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 :)

29w4d Scan and stuff

I am on a two week mid-term break from work at the moment, so no teaching. But there are so many appointments and baby-things to do that it's not exactly a restful time either. I will try and put this down in the right order but things are starting to just become a big ol' blur!

Since my last post the weekend before Easter (when I got sent to labour and delivery for a minor bleed on a Sunday night 13 Apr) I took the Monday off work to rest up and recover, then on Tuesday morning I phoned my diabetes nurse educator (DNE) and told her what had happened and do a pump download. She promptly got me an urgent appointment with both her and my OB for Wed 23 April. She saw that my blood sugar levels were too high (averaging about 10 - 13 mmol/L semi-constantly) and was worried that this may have contributed to the bleed. She also saw that the tests the midwife had taken on Sunday night hadn't been entered in the hospital database and asked me to pop into hospital on my lunch break to re-do tests including a complete blood count and urine test for infections.

The Wednesday appointment was good, if for no other reason that getting two of my 3 medical care team in the same room! The OB took my blood pressure (118/73?? slightly elevated for me) and blood/ox (95% slightly low) the measurements were so out of character for me that the OB tested the machine on himself! That was like the highest BP I've ever had. But I know why... it was raining, I was stressing about my blood sugars and getting to the appointment, and having to reschedule the class I was teaching. Oh, yeah, and I was having another bleed just before leaving campus for the hospital! The OB basically said that since the bleeds were so minor, and apart from slightly elevated white blood cells, and slightly weird BP and blood/ox readings, and slightly raised blood glucose, everything was fine and there was no sign of any definitive problems. He wasn't fussed and put my mind at ease :) saying that some women just have bleeds, and that it could be the placenta previa??

My DNE took me up to her office afterwards, which is just two floors above antenatal clinic, and we went through my blood sugar CGM graphs with a fine tooth comb. I made another bunch of changes, and they seem to have worked out ok. Well, better for now, but things are requiring constant adjustments.

That was the last week of term, and the OB had speculated that it may just all have been caused by stress. An excellent time to have two weeks off!

First week of the hols was supposed to see me have a midwife apt, growth scan, and OB apt.

The appointment with my midwife was supposed to be on Easter Monday 21st April. And I promptly forgot all about it and we went out to have morning tea with friends then have lunch at a cafe instead. I felt VERY guilty when I looked at my phone and saw all these missed messages! Whoops! Brain fade. Got it rescheduled for later in the week.

In the meantime, on Wednesday 23rd April, I had my first growth scan ultrasound which was done at the hospital, and that was followed by another appointment with the OB.

At the growth scan we got to see Tiny Fish looking happy and healthy, with a good heartbeat of 142bpm. Growth sitting at 1417g which places in the 61% percentile. That lines up with what the midwife had measured with the tape measure at previous appointment. Baby was facing towards my spine with head down. Thankfully, we were able to see that the placenta had well and truly moved up and back, right out of the way. No more placenta previa hooray! This means I now have the opportunity to give natural delivery and/or induction a go.

The scan itself was quite quick, and Tiny Fish seemed too big to fit in the picture nicely like had done in the past. And was hiding and squirming about making it nearly impossible to get a nice shot of the head. Here are the pics:

This is, believe it or not, a front-on shot of the head. It is upside down, with the nearly horizontal curved line in bottom-centre of image the top of skull. See the two white horizontal lines on the left of image? They are pointing to Tiny Fish's chin. You can kind of see the right eye socket, and some smudges where nose and mouth are. Tiny Fish was head down way down low, and did NOT want to be photographed thank you!

This one is easier to understand. It is a whopping great foot. See the two little cross-hair markers, those are the heel (top) and toes (bottom) and it is nearly 6cm long! Wow that is big!

The OB appointment was good, and after the Dr talked for a little bit and made happy noises about no more bleeds, that I was looking better, and my blood sugars were now averaging much lower, I made sure to ask a bunch of questions:

• Can I keep my pump and CGM on during labour? Yes, that sounds like a good idea for you to do that.
• Is it possible for me to avoid an induction, as I have read that artificially induced contractions can be much more painful. Plus I don't really want the additional risk of more interventions - specifically a c-section. Yes, if you spontaneously go into labour before 40w, and you are both still healthy then that should be possible. Ideally you would start or be induced between 38 - 40w. But you can't go longer than 40w. That's the max.
• I want to restrict who will have management rights of my diabetes, will that request be respected? Yep we are happy to work with you.
• Can the IV line be placed nice and early in case I need dextrose / glucose? Yes.
• What is causing the nerve pain in my thigh? That's your femoral lateral subcutaneous nerve.
• I had more questions to ask, but silly me didn't actually pull out my phone to look at my list. D'oh. Oh well, next time.

Yes, this post is continuing... feel free to reach for some snacks and refreshments. You deserve some form of chocolatey treat for reading thus far!

Thursday 24th April rolled around and I decided to bake a cake to have ready to come out of the over at just the time when my midwife was due to pop round. What a coincidence! I was thinking that would be a nice touch since I had stood her up on Monday :P

Well, cake was delicious*, but midwife didn't get any of it cos SHE forgot! hahaha We figured that she had been called to a birth as she told me when I rebooked the appointment that that could happen. No drama. More cake for meeeeee! *it had ganache om nom nom.

The step kids came for the weekend and we had some family in from out of town. We went to the 10am ANZAC Day service at the Cenotaph, then took poppies up to Hubby's Grandfather's grave. I Facebooked my midwife and she phoned up terribly apologetic to have missed our apt and we got another one scheduled for tomorrow. Third time's the charm!

Oh, and yesterday I lost my sh*t for the first time in this pregnancy journey. It wasn't a bleed, or blood sugars, or even concerns about whether I will make a good Mum. It wasn't worries about breast-feeding, or how my diabetes will be managed in labour, or what it will be like to leave my job and go on maternity leave. No, all of these things are scary to a certain degree, but have not yet freaked me out.

So what did it?

I feel silly admitting this, but I lost the plot over our earlier purchase of stroller and capsule. See, I was thinking how the capsule didn't have much/any real padding in it and from there it was a short trip to looking at online safety ratings websites and finding that our capsule wasn't listed at all. This did not give me a good feeling and my instinct was that I needed to get a better capsule. The stroller is ok, not great, but I could live with it.

Then things got awfully complex quickly, since that particular model of stroller and capsule are designed to go together, and capsules with higher safety ratings wouldn't fit in the stroller at all. Not even with adaptors. The old capsule we thought had the option of getting a base as the lady at the store we got it from advised us, but when I called the shop they said no, no base to go in the car. Boo. And then I started thinking about how hard the stroller was to fold up. And I wanted to get rid of them and start again. It was a difficult thing to admit because a) I felt stupid b) I felt like I was making a fuss c) the items in question were not broken and would probably be perfectly fine d) Hubby didn't understand, initially, what I was trying to communicate, which upset us both e) I was incredibly confused about what I actually wanted to do to remedy the problem - or even how I defined the problem in the first place.

But once I got my ducks in a row and explained my worries more clearly to Hubby, he was lovely and understood my sometimes awkward feelings-logic.

The end result is that we will look at either selling the current stroller and capsule (about $300 worth) or if we can't then may keep them as spares. I have selected a top-ranking capsule which was an absolute bast4rd to get a stroller to fit it, however I had a ray of sunshine from a local store owner who actually knew what she was talking about. I visited her today and she presented a plan of attack to get the capsule I want with a base that fits in my car (we can hire this for 6 months), with a fantastic new stroller that is easy to fold up. Just waiting on her to order the adaptor and check that the two items will indeed marry-up. Other than that, it looks like a go. So you will get pictures of said stroller etc once it's all done and dusted :)

I know I have been stingy with the belly pics, but it is nearly midnight and I was awake until about 6.30 AM!!! last night (3 x lows, 2 x pee trips + lots of general aches and uncomfortableness) I saw dawn. So I am too tired to take photos right now. I promise to take some more but I will probably just post them to my twitter feed - you can get that over here in my sidebar - - - - - - - - >

Got my HbA1c results in, and even with that spell of higher glucose results, I have dropped ANOTHER mmol/mol:

Don't you dare call me normal.

And now my brain is feeling really scattered, but I will just tack this on the end. I promise, it's the last thing:

I had a bit of a scare on Saturday night when my blood sugar came down from a high to normal reasonably fast, over about 2hrs, and I noticed an anomaly in the vision of my right eye. I was trying to read the fine text on a Beatles album cover that my step-daughter was playing, and I noticed this blurry fizzing shape that was tracking with my vision, just to the right of the centre of focus.

Because I have a Dad who had detatched retinas, and because I am a pregnant Type 1 Diabetic, all these warning signs lit up in neon and screamed OH-MY-GOD-YOUR-VISION-IS-CRAPPING-OUT!!! Followed by a whispered ***don't panic, it's Saturday and no eye place is open now. Just be calm, be calm, and call them on Monday morning***

I called my optometrist first, noting that ironically I have just had my diabetic retinopathy screening within the past 3 weeks and got the all clear. They explained that I needed to see an opthalmologist, and to go via my GP to get a referral. I called the GP's nurse/receptionist and we both agreed that I may be able to phone the opthalmologist directly and get a private appointment quickly. Nope. They were booked up and short staffed and the only was in was for me to go to the GP and get an "acute referral". The nurse phoned me back and said, sorry, you'll have to come in for an appointment. So I did that yesterday (Monday), and the GP had me lay on the bed while he shone the light in my right eye, checking the blood vessels and looking for signs of any pressure or damage. He found none, and declared my eye ball perfect, like that of a 10 year old, and said I didn't need to the urgent appointment since there had been no change in 48hrs. Although he did say to monitor it like a hawk and any change at all I could get the referral letter in a flash. It's still there, but no change so far. I am wondering if I should go back to my optometrist anyway?

So yeah, it's been a busy 3 weeks.

27w2d First official trip to maternity

Okay, so you may remember that at about 12w I had a minor bleed and ended up in the emergency room in the middle of the night? Well, this evening I had another, very very very minor bleed.

It took me all of 3 seconds to argue with myself about whether or not to call my midwife. I lost that debate and texted her immediately. I knew with near certainty that everything was fine, but bleeding is literally at the top of the list of things to call her for. And last visit she had drilled all the signs of pre term labour into me. And she would have my head on a platter if I didn't call her. So. I behaved myself and called.

She was really lovely and concerned, but it is always a hyper-awkward conversation discussing the intricacies of a bleed. Look away now cos TMI coming up....

... Went to the loo and wiped, got a mixture of pale pinky brown mucus type blood and also some bright red fresh blood. But only a super teeny tiny amount. And baby was (is) moving. And I felt fine. Well, sore lower back which is kinda new, and oh shit isn't that a sign of pre term labour? Yes, txt the midwife!

She let me know that I needed to go straight up to labour and delivery. She would call ahead for me, and that I would most probably have to stay in overnight so pack a bag. I am sooo thankful that we live less than 2mins drive from the hospital. Can see it from the road out front of our house. Comfortingly close.

Hubby was out of the house with the 2 younger step kids (eldest has gone to college last week!!!!) and in characteristically he had left his phone on the armchair. So I was just about to call step-daughter to try and get hold of him when they pulled up in the car. He helped me pack, grab extra supplies for the pump and Dex, and we both kind of felt a bit of nerves about having to go up there and the enormity of maybe needing to stay overnight. Serious stuff. But we were calm.

We got up there and met with the on call midwife, S. Ours was 40mins away and didn't know whether it was serious enough to warrant her coming in. S was lovely and looked after us very well. She made up a room for us and got me to do a urine sample, then took my blood pressure and hooked up the CTG monitor to check baby's heartbeat.

Everything came back fine and normal. We got a good long look at Tiny Fish's heartbeat sitting around 120 - 140bpm. There was also heaps and heaps of fetal movement. It seemed that Tiny Fish took an instant dislike to the CTG monitors strapped to my belly as he/she kept trying to kick it off!

Hubby ducked out the room to go to the bathroom and there was drama in the corridor as a lady got wheeled in a wheelchair at top speed towards a delivery suite, right past him. She was screaming some mighty screams - arrived right in the nick of time by the sounds of it!

After S switched the monitor off cos the results were perfect, showing no contractions and a very good heartbeat for bubs, we had to wait a short while for a doctor to arrive to do the exam. We used the time to install a new Dexcom sensor since is taken the old one off that arvo, after 21 days of brave and valuable service.

Then Dr K arrived and asked a few more questions. S prepared me for the exam with a sheet overtop and it was actually quite a hilarious event as all four of us were laughing and joking about how with S doing the exam (training) that she was going to put all the doctors out of a job! Hehe

It was over quickly and the good news was my cervix showed no signs of dilation or any serious bleeding. The urine test came back negative for bacteria so that helped rule out a bladder/kidney infection. They concluded that we may never know what caused the bleed, although the low lying placenta could be a potential cause.

I am intrigued to realize that both this bleed and the previous one have been right on the cusp of a change in trimester. Maybe it's partially a hormonal fluctuation causing it? Maybe it's exhaustion, or blood sugars (had a few more lows overnight, but a bit high today, generally ok though, just done a big set of pump changes with DNE) or maybe it's a delayed reaction to having the flu shot and whooping cough vaccination last week. Who knows.

The good news is that all is well, and even if I feel a bit ridiculous traipsing up to the hospital I am very relieved to know for sure that it's all well and good. Tiny Fish is happy in it's apartment. :)

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

15dp3dt Second Beta (aka 4 weeks 5 days)

Second beta test today came back at 453! Woohoo!

This gives us a doubling time of roughly 42hrs, which is right smack bang in the middle of average.

Got a different nurse on the phone this time, but she sounded very positive and said "it's a good number". The relief I felt when I finally got the call was amazing. As you can tell from my previous post, I was getting a wee bit stressy about it. I was just so unbelievably happy that it came back positive that it was like walking on a cloud for about half an hour. After which time the adrenaline rush wore off and the fatigue set in.

They tested my progesterone too and it is 338 so the nurse said I should start weaning myself off the dreaded progresterone pessaries by dropping the dosage from 2 x 3 times daily, down to 1 x 3 times daily until they run out, or roughly 4 more days. Apparently I am making plenty of my own.

I need to go back in a week (next Tuesday) for another HCG test. The only way I found this out was by refusing to let the nurse hang up on me a la "just one more question!" haha I was determined to get the info out of her! Actually, I think the nurses' office must have been fairly busy, as I could hear other nurses talking to patients on their phones in the background.

I enquired about when is appropriate to enlist an ob/gyn and midwife. Nurse said that the fertility clinic has care of us until the 8 week mark which will be 29th November for me. At that time I should travel back up to Hamilton for my first ultrasound scan. Now, don't get me wrong, I cannot wait for this ultrasound. At about weeks today, I'm about halfway there. These milestones are incredibly important and hold great significance to me and my husband, and all those supporting us. But do I really want to travel over mountains for 3 hrs, have an over night stay, pay for a night in a motel, and book a day off work for two people?? Um, no. I asked the nurse if there was anything special about the ultrasound scan, and she thought about it for a moment, they said "well, there is a radiology place that you could ring and enquire if they would do it, but you would have to pay privately for it, just call and see if you can get an appointment for around the 29th Nov and then let us know so we can send a referral note through to you. They will then need to fax the results back to us." If it's less that the cost of all that travel and missed work, then we'll do it.

I keep thinking it would be great for the fertility clinic to provide a flowchart of procedures and appointments, just a general "what could happen" document. Rather than having to wrangle the info out whenever they choose to phone.

Once I got home Hubby suggested we book an appointment to see our GP this week to get his advice, as we may be able to get the scan for free??? I don't really care too much about paying for it, I just want to know that I won't have to travel. We have an appointment with the GP this Friday so I'm hoping I will learn heaps there!

Some more good news: I got my HbA1c result back. 16 Oct = 45 or 6.3% A slight rise, but this was taken after the transition to the pump (still learning) and before the application of copious amounts of crazy IVF hormones.

Not too shabby.

Went to the two elder step-kids senior high school prize-giving ceremony tonight and they both received awards! Very proud. It was cool with Hubby and I, their Mum and her parents, youngest step-son, and MIL. Some big cheers!

The school hall was packed for the ceremony and it got very hot. I was fanning myself with the paper programme, and started to get some really bad cramps, especially on the right side again but moving all over the place. I felt a bit faint, and figured I just needed to cool down and have some water. Which worked very well.

Thank you everyone for your lovely comments and support. It's wonderful to know you are all out there cheering us on! :D

Insulin Pump Application

Today I met with my diabetes endocrinologist to talk about getting a pump. Short story is that is is a GO! He has to put in a special authority application form from Pharmac so he'll get that started.

I sent him a bunch of my blood sugar details and graphs to use as supporting documentation, to support my application. In his words "it goes before a panel of wise men" who decide whether to accept or decline the application. Cross fingers it will be accepted. Endo says it should be accepted, as I have so many hypos.

My diabetes nurse educator popped in and said that she agrees: if I am to change to a pump then it's best to do it before I'm pregnant, especially if I get morning sickness. (Note: I popped round to my parent's house to have a cuppa tea with my Mum. She told me that she didn't get any nausea, and she doesn't think her mother did either. So that bodes well! Another diabetic friend has recently had her first baby and she got ridiculously ill with hyperemesis gravidarum!)

As I was leaving, I asked about whether the CGM part of the pump is funded. Turns out no, it's not. I kind of expected that, but if it's not too expensive then I would still be keen to try. It would be a real stretch financially for us to do this, but it could give some real insights into my "pattern-less" diabetes.

I also got my most recent lab results, as I went to visit the vampires on Monday. As per normal, my kidneys are still spilling protein. They have been doing this consistently for over 15 years now. I had a kidney biopsy around the time they first picked this anomaly up, and it was inconclusive. I have been on Lisinopril (an ACE inhibitor) but had naughtily taken myself off it as I have very low blood pressure and it was making me too spinny. Anyway, my endo told me today that he doesn't want me on the ACE inhibitor while trying to get pregnant.

HbA1c results: 42 mmol/mol = 6.0%

My graph from TuAnalyze. This is my lowest HbA1c ever. It's kind of scary.

This converter is available at http://www.diabetes.co.uk/hba1c-units-converter.html

Although a low HbA1c is supposedly good for reducing risk for complications, the advice I was given today was to raise my result from 42 up to 52 by my next appointment in October sometime. I was told to stop being so tough on my high blood sugars, and that I would need to run higher for a time to get rid of some of my hypo-unawareness.

Thing is, I feel fine. Sure, I am having a few hypos a week, but that is normal for me. I've been like this for years. I don't currently live in fear of hypos, and I feel comfortable with my management of BG levels. In fact, I have in the last couple of days been feeling rather proud of the fact that I've been staying in the black! (i.e. not in the red=high or blue=low)

Here are some pretty graphs to help explain:

Diabetes Diary App: average 24hrs for my past 7 days

Diabetes Diary App: Each vertical stripe is a whole day. This is my May 2013 so far. Check out 16, 17, 18! Woo!

Diabetes Diary: some details covering my past week, and all of May. May target rate is 8.0 mmol/L

Diabetes Diary: I record my blood sugars into different time slots, so I can check pre- and post-prandial results. All in the black on right hand column. FIRST time that has ever happened. I must say it feels good and healthy.

Now for the slightly boring and ranty aspect of this post: I have just about had it up to here (hold hand up to her neck) with medical receptionist-types.

In the past month I have had 3 unacceptable encounters. The first was with my GPs nurse-receptionist, who doesn't know her elbow from her Pharmac schedule! When I went to get a prescription for test strips, she wrote it for 4 strips a day. As if I was a regular old Type 2 diabetic. This is the same nurse-receptionist who is supposed to have done a bunch of additional diabetes training. I didn't spot the error and it was seen by my (lovely, kind, understanding, accommodating) pharmacist. I went back to see her, and said I needed more like 14 or more strips a day. She said, "well, I can write it for ten, but you won't get it." What?! I know what I am legally entitled to, and I can have as many strips as I want. It's funny, the test strips are the only part of diabetes kit that is so heavily controlled, and it's so hard to get. It's way easier to get lots of insulin, which always surprises me that the strict controls are on the strips and not the insulin, as I know which one could do a lot more damage! I suppose it's a money issue. Test strips are about $2 a pop. Anyway, where was I. Yes, so she thinks I won't get 10 strips a day. I take it and run back to the pharmacy where the pharmacist and I agree that this still isn't enough. He offers to call her, and he explains that yes I am allowed more strips. I think I ended up getting the prescription changed to 12 a day. I said "14" multiple times but they just don't listen! That nurse has had the grumps with me ever since, and on Monday when I went to pick up my lab-test forms she wouldn't acknowledge me :(

Second bad customer service experience came when I was waiting for my appointment with endo to arrive in the post. I was checking the letterbox diligently twice a day for that little appointment card (yes, the District Health Boards here still insist on using snail mail. I. Can't. Believe. They. Don't. Use. Email!!!!) So I teach at the local tertiary institute, and was right in the middle of class. I don't normally get many calls so my phone was still on, and it rang. I recognised the hospital number and guessed the content of the call pretty accurately before even answering. The diabetes clinic receptionist "Justine" literally berated me for missing my endo appointment. Apparently I was about to be marked as "did not attend" and referred back to my GP! For type 1 diabetes! You've got to be kidding me! She suggested that I was a new patient (umm, no, had this for 25 years now!) and that I had somehow done this deliberately. I had to laugh and chuckle, while holding back my rage. I explained calmly and carefully that I am an existing patient, I have been checking my letterbox and expecting this appointment. Her response? A two parter: "You will have to take that up with the post office," and "I've been away on leave so someone else has been doing my job." Well. Don't jump to blaming the patient if your department failed to send the bloody card out!

Third bad experience happened today. I was nervous about going to this appointment with the endo as for me, I know I don't deal well with change. I also know that saying yes to a pump is making a big commitment to my future care and what will hopefully be happening later this year. Pregnancy. IVF. Change. So yes, I was a bit edgy.

Our hospital where the endo and nurse-educator appointments for diabetes are held has split it's outpatients department into two parts, and the diabetes clinic is in another part above the maternity wing (how ironic!). My endo appointment have been held in medical outpatients and oncology. Let me tell you there is nothing more depressing than sitting in a waiting room with a bunch of oncology patients :( Anyway so I rock up to the counter with my appointment card and the receptionist greets me by name. I give her the card. She starts to wave me to go down to the diabetes clinic above maternity. I say, no, this is for Dr Endo, not nurse educator (they are married, so have the same name. Also, there were two stickers for an appointment for each of them on the card... confusing I know). "No, no," she says. "This card is for the diabetes clinic, and this is the medical clinic. You would never have seen Dr Endo here. See, your card is yellow. Our cards are green." I was gob-smacked. I have been having a clinic in this location for like 10 years now. And she knows me. And she just told me I've never had an appointment here. "You must be a new patient?" NO NO NO 25 years what IS it with you people????? I asked, is he currently above maternity? "lskdjfslkdfjdsklfjds" = not a straight answer, and repetition of previous two points. I said a curt thank you and stomped out, much to the amusement of the waiting oncology patients.

It got even better, cos I had to sprint-walk to meet my appointment time. I climbed up the stairs and met the diabetes clinic receptionist. I was holding my yellow card. I asked if Dr Endo was up here? The receptionist looked confused. She came out from behind the desk to talk to me. Oh god, I thought, does no one know where my appointment is? Turns out she thought I was a doctor or a nurse, the way I asked for him! lol - at least she was good natured.

But, sigh. Can the receptionists please please please not be so goddamn rude and insulting? A simple "I don't know, let me check" would have solved things for the test strips issue. A simple re-send of a new appointment and/or a POLITE phone call would have sufficed for the supposed-missed appointment debacle. And the phrase "Oh, hi Kaitake, I see you have a yellow card this time. That's fine. Dr Endo is currently located down in the clinic above maternity" NOT: you are stupid! You are a new patient? And my favourite "You have never been here!"

Good news! We have a "month"!!!

Today I pulled a sickie and spent the morning curled up in bed watching movies. My Mum popped round at afternoon tea to see how I was, and brought the post in from the front gate.

Two envelopes.

From the fertility clinic in Hamilton. Or "Hamildog" as it has become known in our house.

Envelope One:

The results of my AMH test = 9.35 pmol/L. The letter goes on to say that this is "as expected for your age". I am looking at the graph and it would seem that I'm sitting just about on the cusp between the yellow and the green:

So that's OK I guess. At least it's not bad news. I'm sitting on the 25th centile (I'm nearly 30. Gawd! Gasp!)

Envelope Two:

It's THE LETTER. The one that officially states we now qualify for public funding. Our month allocated for starting treatment (IVF) is October 2013. That's little over a year away, and a good bit shorter than the 18 month wait I was expecting. Woohoo!!!   :)

To be honest, one of the first things I thought of was "oh, it's right smack in the middle of a semester. How will I wrangle the time off?" But then I quickly changed to "Good heavens! Why should something trivial like time off work jeopardize this?" So now we have settled on a bit of shock, slight happiness, and wonder at what the hell exactly we have gotten ourselves into. Lolz.

Our initial RE appointment - take 2!

So, we have finally started this thing.

For months, years, it has felt like I am running, moving my legs like a cartoon, trying to gain forward momentum but never going anywhere. As if my legs couldn't gain purchase on the ground. As if I was not even touching the ground. Yesterday the ground was raised up and my toes dug into the soil and I have taken off. Forward. At last.

I have written previously about the veil of grey lifting off me. Now it is like the massive, oppressive weight of uncertainty has lifted. I wasn't even conscious of the huge effect this was having on me until it was gone. I am laughing and joking and the tension has melted somewhat.

We travelled to Hamilton for our second "initial consult" at the fertility clinic. Because the first didn't go so well.

This was were we talked with a reproductive endocrinologist about what we will do to try and get pregnant, to try and have a child together.

We need sperm retrieval surgery, IVF and ICSI.

Things will become official shortly when we get the letter saying we formally qualify for public funding. That letter will contain a date which will be our starting "month" for IVF treatment. Prior to that (about 6 months from now) my husband will have sperm retrieval surgery. And then IVF will occur about 18 months from now. It may be sooner if someone else on the program pulls out.

We spoke to both the RE who explained the procedures and the nurse who will be assisting. Neither of them seemed to have much experience with T1 diabetic patients, so I will be hunting down as much research as I can about how IVF drug therapy affects blood sugars. The nurse even told me outright that she had never worked with a T1 diabetic patient before. She told me that I should expect to "have to contact my diabetes management team at least 3 times while undergoing IVF treatment, you know, to monitor my blood sugar levels and adjust insulin, because you have to maintain a good level" Arrrrggg! said my inside voice. My polite, outside voice said something like "actually, I test my blood sugar about 15 times a day and do about 8 injections, all carefully adjusted by myself, too. I also have a pretty good HbA1c of 6.1%" The nurse did look a little flabbergasted at those numbers. I suppose she is used to having patients freak out at the prospect of injecting themselves once per day for a measly 2 weeks, not 8 in a day for 24 years! I wanted her to know what she is dealing with, and now that she has time to learn about T1, I hope she makes the effort. Both RE and nurse said they will work with my GP and my diabetic endocrinologist, which pleases me.

We opted to do an AMH blood test, which measures ovarian reserve. This will allow the RE to select an appropriate drug protocol for me out of the two choices she's whittled it down to. One is a 4 week protocol, and the other is a more popular 8 week protocol. The nurse made noises like she would put me on the shorter one, so my diabetes is less affected. But I said we want the one that will have the best chance at a good outcome. The $100 AMH test will be making the decision for us. Hopefully it is good news. Bad news would mean we have to act quicker, and as you know we can't afford to pay privately for treatment.

So nothing is set in stone, but is just an amazing feeling for me to know that we are on the waiting list now. Nothing tangible has changed, it's all still quite theoretical, but it's a huge change for me and I must say I feel amazingly light and, dare I say it, buoyant.

We got given a pack of phamphlets and books and a DVD. We have consent forms to sign.

I've been put back on 5mg folic acid, and will stay on it every day for up to 18 months+ We have to try and avoid caffeine, tea, coffee, and green tea even. (Being a T1 diabetic means that the only liquids I currently drink are water, milk, juice for treating lows, diet coke but not so much now that I get migraines from the aspartame, and black tea. God, I am going to miss my tea) Maintain ideal BMI. Be good. Take vitamins. Exercise.

There are a thousand details and questions, but the main things I took away from the appointment are that:

1. Yes, I can work with this woman (RE), the one who destroyed my life 2 years ago. We will not be friends, but we will be able to have a professional relationship.
2. We are finally getting some progress. We are finally starting. It is amazing to be here after fighting so hard for this.
3. Surprisingly, we will get Hubby's part of the procedures done much sooner, so it will break the time up and make the new wait easier. The logical corner of my brain knew this, but 
4. We can start to plan ahead tentatively. Things like accruing up some extra annual leave.
5. Have found a great motel, and little things like knowing where we will be staying are important to me, the control freak lols :P

Yeah so that was positive, I am happy, it's good news.

We are starting. We have come full circle back to the start.

I want OFF this damn rollercoaster! Can you help?

Next week the students come back and I will be in teaching mode again. That will be exhausting but challenging work which I'm looking forward to.

The week just gone has been absolutely frenetic, with last minute course prep (still not done, and it's Sunday!), moving the entire Art department into a newly refurbished facility, oh yeah, and 3 days of compulsory academic staff training!! It's been super nuts.

I know my diabetes control has been degrading. It's like, seriously crappy at the moment. Here's the last 7 days for you:



(Apologies for having to twist your neck to see that!)

As you can see, I'm all over the map. There are some trends, which I guess are a blessing as it may just mean the Lantus (basal) dose is screwed up:




Massive peaks and troughs = massive headaches, tiredness, grumpiness, and brain-fogginess :(

So what I'm doing about it is some intensive tracking and analysis to see if I can figure out where the hell I'm going so wrong. I've just purchased Diabetes Diary for iPhone and that's where I got the pretty graphs. Have to say that so far, I'm liking this app the best of all. And I've tried most of them!

I'd been using the Insulin Calcilator app, made by the same folks (http://www.fridayforward.com/) for nearly a year now and I credit it with a 1.5% drop in my HbA1c, so I figured their diary app was worth a shot too. I like how the two apps work together. I can take a bloodsugar test, enter the results into the Insulin Calculator, then just press a button and it transfers all the data across to the Diabetes Diary, where I can add more info and make adjustments. Cool eh? :)

I think it's really good that I'm back in intensive analysis mode, because if 10+ bloodsugar tests a day aren't giving nice smooth control there must be something else going on. And I can't find it without graphs, averages, and data to help me.

Let's be clear: I test constantly. I inject semi-religiously, and I track it all in my paper log book:



But that doesn't give the instant clarity of a graph, or the insight of weekly averages. I hope this system helps. I suspect it will. I've done this intensive analysis thingy before and it has always had positive results, even if only minor.

BTW, if you can spot any major issues for me by looking at the graphs, please let me know in the comments. All help on nutting this one out is appreciated. :)

I take Lantus twice a day (11u breakfast, 9u dinner), and bolus with Humalog. I'm incredibly sensitive to changes in insulin, and am on child-size doses of Humalog. My I:C ratio is 1:14. I eat between 90 - 180g carbs per day including emergency food like juice and stuff. I walk, weather permitting :P And I work hard and get pretty stressed out at times, which never helps. Anything else you would like to know so you can help, let me know in the comments. Cheers everyone.

- Posted using BlogPress from my iPhone

Day 3 FSH, LH, Oestradiol and cortisol blood tests

I got up super-early this morning (for me, anyway!) so I could get down to the medlab for my 8am blood draw. It had to be 8am because the cortisol test needed to be done specifically at that time. My GP is investigating why my blood pressure is so low (100/60) especially since he wants me to put me on ace-inhibitor to help save my kidneys - which are misbehaving. I believe that if he finds a problem with the cortisol level it will indicate an adrenal issue, which could be what's causing the low blood pressure. So that could be fixed (one hopes??) and then my ace-inhibitor dosage could be increased to PROTECT ZE KIDNEYS! more. Yup.

Also did the CD3 FSH, LH and Oestradiol hormone tests at the same time, and picked up the huge bottle needed for the 24hr urine test for proteinuria - ITZ ZE KIDNEYS U KNOW!

Saw my aunt in the waiting room. She's just got new kittens! Pixie and Poppy! I can't wait to meet them :D

Oh, and then it was off to work. Last day of office work before the students come back from break on Monday.

I had sent out the grades for the students' first projects yesterday, so I was not surprised to get emails from some students wanting to discuss their grades. Of course, my most troublesome student wanted to meet. And bring her Mum.

I asked the other tutors who were in if they would take a bet on whether she would cry or not. They wouldn't take the bet. I so far have a 3 out of 3 strike rate for crying students at my desk. I go through a LOT of tissues. (Let me clarify: they don't cry cos I'm mean to them, quite the opposite. I try to put realistic pressure on them and they get overwhelmed sometimes. It is very difficult to succeed in a design qualification or career because it's so subjective. The students put a lot of pressure on themselves, and getting a low grade can be crushing for them. I offer all the support and help I can, but you can only lead a horse to water...)

Let's just say it was an emotional meeting, but she left happy.

Kids arrived this evening, but one is working and one is at a Pony Club thing, so it has just been Hubby, Me, and Mister 10 for dinner.

Progesterone blood testing - again

I had phoned my GP's nurse to put in a request for more diabetes supplies, and at the same time asked if I could re-do the fertility-hormone blood tests. I just wanted to check and make sure nothings changed. She was really helpful "no worries!".

So today is 21st April, which is coincidentally also my CD21, which means it's time to get my progesterone (and HbA1c and Complete Blood Count) blood draw done. I think I will wait until I've got the remainder of the hormone tests done.

One near-snafu is that the remaining blood tests have to be done on CD3, which currenlty looks like it will fall on a Sunday. When the lab is closed. Dumb.

More blood tests tomorrow

Oh! *looks at clock* Actually, I meant later TODAY! haha :P

I will finally get the last of my pre-fertility-clinic blood tests done. All that's left for me is Day 2 FSH, LH, and Oestradiol, and Hubby's immunology tests. It's been a drama for me to get this test done, as the world and my body seems to always be conspiring against me.

First it was just plain old forgetting. My first "Day 2" occurred the day after the ob/gyn dropped the whole IVF bombshell in my lap. So I was not really in the right headspace to remember ANYTHING at that stage. The next Day 2 I just plain old forgot. Trust me, I was kicking myself when I realised I had missed that opportunity! :S

Next up, I had the hysteroscopy operation, which triggered an early period. So I didn't know when exactly Day 2 was. Sigh.... more waiting.

That brings us to today (ok, it's the middle of the night still :P). And I am proud to have remembered! Now... if only my ob/gyn will get my referral letter written and sent....  :)

In Other News
or, to congratulate you for reading through such a damn boring post :P

Have you seen Dumbo Feather, pass it on? It's a half mag/half book and I luuuurve it. I saw the publisher, Kate Bezar, speak at a conference 2 years ago and I've been on the lookout for Dumbo Feather ever since. Sometimes it can be hard to find, but it's worth it when you do! Unlike most mags, it's not full of glossy yucky ads. It's not full of beautiful people. And it's not full of "filler" body copy. It's a beautiful tactile size on quality matte stock, with gorgeous photography and best of all, 5 interviews/essays/articles per issue.

Have a great weekend! :D

So angry at myself right now

Because I was supposed to do a FSH test on day 2 of my cycle, and I completely forgot! Oh grrrrrrr! I've been so good with all the blood tests and appointments so far. I just woke up this morning, and thought, oh gee, now I've got to wait a whole extra month. What a dumb-ass.

This was supposed to be the last lot of fertility-related blood tests before going to visit the fertility clinic. I was supposed to take hubby along for his blood work as well. And I plain forgot. Day 2 was 2 days ago. I feel like a right idiot.

An hour at the endocrinologist

What a way to end a Monday. An hour long in-depth discussion with my diabetic endocrinologist. Whew!

We discussed my upcoming surgery to remove the uterine polyp, and I wanted to know what to do with my diabetes control during the anaesthesia. He reassured me that my anaesthetist will be able to handle the situation and would have dealt with diabetics before. He also told me in no uncertain terms was I allowed to let anyone take me off the Lantus insulin, as that could put me into diabetic keto-acidosis. Which is bad! He even went as far as saying if anyone tries - call me at home! Wow! :D

Endo wanted to know why I was having the polyp removed, and why I was doing IVF? I explained that it was due to hubby having a vasectomy, and that the odds of a reversal were nowhere near as good as for IVF treatment.

My most recent HbA1c test was done last September (about 7 months ago!) and it was 8.1, which is the highest I've ever had. At that stage, Endo did say that although it's not an ideal number to get pregnant at, he would only get really worried if it was around 12. But now that the idea of pregnancy is so much more serious, he said it would be better for me to get it down to the mid 7's if I can. If you are diabetic, you're probably reading that and going "nuh-uh! That's still too high!" but Endo explained that it makes sense for me, since I am a very brittle diabetic.

Please don't read "brittle" as "badly controlled". I do a gazillion blood sugar tests each day, and constantly correct with insulin, and count carbs religiously. Endo even said that "You're working soooo hard, just not seeing the results." It's not fair, basically. He can't explain why my diabetes is so crap, no matter what changes or experiments we do. I have been tested for everything under the sun. From thyroid disorders, or extra adrenaline, to stomach disorders, to eating disorders, to other weirdly-named things I can't remember. He's tested me for it, to try and discover the missing element which causes my blood sugars to fluctuate so wildly and for insulin to act so randomly.

So I wasn't surprised when he started to bring out the blood test order form and write me up a shopping list of tests to do. But I did nearly fall off my perch when he asked, "Do we even know if you have diabetes? Has anyone ever tested you for it?"

What's the test? I squeaked. I mean, this is major. If I've spend 22 years treating the wrong disease...

"Oh it's simply a blood test to look at your c-peptide level. Here I'll order one for you."

Apparently I could have something called MODY (Mature Onset Diabetes in the Young), which is like having type 1 diabetes AND type 2 diabetes at the same time. He doesn't think it's likely, since my insulin requirements are so little, and MODY usually manifests as insulin resistance requiring more insulin.

But the other reason to test for c-peptide is to see if I am making some of my own insulin. That could help explain the unpredictable lows I get. We shall see, I'm off to take the test in about 30 mins.

Ooh, speaking of tests, I looked over his shoulder and saw the result of a couple of my fertility tests from the other week. Looks like I'm ovulating no worries! Yay! :D

We spoke about getting me on a CGM for a 3 day trial. The hospital paedeatric department owns one, and they may be able to lend it out to me to try and help figure out what is going on.

The idea of going on an insulin pump also came up, and although in the past I've been reluctant to pursue the idea, the need to get better control of my blood sugars in preparation for pregnancy has changed my mind. Also, it's the only thing I haven't tried. Unfortunantely, funding for insulin pumps is now hard to come by in our region of New Zealand, and Endo was grumpy when he told me that if I lived in the a different area only 3 hrs away, I would almost certainly already be on a pump. Grr. Can't. Win.

And in a case of terrible timing, I may have also just said "no" to a cure for diabetes. Endo already has one patient on a trial in another city in New Zealand where a company called LCT Global is having remarkable success with clinical trials of their Diabecell product. Diabecell is an injection into the abdominal cavity of thousands of little cells harvested from specially bred pigs. These cells replace the damaged cells from the pancreas, and make insulin. The magic ingredient is how the pig cells are coated in a special alginate (read, seaweed stuff) that makes the cells invisible to the human immune system. So no need to take any immuno-suppressant drugs.

Twice Endo has offered to put me on this trial, which has in some cases cured diabetes and in all other cases lessened the blood sugar fluctuations. And twice I've had to decline because I want to get pregnant. One of the rules of the trial is that you can't reproduce after having the implant, since they haven't studied the effects through generations yet. Sigh. I will just have to wait. The good news is that they hope to be "bringing it to market" in 2 years.

That's a lot of stuff. I came home and my head was pounding with a headache, which is still with me today. I'm off work and taking it easy. Oh wait - got to go and do more blood tests!

Catch you next time :D

Two trips to have blood tests

I have spent the lunchtimes of yesterday and today at the medlab, getting my blood drawn for the progesterone tests. Oh what fun! :P

Everything went fine, although I am wondering if I may have to repeat the tests next cycle, since I missed day 17 and got days 18 and 19 instead! The ob/gyn said it should be fine, but since both of the lab techs asked me about it, now I'm not so sure. Oh well, time will tell. It will be interesting to see the results come back.

My appointment with the diabetic endocrinologist is next Monday, and I hope to introduce him to the new diabetes tracking software I've been using. More about that when I have more time :)

Wonderful ladies who blog about diabetes and pregnancy

I just found out that you don't normally get an obstetrician until after you become pregnant, and even then you may not need one.

I feel a bit special, since I've met my ob/gyn already. Have a read through some of my earlier posts to find out how that happened. :)

I would like to share a couple of links with you, to two blogs I am following:

sixuntilme.com

pregnantbethany.blogspot.com

Both of these women blog about their experiences as type 1 diabetics having their first child.

There are plenty of IVF blogs, and even some on youtube, but nothing that has caught my fancy to follow yet. And no luck yet finding a blog dealing with diabetes, pregnancy, IVF, and vasectomy! I will keep looking!

Have my first ob/gyn sanctioned blood tests tomorrow, and I can't wait! (Unusual, I know: normally a blood test is the last thing a diabetic wants!)

Wish me luck! :)

Progesterone blood tests

It's also time for me to start doing that long list of pre-appointment blood tests for the fertility clinic. I have decided to start with the progesterone tests, as they are mid-cycle tests to be done on days 17 and 18 of my monthly cycle. Unfortunately, day 17 is tomorrow, a Sunday, so the lab is not open. :( The ob/gyn doctor said it will be ok to move the test to the next day, which is Monday. I hope this will be ok, I would hate to have to wait another month to repeat the tests!

They're testing for other interesting stuff too, like Hep C Antibody, HIV Antibody, and a group of tests called the Initial Antenatal Group. This includes Rubella, HBsAg (Hep B), Group, Antibodies, CBC (complete blood count), and RPR (syphilis).

In my next cycle, I have a day 2 blood test which includes FSH, LH, and Oestradiol. But that will be another post!