Birth Story: part 1

It's been over 8 weeks since the birth of our daughter, the Tiny Fish. She is glorious and gorgeous and has the most delicious cheeky smile.

I've found a rare moment of quiet time where she is asleep, I am awake enough to type, and all is calm in our house. So I'm going to put down a really short and sweet version of my birth story. Before I forget too much.

My waters broke at 3am on 24/6/14. I drenched the bed, the bedroom carpet, hallway carpet, the Lino in the kitchen, porch hallway and then proceeded to flood the toilet floor too. I managed to clean the floor. Went and woke up my Hubby who took a second to click. I put a towel down and went back to bed.

Mild contractions started very gently half an hour later. They I had to get up and spend some quality time in the loo. Then I wondered how in hell I was going to get off the loo and not make another mess and wake my Hubby up again. I had time to download an app to time contractions. Good thing I did too as they were coming fast.

5.30am it was time to phone our midwife. 6.30am we phoned her again and said I wasn't going to be able to wait until 7am and we were gonna go up to hospital now.

We live just down the road from the hospital. I cursed every single one of the speed bumps on the way thru the hospital.

It had been raining. A friendly person in the corridor made a joke about it's gonna be a long night. Or day. We had no clue. Entering the maternity wing and this giant hug of warm air and weirdly soothing elevator music - which turned out to be the first morning alarm on Hubby's phone. We checked in and got room 4. G, a ward midwife looked after us until ours arrived.

Our mw wasn't there yet as she had to travel from a village outside of the city. Her battery went flat so she tried to jump start it and accidentally started a fire. She borrowed a car and it ran very low on petrol so she had to go back home and steal the lawnmower petrol. When she got there at 7.20am I was 9cm dilated already. I couldn't believe I was that far along.

Soon I was allowed to push. I never felt like I couldn't do it. I used breathing, saying out loud "relax everything" in between contractions, and etonox (gas and air). Looking back, I wish I had had an epidural. But nobody could have known what was coming.

Anyway, baby's heart rate was taking a few dips and not recovering very fast so my mw got me up resting over the back of the bed which seemed to help.

I pushed for 2hrs at which point my contractions started to taper off a bit. I personally thought this was delightful as I got a black spell of rest between the contractions. Empty painfree bliss. But apparently that was not good. My mw had me do nipple stimulation to try and get contractions happening with more strength and speed and it worked. But baby wasn't moving. She called in the OB who discovered that my baby's head was turtle-ing. A sign of shoulder dystocia.

My baby would need help. It's heart rate started dropping. The emergency bell was pushed and people flooded into the room. I felt calm under it all as I trusted those around me to take care of me.

First up the OB tried ventouse as baby's head had gone a bit crooked. The cap popped off a couple if times, so she moved on to forceps. And an episiotomy. Boo.

She was pulling so hard. Her foot up on the bed. At last I felt baby's head be born very quickly. And then all the pain of labour suddenly paled and was completely overwhelmed by this new thing which was just so big and massive I didn't know how to feel it. The pain was so incredible and multi faceted and discordant. I could feel my bones. Tiny Fish's shoulders were stuck. I remember writhing? Screaming noises I didn't know we're human let alone me. So high those noises. The OB working frantically. Eyes shut, open just for glimpses. The intense unbelievable indescribable feeling of pushing and actually feeling the resistance akin to pushing against a concrete wall. It was just not gonna move. The OB did the Woodward screw manoever where she had to get hold of an arm and spin the baby.

A huge movement and then the biggest physical and mental relief I've ever felt.

Tiny Fish was born arm-first at 10.29am. After 5hrs10mins of labour.

She landed on my chest and lifted her head and opened her black, disgruntled eyes and looked at me I will never forget that look. She was purple and wet and had hair that wasn't as black as I'd expected. The mw checked if she was a boy or girl. She was there about ten minutes I'm told but I kept blacking out so it felt like only 30 seconds. I have two memories of her on my chest: eyes and gender. My third memory is seeing her across the room on the baby bed where 3(?) paediatricians are working like mad over her with an oxygen mask. But I knew she would be fine cos she looked at me. And besides, what newborn can lift their head defiantly as their very first act? She did cry but I can't recall what it sounded like.

My husband. By my side helping me through. Together. Just being pure love. He always knew what I needed. I always cry thinking of what he went through that day, and the strength he has.

Tiny Fish had to go to NICU for potential breathing issues and hypoglycemia. I had brought along a small amount of expressed colostrum for her to have.

The OB was trying to sew me up. The midwives were massaging my tummy. There was blood on my thigh. Legs up in black leather stirrup things. Lithotomy position my birth notes say. Nurses were putting more IV lines in. Everything was hurting again. I was still having to breath through the pain. The placenta came but it was incomplete. I remember someone asking a nurse to measure the blood loss. 2 litres. Enough to warrant a trip to theatre to get stitched up. An episiotomy and a 3rd degree tear. When I asked how many stitches I had received later, the OB said she didn't bother counting.

Getting ready to go to the operating theatre was strangely calm after that. I got terrible shakes and said I was cold so they bundled me up in white. I had to shimmy across to another bed to make the long trip to the other end of the hospital. From the old wing to the new.

Hubby went out to meet my parents who had been waiting in the waiting room. Worried as they could hear everything. When he came back in the room he surveyed all the blood and fainted.

My parents met me as I was leaving the delivery suite. Tears and smiles and kisses and hugs. They would go to neonates and watch over their first grandchild.

Then there was the strange calm of being wheeled down endless corridors, fluorescent lights overhead. It was mid morning and the day was a drizzly grey winters morning. Fog and condensation on the windows. In pre-op Hubby couldn't come in so he went back to be with our daughter. My midwife was allowed to accompany me into theatre. I had 3 anaesthetists, one of whom has T1D and wanted to know all about my pump and Dex (diabetes stuff all went fine, in case you were wondering). The OB stitched me up and I woke up in post-op recovery so terribly thirsty. But content. I knew she was fine. I knew Hubby was with her. I was alive. I got what I wanted: everybody healthy and alive.

My mw came and said that she had arranged it so that I could be wheeled right into the NICU to meet my daughter again. I have never wanted to be wheeled faster. The urge to try and jump off the bed and hurry towards her. But I was so tired and heavy.

Euphoria.

She was in an incubator. Someone got her out and laid her on my chest. She looked up at me with bleary eyes. She had massive bruising from the forceps and ventouse. Her head was a beautiful round shape. Black eyes. And torn skin from the forceps. She still has a scar even now.

And then I was put into a room to recover. That will be the next part, cos the story is not over yet.

~~~Happy birthday, my sweet one. You are so wanted. Mummy and Daddy love you. Xoxo

35w2d CTG monitoring for suspected placental failure

Yes yes I know, there has been a major gap in my posting on here. Sorry to have worried anyone! I appreciate those of you who have given me a poke with the comment stick hehe. Basically all is fine. But third trimester exhaustion hit me and I've been dealing with insulin resistance (blood sugars kept creeping upwards). Every evening I thought of posting I would fall asleep!

Here are some pictures of what happened yesterday:

Hi Interwebs! Check out my belly!

Oh it hasn't been all napping and falling asleep in the armchair around here. Or struggling to make it through the last several weeks of work (only 5 working days left, folks!!!) Oh no! In fact yesterday things got all interesting again as I found myself back up in Labour and Delivery having the baby's heart rate checked out, to check for placental failure. Fun times. Don't let that smile fool you.

From about 24 weeks onwards I started to get insulin resistance meaning that my blood sugars would be slightly higher each day, and a dose of insulin which worked one day, would no longer be enough. The treatment is not difficult, but it takes a huge amount of observation and dedication and trial and error to get right. Especially since it has to be done at least once a week, more likely every 3 days or so: adjusting insulin basal rates up, making insulin:carb ratios stronger, and giving more corrections throughout the day (and night) when those two prior things weren't doing the trick.

Cut to Friday, my 6th to last day at work, and I was feeling like crap. Had an awful night with barely any sleep due to almost constant low blood glucose alarms going off. I must have drunk nearly 750ml of juice throughout the night! Plus now that I'm so huge, reflux/heartburn and belly/back aches have made my nights a bit of a living hell. If I could get away with just staying awake for the rest of this pregnancy, I think I'd take it as lying down can be most uncomfortable if I'm overtired.

I checked back over my blood glucose logs and noticed that my blood sugars had been dropping more and more from Wednesday through to Friday. This set off some mild alarm bells. It could be that because I was mid-34w that my insulin resistance was starting to wane, and that would be, from what I read, somewhat normal for the increases in blood glucose to plateau out a bit. But this was a drop. I was running -30% temp basals and still getting lows. I was drinking juice by the glass and needing more in half and hour. Not normal. Plus I felt like arse. So tired, so achy, got cankles. Boo.

After scouring the interwebs on Friday night and getting help from some lovely FB ppl, I decided to give things one more night and see if they would fix themselves. Nope. So Saturday morning I messaged my Diabetes Nurse Educator who promptly phoned my OB and they both wanted me in immediately for CTG monitoring just to check for placental failure (where the placenta has started to degrade and so the baby isn't getting the blood supply it needs). I once again felt like a silly fool traipsing up the road to the hospital when by all outward appearances I was well and good. But there are no maternal symptoms of placental failure so for once I was actually quite thankful to have diabetes - my blood sugar drop being a potential early warning sign! Yay for the silver lining! :)

A lovely little British nurse got me setup on the monitor at about 11.30am, and since I had told Hubby there was no real need for him to come and sit and be bored with me in hospital, I was left alone with the wonderful sound of Tiny Fish's heartbeat.

30 mins later she came back to check on me, and kinda hummed and hawed at the graph. She said that the heart rate was good, but there wasn't really much variability. It showed one "tightening" of the uterus, but didn't capture any braxton hicks contractions in the entire time I was there. She decided to leave the monitors on for another 30 mins. I rolled to my left side at her suggestion to try and wake Tiny Fish up, even though I thought baby was already awake with some gentle movement happening. This helped to increase the variability of the heart rate which was what the midwife was looking for. She said that normally this would be a perfectly acceptable graph, but with my diabetes and the low blood she wanted to see a "perfect" graph before letting me go.

It was really nice, one of the first things she said when she came in was "I've read your notes" (Wow!!!) and I see you are Type 1, I don't know much about Type 1 as most women we get through here are Type 2 or gestational. Tell me about it" Just, wow!!! That's so awesome to have a healthcare professional being so open and friendly, and genuinely wanting to know all about Type 1 and how I manage it. She was fascinated by the CGM, and kept asking me interesting and intelligent questions about how I deal with different aspects of my diabetes. She even wanted to check with me who she should call if there was a problem with the heart rate! (It was awesome that my OB was scheduled on shift that morning. I didn't get to see him, but I believe she checked the graph with him).

At one point I was on my own again, and I noticed that Tiny Fish's heart rate that had been sitting at about 144 - 146bpm was suddenly going 140, 139, 138, 137... I felt fine, but I checked my Dexcom graph and saw that I was indeed slipping ever so slowly low:

I had been in hospital for an hour and a quarter, right across lunchtime, and had no food. Lucky I packed a banana, muesli bar, mandarin, juice... My blood glucose meter was, as normal, slacking and only showed 5.5mmol (a no-drama number), and no alarms had gone off on the dex. So I decided to see what would happen for a minute. Not long, but it intrigued me greatly that the baby's heart rate would start dropping noticeably before I felt symptoms or got low alarms. Shortly after that, the midwife came back in and by that stage I felt it necessary to eat the banana. She too was interested, and of course insisted that I stay a further 30 mins. Gah. She also threatened me with a hospital lunch but I said no thanks I have plenty!

Another goodly wait and Tiny Fish got the hiccups. The were strong enough to be seen moving my belly, and through the CTG monitor they were very loud! They were so strong the monitor kept slipping to the point that I couldn't keep it lined up with my hand, and the CTG alarm started going loudly. So that, plus loud hiccups, plus dexcom alarms, plus my phone buzzing with incoming text messages (hey, I was bored!) and soon another midwife came quickly in to sort me out. She looked at the graph and decided it was pretty good. My midwife came back in and ripped off the paper print out and took it out to get checked, and then I was released!

I packed up and got all the jelly wiped off my belly. Walking back up the corridor I started bumping into folks from my antenatal class, another and another. What was going on? Oh riiiiiiight, this was the antenatal class tour of the labour ward! lol. I was starving (hey, a banana and muesli bar is NOT enough at this stage ok) and hubby was on his way to pick me up so I decided to flag the tour. But they were all like "oh is this where we meet?" "um, yeah, I've just been in here for monitoring, I'm not staying for the tour" "Oh! Are you ok???!" "Yep, got the all clear".

So it was the result I expected, no problems, and next scan is on Thursday. But since we live so close to the hospital it is worth getting checked out anytime I see something unusual. This week is my last week of work with handovers to all the new tutors (5 replacements!) and I have 4 official medical appointments, with a recommendation from the midwife to go for another CTG monitoring session after the scan on Thursday. Current thinking is that I will talk to my boss about working shorter hours this week as the exhaustion is just getting too much for me. Hopefully I can just work mornings??? We will see :)

Thanks for reading :)

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!

19w3d Swimming and sore thigh

Tiny Fish is somersaulting and kicking as I type this :)

I've been swimming twice with the insulin pump infusion site and Dexcom transmitter in. At first, on the weekend, I was worried about going untethered from the pump (would I go too high without insulin? Or too low with all the exercise. Answer = too low) and what the pool water might do to the adhesives or reliability of the Dexcom.

Turns out it was fine. My Dexcom has a whopping great piece of opsite Flexifix taped over it (with a little window so the transmitter can poke through) so the adhesive was really no issue. The infusion site (inset30) was at the end of its 3 days so was already a little worse for wear.

All in all it felt marvelous to be in the water and we went again tonight after work. Even with a banana beforehand I still drop between 4 - 6mmol in 40 mins untethered. But then I do climb to about 11mmol a couple of hours later. This rise is due to the lack of basal plus the emergency juice after the swim. Must try basal reduction prior to the swim itself.

In other news: OWWWWW!!!

My right thigh is hu-uu-rting! It gets tingly then goes numb on the main muscle down the front/outside of the thigh. Then it gets achy. Then the ache gets a bit stabby. Then my hip gets achy and stabby cos it feels all left out. Long story short: standing and walking hurt. Standing to take a shower hurts. Sitting or lying down makes it better. Even though I have a job that has many hours in front of a computer, I still do a lot of traipsing around campus and it's surprising how many people think it's cool to have long-winded chats in the hallway, standing up, with no chairs ready to rescue me!

I asked my OB about this when I met him the other week and he wasn't too concerned, just said to watch if it got worse. Well, it's definitely worse.

So I gave in and texted my midwife asking her advice. She thinks it might either be a pinched nerve or maybe a torn ligament in my hip. I am going to call a physiotherapist (I can do self referral which is quicker, but it would be pay out of pocket either way) tomorrow morning hopefully.

Oh and I had a quick unexpected catchup with my pump reps T and K today up at the hospital. On Saturday night I was having a headache, exhaustion, and lows. The Dexcom and the vibe (both of which had new sites inserted that evening after the first swim) took it upon themselves to wake me up no less than 20 times with various low alarms, false low alarms, error code 0, error code 1, calibration warnings, and reminders that the calibrations were failing. Bah! By 3am I gave up and turned the CGM functionality off both devices just so I could get some sleep.

An email to my rep in the morning and she offered to meet up and bring me a replacement sensor, and explain the error codes. Since they are normally in another city it was an unexpected pleasure to get to see both of them face to face. :)

And now for some devastating news. You might want to click away now if you're not in a particularly happy spot right now as this next bit is just utterly heartbreaking :(

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My little second cousin, a 10 year old boy, has just been diagnosed with a very rare form of cancer with a simply awful prognosis. He's already about to have his second surgery in a month, the first removed a strange lump and now that pathology has finally identified it he's been rushed to the children's hospital. He is not expected to out live his parents. Apart from some radical drugs in clinical trials, surgeries are the only option. Chemo and radiation don't really work well for this type. Our whole family is pretty much in shock and I would love advice from anyone about how I can best support my cousins at this time.

So, that's it for now. I don't expect to be posting many updates about my cousin as that's not really my story to tell. I'll just see how it goes and do what I can for them.

17w2d First Kicks

Our little Tiny Fish has made his/her presence felt. About 16w4d I felt what I thought might be a kick. It was not some subdued flutter or bubbles. It felt like a tapping finger, but inside. The most similar feeling I could describe would be if you tap the inside of your cheek with your finger.

A couple of days after that I was quite sure of what I was feeling and Hubby could feel it too!

Two nights ago I was doing a site change and I suddenly sneezed. I got a right strong internal thumping, and due to my excited yelping Hubby got a nice strong kick on the hand too :)

I'm now getting either kicks or rolling movements every 2+ hours or so. It gets easier to feel when I'm sitting up in bed, or in the recliner with my feet up, or wearing my pants done up (rare, now lol).

It's Sunday night and we've just had a lovely summer BBQ with my parents and the step kids. The two youngest go back to high school tomorrow, with it being the first day of secondary school for the youngest. Eldest step son has finished school and goes to college in April.

My first day of work is tomorrow and although Thursday is a holiday (Waitangi Day) I'm still not sure how I'll handle getting back into the whole work routine - I quite like being able to nap from 2 - 6pm if necessary.

Get to meet the OB on Wednesday, and Tuesday is a training day so it should be a bit of a wasted week.

I did my first ever basal test this morning. My diabetes nurse advised me just to have a carb-free breakfast I think cos she knew a complete fast would be a bit impossible for me - hungry pregnant lady raaaarrr!!! I had 2x boiled eggs, a spoon of peanut butter and a cup of tea. Looking back the peanut butter probably wasn't a good choice cos I went from 5.8mmol to sit around 10 for the entire morning. It was great to see how flat it was on the Dexcom, but I was frustrated not being able to do a correction. I think I should probably repeat this morning segment of the test just to check that the basal is fine and the pb didn't screw up the test too much. Oh well. It wasn't too much of a drama and I'm not worried to repeat it, it just too four mornings to start as I kept going low!!

In other good news, my good friend who has been trying for a baby for ages has just discovered she's pregnant. Very exciting to have someone close to me on this journey too!

I'm just so pleased that Tiny Fish is kicking away in there - it makes me feel so reassured and it just feels so, right. Before, all the weird machinations in my abdomen felt rather alien and strange. Now it finally physically feels like it has purpose.

Here is a belly shot for you. I'm tall, so I'm not sticking out much yet.

Slightly belated: 7w6d ultrasound

Sorry to keep you all waiting so long, my only excuse is that I have been exhausted. Like, take a nap at 3pm exhausted!

Great news: we had the "8 week" ultrasound done on Thursday 28th 2013 when I was 7w6d.

Here is a piccy:

The size of a raspberry? Kidney bean?

If you need help deciphering the picture, the line between the two little white crosses is the crown to rump length CRL 1.29cm, and the head is down with bum up. The left curve is the back, and the interesting fluffy parts on the right is the umbilical cord, and perhaps arm and leg paddles? Who knows. We saw a good heartbeat of 164bpm which the OB/sonographer said was right on target. She also looked a bit bored but basically told us that everything looks right on track.

I have never been so relieved to see some flashing, pulsing pixels in my life.

Hubby filmed it on his phone, so I will try and post the video up sometime too.

When the OB checked my ovaries, she said they were still quite swollen, and even asked if I had been overstimulated. They were big and empty looking. She said they were still recovering, but I hadn't expected that to take so long. Who knew the ER would be so damaging to them?

In other news, we had another chat about the ante-natal testing, and Hubby basically came to the conclusion that I will worry like a crazy woman unless I know, and I came to the conclusion that if it was really that important to him I could live with not doing the testing. End result is that we have agreed to do the testing including blood screening test and nuchal translucency ultrasound scan. I am pretty relieved about that. It means a great deal to me that should we find anything, I can have time to prepare myself.

Symptoms? Yes. Plenty.

Sheer and all-encompassing exhaustion is the major one at the moment. I am fine (sort of) and awake one moment, and the next I am the walking dead. lol. Mostly I can get through the day, but I am taking some serious cat-naps in the weekends.

No morning sickness. And that is the way I have decided it shall stay! There has been a little bit of mild nausea, but it's actually more like what I would describe as extreme hunger. As a diabetic I don't get hungry, like ever and this is because I am and have always eaten on a regular schedule. On the rare occasions when I have experienced hunger (from illness etc) I never really recognise it as such, and it instead feels a lot like a cold, slightly nauseas feeling radiating out from my sternum/high-stomach area. It's not an "I'm about to puke" feeling, and it usually goes away with application of noms.

I am sneezing a lot at the moment, not sure if it's hayfever or just irritation from the increased blood supply to well, everywhere including my nose that's doing it. It's tolerable but if it gets much worse I will have to look and see if I can take any hayfever meds... don't like my chances though.

Peeing is my new hobby. My record at night is 3 times. And none of those was caused by a low or low alarm.

Prunes and kiwifruit are my new best friends, as are bottles of water.

My diabetes is being...predictable. Well, almost. It's not terribly stable, in that I am going low multiple times per day (and night), but the predictability comes in the timing of those lows. They tend to happen about 2hrs post meal. My DNE nurse put my I:C ratios up for all main meals a couple of weeks ago when I was still having quite a few highs. At the time I thought the increases in I:Cs were a bit late, since I could already tell that my blood sugars were dropping. And now they are tanking multiple times per day, however the insulin doesn't kick in soon enough if I take it when I start eating (I know, I know, supposed to take it earlier!) and I am still getting a noticeable rise in blood sugar after a meal. Trouble is by the time the bulk of the insulin is kicking in, the food is wearing off and that's when I go low.

When I was last on the phone to my DNE she recommended that I eat a lot MORE food and a lot more fat and protein, especially for lunch. Well, I have been trying that for a week now. I feel stuffed to the gunnels most of the time and have regained half a kilo (after losing 1.5Kg in 2 weeks which is what got her so worried). I do get more hunger feelings that I am used to, however I cannot really handle eating this quantity of food PLUS all the emergency food I am eating/drinking to get my blood sugars up when they go low.

This evening I went to the supermarket to get three things: yoghurt, strawberries, and bananas. Smoothie time. Well, I pulled into the carpark and since my Dex was still on start-up, I did a quick test. 3.8mmol so I drank a juice, ate an afghan bar and decided to wait. The Dex and Vibe then both started bleating for calibration tests, so I did those too. My brain was foggy but not so foggy that I couldn't do a quick nip into the supermarket. I had a written list and I thought I had just eaten all of my food - turns out my foggy brain had completely forgotten about the pack of jelly beans in the globe box, as well as doing anything sensible like phoning Hubby. Sigh. My brain just gets super fixated on a single thing, in this case I knew that the supermarket had food, and I knew I needed sugar, so that's where I went.

Got a trolley to hang on to instead of just a basket, and started working my way slowly through the shop to get the items on the list. Note to self: do not shop while low. What should have been a $15 trip cost $90!!!! All manner of tasty treats found their way into my trolley! Whoops! Just before I got to the checkout, I started to panic a bit as the low symptoms were coming on really strongly. I must have been looking rather pale as several shelf-packers gave me weird looks. I headed to the drink aisle to get something sweet and fast. Ended up grabbing a bottle of lucozade which is 68g of carbs in a bottle, but no caffeine - I checked.

At the checkout, the woman in the queue in front of me was taking forever. Then she decided to pay using a credit card that wouldn't scan. The receipt finally printed and the checkout-chick tried to fold it up, got is scrumpled up, tried again, and again; there was lots of smiling and laughing amongst them while I contemplated breaking all the social conventions of supermarket shopping by ripping into the lucozade before actually buying it. I had my eftpos card out and ready. I was standing with both feet flat, the trolley wedged against the counter so that I could lean on it. Even in my hazy mind I knew that 3 point support wouldn't tip over! Finally I got my groceries scanned, paid for and bagged, and headed out to the car. Got things loaded in ok, all while the world wooshed and fuzzed around me. A bit of a mix between extreme tiredness and hyper-sensitivity to lights and colours. My brain slows right down and I must carefully check every thought to ensure that what I am doing is correct, will use the least energy until I can get more glucose in me, and will not be liable to draw unwanted attention to me. I am quite good at this (I think) so managed to do a moderate sized grocery shop on a blood sugar of about 3mmol (and it was still dropping at one point, with Dex alarms blaring!) all while no one around me was any the wiser.

Got that lucozade in me, waited, tested and as soon as my brain felt ok, and the test was over 5mmol I drove home.

Hoping to get my DNE nurse on the phone early this week to see what she suggests to sort this out. And eating more is not practical!!! I just do not have room!

Only a could of weeks of work left and then I will be on Christmas holidays. Yay!

Thank you to everyone who wrote comments on my last post with advice and support. I really appreciate you help :D

5w3d Panadol vs. Dex

I woke yesterday morning to the mother of all headaches. I knew instantly that it was going to be a long grueling day: my super-human sense of smell sniffed something like paint as I was waking up, and the headache decided to stay with me from 7am to 11pm.

Of course, I can't take neurofen at the moment, bit I didn't want to take panadol either as that messes up the Dexcom readings.

We had the step kids and they wanted to go to a gala day which was a beautiful, noisy, rowdy, fun outing except my head was killing me and I kept going really low. Hubby bought me a lolly kebab on a stick!

I slept fitfully most of Sunday afternoon, waking a couple of times for high alarms. At one point I woke up enough to check the tubing and found a massive bubble going right into the infusion site, so I unplugged things and primed. It dripped a few drops and then seemed to stop. With the bedroom curtains drawn, and bleary eyes, I couldn't see that I was actually shooting a thin spout of insulin across the bead spread! Oops!

By 11pm, and after every natural remedy I could think of, my head was pounding so I gave up and took 4 panadol - why that many? Because paracetamol normally doesn't work for me.

True to form, the Dex duly started to rise higher and higher. That's because it measures glucose molecules, but acetaminophen molecules look very similar to the Dex sensor. This causes false high readings. Very high. My meter said I was about 10mmol, while the Dex thought I was about 19.3! Let's just say I learnt how to disable the high-alarm feature pretty quickly. With the Dex and the Vibe pump both going mad at me every couple of minutes there was no way I would get sleep with them on.

Felt much better this morning, taught Monday class - always a drain that class - and tried to get away early but failed.

I did however get home in time to start calling midwives and OBs. Turns out the OB I want is private only, and costs nearly $4000!!! Although we could just afford that, it would be stupid as there are funded OB options available. I'll just have to make sure I don't get the one we had at the start of this IVF journey as he was strange and gave bad advice.

I did manage to book in my 8w scan with the private OB, as she has ultrasound equipment. I then had to email the fertility clinic so they can send a referral letter through to her offices, and that way it will be covered under maternity funding so free to us - yay! I just hope I don't like her too much :/ I'm checking with my health insurance to see if it covers obstetrics, but don't hold out much hope. I'm just going to have to accept the fact that I won't get the OB of my choice. Which sux big time since I've heard great things about her. Sigh.

The midwife was a more positive call. We left a message and she rang back after dinner. She is the first one I looked at, mainly because she stated in her online profile that she works closely with specialists. She took time with us on the phone and we will meet her early next week.

3rd HCG test is tomorrow. I don't really have any nerves about this one, as I've had so many symptoms. And no bleeding with cramping, or bleeding at all, which I take as a good sign.

Oh, did I mention that the gala day was held at the primary school where me, Hubby, his Dad, my Sister, my 3 step-kids all went? Yeah, it has zoning and we're not in the zone, but Hubby knows the principal and asked him if it's possible to put our name on the list anyway and we can! Talk about forward thinking! So exciting! I really hope this pregnancy sticks and goes smoothly, I am getting a bit fond of our little embryo!

9dp3dt Beta Eve

It hurts to sneeze. I know this as I have just doubled over after 2 mild sneezes.

The trouble? A combination of two things, one of which is directly related to progesterone and I hope can be solved with prunes. Sorry TMI. The other is new today: bloating/swelling of my tummy.

I got Hubby to come and inspect, and he agrees that there has been a significant change in the, um, density? Consistency? Of my tummy. What used to be soft'n'squishy is now much firmer and full feeling.

I have had cramping continuously today. It started off rough, as I didn't get a very good sleep last night. The Dexcom sensor insertion went horribly wrong in vampire-fashion and bled. It did hook up and start working, but then it decided that I didn't really need sleep at all. I got woken by the Dex and Animas Vibe low alarms no less than 10 times. Oh, and i wasnt actually low. Cue a very grumpy morning me. Almost didn't go to work as I felt so crappy, but since I'm taking half of tomorrow I thought I'd better get in there.

Class was good, but the bloody Dex decided to swing the other way and scream high alarms at me throughout my lesson. I had to keep apologizing for it. :(

Let's just say that between the lack of sleep, the suspense, and the physical pain I am in at the moment with the cramping et al., I was super happy to come home mid arvo.

Oh, but then we needed groceries, and Hubby and I cooked dinner together (which I love!), and then we both worked until late.

I'm in bed now, so should shut all this off and go to sleep!

Wish us luck for tomorrow! :)

I hope I hope I hope I hope I hope I hope I hope I hope I hope I hope we get a positive result.

8dp3dt Only 2 days to go!!!

I have spent most of the past couple of days wondering how to stop myself getting too optimistic.

A quick look at the website of a pregnancy-test company shows that I have several "symptoms" which could be good signs: fatigue (I'm getting very tired by 3pm, to the point where it is strenuous to remain standing for more than a few minutes), dizziness (mostly related to the fatigue, I think), tender breasts (could be the progesterone?), frequent need to pee (and I have unintentionally cut back my water intake due to teaching class - I am thirsty a lot though so must remember to drink more water!), cramping (again, could be progesterone), mood swings (not consistent thank goodness, but did you see my last post lol?) and, lastly, unfortunately: constipation (mild, but combined with cramping and progesterone and pre-natal iron means more fatigue). That is 7 out of their 9 listed symptoms.

Beta will be at 10dp3dt on Friday, which means it will be 15dp ER (egg retrieval and conception).

Many of the people around me seem more outwardly excited than I am. I am trying really hard to moderate my emotions and not get too damn soppy about all this, lest it come crashing down around my ears. I must remember that it is a tough journey for any embryo to make it, and that it is definitely not guaranteed at all. So, I seem to be spending odd and random snippets of my day trying to calm other people down. A lot. Like my delightful friend who tells me she has already started knitting!

At least my Mum, Dad and Sister are no trouble. If anything, they seem to be a mixture of stunned, embarrassed, delighted, and worried about the whole IVF process. Mostly, it is expressed as not asking questions and letting me do the talking. We have always been a family that doesn't really talk about taboo stuff, and you can't get much more taboo than the nitty gritty of reproduction!

Tonight I changed both my infusion site for my Animas Vibe and my Dexcom sensor. The infusion site change went well, although after dinner, and working on some coding project, I was pretty tired.

The Dexcom sensor change was a disaster. It stung when I inserted the sensor, and when I removed the inserter, I looked and saw a pool of blood gathering under the clear plastic. Boo.

Maybe it knows Halloween is just around the corner?

Initially it was just a spot of blood, but it grew quickly until it was about 1cm diameter: about the width of the sensor base.

I was distraught. Each sensor is about $125 (my parents are kindly funding them, and I was so proud of being able to make the previous sensor last 14 days) and they do not grow on trees. But my bigger problem is that if I have to replace it, I have almost no spare real estate on my belly!

With my dress still hitched up under my bra, and the little snap-off plastic doohicky that helps snap the transmitter in place still attached, I grabbed my Animas/Dexcom manual, and promptly cussed when I could immediately find the phone number. The Interwebs knew it though, and in no time I was talking to my Pump Rep at 9.30pm. She assured me that it happens, that I should put the transmitter in and see if it works, and email her in the morning if it hasn't hooked up by then. If it's still dodgy then they will replace it under warranty. Fantastic!

Thank you everyone so much for your kind words and support! I really appreciate it :D

2dp3dt The waiting is hard

Because my mind is playing tricks on me and my body is doing this that are unusual.

Yesterday (Tues) I went back to work. I park my car down the bottom of a big hill and it normally takes me about 2mins to walk up it. Well. My feet felt like they were made of lead, my thighs were aching, my tummy was crampy (not really painful, just tense and heavy feeling). I slowed right down and just had to concentrate on breathing to get up the hill and to my first class.

I spent yesterday with pretty good blood sugars, although now I have the Dexcom I'm definitely more discerning and I don't like to be above about 12 mmol for any length of time.

Today when I woke the crampiness was much reduced, and it stopped quite suddenly at about 11am today - the same time my blood sugar dropped to 4.9 which is the lowest it's been in about 5 days.

This evening my left breast has a hard sore patch, feels like a sharp bruise, so in short I have no goddamn idea what these hormones are doing to me.

I am maintaining my positive outlook and I seem to be able to work ok. I definitely didn't get as tired today and worked a full day, then freelanced until 9.30pm!

Still avoiding caffeine, and I have been resisting the temptation to go get a kebab and instead every night i am cooking vege-rich meals, which is actually making me feel good.

With the pump and Dex site changes, the 3x daily progesterone (600mg total a day) I have actually forgotten my prenatal vitamins twice in the last 4 days. Felt a bit bad about this, but since I don't have a time machine I just have to leave that guilt and remember the next dose.

This evening I went quite high 15.0 and sat there for a while. Boluses weren't working and I realized my site change as due this morning. So I did that and changed the battery for the first time also. Good news is my blood sugar has dropped to 10.5 now, but that took a ezBG bolus, plus a normal bolus just to kick things along, plus the +20% increase basal.

It's hard to know what is a symptom and what isn't. Google is little help, but I have been reading forums about implantation signs and it seems like anything goes. Cramping is both good and an omen, or just your body recovering from the ER and ET. Sore boobs can be a sign, or a coincidence. Fatigue, cravings, having a westerly-facing letterbox: according to the interwebs these could all be predictors of both implantation or not.

So I am waiting with a certain about of chargrin. It's kind of nice to be in this space where Hubby and I can know we might be pregnant, but science can't tell yet, you know? Makes it even more special.

The lab sent me the embryo photo. Hubby thinks its cute. I will share it with you after I get the initial results. As I said in the previous paragraph, it's kinda nice having something private in all of this. Gosh, my whole office knows what I'm up to. My close family, several of my friends, plus Hubby's colleagues and friends and family too! I like to think of it as "sharing the burden either way"

CD 15: Embryo Transfer day! 0dp3dt

Our Day 3 embryo transfer went perfectly. I am now - dare I even type it? - PUPO!

Since our appointment was at 11.10am, we didn't rush getting up. I woke at about 7.30am and made us both tea and toast (I am on caffeine free tea, but not being terribly strict about it).

We packed up the motel room and drove down to the lake for a walk. Since it's spring here in NZ, there are just loads of cute baby animals all around. Awww! I saw 3 baby pukekoes and a bunch of ducklings. In case you have never heard of a pukeko, here is a pic:

Source. These rather prehistoric looking creatures have enormous feet and live in fields and wetlands.

And that is not counting all the baby lambs and calves, and kid-goats and piglets I saw out the window on the car on the drive up!

Focus. Ok, so it went really well. When we got to the clinic I was busting, since they needed me to drink lots of water for the external ultrasound. We were shown to a room where I could get changed into the beautiful hospital gown moo-moo. Once again I clipped my insulin pump to the neckline, and we then found I'd cleverly left the Dexcom receiver down in the car! Poor Hubby had to race back down to get it. The embryologist and Dr G both came to see us, and nurse M gave us a gently-toned lecture about keeping my core body temperature after the procedure, and using the progesterone pessaries until told to stop.

We were led through to the OR with the spaceship door, and I had to walk right around the bed and climb on. The lovely nurse D was helping setup the bed with stirrups and towels and stuff, and Hubby took a seat to the left of my head. The ultrasound screen was, as before, to the right of my legs and then - I looked more to the right, past the hatch to the lab - I saw our one little embryo on screen!!!! The photo had been take yesterday when it was just a 6-cell, although the embryologist, M, had said it was now a great looking 8-cell. We only get to transfer 1 embryo since this is a publicly funded cycle, and even then I don't think anyone would be in a hurry to risk multiples in a Type 1 Diabetic woman.

Hubby and I were both shocked at this tiny little thing. Granted, it was magnified to be about 10cm wide on screen (only 125 microns in real life, we later learned) but it was amazing. I am hoping to receive a copy of the pic soon, will share when I get it!

Nurse D squeezed gel on my tummy and used the ultrasound thing to show us my (full) badder and uterus-squashed-flattish-under-said-bladder. She showed us where to look. Then Dr G came in and both of them laughed about how no one had told the lab that we were in here, and how there was some mild role-reversal going on with doc making the call to the lab and nurse working the ultrasound!

The doctor inserted the speculum and did something else, advising me I would feel some "mild tugging" on my cervix. Now, how am I supposed to know what that should feel like, eh? Anyway, to me it felt like a catheter being inserted - I could feel it go the length of the, um, journey into my cervix and there was some mild stingy/cold (very mild), mainly tickley sensations. Not unpleasant at all. Just weird as it was novel. This was not the real deal yet, so I'm now entirely sure what Dr G was doing, a test run maybe?

Next thing they were checking my name and date of birth again, Dr G checked the name matched the petri dish on the shelf at the lab-hatch. The lab tech then loaded up the catheter from the petri dish. I could see her peering under the microscope and taking her time/having a devil of a job scooping up the embryo into the catheter. She passed it carefully through the hatch to the doctor, I made sure to watch the screen and take a deep breath.

Of course, I was looking in the wrong place. I caught the "bright spot" out the corner of my eye right in the centre of the screen, but Hubby saw it no worries. It stayed bright for the time the ultrasound was trained on it, and Dr G told us that it was the bubble of liquid around the embryo that we could see.

And then it was over. I wasn't asked to lie down for an hour. I could get up right away and make my way back to the first room. Cue a stream of nurses all telling me to avoid raising my core body temperature, again. Nurse H, Nurse D, and Dr G all wished us best of luck and that they hoped it would work for us.

So that is that. We drove home this afternoon. I had a horrendous high blood sugar caused by a not so brilliant lunch choice, and that damn progesterone. Seriously, that stuff is an absolute nightmare for a diabetic, let alone one who is now supposed to be watching her blood sugars like a hawk! I am having to set a 20% basal increase for 2hrs every time I have the progesterone, although unlike an injection I never know when it's going to "kick in"! Arrgh!

Apart from that it's all good. Surreal, but good. I don't feel any different and it will be nice just to be calm for a while with no trips back to Hamilton planned for the near future.

p.s. So, you are wondering about the other embryos eh? Well, yesterday the second-best one was a 5-cell and had grown to a 6-cell today. They will culture it on and if it gets to blastocyst stage, then it will go into the freezer. The other one stopped growing at 3-cells. I kinda wished we had at least one more to freeze, knowing that we have had a pretty consistent 40% attrition rate all along this journey. Maybe my stim meds were not strong enough? Oh well. For now, I will wait and see what happens at the end of the 2ww.

p.p.s. Dr G said I have a small polyp on my cervix. Looks benign, but that sux.

CD 14: How many embryos made it?

And are we going to be doing a day 3 or day 5 embryo transfer?

Today was the first day I lost my shi*t in this whole thing. I had been getting dreams last night about the embryo transfer and so when I woke up it was the first thing on my mind. I woke at 7.30am, and then had to wait until "lunchtime" for the embryologist to call us with the news of how many embryos had made it overnight.

I didn't realise how attached I would get to them. Those three little potential-people.

MIL was preparing for her first open home so we went around there to help her prepare a bit, and we were just walking in from the garden when I heard a phone ring. I nearly jumped out of my skin and literally yelled at Hubby "PHONE!!!!" He looked at me like I had lost my mind - which I had - and politely told me it was my phone.

I answered, but in my nervousness I couldn't remember how to put it on speakerphone so we were head to hear trying to listen-in. T the embryologist was lovely, and said that of the 3, one of them didn't look so good today. But of the other 2, on looked great and the other was ok. She said "well since we already have our shining star, we will do a day 3 transfer, I have an appointment for you at 11.20am tomorrow morning."

I asked about whether it would be possible to get a photo of the embryos and she said yes she would note that down for us but we would also need to tell the embryologist on tomorrow as it will be her day off. Then I wanted to know if the clinic provided valium or anything for the ET, and she said no. I explained that I had read some things suggesting it would be good to relax the muscles, and she said "stop reading!! I have seen hundreds of ETs over 7 years and there has never been a problem like that" I felt very reassured. We thanked her once again for explaining things so well the other day, and then hung up. We were off to Hamilton again!

Every now and then the enormity of what we are doing just hits me. It is so amazing and scary and exciting. There is such hope. We have been through so many obstacles and although I am trying to think of this as "a chance at a chance" it is becoming more difficult not to get attached to those little embryos. I must try and think of this just as another medical procedure. Stay calm, as going nuts doesn't help and it just puts additional pressure on Hubby.

So we are now up in Hamilton. We have been out for a big meal and I have been writing lesson plans to send to the relief teacher who is looking after my class tomorrow.

Wish us luck. This is a surreal time.

p.s. my sister just clicked that she might become an aunt tomorrow! How cute :)

CD 12: Egg retrieval procedure

Please forgive me if this post makes less sense than usual, or rambles, as I am still awash with codeine!

Good news! We got 5 excellent looking eggs! I'm really happy with this and the embryologist said they all look the have good membranes.

By now, we may have a 7-hour-old! How crazy is that?

Started off this morning very early with a light breakfast at 5.40am (4hrs prior to OPU) and then napped until 7am. I got up, had a shower, got dressed and we packed up the car and drove over to the fertility clinic at 9am.

As normal we checked in and were given little slips of paper to take across to the other side of the building. Mine said OPU 9.40am (oocyte pick-up) and Hubby's said sperm sample! I told the receptionist that wouldn't be necessary or possible since Hubby had to have TESA sperm retrieval, but on closer inspection the form said "from andrology" so it must just have been a "defrost this please" note lol.

We were in the waiting room long enough for me to look through a couple pages of the morning paper, and then our old nurse came out to take us through to the Pre-op/post-op room with the armchair.

We got talking about diabetes and she told us how she has struggled with T2 and so has her family. It was nice to share with her, and Hubby showed her the Dexcom while I went to the bathroom.
Then started an onslaught of nurses, doctors, embryologists all checking my name and date of birth. I had yet more forms to fill out, and they must have told me all about everything at least thrice.
I was very impressed with the embryologist, T, who told us how she feels a great responsibility to take get time to search for the best quality sperm from a sample, since she is choosing the DNA of our potential future children. We asked her when exactly would the ICSI fertilization take place, and she said she would start the process at 2pm, carefully washing the eggs, then putting then in an acid solution to remove the outer membrane. She would then take her time looking for good quality sperm to fertilize all the eggs with. She reckoned that 2.30pm should be about fertilization time! :D

---- I had a break from writing, got a bit tired! ----

Anyway, after the doctor tried to come in several times only to find the nurse and I were busy chatting (she took my blood pressure too - slightly raised for me), she was finally able to put in the cannula for the IV. I only told her afterwards what a drama it was last time!

It made a lot of difference having a plan to manage diabetes, and having the medical folks take it seriously. I made sure that I remained calm (and I truly never got stressed even when I got locked OUT of the OR! Lol) as it can affect my blood sugars and make them drop rapidly.

Getting the cannula in meant that I could have IV dextrose should I need it, and having the early breakfast ensured I had a "buffer" in the tank. But the Dexcom was the absolute winner on the day. Hubby could hold on to the receiver and manage it, we even practiced with him testing my blood sugar via fingerprick test the night before. We made sure to tell all nurses and the doctor that the alarms might go off and not to panic. We were able to discuss with Dr G how she would give small boluses of 20% dextrose should I go hypo.

I was now in my stylish white hospital-moo-moo gown and I clipped the insulin pump to the neckline. I was told to go to the bathroom one last time, and then it was show time!

When I came out of the bathroom the pre-op room was empty, but I could hear Hubby's voice behind the big wooden spaceship theatre door. They were saying "push the green button!" and once I figured out they were talking to me, I let myself into the OR!

Setup similarly to when Hubby had his sperm retrieval, the bed was on the left and I had to walk around him at the head of the bed, around the ultra-sound machine at the foot, past the hatch to the embryo-makin' lab, and climb on from the other side.
The stirrups were padded, but they still freaked me out a bit. I knew that there would be lots of scary equipment in there so I guess I was prepared for it. I hopped up (carefully this time!) and the two nurses, H and P, kept wanting me to shuffle down the bed. I got my calves in the stirrups and they laid a large white towel across me and asked me to shuffle the bottom of my gown/moo-moo up.

--- got tired again and had some dinner! ---

While one nurse attached a blood pressure cuff to my right arm, and a blood-oxygen monitor to my left index finger (which kept slipping, causing me to adjust it, causing the nurse to scold me for moving my IV arm hehe!), the other nurse was placing black drapes over my legs to keep them warm. They unhooked the "bum" of the bed and suddenly the towel didn't feel like enough coverage lol!

The doctor appeared at the foot of the bed and asked me my weight, she then used this to calculate the dosage of midazolam and fentanyl. The nurse gave me these (and some augmentin antibiotic since I'm T1) and warned I would start to feel loopy. I got a rush of cold choking feeling all up around my neck and got a bit worried, but everyone quickly reassured me that would just be because the medication was cold.
Hubby was right by my side and kept his hand on my right shoulder. :D

The drugs took effect very quickly and I got loopy really fast! I was intent on watching the ultrasound screen - I really wanted to see my eggs! - but it was all mostly hazy. I don't remember seeing the hatch or hearing the embryologist to my right at all, although she was well within earshot.

I felt the ultrasound probe and then the doctor told me to take a deep breath and she went in for the right ovary. There was pain which made me wince, but it was over relatively fast. Two eggs retrieved on the right. I knew I'd seen 3 there the other day so my brain was still working, sort of. I was awake enough to make jokes and be surprised at how awake I was. The sedation was pretty light, but I was really loopy.

Another breath, now the left side. This one was a lot more painful, and it got worse in the seconds following the needle going in, a kind of wrenching movement. I described the nature of the pain later to Hubby as being similar to when you get an intra-muscular injection in your arm, well think of a wider needle, and then imagine you get a really bad cramp in the muscle the moment of the injection. Yes it hurt, but it was very short lived feeling and I got instant relief once the needle was out. I later learned we got 3 on the left side.

It was over! We had eggs! I was really happy to be through it, and to know that it was a calm, happy, exciting experience. Yes there was some pain but it wasn't too bad and it felt like it was only a total of 30 seconds.

It seemed like after all the activity, there was a lull for a minute. The doctor and nurses seemed to vanish out of the room (probably just out of my line of sight) and I recall a kiss with my Hubby and him telling me he loved me and how brave I was. It was pure relief.

Nurse H took my blood pressure one last time and then re-installed the end of the bed and helped me take my legs out of the stirrups. I was unhooked from all the monitors and the nurse put a pad in my knickers and then got me to slide into them while half sitting up.

Then came the slow ascent to sitting up, swinging my legs down to the left. They made me wait until I was steady enough to stand and then Nurse H helped me up and held me steady from behind by each upper arm as she walked me back to the pre-op/post-op room. I sat in the big armchair and she wrapped me up in one of those flannel blanket sheet things. Nurse P brought in a tray of tea, coffee for Hubby, and plain biscuits. The embryologist popped in to say there were a total of 5 high quality eggs retrieved. Dr G came in on a couple of occasions to check on me. Two nurses and the doc all explained on separate occasions how to use the progesterone suppositories which I have take for 5 days at least! Eew!

Oh, the embryologist wrote her direct dial number down as I have to call her at 10am tomorrow (Sat) morning to learn how many have fertilized.

She will also call us on Sunday to advise whether a day 3 or day 5 embryo transfer will be best. Looks like we will be back in Hamilton on Monday or Wednesday!

We waited about an hour then I was awake enough to leave and we went to get lunch at our favorite kitchen. I picked up the prescription for codeine and then we set off home. I took another 2 codeine tablets after the one at the clinic, but the ride home was fairly loopy and dozy, although we were both pretty happy about how well things went.

After the clinic meds and the initial Codeine wore off I got some sharp stabby cramps so took another tab. I have had mild to moderate cramps for the rest of the day, although not too bad. I can walk carefully but no long distances - by which I mean walking from the house to the car is plenty!

It was great to get home and see the pets. My friends and family were all texting me supportive texts, and after a yummy dinner cooked by Hubby, he dropped me around to my parents and my Mum cut my hair for me! Win!

Please cross your fingers, wish me luck, say a little something, or think a happy thought for good news from the embryologist tomorrow! Thank you! :D

CD 10: Blood test and trigger shot

I was full of beans for most of today even after the huge road trip (9.5hrs) yesterday, trying to get home from the clinic through a storm, floods, slips, bridges out, trees fallen over!

The fertility clinic had called yesterday and advised that I would need a blood test this morning (progesterone and something else...?) so I was up early, had my last Orgalutran injection, then it was off to the med lab to visit the vampires. I passed over my "regular fertility patient" card for the first time, and decided to get an HbA1c while I was there. The technician was really great and told me an awesome story about the last time she got stuck on the road after a crash involving, of all things, a molasses truck. Good times.

Work was alright and I taught my class fine. In the after-lunch session the nurse called to advise me of the exact time for the trigger shot (Ovidrel): 9.40pm tonight. Since the egg collection will be precisely 36hrs after trigger, that means our appointment will be 9.40am on Friday morning (CD 12).

Mid-afternoon I felt absolutely exhausted. Yesterday is really catching up with me! I went around to have a chat with my Mum, and the Dr G (who did the scan yesterday) called twice to give me advice about the egg retrieval procedure. I can't eat for 4, preferably 6 hrs before the procedure, and can't drink for 2hrs prior. If I go low I can manage things with small amounts of clear apple juice, but the doc would really prefer if I woke up early and ate a small breakfast (this would be at 5.40am). At one point she wanted me to disconnect the insulin pump altogether as she thought that would prevent hypos, but I quickly informed her that it delivers my basal and I can't take it off. She was cool with it once I explained the difference between basal and bolus doses, but man, I really hate when other medical professionals (especially well meaning ones I have only just met) make sweeping proclamations about Type 1 Diabetes management! She wanted to know what model of pump I had, cos, she said, if I had one of the newer ones with the cgm capability that would be better. Why yes, yes I do have one of those, and Animas Vibe with Dexcom CGM and it is fantastic. I should have done it ages ago. But hey.

Paracetemol (acetiminophen) is contra-indicated with the Dexcom, and the nurse yesterday had asked me to take 3 x panadol tabs before the procedure. Dr G confirmed that I could just skip that altogether as it would be far better to have Hubby able to monitor my blood sugars, and they could manage my pain with fentanyl and codeine... good stuff. Codeine normally doesn't cut pain for me, it only makes me loopy. And I have had fentanyl before with no pain so I figure I should be fine. I confirmed that they will have a dextrose drip handy should I go low during the egg collection, and to get the cannula line in as soon as possible. That's all I really wanted them to do. I did not want suggestions on the pump or anything, I can do that thanks, been doing diabetes management for 25 years, and now Hubby and I have the Dexcom it's taken it, in his words "from a dark art to a manageable science." Indeed.

Oh, and I also had to do an infusion site change, and a dexcom site change! I was working my way through those site changes methodically while Hubby cooked dinner, and it took me over half an hour. By the end of it I thought I was going to slide off my chair with tiredness, but a tasty dinner of fish cakes, bacon, eggs on toast worked well to perk me up.

I took a shower after dinner, and didn't hear any of the reminder alarms going off telling me to take the Ovidrel. Whoops! step out of the shower and the insulin pumps says 9.39pm OMG rush out dripping and rip the Ovidrel out of the fridge. I quickly prepped my skin with an alcohol wipe and stabbed it in no probs. But man, I could have thrown the whole schedule out of whack!

No drugs or anything tomorrow. We have been madly checking the road closure websites, and it looks like we should be able to take our preferred route up tomorrow afternoon. Although Hubby has also been checking the airlines to make sure we can take a flight should it all go pear shaped! I figure we are setting off the afternoon prior to our appointment for a 3 hr journey, that should give us enough time to drive even the longest way should we need it. But I have to teach one more class tomorrow before we leave. Thankfully I will only miss one class this week (I don't teach Friday's on this semester) and then maybe another couple of days next week if we get to embryo transfer. Fingers crossed. I believe I am calm now, but I suspect I might get more tense and nervous once the transfer takes place cos then it's just up to me.

CD 6: First Orgalutran injection

Did you know that they still used glass syringes? No? Neither did I, but that is how the Orgalutran is packaged:

Orgalutran is such a mouthful of a word. I prefer to call them my Orangutan injections, and Hubby and I startled the step-kids by hooting like monkeys last night when we were talking about doing the first shot. haha

Source Where you get all good orangutans.

This first orgalutran/orangutan certainly seemed to affect my blood sugar. It is a ganirelix injection, and here is what happened after breakfast (1 slice of peanut butter toast + tea = 16g carbs total)

Blood sugar reaction after breakfast and some tasty ganirelix / orgalutran

My headache is still here. Yes. I am now grumpy and tired of having this headache. It makes me useless. I went to buy a birthday present in town today, by myself, and it was a bad idea. The Saturday crowds, the noise, and soon I was scurrying back to my car to drink water and test my blood sugar and think calm, calm, calm non-headachy thoughts. And I have at least this many more of these orangutans to go!

I found this to be the most unusual injection I have ever given myself. And I like to think I am a bit of a connoisseur. I have been doing multiple daily injections since I was 5, so I've seen the sharp end of a few needles. This syringe, apart from being glass (first glass syringe I've ever used!) had a strange cap with rubber inside which I've never seen before. The needle itself was the gauge I like to class as "drainpipe". No mucking around here with dainty little teflon coated needles. No. This one was so thick, although it honestly truly didn't hurt, I had to push it into the skin! It went pop and then it was in. No pain, but then I had to draw back on the plunger to check I wasn't injecting into a blood vessel, then inject.

The other strange thing was how both the nurse and the instructions didn't want me to remove the air-bubble from the syringe. I really struggled with this one, and was about to hold the syringe upright and push the bubble out, but then remembered the nurse telling me "no don't worry, just inject the whole thing!" I came to a compromise with myself and injected so that the needle pointed slightly downwards and the bubble rose to the plunger-end. I injected so that about half of the bubble went in. There was a little hiss noise as some of the air escaped back out from my skin.

The headache continued through lunch with the step-kinds and MIL, and just got worse. I ended up giving in and having a nap before dinner, while the kind and wonderful Hubby cooked us all a tasty dinner of lamb chops and veges with cheese sauce. He has been absolutely marvellous, and keeps checking how I'm feeling. The other day he told me he'd like "to wrap me up in a blanket and keep me safe through it" Awww :D

When I was woken for dinner, the headache was so bad I thought I would have to take some ibuprofen. I can't take paracetamol (well, I can, but I don't want to) because it will interfere with the Dexcom and it just plain doesn't work. at. all. And there is such conflicting advice on the interwebs about whether it's safe or not. Seems it's a bit of a no-no when using gonal-f, and the previous RE said no ibuprofen. But this new doc and nurse didn't mention it as a problem. I've already had 4 x 200mg capsules since CD2 because the headache turned into a migraine and there ain't no way I can deal with that pain on my own.

7pm, dinnertime, and I had a new strategy. I would do the bolus dose of insulin earlier, and give a generous dose to stop any marked spike rise in blood sugar. Also, I had some 1/2 juice and water and just drank sips of it over the hour post meal to keep the blood sugar level. This has worked very well so far, and being stable, my headache has finally alleviated:

Above, you can see a little rise from the meal after 7pm / 1900 and then the insulin on board IOB starts to kick in and bring it down gently again. I have been monitoring it now for 2 hours and it's extremely flat! Win!

Got another letter from the fertility clinic, this one from our nurse. It confirms out treatment plan with the dates for specific injections and scans, but it also suggests that "expected week of egg retrieval: week of Sat 19 Oct 2013". I am wondering what will happen after our appointment on Tuesday.

We have a birthday party to attend tomorrow night, and on Monday I am supposed to be teaching a class. If I have this headache I will stay home and nap; it's just not worth tiring myself out, and I get so very tired at the moment.

CD 4: When the headache takes control

When I woke up this morning it was to in incessant bleep-blaring of an anxious Dexcom screaming that my blood sugar was low. Again. Two lows in one night and the result was my headache from yesterday growing super-powers. I felt awful this morning.

Some breakfast and out the door to work. Hubby offered to drive me in, which I though was a good idea since my head was feeling pretty fuzzy but it was live able.

At work things quickly deteriorated. I had a meeting and at the end of that I stood up and felt my stomach lurch: that moment when a headache takes on migraine qualities and suddenly there is aura, light and sound sensitivity, nausea, and head pain that is like a physical presence.

I got back to my shared office as soon as I could and downed some ibuprofen and a bottle of water. Blood sugars at this stage were thankfully stable at around 7 mmol.

I emailed Hubby to come collect me. I had lasted only until 10.45am :S

Once home, the neurofen kicked in and the pain went away. The pressure in my head was still there so I knew I had to be careful. I did some drawing and had lunch. Felt better. Read my book (great book! The Luminaries by Eleanor Catton)

And then I fell asleep in the armchair. I was awoken by the promise of junk food for dinner. :D

I've since brightened up and got a ravenous hunger for celery:



Nom nom nom. I love the watery fresh crispy taste.

Also I've just remembered that I should be not-drinking caffeine. Damn. Tea. I also looooove tea: black with trim milk and a spoon of raw sugar. Ooh so good. I'd bought a box of decaffeinated tea months ago and it tastes ok, but Hubby is very unsure if it's safe to drink. Being diabetic, there are very few tasty beverage choices. Juice is out (carbs), alcohol is out (I don't drink anyways), and milk is out (lactose doesn't like me in great quantities, plus, carbs). That leaves diet coke (yum, but caffeine and artificial sweeteners = headache material). Maybe tomato juice is the perfect option, but it just makes me thirstier. So. Water.

Oh, here are the pre-natal vitamins Im taking:



Left to right: Elevit with iodine, 1000 IU vitamin D (2 per night), 5mg folic acid.

That is all. Oh gawd damn! The Dex has just high alarmed again. I ate CELERY!!! (I should have eaten cake!)

My Pump Start Experience - Part 2

Pre-pump start preparation

Try saying that 3 times quickly. ha.

Following on from my part 1 post, here are a few more things I did to prepare myself for the pump training day and pump start. Here are my recommendations:

• Do the grocery shopping so you will have enough food for healthy easy-to-cook meals in the house for a week.
• Have a shower the night before pump start. Take your time, wash your hair. Enjoy your last "free shower" for a while. Recognise that the next time you bathe it will be different.
• Put all the pump supplies and stuff in a box to take to training. Take more, or ask your nurse if you're not sure what to bring.
• Because I wasn't given a list of what to bring, I needed a few things extra which I only learned about or guessed because of reading blogs. Take the following:
• Your pump. Duh. But my trainer said it happens. And in one instance a mother of a diabetic child asked if she had to bring her kid!
• Infusion sets, cartridges, lines.
• Your CGM.
• Sensors and inserter.
• IV Prep wipes (they have adhesive in them, as well as alcohol)
• Unisolve wipes (for removing sticky things, you won't need it immediately but it's good to have it handy. A must for getting adhesive residue off)
• Micropore tape (to tape the line to your skin in a safety loop. My first safety loop saved my pump from the toilet on the very first night!)
• Opsite Felifix tape. (Use this to hold the Dexcom on for longer)
• Scissors (for various tapes and packaging)
• A small bottle of hand-sanitiser (alcohol, I got one that has aloe vera in it)
• A notebook and pen.
• Your camera/smartphone to take a pic of your first site insertion!
• Pack your lunch the night before. Everything needs to be carb counted. I have been weighing things all week, and then looking them up on Calorie King. I also started writing the carb counts of food like muesli bars on the individual wrappers, and on the glad wrap of unpackaged foods.
• Aim to eat similar meals at similar times of the day for a couple of days prior to the pump start, so you know what those foods should do to your blood sugars.
• Record your blood sugars in as much detail as possible to get a good "before and after" picture.
• Preferably earlier than the day before pump start: get your HbA1c, get a general medical check done, go to the dentist for your checkup, take your vitamins (if any), stay away from sick folks as you don't want any unplanned sickness while you are learning the pump.

Pump Start Training

My husband works from home mostly, so he was able to drive me to the pump start day at the hospital. There would be two of us being trained by two different pump reps for both Animas and Medtronic. I also knew my DNE would be there.

Well, there were 9 people in that room when I walked in! Me, the other diabetic woman, our DNE (1), two more DNEs (2 + 3) who wanted to learn more about T1 and pumps, two Animas pump trainers and two Medtronic trainers. Plus our endo popped in at one point. Plus me makes 10. There were a total of four diabetics present. The most I have ever experienced as an adult.

I put my huge box of stuff on the floor and started pulling out my Animas box. I felt rather self-conscious as 9 pairs of eyes watched me, and I must say that the other T1D's face was fixated on my pump box. She had the Minimed Paradigm plus their CGM. I opened my box and showed her my pink pump, and I may have detected a little envy? Maybe a little consternation that she had not been offered this pump choice? Or that she had been counselled away from it? Who knows. I could be reading too much into it. Could have just been nerves.

We started off by going over the rough schedule for the day, and introducing everyone. I introduced myself and explained what I did for a career. Our DNE gave us some initial instruction, and we were given out basal rates, I:C ratios, ISF, and BG targets for the first day.

Then we split up into two camps to complete basic training and installation. I can't speak for what happened in the Medtronic training as I didn't see any of it, but everyone was pretty friendly - and nervous! The anticipation! Wow!

I had my Animas trainer, T, and a new Animas trainer, K, who would be doing his very first training session with me. I felt fully fine with this, as T was obviously going to be helping out and watching closely, and I had so many nurses and diabetics to hand that I knew I would be looked after well. One of the other DNE's also joined us, as she (I think) specialised in T2 and wanted to upskill by learning about the pump.

The Animas-camp moved into a smaller room, and K explained that the first thing we would do was install the infusion set, to "get it out of the way, otherwise you won't be able to concentrate". Very cool! I was given a training manual and then we were into the practical stuff.

Very quickly, I learned that humour and nodding and saying "I understand" would be the quickest way through this. Since I had watched so many videos of people doing site changes, there were few pieces of brand new information to me. I had a good overall idea of what was going to happen, and just made sure to ask questions as they occurred to me. It's just, things seemed to take so long, and even when I nodded that I understood, K would still have to explain things in full to me. I expect that as part of the routine there are various things that have to be explained ad nauseum for legal reasons. But it's a small moan really, as the trainers both said I was doing really well all the time.

Best bits

K had two demo pumps, plus I had my real one. Nurse S was offered one pump to use and K took the other. After putting in the battery I learnt how to set my basal rates into the pump and review them carefully.

We started off with washing hands and talking about keeping surfaces and hands clean. And then it was time to put in my first ever infusion site!!!

Looking ever so slightly green, K announced that he would put in a site on himself which surprised me a bit, I was expecting only to be guided through it. I suggested that instead of him doing the whole thing then asking me to repeat a long bunch of steps that rather we do it together step-by-step. Hey, if it works for my students, it should work for me too! hee! They liked the idea so K took a blue Inset 30 inserter, and I took my pink one.

He showed me how to open the inserter pack, and suggested I hitch my skivvy up under my bra so it wouldn't fall down and contaminate the site. I used the alcohol wipe to clean my skin in a spiral motion. And after watching K carefully as he inserted his blue site, it was my turn. I decided that if I just did it, then it would be done. If I screwed it up, so what? I could just try again elsewhere. So I put the little feet of the inserter on my belly, pushed a little bit so the skin bulged, and then squeezed the release trigger. It shot the needle down into my abdomen at an angle, and I sure did feel it go in. But it wasn't super painful. Nowhere near as bad as getting an intramuscular immunisations shot in the arm, for instance. It was worse than a pen injection due to the speed and force, and I think I was quite tense which made it worse. But it was more the force I felt, not pain. The closest I could explain it is if someone pokes you with a wooden toothpick hard but quickly. Overall I was surprised at how quickly it was over and how very little it hurt. In fact I couldn't feel it at all after about 15 seconds. After about 30 seconds, a wave of a dull ache started at the site, the feeling you get when there is something sharp sticking in you, and if you move too far or too fast, it will really hurt. But I wouldn't classify it as pain. More just a warning of potential pain if I moved. I was also quite tense and since I was unsure about how it should feel, I took great effort not to knock it or move my belly muscles.

But it never did get any worse and before I knew it, it was right on to doing my first cartridge fill with a demo cartridge and... "Pretendy Insulin" so labelled because it is in fact an old Novolog vial filled with tap water! This was T's sense of humour and it takes the prize for the cutest thing of the day! :)

After the demo cartridge, it was time to do my real cartridge, with real insulin. Suddenly I was a lot more concerned about the bubbles! K kept telling me to hold the cartridge upright and flick it around in a swirling motion, but I must have been doing it wrong lol. I just wanted to fix it the way I knew works best, from years and years of MDI with syringes!

I loaded the cartridge and then attached the line. And before I knew it, I was pumping insulin. It was all so delightfully easy and pain-free that I couldn't help smiling a huge smile and taking a photo:

First pic of my first infusion site and pumping insulin for the first time evah! I'm sitting down that's why my tummy looks so odd. lol

Worst bits

[I didn't really want to write this bit, mainly because I know one of the people involved has access to this blog. Isn't that always the way. You find yourself censoring things to protect folks in real life. Well, I figure if this is to be an accurate record then it should be honest. The person involved, I'm sure, would be the first to admit that we both have strong personalities, and that we have all made up and are fine now. It's not identifying. But it did affect me terribly at the time so I have decided to write it down. It it's you, well, um sorry? Hey it happened and it wasn't exactly a private exchange...]

After all of the adrenaline of the morning, and after afternoon tea and a second session of training which covered setting all manner of things on the pump, we gathered together in the big room before lunch. We had covered a lot of stuff including putting on the Dexcom, but not boluses. It was the one thing I was suddenly getting some urgency about because lunch was coming up. Earlier in the morning, DNE 1 had asked when we should break for lunch. She suggested 12.30 or 1pm. I raised my hand and suggested that maybe the diabetics should decide, as I ate at 12noon. Well, lunch was late. I was edgy, and in the pre-lunch gathering DNE growled my trainers for not teaching me boluses yet! However, I knew more about the CGM than the other "team" as it turned out. It started to get quite competitive and I did not find that helpful one little bit.

Lunch was short, because.... um the morning session ran late, but for some unknown reason they couldn't give more than 20 mins for lunch??? Anyway, I texted my Hubby to come and pick me up so I could have lunch at home. He was a the front doors in a flash and once we got home (like a 60 second journey! They wouldn't let me walk home!) I heated my lunch, did tests, and discovered that the Dexcom 2hr warm-up time had just finished. So I got distracted, but in a good way! I tested and was low. 4.3mmol/L. Sh*t. Normally I would eat my lunch and have juice and test again some 15 mins later. But I had to get back to training. And I had to use the pump to deliver my insulin according to it's software and algorithms. So I hoovered up my noodles and kiwifruit, and tested again as late as possible. But not long enough, only 10 mins. I was still low. I decided to work out a dose on my iPhone app and just give that manually.

Well, when I got back to training I was going a bit high. Only 12 or something. Not much. But enough for DNE 1 to scold me out in front of everyone and ask my why I had done things the way I did them. And basically tell me I made the wrong decision not to just trust the pump. I was recovering from a low (which she had been made aware of) and was super stressed and nervous about the whole process of changing to the pump. I started to get emotional and I could feel the frustration and anger and tears welling up. When I go low, I lose my words, and I often have an inability to form my thoughts into coherent sentences which actually mean what I am thinking for up to 15 mins post a low. I get severe lethargy and a semi-wet-concrete brain for up to a couple of hours post a low. I was not in a good place to be called out on something as basic as an insulin dose at that moment. I just told her "I can't take this right now!" Thankfully, one of the Medtronic trainers who also happened to be diabetic piped up and said some soothing comforting things, and smoothed things over. I made sure, once I understood where my feeling came from to tell DNE that I understood what she was trying to say to me. I know she was just trying to look after me, but her manner was rough in that minute.

And what were my feelings, you ask? Well, I had spent so long preparing and thinking about the physical aspect of being attached to the pump, that I hadn't considered quite how dramatically it would affect me emotionally.

Having to give over control, completely, to a machine.

In my 25 years with T1D, most of the time either it's been my parents or myself in the driver's seat. I have been working out the carbs, dosing the insulin, and organising all the appointment and treatment since my teens. Giving even part of that up was hard. Once I had had that shown to me, I could actively manage my emotions and make strategies to deal with the changeover. Such as just treating the new pump as an experiment, one that although not without risks, was done in a semi-controlled environment with lots of people around me to help. I would be ok. Suddenly, it seemed do-able.

Things I didn't expect

• How NOT painful site and sensor insertions would be. Just do them calmly and quickly so you don't tense up. No big deal.
• How much I was unprepared for the giving-over of control to the pump.
• How useful all the video-watching and prep I'd done would be. The training is a blur to me now, but it was helpful to see things in real life and to pull and the bits together.
• How emotional it could get.
• That my DNE would expect me to run at 4.5 all day. Both the other trainee and I went "you've got to be kidding!" but she assured me it would be fine. And she was right.
• To have all those people in the room.
• How unsupported I could feel at times.
• How very strange it would be to spend a whole 2 days dedicated to diabetes AND NOTHING ELSE.
• How weird it would be talking to nearly complete strangers about my most personal and intimate moments and choices with diabetes.

What I wish I knew before hand

• It's quite possible to wear the pump so no-one knows.
• It also possible to be so comfortable with the pump and dex that you forget you're wearing them.
• It's super fantastic to have another method to measure my blood glucose, and the Dex certainly gives the crappy Caresens N-Pop a run for it's money! On the very first day the Dex caught multiple lows that the meter didn't show up and I didn't feel. Being able to take preventative action to both lows and highs is amazing.
  Don't expect to come down from highs really fast. Generally I am finding that if I go high (above about 11) then it takes about an hour before I come down, but the drop is more gradual. IOB is excellent and prevent the never-ending roller-coaster of glucose fluctuations.
• Taking a shower is different, but not bad. It just takes more planning (taping etc).
• You will still need to be your own advocate for your health, and to take charge of your diabetes.
• But... it's important to listen and allow the trainers and DNEs to take care of you.
• Involve your partner, spouse, family, etc as much as possible, and don't be shy to share what you have learnt with them. They are probably quite affected by the whole process and they may be more scared and nervous than you are. Clear communication is very important!
• Drink lots of water. You can actually see the action of water as it dilutes your blood sugar on the Dexcom graph!
• That I would get a 2-day migraine from the sudden drop and stabilisation of my blood sugars. Since panadol (acetaminophen) is out of the question with the Dex (and is useless to boot) I had neurofen (ibuprofen).
• Just how much it would take over my brain. I can talk of little else, to the point where I can be concentrating on a conversation and then I'll just say something totally out of context like "it's really cool being bionic, here let me know you..."
• How many different names for pumping there are: robot-parts, android, cyborg, bionic. And people's funny responses to seeing the pump first time: "so, you don't have to inject or test your blood anymore?", "oh that will make things so much simpler for you!", "can you be hacked?", "I'm a tax-payer, and you are now my tax-payer funded android. You are a terrible android since you won't grade all these students' assignments for me!", "I think you will be the first to reach the singularity (where the human mind can be uploaded to the computer. It was followed by raised eye-brows when I informed them how I had been already uploading my data", "ooh! Biometric data!".
• You can do this!

My thoughts now

At the time of finishing writing this post, I have been wearing the pump and dex for 10 days. I have done 4 site changes and one dex change.

I am now very comfortable wearing both, and I have developed a habit of flashing people my belly to show them my cool new robot parts. I even showed an entire class. It prompted a really good discussion and they were all so curious.

As each day went on, things got easier and more familiar. I was at first very tense, both physically and emotionally about having the devices attached, but as I learned to relax into it, things got easier. I treated each new activity as a challenge: first night with the pump, first day back at work, first bike ride, first unbroken sleep, first pump low alarm, first class taught, first shopping trip for clothing, wearing the pump in as many places as possible, stretching (that took me a while! I thought it would hurt lol).

The Dexcom is AMAZING and if I had to pick just one device, it would be the Dex all the way. The pump is allowing me to achieve flat lines in my blood glucose graphs like I've never seen before in my life. With these two devices I am finally able to spot some trends and patterns. When I start to go low, I know roughly how fast I am dropping and how low I am currently so I can take an appropriate amount of juice - not too much.

I am really loving the stability and control I have gained.

My husband keeps telling me he can't believe how much energy I have now. And my semi-continuous headache has finally lifted (you know, the one you get from bouncing between 2 and 20 in a day?)

My family, friends, colleagues and students have all been loving, supportive, or curious. I have not had anyone be negative about it, and I have been able to talk about T1D a lot in this past week. That has to be positive.

I am downloading all my data nightly and uploading it to Diasend. So far I am averaging about 92% in target range. My target is 8 and that is my average reading both from my CGM and blood glucose meter.

For the future

I really hope that this will mean excellent control as we head into IVF soon. It will only be a couple of weeks away now, and we got some more good news: the AMH test came back at 15.35 mmol which is firmly in the green! I was worried about this, but things are all lining up as best they can.

I am really excited about this huge step in my life. Overall things are going incredibly positively, and the pump and CGM together are like having my eyes opened after being blind for 25 years. It's going well. If you are considering doing this, I would love to hear from you. If you have tips and tricks for me - yes, you should so email me! I need to know all your goodness and pick your brain please?! :D thekaitakeblog @ gmail com