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.

22w4d Shopping for baby hardware

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

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

Urban Escape II stroller

Urban Escape II Capsule

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

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

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

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

21w3d Midwife appointment and HbA1c

This HbA1c result really blew me away!

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

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

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

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

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

A bright teal 21w3d Tiny Fish house.

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.

14w1d Bleeding at 13w6d weeks pregnant

Last post I wrote Monday morning, expecting to go and have my nuchal translucency scan later that afternoon. We were planning to take a short holiday trip across the island and in the course of packing became a bit late and had to rush to the scan. Turns out the day started as it meant to go on, as I had gotten the times mixed up and our appointment was not 1pm but 4pm! So that would delay our trip (5hr travel time). We went home, double checked the pack-list and grabbed all the things we had forgotten, then hopped around to my parents' place for a cup of tea and a debrief.

In the car on the way there (4pm) the ultrasound clinic called and apologised: the OB/tech (who is the best in our province, but is private = expensive = only using her for some scans) had to rush to the hospital to deal with a woman in labour. So. No way to have the scan. I started to get agitated as I knew that the scan would only be possible up to 13w6d, and although the ultrasound clinic wanted to re-schedule me for the next day we would be out of town by then. Plus Hubby sort of still didn't really want to do the scan at all. I could try and get my midwife to organise to have the scan at our holiday destination (fun). Or the clinic said they would try and swap another patient so I could get a slot on Thursday, which would be the last day I could have the scan by my count - going from the date of conception. Or we could just not do the scan and only do more blood tests later in trimester 2. Then the receptionist was telling me I had my dates all wrong and I was actually not that far along and I could possibly wait even further. She wasn't really listening to me, just telling me I had it all wrong. Not helpful! I know the date of conception down to the hour for crying out loud!

So, with that, we started out trip and I tried to put if out of my mind. We were only really away for a day, but managed to get in some mountain biking and sailing. Both of which freaked me out. The mountain biking was supposed to be a gentle, flat ride along the banks of a beautiful river. Well, it turned out to be a thin gravel track that went UP and DOWN. I have never ridden that sort of track before and couldn't really control my bike well on the multiple down-hill segments with the gravel skidding my bike out from under me. Long story short I had a panic attack as I thought I was about to crash / roll over / tumble into the river. Oh, and I was having a low (hypo) at the same time! What fun! I was unable to stop from panting these really deep fast breaths and wheezing and trying not to cry and feeling sick and my arms and legs just locked up like stone on the bike. Hubby looked after me and got juice and a muesli bar into me. I recovered ok and we were able to bike back slowly. I did feel much better on the way back as I knew what to expect of the terrain, and Hubby showed me a technique with the brakes which helped me control my bike better.

The sailing was fun although at the first turn I thought we were about to tip over and squealed like a mad thing! hehe The lake was a bit choppy and it was just the pair of us on this tiny little yacht. But very cool experience. Boy did I sleep well that afternoon. We cooked a lovely BBQ at the motel that evening and had cheesecake for dessert.

The drive back the next day took a little longer as we headed up to another city to collect youngest-step-son from his friend's place, then drive us all back home. On the way back I got a bad headache that was awful by the time we got home. I managed to eat some dinner then went straight to bed with 2 paracetamol.

At 2.30am that morning (Thursday 9 Jan) the Dexcom woke me up with a noisy beepy alarm: low. I trundled out to the kitchen to get some juice, as has become my custom in the wee hours of the mornings, and took a detour to the loo first. And there it was. Bright red. Bleeding. No pain, just a feeling I can only describe as numbness, like my heart just sank. I knew that if this was going to go badly, there would be nothing anyone could do about it, and that it would hurt a lot. With no baby at the end.

Aware enough to realise that the low could be part of the problem, I drank down some juice and went back to the bedroom to wake Hubby and tell him. After about ten minutes he asked if I was still bleeding so I went back to check, and it seemed to have mostly stopped. We live 5 mins from the hospital so it would have been foolish not to pop up there and get checked out. Yay: A&E in the middle of the night; my favourite :-/

Thankfully the ER waiting room was blissfully empty and quiet. I rang the bell and the triage nurse came out. I gave her my name, how many weeks pregnant I was (13w5/6d) and the fact that I was bleeding. She took us straight through to the triage room behind the automated security doors, and asked me questions while Hubby filled out the paperwork. From my answers the triage nurse was able to determine that I had a "light bleed" but it would be worth checking anyway, and that there was not much they could do except wait in circumstances like these. She slipped a cute little pulse/ox meter on my finger and announced that at 99% oxygen saturation that was a good sign.

The triage nurse took me around the corridor to a private room and a cheerful ER nurse arrived. She was really sweet and gave me "points" for knowing what my blood type was! She took my blood pressure, temperature and pulse and they all came back normal. Next in came the doctor who asked similar questions: when did it start? (2.30am) how many pads? (none!) do you have any pain? (just some mild pressure and ache as I normally have had that I associate as being normal for me being pregnant. Is this your first pregnancy? yes. Any allergies? (no) etc.

Both the doctor and the nurse agreed that the low blood sugar (hypoglycemia) could have maybe had something to do with the bleed, but it could also have to do with the mountain biking or exhaustion. They listed it as a threatened miscarriage and explained gently that the only thing they could do is check for the heartbeat with ultrasound (a strong and healthy heartbeat was present immediately! The most wonderful news in the world!) and do an internal exam to gauge the blood loss and possible cause. They took a urine sample and tested for signs of infection but everything came back negative. Swabs were taken although the results of those won't be available until next week at my GP's office. So in all, it seemed mild, although they noted that it could progress further. They told me to take it very easy for the next four days, and were happy that I had the NT ultrasound that afternoon. We were sent home and I didn't sleep very much for the rest of the night worrying about every little twinge and ache I felt. I was rolling over very carefully!

In the morning I felt fine. Hubby went to work and I tried to do as little as possible. Mainly this consisted of calling all my healthcare providers to get their advice:

First up, the midwife: she listened carefully and asked me more questions. She promised to contact the on-call specialist at the hospital for more advice, but she advised me to get in touch with my diabetes nurse to adjust the pump settings as she suspected the low blood sugar of being a potential cause.

Diabetes nurse: I got her on the phone the second try (a miracle! It sometimes takes days to get through to her as she is soooo busy with patients). She spoke to me for a good 20 mins and we made adjustments to the basal rates of my midnight to 6am rates. In the two days since, I have lowered these rates even further and I am very close to having a night sans-hypos! Yipee!

Midwife again: she called back and advised that the Charge Midwife at the hospital had advised more frequent monitoring (I think that means Doppler?) and I should come in on Sunday (tomorrow) to the Labour and Delivery ward where my midwife was having a clinic. So that will be an experience. I certainly didn't expect to be going there this soon. Oh, and I also have an appointment booked with the hospital OB. Finally.

Later in the day, we went to the ultrasound clinic for the NT ultrasound scan. I told the OB what had happened the night previously and she immediately got to work looking for the baby and any potential problems. She found the baby straight away (it's hard to miss now. I even have a mini-bump!) and found the probable cause of the bleed too: I have a low-lying placenta. It's completely covering the "exit" and she told us that it could easily be disturbed or aggravated by sudden jostling movements. Such as bike riding. Boo. I love bike riding! She went on to say that at 13 weeks it was too early to diagnose placenta previa as it will most likely migrate up higher, however I should have it checked at 20 weeks to make sure.

Knowing what had caused the bleed was such a huge relief, although the OB did say that I can expect more bleeds which freaks me out a bit. I have been being very careful with my movements since then, but I am still active.

Then the checks for the baby began: she did the NT measurement three times throughout the 20 min scan just to triple check, and each time the result came back just slightly over 2mm. If the result is 2.5mm+ then that strongly indicates Down's Syndrome as the likelihood of potential heart defects causing excess fluid is much higher in that case. So, passed that one.

And then she started looking at everything else. I had only really thought to worry about the NT check, but she was looking for the correct number of arms! I hadn't thought about that! It was all fine. We saw two arms, two legs, five fingers on each hand. The spine. The CRL was 7.71cm and this put the fetus at about 13w3d (3 days slower that what I thought from the conception date). She measured the head size and looked at the brain, stomach, bladder, legs, knees, and the mouth which was swallowing. We could see the stomach filling with liquid as the scan went on! She took at few photos for us and seemed much happier and more interested this time, probably because there was so much more to see.

She checked the rest of my uterus and found a fibroid (towards the top, I think?) in the uterine muscle itself. Apparently this is of no cause for concern at the moment.

So overall it has been an absolutely exhausting week. Good news in the end, out little one is still going strong, kicking up a storm in there.

Thanks for reading this far. Here are some pics as your reward:

Our little one dancing and waving and kicking!

Here you can see the brain and the mouth, nose, and the right arm and hand.

My mini-bump. I can just get my pants done up. And those are stretch jeans too! Gone with a blue inset 30 for my Animas pump at the moment.

9w How to thoroughly scare everyone, including yourself

First, be a high-risk Type 1 Diabetic pregnant woman who has just done IVF.

Next, wake up at 2am on a Friday morning with a splitting headache and take a couple of panadol. Wait 20 mins.

Start vomiting dramatically and violently for several hours. Decide you have suddenly been hit by the worst morning sickness the world has ever known.

Drink a tiny amount of water. Fail to keep even that down. Repeat a couple of times, enough to get really scared about dehydration and the baby and whatnot.

Thank the heavens that your husband is here and that he can monitor the Dexcom. Double thank you to the diabetes gods who prevented me from going low throughout all of this.

The the other end joins in. Belly pains. Not morning sickness. Food poisoning. Well, that's sort of okay if it means I won't be doing this every day, but only on the condition that little walnut baby is kept safe and healthy.

At one point I feel so sick, I'm sitting on the couch cos it's closer to the bog that the bed is. My temperature is mega hot and I've just sweated so much I've drenched my big fluffy pink polar fleece dressing gown. Hubby gets very worried when I start moaning and pacing. I know he nearly took me to hospital right then and there.

Early hours of the morning: remember that vomiting plus headache could equal ketones. Do a blood test and get 0.3 on the Optium. Fail to remember that this is still within the normal range and decide I will probably need to go to A&E for IV fluids. Decide to wait a bit until morning and if it's not better, then trundle off down the road to the hospital.

As soon as it's respectable, start texting and calling: my Diabetes Nurse Educator, my GP, my midwife, my boss, my friend, my Mum.

DNE was great, she called or texted throughout the day to monitor my progress. We discussed it and she suggested if I was really worried about dehydration I could go straight to A&E, but that we could try managing this at home.

The time between events started to increase. By about 9am I can drink a little ginger ale, and I try my hand at some marmite toast (too soon!). Tiny, tiny bites. We'll chewed.

The GP doesn't want to see me, even though the DNE and midwife both want me to see him. Well, technically the receptionist doesn't want to see we. She tells me just to go straight to the hospital.

The midwife phones after 1pm and is working off old info by that time. She wants all sorts of nasty tests that involve leaving the house. I tell her I am now able to hold down liquid. Put down the phone, and turn my truth into a lie! Sigh.

DNE checks in again, she is happy with my progress. Hubby looks exhausted, poor darling.

Snack on ginger ale (regular) and ready salted chips. I find that if I let my tummy go empty I feel a lot worse. Use a couple of temp basal increases, and bolus carefully for any food - but always wait to see if I'm going to keep it!

Mum pops round about 4pm, by which time I have finally, almost got a complete set of clothes on.

I manage a small dinner of pasta spirals with chopper mini tomatoes in olive oil and black pepper. The best food in the world it tastes like!

Last night I sleep a full night for the first time in weeks. I didn't even get up to pee. Which probably means I'm still a bit dehydrated. I feel much better today, although I've lost 4kg (from 59kg back down to 55kg). I am eating small snack and trying to drink a steady amount of water.

So, yeah, that is how to scare the pants off everyone around you.

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

13dp3dt Well, it feels real...

..but will it stick around? Will I get a good beta on Tuesday?

I am pretty calm, and it's sinking in more. I am currently pregnant and I have to keep telling it to myself cos I just don't believe it. I have been to look at the pee-stick several times today. Just to check I didn't imagine that line. Or the phone call from the nurse. I am hoping they will send the results out to me on paper, so I have something tangible to fret over.

Things I have discovered today:

• People are treating me differently already. Which bugs me. Why are you all getting worried about me now, but not the day before first beta? eh? I am the same person!
• People who don't have a clue I'm pregnant treat me the same as always. Which also bugs me. Where is my special treatment already!? Can't win over here. lol
• It should not be possible to forget that something is going on down there. Most of the time, it is painful and crampy (not severe cramping). Plus there are the twinges. I guess that's what you'd call them? Sharper, achier pains that occur all over the place. Anywhere from my hip joints right up to my clavicles. Ribs. And of course the abdomen. Sometimes I can feel a twinge going right um, up me. Sometimes it goes around my uterus. I think. Without an MRI to hand, I am just guessing at anatomy here. Oh and also the firm-en-ing-up of my tummy, and the general inability to button my jeans.
• I gave in the moment we got the nurse's phone call. By that, I mean, I have allowed myself to dream of this child. I have been collecting names. Hubby and I even had the briefest of brief chat about names. I have been watching videos about what happens at 3 and 4 weeks pregnant, and I have downloaded a couple of pregnancy tracking apps. By the power vested in the Interwebs, I am able to determine that my Estimated Due Date should be 11 July 2014. None of these things are what I would consider "safe". I mean, throughout the whole time I have been waiting for this (can't use "trying" as we've technically never "tried" to get pregnant in the traditional sense lol) I have been moderating my thoughts severely. To keep my mind from exploding and my self from collapsing in a crumple of tears, I made a bargain with myself: I could think of certain things (names, due dates, pregnancy details, maternity clothes, nursery decorating ideas) only once I reached certain goals (accepted for treatment, started treatment, positive beta) to protect my mind. My reasoning being that if I didn't think up good, wishful, dreams then I wouldn't be hurt as badly should things go south.
• And now I have gone there. The gates are open and I cannot reign in my insatiable curiosity and dreaming. It is lovely to be able to feel I can now safely think about this sort of wonderful stuff...
• ...But, then I realise that I could lose it all on Tuesday, making the fall so much harder. I hope beyond everything that this, my first pregnancy, sticks, stays, grows, and is healthy. I have never wanted anything so much in my entire existence.
• The centre of my universe has changed. I'm not sure where it was before, but it's now growing in me (I hope).
• My brain can think of little else. Until I do something (gardening, cooking) and forget entirely.
• Speaking of gardening: I did lots. I know, I know - I'm not supposed to exert myself. Or get too hot. And I know. It's bad for the embryo. But it has been the most beautiful spring weekend and I have been so at peace. I was, I think, not able to garden all winter until this IVF was done. Now that I feel positive again (it's been a while since I've felt so energized) the garden is crying out for attention. I drank lots of water, made sure not to over do things, and only went out in the sun for short spells. Oh, and there is another reason why I feel positive about it. Part of the stories the women in my family share include that of doing some crazy, manual labour such as cleaning the stove, washing all the windows, or weeding the garden. So I take the desire to garden as a good omen.
• You may have noticed the word energized in the last bullet point. Imagine having all this energy and happiness one moment, and then the most crippling fatigue so you have to lie down or risk feeling faint the next. Well, that has been my day. I get especially tired towards the end of the day.
• I decided to get tougher on my blood sugars. I really really tried to get in touch with my Diabetes Nurse Educator last week, but we are playing a mammoth game of phone tag at present. Too timid to adjust the basal rates (especially while still on those progesterone pessaries ewww), I spent most of Saturday thinking what I could do instead. First up, I tried doing more correction boluses when ever I went over 12mmol. I also started ignoring the pumps suggestions of "0 units" when I had IOB, and instead gave small conservative boluses. This worked ok, so I then thought up a more permanent method - Oh hey! I will just adjust my insulin sensitivity factor a bit! I went from 1u:4mmol up to 1u:3mmol. This has proved to be too strong especially in conjunction with gardening, so I've just put it back down to 1u:3.7mmol. Let's see how that goes.
• Tomorrow is my first day of work where I will be pregnant. I have a rather unpleasant bunch of students to teach, and I hope, for my sake, that they behave themselves. I will not hesitate to "pop down to the office to get something" if I feel they are upsetting me or getting my heart rate up at all!
• I can count things in pregnancy-numbers now: 4 weeks 3 days pregnant.

So, that is all. Sorry about the rather random haphazard post today. It's nearly 11pm and I am beat. Also, just gone low. Also, getting a twinge right now!

Sing it with me: I hope, I hope, I hope, I hope, I hope, I hope, I hope, I hope, I hope, I hope, I hope, I hope, I hope, I hope, I hope, I hope, I hope, I hope, I hope, I hope, I hope, I hope, I hope, I hope, I hope, I hope, I hope, I hope, I hope, I hope, I hope, I hope Tuesday's beta is a good positive number; strong doubling is what I am hoping for.

Thank you for the flood of support you have offered me. It is truly humbling to know that so many people across the world are supportive. Thank you! :D

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