Riddle me this

I'm no doctor, but maybe you are. Maybe, if you are, you can explain this to me, because I'm at a loss.

Without insulin, my fasting blood sugar hovers between 100 and 110. A few times it's dropped into the 90's, occasionally it's been 112. But in general, 100 - 110. Now then. I introduced 6 units of long acting insulin at night on Friday. I've had absolutely no response to it. My numbers are still exactly the same as when I was not injecting myself.

When I told the perinatal NP this? Her regime change was to add 1 more unit to the injection. So now I'm supposed to take 7 units. I'm completely unclear what she hopes to accomplish by this. I went from no insulin to 6 units and saw no change at all. If 6 did nothing to budge the numbers, why would the addition of one more (which equates to an additional 2 drops, these units are so tiny) make any difference whatsoever?

I asked myself this all evening, hoping that a reasonable response would come to me. As it did not, I filled the syringe with 7 units (which is a real bitch because the space between 6 and 8 is itty-bitty) and did the deed.

And this morning, you know what? No change at all. Fasting blood sugar was 102.

Still... I'm no doctor. What do you (doctors and others) make of it?
Posted by GoddessKristin on 03/27/07 at 07:40 AM [link]

Stick it to me

For a person who really really really dislikes needles, I have become downright comfortable with my insulin injections. For one thing, I don't even feel them - honest to God. I watched the whisper thin blade poke through my fishbelly white abdomen with a feeling of absolute amazement last evening - how come I wasn't feeling that? Was it a trick needle, like on TV? Was it even puncturing anything? How can that be?

It's a good thing they don't hurt, because they haven't done a damn bit of good so far.

I'm only taking 6 units a night, which apparently is the most embarrassingly small dose they can prescribe without laughing you out of the office. But it appears to be too small for me (and this may be the only time in my life I can say that something is too small for me). My fasting numbers have not budged and while they are not going up, other numbers appear to be. This may be because I am absolutely sick to death of the 3 things I can eat without going over my target levels and have branched out. Half a cup of milk! A boneless, skinless chicken breast and half an English muffin at once! An apple larger than a cherry pit! Oh the chances we take!

I figure if I'm going down, I'm going down with all the guns blazing. It does me no good to mask the extent of this debacle by limiting my menu to cheese sticks and mushrooms. It's not sustainable for the next 10 weeks and I will hurt someone if I have to do it. Plus, it's not healthy - one has to eat carbs when pregnant. Ketosis is not a good thing here.

But enough about the damn diabetes. We are so close to finishing the nursery! The vast majority of the painting is finished (just a tad of touchup and the windowsill and doorframe needs to be painted) and the Tinkerbell border is up (and is actually sticking to the wall, Gods be praised). The crib, dressing table and Tinkerbell blinds are sitting in the living room awaiting placement in their new homes (along with clothes, books, a few toys, and various other items for this child). All we need is a baby!

Oh my God we're going to have a baby in that room in 10 weeks or less. I think I need to lie down.
Posted by GoddessKristin on 03/26/07 at 02:01 PM [link]

So it has come to this

When my midwife walked into the examining room this afternoon, she apologized for having taken so long. "I was working on setting you up with an OB," she explained. Because of the diabetes, you see. And the fact that I will be going on insulin ASAP.

So I have that going for me.

Much dietary tweaking has been done this past week. I have eaten no milk or fruit at breakfast, only one fruit and no milk at lunch (and vice versa), only one of my two allotted starches at dinner, played endlessly with my evening snack and... my numbers are still all goofy. One day I'll have all the daytime numbers under control but the fasting blood sugar is too high. Then the next day the fasting is OK (on the high end of where we want it, but in range) but my post-breakfast and post-lunch numbers are bloated, despite eating the same things in the same amounts that were fine 3 days ago.

My placenta is going on some sort of military-backed coup in there and my pancreas is powerless to stop it, is what I'm saying.

So... off to the OB's. I'm actually less upset about this that you might think, because at least now I know. I am a girl who does not deal well with ambiguity. I don't like not knowing what's going to happen. Tell me the world is going down in flames, tell me things are royally screwed up but just tell me. Don't say, "It's possible that you're hosed." Either I am or I'm not - I don't do middle ground.

I did find it interesting that my midwife set me up with a different OB than I see for my paps and the like. My regular coochie doc (who I will refer to here as Dr. Oldcottage) has a bit of a reputation for being a horse's ass, actually. My mother, for instance, cannot stand the man. He can, I'll agree, be arrogant and condescending, but my own experiences with him have been limited to the occasional womanly exam and I haven't laid eyes on him in over a year, and I've never had much in the way of a relationship with him. I think that's a-OK. I don't want to feel too close to someone who does what a gynecologist needs to do to me. Get in, get out and don't make me handle deep conversation, is my motto.

On the other hand, Dr. Oldcottage is also terrible about returning messages. And I don't think I really need that with everything else that's going on, you know? So the fact that Maggie the Midwife pointed out that my regular OB is Dr. Oldcottage but she had spoken to another doctor about taking me on was interesting. What was behind her interest in sending me to a different OB? Was Dr. Oldcottage not around today? Does he not deal with this type of problem? Or perhaps is he such a known horse's ass that she wished to spare me his (ahem) care?

The world may never know.

I will see the new doctor on Thursday, when we will talk insulin and other plans. I can't say I'm looking forward to it, but at least I know where I stand. More info as I get it.
Posted by GoddessKristin on 03/20/07 at 07:18 PM [link]

When is it summer, again?

Test question: How did George Washington handle The Whiskey Rebellion?

Real answer from a student I didn't throttle today but totally wanted to: He handled it great.

We are praying for summer 'round these parts. How are you?
Posted by GoddessKristin on 03/19/07 at 03:11 PM [link]

And now I shall cry a little

Remember when I was crowing about how stable and even my hormones have been during pregnancy and how this was a cakewalk compared to the pre-menstrual swings of yester-months?

Yeah. I spoke a tad too soon.

See, I hit the third trimester mark and everything went to hell, merrily, in a handbasket. I have pretty much felt like a train wreck this past week. I blame the hormones, yes, and I blame the fact that I cannot get more than 2 hours of unbroken sleep anymore (I'm either making the Herculean effort to roll over or making one of my many trips to the bathroom) but mostly I blame my old friend Worry.

Worry and I have been intimate on many, many occasions. Worry comes to visit me often in the wee hours on the night, especially during the school year when together we traipse the well-worn fields of "Am I doing everything I can to teach these kids?" and "Are all my lesson plans in place?" and my own personal favorite, "What did I forget to do today?" That last one has kept me up for many an hour as I go over and over and over a never-ending list of things that I either should have done, wanted to do, forgot to do or didn't actually want to do and am actively trying to figure out how to get out of doing.

Oh it's jolly times with Worry. We have nothing but fun.

Lately, of course, Worry has had a new playmate. Stark-Raving Freakout has joined in the party and it's all I can do most of the time to keep her at bay. The gestational diabetes diagnosis has brought SRF out from her hidey-hole where she'd been lying in wait since the first trimester. See, the whole first 13 weeks of my pregnancy, Freak and I were close pals but I kept the upper hand. Worry helped push me toward the loving arms of Stark-Raving Freakout more times than I can count - every cramp, twinge, ache, pain or lack thereof was an opportunity for the two of them to whisper in my ear the siren song that goes, "What was thaaaaat? Is that the first sign of a miiiiiscarriage? Is your baby OOOOOOO-kay? So many things could go wrooooooooong."

It was not a platinum hit, but it had a good beat and I could dance to it (which I did, many times). But I kept myself to myself and, as far as I can recall, never really melted down.

I guess my immunity is weakening though (something is sure as hell weakening because it just took me two minutes to come up with the word "immunity" and every time I typed "weakening" in the last sentence? I typed "weaking" first. EVERY TIME). Anyway, since the diabetes diagnosis it's been nothing but a non-stop rave with Worry and Stark-Raving Freakout. They are in the hiz-ouse and nothing can make them leave.

I will not chronicle the litany I go through, because it bores even me. Suffice it to say that the list of things that can go wrong with a diabetic pregnancy, up to and including stillbirth, is never far from my mind. I know that the likelihood of a problem that extreme is so remote as to be laughable because I am doing everything in my power to manage this and it's not that far out of control. Plus, I'm doing things outside of my power - because really, if I think worrying is helpful here I am deluding only myself, but I am the type of idiot who feels that if she is not worrying she is not doing everything possible to stave off The Badness.

It's the unknowns that get me. I freely admit to being a huge control freak and the fact that my fasting and post-breakfast blood sugar levels are too high is not boding well. I am also a competitive person and this whole thing feels like a tremendous failure to me. The reasoning - illogical though I know it is goes like this: Good mommies do not get gestational diabetes and put their babies in any sort of risk categories. And if good mommies have the poor fortune to get into this situation, they get on the ball and take care of business immediatement! Good mommies do not dick around with fasting blood sugar levels that are 6 to 10 points too high. They get in there and kick that blood sugar's ass. You do not appear to be doing that. A=B=C and therefore, not such a great mommy.

The fact that I am doing what the dietician says to do and I am exercising and the blood sugar hasn't budged? Extremely frustrating. And it's the frustration and the worry together that are pushing me towards the freakout. I spent much of the day yesterday trying not to cry and failing many times. It didn't help that I was watching Discovery Health and those people have a penchant for shows that tug the heartstrings. If it's not life-saving surgery that brings someone back from the brink of death it's a miracle baby or six. One baby actually died at the end of "Special Delivery" and I freely admit to losing my shit altogether.

I don't know quite how to approach the next weeks. I would prefer to sleep through them, but this is not practical (how would I get up to pee?). I would attempt the tried-and-true method of ignoring it as much as possible but this is equally difficult because 7 finger sticks a day will tend to remind me. Even I, a happy queen of denial, cannot ignore 7 blood-stained fingers a day. Eating every 2 hours and poking oneself with a pin 7 times a day does not a normal life make, you see, and it is hard to pretend otherwise.

We are at the 12 weeks and counting point. It is extremely unlikely that they will let Dessa bake any longer than that, so one way or another... just under 12 weeks. It is not the prospect of the diet or the finger sticks that bother me for the next 12 weeks. It's the goddamn uncertainty. Poke me and bleed me as much as you need to... but don't make me wonder. That I cannot handle.
Posted by GoddessKristin on 03/15/07 at 09:26 AM [link]

At long last

Finally! The CD from the 3D ultrasound place arrived today and I can now share the pictures with you! We were beginning to think the long-promised jpgs were lost to the ether and would never show up. And you are glad you waited because the sepia pictures are, in fact, better than the black and white pictures, if only because it's easier to imagine the inside of a uterus being sepia toned. Well, it's easier for me, anyway. Sepia tones are like old friendly photos, while black and white is more akin to East Germany in the 1960's. I don't want to think of the womb as a bastion for Communism, so there you go.

I will shut up now. Here is the baby, who we have decided to name Dessa Juliana:

Here is my accomplished child either picking her nose or bashing herself in the head. We are so proud.

Later, she took up boxing:



Here is our child, a la The Thinker. Doesn't she look like she's concentrating on something?



Her head looks wierd in this next one, but I'm assured that it's the ultrasound software and not something bizarre with her actual skull:



And here she is with her mouth open, and frowning. She was drinking the amniotic fluid here and I assume there was something in there she didn't care for, given her facial expression.



There are a few others on the disk we got but these are the clearest. I would show you the image of her arms, legs and girl parts all tangled up together because it looks like a total mess in there and kind of cracks me up, but I will spare you (and Dessa) the crotch shot. I can imagine her 13 years from now, "Moooooooom! How could you show my naughty bits to the woooooorld!"

I'll simply hide those shots away for blackmail material. You can never start too early.
Posted by GoddessKristin on 03/08/07 at 06:40 PM [link]

This just keeps getting better and better

An inauspicious visit with Maggie the Midwife yesterday. Without going into extreme detail, she is not at all confident that diet will help me bring the diabetes under control. Basically, here is her thinking:

1) My fasting glucose level was 112 when they want it under 94. This indicates that my pancreas is lolling around like a useless bum for hours and hours after I eat. Fasting glucose should be a gimme, but mine was already too high even before we started the test.

2) My one and two hour numbers were "the highest I've seen" according to her. This is not comforting.

3) My hemoglobin numbers are lovely. This is good because I am nothing like anemic, but it indicates that my diet is already peachy keen.

4) I have not gained any weight over the pregnancy (given my starting weight, this was the goal). In fact, I've lost something like 6 lbs net. Thus, the glucose rampage is not related to out of control portion size, rapid weight gain or junk food, which are the sorts of culprits that the diabetes diet is targeting.

Ultimately, she thinks I will be on insulin soon and for the duration of the pregnancy. This, on it's face, doesn't alarm me all that much. Not that I think it's thrilling or anything I actually wanted, but it's not a huge surprise and it's only a few months and you do what you need to do for the well-being of your child etc etc etc.

The bummer of the deal is that if I wind up on insulin I am slapped with the "high-risk" label and thrown to the OB's. I can't stay with my wonderful midwife, who I love to death. I suspect the delivery becomes a lot more filled with protocol and possible interventions because Kaiser's just sort of like that, too. On the one hand, it's not like it really matters that much who I see in the office for the last few months, because, much more likely than not, they won't be on-duty in Hayward when I give birth anyway. On the other hand, any time you get that high-risk label, the tendency for birth to be considered a medical condition and not a natural thing goes sky-high. Particularly when you're going into a situation where you're unlikely to have ever met the on-call OB, or any of the nurses, and they don't know you beyond your medical chart.

The thing I most want to avoid is a C-section. Managing the diabetes so that the baby isn't ginormous is a critical part in that, but so is dealing with the medical staff. Gestational diabetes tends to lead to things like induction, which can lead to long, unproductive labors, which leads to C-sections. I hope I'm borrowing trouble, I honestly do, but I feel like I need to go through all the possibilities to see how I can work to avoid them. It's a sad thing to say, but I have no confidence that anyone at Kaiser will advocate for me or go out of their way to help me have a good birth experience beyond the midwives, who I had great confidence in. If - and I hope it doesn't come to this, but I do have to prepare myself for it - if I can't work with the midwives anymore, I really feel like I'll have to be my own advocate at a time when I will be hard pressed to do much more than get through the next minute or two.

People offer suggestions like, "Hire a doula" but that doesn't appeal at all to me. I don't want someone I've had to hire with me when I give birth. It's an intimate family experience that I don't want to share with anyone I'd have to consider an employee. And perhaps it's wrong of me, but I can't think of it any other way. I'm not the sort who bonds with other women naturally, so... it's just really not an option for me.

I don't know. For the next few weeks I will hope that Maggie the Midwife is wrong and that diet will cure all evils, but I am not betting on it. I'll do everything I'm supposed to, so that at least if it does come down to insulin I'll know I did everything I could. And I will continue to keep in mind that, yes, the object is my happy, healthy daughter, however she gets here.

But I will not go down without Googling the living shit out of everything I possibly can and being the best informed patient possible. That much you can put money on.
Posted by GoddessKristin on 03/07/07 at 12:39 PM [link]

Kaiser strikes again

Remember when I said yesterday that my glucose numbers didn't make any sense because my level at three hours was higher than my level at two hours? Yeah, that's because THAT DIDN'T MAKE ANY SENSE.

Turns out the "advice nurse" who I had to wait for to talk about my results? She read the results in no discernable order whatsoever. She was just reading numbers like a crazed auctioneer. As in, she told me the 3 hour number, then the 1 hour number, then the 2 hour number and never even gave me my baseline. But she said they went one hour, two hour, three hour. Which was mystifying and also very wrong. So I spent an inordinate amount of time yesterday Googling "glucose challenge results rising" and "3 hour glucose test rising results" and "Glucose numbers all over the fucking map is everything OK with my baby HELP ME" with nothing to show for it because people's numbers don't jump around over 3 hours like that when they're not eating anything.

I knew something wasn't right. I should, honest to God, skip right over medical school and go directly into practice for myself, with Google as my partner. We would do better than the entire "advice line" at Kaiser put together.

It turns out that, although I am indeed screwed in the gestational diabetes department, I am not New England Journal of Medicine screwed. This is more comforting that you might think. My baseline fasting number was high (they want under 94, I was 112 - a poor start), my 1 hour number was 211 (they want under 180), the 2 hour number was 203 (going down veeeeerrrry slowly, but they want it under 155 so I was definitely hosed) and then I was 118 at 3 hours, which is actually a good number and under where they want it. I guess my pancreas finally stepped up. But it was too little too late. Of four draws, I flunked three of them and with this test if you're bad on even two numbers you're outta there.

Next week I go in to see a dietician and get testing supplies and learn how not to infect entire nations through the judicious use of a sharps container. And since I am 27 weeks today, I only have about 13 weeks or so of daily finger sticks to go since they won't let the baby bake for much longer than that, given how GD tends to grow big ol' honking kids (actually, with careful monitoring and diet, there should be no problem, and we know how I will insist on careful monitoring. I'll insist - though at Kaiser we know that's no guarantee that I will receive).

So... good news. Sort of. At least I'm trying to see it that way, since there's nothing else to be done about it. More news tomorrow, as I'm seeing my midwife this afternoon.
Posted by GoddessKristin on 03/06/07 at 08:26 AM [link]

My placenta is kicking my pancreas' ass

The bad news is that it seems I failed my 3 hour glucose tolerance test in an emphatic way. The good news is that I am, as usual, a medical anomaly. My numbers make no sense as far as I can tell. Hooray!

For anyone not in the know, the glucose tests are checking for gestational diabetes. Given my age, weight and luminous family history, I'm a prime candidate for gestational diabetes. I was tested at the beginning of my pregnancy because of the miscarriage. My midwife wanted to rule out undiagnosed diabetes as a contributing factor. I passed that one just fine. So we know that everything that's happened over the past week is the fault of the placenta, which is pumping out god knows what hormone and kicking in the teeth of my poor pancreas, which lies, huddled in the corner, weeping piteously (because we know for damn sure it's not busy pumping out insulin).

I took the 1-hour glucose challenge last Tuesday. (And I have to say, I love the name of the test "The One Hour Glucose Challenge". Sounds like a reality TV show, doesn't it?) Suffice it to say that I failed the 1-hour test. They were looking for a number below 140 and I was 153. So I got the singular joy of taking the 3-hour challenge.

This test involves fasting for 8-10 hours and then showing up at the lab to have your blood drawn 4 times over 3 hours. They take a baseline blood draw and then have you chug the nastiest, syrupiest lemon-lime sugar drink ever. Fortunately it was cold because if it hadn't been refrigerated I would have revisited that drink in about 3 seconds flat. Then you wait around for 3 hours and pop in to have your blood drawn at 1 hour, 2 hour and 3 hour intervals. While you wait for the hourly puncture, you have to stay at the lab and you can't move around. You have to just sit there. Nothing but water can pass your lips.

It gets tedious.

I called for my results this morning. At 1 hour, an abnormal reading is 180 or higher. Mine was 118 - good! Then things went south quickly. At 2 hours it's supposed to be under 155. I was 203. Not good at all. After 3 hours, we're looking for under 140 and I had an improbable 211. Higher than my 2-hour number. I have no idea how it went up or what that means. Shouldn't at least some of the glucose have gone away?

I see my midwife tomorrow and we'll work out a plan, I guess, because I know what this means. I have gestational diabetes - surprise! I'm actually not shocked at all and not quite as freaked out as I thought I'd be. It's managable, and while I love my carbs, giving them up until June cannot possibly be the hardest thing I will do for this baby. So I'll just do it.

Of course, that sounds all philosophical and great now, but I have no idea how I'll really react when I get the full instructions. I'm sort of bummed because all my vices are forbidden these days - no wine in a hot bath to relax, no rock concert (Sting, I'm looking at you), and now no sugar.

The payoff though... the payoff is so worth it.
Posted by GoddessKristin on 03/05/07 at 10:53 AM [link]

What kitchen?

We do, in fact, have a functional kitchen, for those of you who were wondering. We've had a functional kitchen since January. I haven't posted pictures of it because I don't actually consider it completely finished. I am a stickler for accuracy and I really wanted to be able to whip the pictures on you and say, "Ta da! It's done! Here's the kitchen!"

That may not happen for... ever.

But it's done for all intents and purposes. There are still two side panels that need to be attached and all the kick plates for the bottoms of the cabinets are lying, uncut, in the garage, but honestly? Close enough for atomic bombs and horseshoes.

So here, without any further ado (because there has been more than enough ado around these parts) are the results.

We started out with this, if you recall:

Things now look much better, because they look like this:



So. Much. Brighter! The kitchen no longer looks like a den of iniquity! It looks like a pleasant place to chop things and mix them and create fantabulous dishes such as lasange, or beef stew, or duck with blueberry glaze, or any number of marvelous things which we have, in fact, cooked in there! I am thrilled beyond words.

From the other direction, we have this:



And then there is this:



Even if we never install the kickplates (but we totally will) I am thrilled beyond words. It is incomprehensible to me that we pulled this off without injury or major mishap. There were moments when I wasn't all too certain about this endevour. One of those moments might have been five days before we started demolition when I wandered through the house clutching my hair and crying, "We are so unqualified to do this! What makes us think we should attempt this!?"

I was in my first trimester, is my only excuse. I am better now.

Sort of.

Anyway, that's the status of the kitchen. Status=good. Also lovely.

Soon I will be posting pictures from the 3D ultrasound. Possibly tomorrow. I cannot promise these things because I do not scan pictures. Dave does. I cannot make promises on his behalf. Also, we're awaiting the CD from the ultrasound place that will contain "color" pictures (read: sepia tone) and those might be better than the black and white ones and I want to post the best pictures I can. Because I am a giver! I think only of you!

You're welcome.
Posted by GoddessKristin on 03/04/07 at 12:05 PM [link]