half. I wore it for 2 days before ripping it off for good. The pressure of it squishing my belly was just too much, and I got a very good impression of what a sausage would feel like!

Today I had to take my students on a field trip. About 30mins before we were due to depart, I remembered that on this particular field trip there are very few places to sit. It would be standing for about 2 hours. I started to panic because at the moment I can't stand up for more than about 10 mins before the searing, burning, buzzing, icicle-stabbing pain goes through my right front thigh muscle. I can no longer wear shoes with a heel of any sort. This, I do not like. I spent most of the field trip propping my right foot up on anything the right height, looking like a flamingo, trying to take the weight off that hip. Not that it relieves the pain or anything, it just means I don't collapse.

I managed a gentle 20 min walk along the seaside walkway on the weekend, but couldn't walk back so Hubby had to get the car to collect me. This piece of exercise did me good and yesterday way brilliant with loads of energy. today not so great but that's cos I forgot my pre-natal vitamins!

So I have decided that the physio has reached it's limits. I will instead look at something for more whole-body relaxation, like a pregnancy massage. And I want to do more swimming and more gentle walks even though it hurts. The exercise does me good in the long run.

Depending on whether Tiny Fish is having a growth spurt (I get headaches, tiredness, and all over achiness +++) or not, then my sleep is either reasonable or complete crap. On the nights where I wake up multiple times with low or high blood sugars, plus a couple of times to pee, and then every time I need to rollover I "wake" exhausted in the mornings. The achiness is something else. Shoulders, upper back, hips, all my belly, and legs all aching together. On those nights I build a fort of towels and pillows in the bed and try to be careful with rolling over. Last night was pretty good, no towels or pillows necessary so I could spread out a bit, and just Sockington the insulin pump (in his snazzy blue sock) to take care of when I roll over. I never thought sleep would be such a complex drama. But insomnia sometimes grabs me when I am very over tired and that just makes things worse. The key is to go to bed early. Easier said than done!

Sorry for the ramble-ness of this post, that's about as coherent as I get these days.

Thank you to all of you who have taken time to post comments, it's lovely to hear from you! Even though I am not posting super-regularly I am reading all your blogs every day!

22w4d Shopping for baby hardware

I didn't expect to come buy a stroller and a capsule already. Really! We were just going in to have a look. I was relieved when we walked into the baby-stuff shop and saw only four strollers. "This won't be too hard," I thought to myself.

But then I turned around, and there were 20 more strollers and a whole wall of capsules! So overwhelming! Hubby, having some experience in this area before, saved my bacon on this one. He knew what he was looking for and he knew when he had found a bargain. There was a shop demo model (aren't they all demo models??) that was nearly half price and it had a matching capsule. Here's what we got:

Urban Escape II stroller

Urban Escape II Capsule

It all looks far too big for a newborn to me. I use the phrase "I have no idea!" multiple times per day when talking about baby stuff. It is all so foreign and new to me, so unfamiliar, that I want to learn more about it. Spending a lot of time looking at all the many weird contraptions for sale on baby-stuff websites. Trying to make tentative lists of the basic things I would like to purchase. Reading a lot of reviews and watching some YT vids of what items people found useful. But really, I won't know until we get there. Or rather, until Tiny Fish gets here. Lots of kicking in response to that!

My diabetes has been a bit naughty over the weekend and I think this is because there has been another growth spurt. I have gained 2kgs, so now +7kgs for a total of 62kgs. I am very glad to finally be gaining a bit of weight as I was very concerned for a while there. So I got a couple of highs and a few more lows, just more fluctuations than I would have like over the weekend. My diabetes nurse and I made some adjustments last week to try and bring the afternoon blood sugar levels down, so I know that will potentially have messed things up. And I got the traditional bad 2 day headache which panadol barely touches and means I have to sleep more. Long story short: I am thinking that maybe I am getting a taste of the 2nd trimester insulin resistance, or at least needing slightly more as my weight increases.

My leg. Oh geezjus my right thigh is painful. It hurts to stand, and now it hurts to sit and sometimes even to lie down. I cannot find any stretches which alleviate the buzzing, burning feeling in the muscle. Swimming used to give me about 40mins of bliss in the water, but we went for a swim on the weekend and even in the water my leg ached and burned :( Now when I touch the skin gently on my thigh, it burns and buzzes. Not good. I have another appointment with the physio this week so I will see if there is anything else I can do. She had mentioned I might need to wear a belly-belt to support the tummy, but that doesn't usually get prescribed until much later in pregnancy.

Today I feel really high. Sick, thirsty, like I have ketones or something which I don't. My blood sugar is pretty stable and level. I am just sitting at my desk waiting for class to start. I notice stress is doing this to me, as well as having an empty stomach: makes me feel sick. Just tired and exhausted. I'm sure I will perk up once I get into class though :)

21w3d Midwife appointment and HbA1c

This HbA1c result really blew me away!

Two lots of good news: my HbA1c is the lowest it has ever been. In fact, it's so low that I don't believe it, but when I think of all the hard work I have done working with my Diabetes Nurse Educator and learning about using the advanced pump features, I realise that it is justified. I am so very happy with this number because, unlike the last HbA1c test I had, this one is not caused by masses of low blood sugars. Rather this 5.4% has been achieved by massively reducing the range and fluctuations of my blood glucose results. When I used to get high-symptoms at around 15 - 20 mmol, I now get those symptoms at around 9 - 11 mmol. I have acclimatised to this nice, luscious lower blood glucose range and it genuinely makes me feel better (healthier, clear-headed) when I am sitting in the 5 - 7 mmol range. So that is awesome. I never expected I would be able to achieve this. Trimester two must have something to do with it as well I think, plus I have recently taken up swimming. And of course eating a really healthy diet for the Tiny Fish.

And speaking of Tiny Fish, my midwife visited this morning and in her words I'm "doing awesome." It can't get much better than that. My blood pressure is a lovely 100/60, and Tiny Fish's BPM is around the high 140s still. I am getting a load of movement (read: kicks and thumps. None of this "feels like butterflies" stuff haha) and when I told the midwife that I've woken up a couple of times with a rock-hard belly she said those were classic braxton hicks contractions. Already. With the movement starting at 16w she thinks it might be an indicator for an early arrival.... we shall see. I still haven't gotten the info I want about insulin pump protocols during labour for my hospital, but she promised to follow that up for me.

Other medical things on the to-do list in the near future include:

• another midwife appointment
• a second OB appointment
• am waiting on a retinopathy screening appointment (retina photos)
• I will get monthly scans from 28w onwards or so... Should get to see Tiny Fish a lot!

Oh gosh, I haven't done any belly pics for a while (scrabbles about and takes a quick snap of the ever-expanding belly-o-saurus) and..... here you go :)

A bright teal 21w3d Tiny Fish house.