Tuesday, March 25, 2014

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!

1 comment:

  1. I can't imagine navigating pregnancy with the added complication of diabetes. I'm glad that it's been manageable so far and I hope it continues to be. Yay for viability and the continued thriving of tiny fish (have I mentioned I love that nickname??)!