I had a frightening morning today. I knew that in early pregnancy insulin requirements can reduce, and hypo warning signs can dull. Here's Gary Schreiner on the subject: 'During weeks 8 to 16 of pregnancy, insulin requirements tend to be lower than usual, followed by a gradual increase in insulin needs until the baby is delivered. Severe hypoglycaemia is three times more common during the first trimester of pregnancy than during the four months preceding pregnancy. This is partially due to the drive for very tight control during pregnancy, and partially due to the uptake of glucose by the growing fetus. Compounding the problem is a suppressed counter-regulatory hormone response to hypoglycaemia. Traditional hypoglycaemic symptoms tend to appear at lower blood sugar levels during pregnancy.' Gary Schreiner, Think Like a Pancreas, (Da Capo, Cambridge MA, 2004), p. 173.* So far I've had the slight dulling in hypo warning symptoms, but my insulin requirements have been holding up to usual levels (maybe even a little more). Until the last couple of days, that is.
Yesterday evening I came home from work and cooked a yummy spiced butternut squash and sweet potato soup, which I served with Irish potato farls on the side. This is an old faithful meal which keeps my sugars nice and level. I took the usual insulin for it, ate my dinner (a good sized portion) and then an hour later I had that horrible sinking feeling. I tested, and sure enough I'd plummeted to 4.2 mmol/l one hour postprandial. 8.0 mmol/l would be the target. So I started the cycle of treating, waiting 15 minutes or so, testing and repeating. Which went on for the better part of two hours. Here's how it went: 10.19pm - 4.2 (and dropping). 10.52pm - 3.3. 11.22pm - 3.4. 11.35pm - 3.9. 11.47pm - 3.7 (down again?) 12.50am - 7.1 (finally!) During this time I forced down a chocolate oat cake bar and half a packet of Dextro Energy tablets (ick). When I woke in the middle of the night to go to the loo ( a regular occurance these days), I did my usual test and found that I'd crept up to 10.7 (at 5am). Took a small correction dose, and by 8am I was sitting pretty at 4.1mmol/l, which is a good place to be.
I felt slightly crappy when I woke up (not surprising really), and decided that maybe this was the beginning of my changing insulin requirements, so I dropped my breakfast insulin slightly and ate a slightly larger than usual breakfast before setting off for my 40 mile drive to work. Here's how it went, and it was absolutely terrifying... 9.06am, test sugars at 3.4 mmol/l, eat five glucose tablets on top of my big breakfast and set off. 9.26am, pull into a layby in a country lane somewhere between Bristol and Bath because it feels like my sugars are going south. Test reads 2.6 mmol/l. Eat more glucose tablets and call work to say that I'm hypo and have pulled off the road so I'll be late. Wait and test again: 9.34 am - 3.9 (coming up - good). Wait some more, still feeling weird so eat more revolting glucose tablets. Test again: 9.48am - 3.3 mmol/l (going down - seriously? how??) Eat the remainder of the packet of glucose tablets. Wait, and test again: 9.55am - 4.3 mmol/l. Give it five more minutes then retest. 10.00am - 4.6. (Woo-hoo - safe to drive). By this time I've received a text from my boss telling me to head home as it's closer. 10.19 am, arrive home and test again - 4.1 mmol/l. Down again? Really? More glucose from the half packet left on the bedside table from last night's excitement. Head thumping by now, I lie down but don't dare to sleep. Set alarm on mobile phone for ten minutes time. Test again at 10.31am - 5.4 finally, and I can doze off for an hour. Test again at 11.51am, and I've reached the comfort of 6.6 mmol/l. However, I've eaten most of the day's calories in one go (and as glucose tablets - eeeew) and I've had enough carbs to put me in hospital under normal circumstances.
Hence my feeling that it may be time to revisit my insulin requirements! What has surprised me is just how fast this has come on, and how scary it is to be forcing glucose down and see your numbers continue to travel in the wrong direction. Looking back, I think this may have all begun on Saturday, when S and I spent the weekend with my parents and brother to celebrate my Dad's 65th birthday. We went out for a beautiful meal in a very posh restaurant and I took my usual insulin to cover this blow out, rather than increasing my doses. I was cruising at 5mmol/l two hours post-prandial. Just wrong really! So, as of today I'm going to start reducing Novorapid doses at each meal, and will also slightly reduce my background Levemir doses too. I'm home for the rest of the day (banned from coming into work by my very solicitous boss, whose wife is a T2, and hence who understands a little bit about diabetes), so I can check my sugars even more than usual and keep a close watch on what's happening. I was supposed to stay in London tonight but have contacted the people I'm meeting tomorrow to say that I'll be doing the meeting by teleconference instead. It's awkward, as no-one know's I'm pregnant yet. I'm planning to tell work once I'm safely through the first trimester, so when I was asked why this might have happened I couldn't say, 'ah, yes - this happens to pregnant diabetic ladies'. Instead I had to fall back on the oldie but goodie 'sometimes things happen to type 1s that don't make sense, it's just one of those diabetes things'. I guess I'm lucky that in almost 16 years I've never had a truly disabling hypo, never had to use a glucagon kit, and never had to call the paramedics. I hope that continues, and I'll be testing and altering my doses all the more to make sure that it doesn't. Oh, my poor fingertips.
This post has been a bit of a downer, all in all, but really I'm fine, and by applying all the 'diabetes rules' I got through my scary morning okay. I guess it's all part of the challenge of diabetes and pregnancy. I did have some good news yesterday though, so I'll finish on a high note. My last HbA1C, taken at the hospital on Thursday last week, was better than I expected. I'd been running a little higher than I would have liked for about a week around the time I conceived, so I was expecting a less good result than the previous two. Instead, I improved again! It was 6.3% - a number I haven't seen since my post-diagnosis honeymoon period. Not too shabby at all. So, my little passenger and I are doing fine, despite all the dramas of the last couple of days. Long may that continue. :)
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NOTES:
* Also see this fascinating article for more detailed information: L. Jovanovic et al, 'Declining Insulin Requirement in the Late First Trimester of Diabetic Pregnancy' in Diabetes Care, July 2001, vol 24, no 7, 1130-1136. Particularly interesting is the information that 'In pregnancies that resulted in live-born full-term singleton infants, a significant 18% increase in mean weekly dosage was observed between weeks 3 and 7 (P = 0.000), followed by a significant 9% decline from week 7 through week 15 (P = 0.000).' Might use these percentages as an initial guide for tweaking my doses since I seem to have experienced the increase in weeks 3 to 7.
Lilypie First Birthday tickers
Tuesday, 7 September 2010
Thursday, 2 September 2010
Sixth Appointment a.k.a. the 'booking appointment'
So, this morning I had my first appointment at the clinic since I found out I was pregnant. It's been a beautiful late summer's day, so I parked the car about 20 minutes walk away from the clinic and enjoyed walking in. Nice to get some exercise, but actually not the best idea I've ever had, since by the time I arrived at 8.30 I was already hypo, and had to treat twice before my sugars came back to normal. Ah well, if you're going to do it there's probably no better place than the diabetes clinic!
I waited for about half an hour before I was seen (could have stayed in my lovely comfy bed a little longer!) by two new faces, a lady endocrinologist called S, and a DSN (Diabetes Specialist Nurse) called D. They had a really good look at my monitoring diary, suggested that I might be taking a unit too much insulin at each meal, but especially lunchtime, and then hit me with a tsunami of information! The researcher in me totally geeked out ;) Rather than try to capture it all as it happened I'm just going to try to pull out the essentials! Thank goodness for my trusty notebook, which is allowing me to reconstruct what was said. They both said they could see why my sugars have been so good and my HbA1c has come into line so well - I'm obviously a control freak! (Maybe the list of questions I'd brought with me gave it away?)
Once I'd seen the diabetes duo, I waited in the same room to be seen by one of the obstetricians. L, the dietician, popped her head round the door for a chat and to congratulate me, so I was able to thank her for the ovulation sticks tip. Turns out the reason she knew they're so great is that she's 18 weeks pregnant herself! I'm thrilled for her, and we had a little mums-to-be gossip for a few minutes, which was nice. I think it might be catching, as I noticed that the clinic receptionist is also pregnant! :)
My next caller was A, one of the obstetricians, who took a detailed history from me to add to my notes, and explained some more about what will happen on the obstetrics side. (I don't have the fabled 'yellow file' yet, which all UK pregnant ladies carry around with them. This is the pregnancy medical notes which will be started by the community midwife and given to me for safekeeping.) A briefly went over the diabetes-pregnancy 101 stuff - bigger babies, risks if sugars are high, possible c-sections, early delivery (although she said that it could be 38-39 weeks, not a blanket 38. It will depend on baby's growth and my sugars). Then she ran me through the various different scans and tests that I'd be offered. These include:
Once I'd seen both the diabetes and obstetrics teams all that remained was to have some bloods taken and produce a urine sample (no worries for me these days - my bladder's already working overtime). On the way to have my bloods taken I ran into Dr I, who stopped for a 5 minute chat to offer me his congratulations and see how things are going. All in all I was at the clinic for two and a half hours, and everyone is so great it's almost like being in a parallel universe (certainly compared to the clinic I used to attend for many years in another big city).
Once I'd booked my next appointment and confirmed the one I already had booked (and changed its designation from pre-pregnancy to pregnancy) I headed home, with the notes A had made tucked in my bag for inclusion in the yellow file once it's been started. This afternoon I went to arrange my first appointment with the community midwife at my GP surgery (which involved some form filling and sharing of dates I can and can't do). She'll apparently call me to set a time to meet sometime between weeks 8 and 12. I also had my prescription dispensed, so I'm now the proud owner of a box of ketostix that I hope I never have to open :)
So that was my day. Pretty busy, and I'm feeling tired now. I also had a busy day yesterday visiting my friend L, her son J, and her new baby daugher L. We went on a long walk in the sunshine and had a lovely time, and I told her my news. L's a hugely trusted friend who's been through a lot pregnancy-wise, and she's going to be my pregnancy buddy and mentor. That was supposed to be it for the telling people - I don't want to spread the news too far and wide just yet as it really is early days. S has told one friend (his best man), I told L, we've told both sets of parents and when we see my brother this weekend we'll tell him. However, another extremely good friend, J, rang out of the blue last night for a chat and to invite us to go and stay with her and her husband and meet her 6 month old daughter. I can't wait, and I'm afraid I cracked and told her too! Obviously it's still early days, and things could go wrong for me, but S and I agreed that if we were going to tell a select few people it would be in the full knowledge that we'd have to be able to face telling them we've had a miscarriage if anything does go wrong. L and J are two of my best friends, and I'd tell them anything, so I feel comfortable with telling them this news. We share stuff. However, I'm now drawing the line around my inner circle. Anyone else who asks (and actually J did ask outright) will be told 'we're working on it' - which is not untrue, just not the whole truth either!
Wow. Just realised I've been typing away for ages. S has arrived home from work whilst I've been tapping the keyboard. Must be time to check the old sugars and see what's for dinner. Bye for now!
I waited for about half an hour before I was seen (could have stayed in my lovely comfy bed a little longer!) by two new faces, a lady endocrinologist called S, and a DSN (Diabetes Specialist Nurse) called D. They had a really good look at my monitoring diary, suggested that I might be taking a unit too much insulin at each meal, but especially lunchtime, and then hit me with a tsunami of information! The researcher in me totally geeked out ;) Rather than try to capture it all as it happened I'm just going to try to pull out the essentials! Thank goodness for my trusty notebook, which is allowing me to reconstruct what was said. They both said they could see why my sugars have been so good and my HbA1c has come into line so well - I'm obviously a control freak! (Maybe the list of questions I'd brought with me gave it away?)
- Contrary to what I'd understood before my care will actually be shared between the clinic and the community midwife team (sorry to my lovely GP who was right on that score). The lines are still a little blurry to me though, as some of my scans and suchlike will not be organised by the midwife but rather by the obstetrics team at the hospital clinic. I guess we'll just have to see how it all works in practice, but attention from two different sources can't hurt! Apparently the community midwives have more time than the hospital based ones, so that's the rationale for the split.
- There is no set schedule of appointments for a diabetic mum-to-be - it very much depends on how things are going and how well controlled the person is. Some people go into the hospital every single week, others might not be seen for three or even four weeks at a time earlier on in the pregnancy. Apparently I'm doing brilliantly at the moment so the dynamic duo thought that I'll probably be able to keep on top of changing insulin requirements pretty well on my own behalf, and can use the clinic appointments as more of a safety net. Nice to get the praise, but also nice to know that there is a safety net! One thing they said was that my sugars have been so good recently that my risks of problems are likely to be no greater than those of a non-diabetic woman of my age. Hurrah!
- I'm likely to be induced at 38 weeks rather than going into spontaneous labour. The received wisdom (which I already knew from fossicking around on the internet) is that diabetic mums can have problems with their placentas in the last couple of weeks - presumably linked to the other vascular issues we all have - so as a precaution T1s are made to deliver early. When I'm in labour I'll be put on a sliding scale, although I'll still be able to monitor my own sugars as well, if I wish (can you say control freak!?) I'm on MDI, not a pump, so this makes sense to me (although the last time I was on a sliding scale, when I had my wisdom teeth out, it was so mismanaged that I ended up discharging myself in order to get my sugars back down to a number that wasn't in the twenties - that's mmol/l for my friends in the US - or about 360mg/dl plus!)
- Delivering early also takes account of the fact that diabetic women can have big babies (macrosomia) if their sugars are high in the later trimesters. We all know that there's also a greater risk of having a C-section, but I was relieved to hear that this particular clinic doesn't push people into having unneccesary C-sections. They'll see how things are going and make a decision based on the evidence at hand.
- I don't have the option of a home birth, since it's important for the baby to be monitored closely in the first couple of days - even if my sugars are good there's still a risk that baby's pancreas will be working overtime at birth with consequent low blood sugars. I'm totally at peace with this one. I know some people don't like the idea of a hospital birth, but frankly I'm all about the big old safety net.
- I need to keep taking the high dose folic acid until I'm 13 weeks. Once I reach that point all the benefit will have accrued and I can revert to just taking a maternity vitamin with the 'normal pregnant lady dose' (ie. twice the normal RDA).
- My blood pressure will be monitored closely as T1 ladies face a higher risk of pre-eclampsia. Both the hospital clinic and the community midwife should be all over this one. I also have a BP cuff at home, so I can keep an eye on this myself. Mum had pre-eclampsia with me, so I'm wary about this possibility.
- My thyroid function tests at my last appointment were fine. I am on the edge of what's normal, and have been warned that a pregnancy might just tip me over into having an underactive thyroid, but at the moment all is okay, and they'll watch me closely.
- My eyes will be checked once a trimester for any signs of retinopathy. So far I've been extremely lucky and have had no trouble in this regard (retinopathy still terrifies me even though I know most T1s will experience it at some point in their lives and that treatments have improved a hell of a lot since I was first diagnosed back in 1991). I'll be having my eyes checked at my next appointment, which will mean not driving (expensive cab time) and taking the day off work (as I won't be able to get in later in the day, what with the 40 mile commute).
- I wanted to know if I should have some ketostix. Honestly I don't think I've clapped eyes on these since I was first diagnosed, and being pregnant I wanted to reacquaint myself! The answer was a resounding yes, and I left the appointment with a prescription.
- I also wondered about how much weight I should be gaining in this pregnancy. As those who've read my earlier posts will have realised I'm not a svelte little person. No, I'm what my Dad once described as 'dense'. My BMI is hovering around the 29-31 level, and I'd read that I should try to restrict my weight gain to about 6 kgs (15 lb) instead of the recommended ideal of 11.5-16 kgs (25 lb - 35 lb) suggested for people with a 'normal' BMI. The doctor told me not to worry too much about this. With my levels of control and the kind of doses of insulin I'm taking I will be likely to gain, apparently, but she didn't think that I was in a worrying category weightwise. The trick is to eat for one (with 200 cals extra in the last trimester) and stick to healthy foods. I've been trying to do that for months now, so I hope I won't struggle. So far I'm not really experiencing any morning sickness, food aversions or weird cravings, so that makes things simpler. Fingers crossed that I stay this way!
- I've recently been invited for an annual flu jab (all T1s in the UK are considered to be in an 'at risk group' and get routinely invited). I was told that having this is fine whilst pregnant, and in fact is a good idea.
- My final question was 'when should I worry?' I know that the odd high blood sugar is fine (although I'd prefer not to see any!), and that the real concern would be soaking this embryo in persistently high sugars, but I wanted to know if there was any guidance on when I should be worrying more. Apparently pregnant women can be at greater risk of DKA, and if I'm vomiting, not eating or drinking, and have ketones of 3+ (hence the ketostix), I should call the hospital and come straight in. I should also start to worry if my insulin requirements start to tail off (instead of increasing rapidly) in later pregnancy, as this can be a sign that all's not well with the foetus.
Once I'd seen the diabetes duo, I waited in the same room to be seen by one of the obstetricians. L, the dietician, popped her head round the door for a chat and to congratulate me, so I was able to thank her for the ovulation sticks tip. Turns out the reason she knew they're so great is that she's 18 weeks pregnant herself! I'm thrilled for her, and we had a little mums-to-be gossip for a few minutes, which was nice. I think it might be catching, as I noticed that the clinic receptionist is also pregnant! :)
My next caller was A, one of the obstetricians, who took a detailed history from me to add to my notes, and explained some more about what will happen on the obstetrics side. (I don't have the fabled 'yellow file' yet, which all UK pregnant ladies carry around with them. This is the pregnancy medical notes which will be started by the community midwife and given to me for safekeeping.) A briefly went over the diabetes-pregnancy 101 stuff - bigger babies, risks if sugars are high, possible c-sections, early delivery (although she said that it could be 38-39 weeks, not a blanket 38. It will depend on baby's growth and my sugars). Then she ran me through the various different scans and tests that I'd be offered. These include:
- early viability/dating scan - which will happen in 4 weeks time.
- Downs screening. The usual blood tests aren't valid for T1 ladies, so they offer the nuchal scan instead. This usually takes place at 12-14 weeks.
- A detailed 20 week anatomy scan.
- Regular growth scans from 24 weeks onwards.
Once I'd seen both the diabetes and obstetrics teams all that remained was to have some bloods taken and produce a urine sample (no worries for me these days - my bladder's already working overtime). On the way to have my bloods taken I ran into Dr I, who stopped for a 5 minute chat to offer me his congratulations and see how things are going. All in all I was at the clinic for two and a half hours, and everyone is so great it's almost like being in a parallel universe (certainly compared to the clinic I used to attend for many years in another big city).
Once I'd booked my next appointment and confirmed the one I already had booked (and changed its designation from pre-pregnancy to pregnancy) I headed home, with the notes A had made tucked in my bag for inclusion in the yellow file once it's been started. This afternoon I went to arrange my first appointment with the community midwife at my GP surgery (which involved some form filling and sharing of dates I can and can't do). She'll apparently call me to set a time to meet sometime between weeks 8 and 12. I also had my prescription dispensed, so I'm now the proud owner of a box of ketostix that I hope I never have to open :)
So that was my day. Pretty busy, and I'm feeling tired now. I also had a busy day yesterday visiting my friend L, her son J, and her new baby daugher L. We went on a long walk in the sunshine and had a lovely time, and I told her my news. L's a hugely trusted friend who's been through a lot pregnancy-wise, and she's going to be my pregnancy buddy and mentor. That was supposed to be it for the telling people - I don't want to spread the news too far and wide just yet as it really is early days. S has told one friend (his best man), I told L, we've told both sets of parents and when we see my brother this weekend we'll tell him. However, another extremely good friend, J, rang out of the blue last night for a chat and to invite us to go and stay with her and her husband and meet her 6 month old daughter. I can't wait, and I'm afraid I cracked and told her too! Obviously it's still early days, and things could go wrong for me, but S and I agreed that if we were going to tell a select few people it would be in the full knowledge that we'd have to be able to face telling them we've had a miscarriage if anything does go wrong. L and J are two of my best friends, and I'd tell them anything, so I feel comfortable with telling them this news. We share stuff. However, I'm now drawing the line around my inner circle. Anyone else who asks (and actually J did ask outright) will be told 'we're working on it' - which is not untrue, just not the whole truth either!
Wow. Just realised I've been typing away for ages. S has arrived home from work whilst I've been tapping the keyboard. Must be time to check the old sugars and see what's for dinner. Bye for now!
Monday, 30 August 2010
Bank Holiday Update
It's Bank Holiday Monday in the UK, so hubby and I both have the day off work. Hurrah! I've actually been off work since last Thursday, using up some annual leave, and I'm not going back until next Monday, which is a huge luxury. As I said in my earlier post, S could only take a couple of days off with me, so this has been a bit of a staycation, allowing me to catch up with all kinds of errands (which has actually been more fun than I thought it would be). For the last few days now I've been doing what can only be described as a very belated spring clean. I've been tidying up cupboards, emptying the few remaining boxes from when we moved in (two years ago, the shame!), and vacuuming like a demon. Mum says I must be nesting, but it's a little early in her opinion - in her experience it usually hits at 38 weeks! Maybe, but at 38 weeks I'd be the size of a house, whereas at the moment I can still crawl around the floors on my hands and knees, and I can still fit under the beds :) S has also been brilliant - I found him mopping all our wooden floors on Saturday!
Not much to update on the pregnancy front. I'm really looking forwards to my appointment on Thursday when I'll get to see Dr Inspiring and his crew, and can ask the gazillion questions I'm collecting. Most of all, I guess I just want to know what the next few months will hold, medical appointment-wise. How often will I need to attend the clinic, when, and what for? I remember at my first appointment they waved a schedule at me and briefly explained that this was the shape of things to come, but now I want to get my hands on that piece of paper!!! I'll be six weeks when I go to the clinic. When I spoke to Dr I last week he said something vague about it maybe being too early to see a heartbeat on an ultrasound, so I don't know if I'll have one or if they'll wait. It's a weird feeling at the moment - I know I'm pregnant, but still can't quite believe it! I'm doing everything I need to, diabetes-wise, and my 7 day meter average has now come down to 6.6 mmol/l, which is where I'd like it to be (and round about where it was when I had my last fab HbA1c). I guess I just need a little reassurance that all's okay, so far. My breasts are still very tender (I drove over a pothole last week and... ouch!), and I've continued to need to go to the loo more often than usual, although I'm starting to get more used to that, and don't notice as much. I'm also not sleeping through the night - I usually have to get up to go to the loo at around 4am-5am, so I take the opportunity to check my blood sugars and have a little correction dose if necessary. My overnight sugars have been pretty good the last week or so, which is brilliant, as that's where I always struggle the most.* The other slightly weird thing is that I've lost weight since I found out I was pregnant - 4 lbs by this morning. I guess that's because all my energy's going into making a healthy placenta? I have been pretty tired too, so it's been lovely to have a few days off to catch up on some sleep.
I did go to see my own GP on Thursday, to let him know the news and to sort out one or two things. He was thrilled for me, which was really nice. He's also been a huge support, what with checking my rubella status and folate levels, arranging regular HbA1cs and referring me to Dr Inspiring's clinic. We agreed that I'd delay my smear, as the histology clinic struggle to read samples from pregnant ladies. He also upped my repeat prescription for Levemir, as I seem to need more of it that I did of the Lantus. Finally he printed off a letter letting me know how to register with the surgery's midwife. He seems to think that my care will be shared between the diabetes/obstetrics clinic up at the hospital, and my GP practice. I'm not so sure he's right on this one, so I'm going to wait to talk to Dr I and co on Thursday before I do anything more in that regard.
The one thing I am doing a lot of is reading pregnancy books and websites and trying to digest as much as I possibly can. Cheryl Alkon's book (Balancing Pregnancy with Pre-existing Diabetes) is fabulously reassuring - thanks Cheryl! and I'm also enjoying Prof Ian Greer's book, Pregnancy: The Inside Guide, which has lots of useful information for people with a whole host of pre-existing medical conditions. One statistic which has blown my mind is just how fast my little passenger is growing. According to TheBump.com he/she has already grown from the size of a poppyseed (weeks 3&4) to the size of an appleseed (week 5)! How amazing is that??
Well, can't think of any more to say for the moment. I'm off to test my blood sugars (I'm up to 15 times a day, and the ends of my fingertips are wrecked!)
PS. S says that he should maybe have a right of reply on this blog, as I write about him too. Well honey, I love that you read, I love you, and you're always welcome to comment :)
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Notes:
* The week before I had one really hellish night where I had a very, very, very persistent hypo - 3.2 mmol/l for over three hours, with bucketloads of carbs having no effect at all - followed by a rebound to 15 mmol/l which then persisted despite a whacking great correction dose. Sometimes diabetes just sucks!
Not much to update on the pregnancy front. I'm really looking forwards to my appointment on Thursday when I'll get to see Dr Inspiring and his crew, and can ask the gazillion questions I'm collecting. Most of all, I guess I just want to know what the next few months will hold, medical appointment-wise. How often will I need to attend the clinic, when, and what for? I remember at my first appointment they waved a schedule at me and briefly explained that this was the shape of things to come, but now I want to get my hands on that piece of paper!!! I'll be six weeks when I go to the clinic. When I spoke to Dr I last week he said something vague about it maybe being too early to see a heartbeat on an ultrasound, so I don't know if I'll have one or if they'll wait. It's a weird feeling at the moment - I know I'm pregnant, but still can't quite believe it! I'm doing everything I need to, diabetes-wise, and my 7 day meter average has now come down to 6.6 mmol/l, which is where I'd like it to be (and round about where it was when I had my last fab HbA1c). I guess I just need a little reassurance that all's okay, so far. My breasts are still very tender (I drove over a pothole last week and... ouch!), and I've continued to need to go to the loo more often than usual, although I'm starting to get more used to that, and don't notice as much. I'm also not sleeping through the night - I usually have to get up to go to the loo at around 4am-5am, so I take the opportunity to check my blood sugars and have a little correction dose if necessary. My overnight sugars have been pretty good the last week or so, which is brilliant, as that's where I always struggle the most.* The other slightly weird thing is that I've lost weight since I found out I was pregnant - 4 lbs by this morning. I guess that's because all my energy's going into making a healthy placenta? I have been pretty tired too, so it's been lovely to have a few days off to catch up on some sleep.
I did go to see my own GP on Thursday, to let him know the news and to sort out one or two things. He was thrilled for me, which was really nice. He's also been a huge support, what with checking my rubella status and folate levels, arranging regular HbA1cs and referring me to Dr Inspiring's clinic. We agreed that I'd delay my smear, as the histology clinic struggle to read samples from pregnant ladies. He also upped my repeat prescription for Levemir, as I seem to need more of it that I did of the Lantus. Finally he printed off a letter letting me know how to register with the surgery's midwife. He seems to think that my care will be shared between the diabetes/obstetrics clinic up at the hospital, and my GP practice. I'm not so sure he's right on this one, so I'm going to wait to talk to Dr I and co on Thursday before I do anything more in that regard.
The one thing I am doing a lot of is reading pregnancy books and websites and trying to digest as much as I possibly can. Cheryl Alkon's book (Balancing Pregnancy with Pre-existing Diabetes) is fabulously reassuring - thanks Cheryl! and I'm also enjoying Prof Ian Greer's book, Pregnancy: The Inside Guide, which has lots of useful information for people with a whole host of pre-existing medical conditions. One statistic which has blown my mind is just how fast my little passenger is growing. According to TheBump.com he/she has already grown from the size of a poppyseed (weeks 3&4) to the size of an appleseed (week 5)! How amazing is that??
Well, can't think of any more to say for the moment. I'm off to test my blood sugars (I'm up to 15 times a day, and the ends of my fingertips are wrecked!)
PS. S says that he should maybe have a right of reply on this blog, as I write about him too. Well honey, I love that you read, I love you, and you're always welcome to comment :)
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Notes:
* The week before I had one really hellish night where I had a very, very, very persistent hypo - 3.2 mmol/l for over three hours, with bucketloads of carbs having no effect at all - followed by a rebound to 15 mmol/l which then persisted despite a whacking great correction dose. Sometimes diabetes just sucks!
Tuesday, 24 August 2010
Taking it all in...
So, my blog's finally out in the open and I had comments from Brooke and Kerri, whose blogs I follow, which made me smile.
This week's been my first at work since finding out I'm pregnant, and I'm not sure if I'm imagining things, but I'm pretty tired. One more day to go before I have a few days' holiday, and to be honest I can't wait! Unfortunately S has to work, so it's going to be a bit of a 'staycation' and I'm really looking forwards to a few days of chilling out and relaxing at home. Our trip to Cambridge at the weekend (via my parents' house) was great, but it was a long drive and Saturday was a late night catching up with all of S's old friends, including lots of people I haven't met before. At one point the conversation came around to babies and S and I spent the next few minutes nudging each other under the table and giving each other meaningful looks, but we didn't crack. So far, so good. We managed to keep quiet! On the downside, I found myself surrounded by smokers, and just wanted to make them stop. It's one thing to blow smoke in my face, another entirely when I have a little sprog on board. I did my best to keep away from the worst of it, without being antisocial. I also managed a pretty good set of sugars considering that I was eating to someone else's timetable (ie. later than usual) and snarfing down sausages and bbq chicken. Scoreline: Me - 1; Diabetes - 0!
It was lovely visiting my parents on Friday night, and the look on my Mum's face when we told them our news was priceless. Total shellshock. They're both delighted, although Mum can't quite stop herself from worrying about me, what with the diabetes and my crazy job. S did a slightly less effective job of telling his parents when we got home on Sunday evening. I cooked dinner whilst he had his regular phonecall with his folks, and when the food was ready I called him. 'So, what did they think?' I asked. 'Oops - forgot to tell them!' said he. Talk about laid back. My husband could win the gold medal if it were a sport!!
The last couple of days I've worked extra hard on keeping my sugars in check, and so far things are pretty good. My averages aren't back to where they were, but they're going in the right direction, and I'm planning to be pretty aggressive with my adjustments and correction doses. Only 246 more days to go! Eeek - that's terrifying in so many ways. I have noticed that I'm needing slightly more insulin than usual though. According to one of the pregnancy books I'm reading that can happen, although typically requirements will go down for a while in early pregnancy. I can see that this is going to be quite a balancing act! I also managed to book an appointment with my GP, and to speak to Dr Inspiring's secretary as requested. So, I'm seeing my GP on Thursday afternoon, and will be able to give him the big news, ask him to up the amount of Novorapid and Levemir on my repeat prescription, and put off my smear test until after the big event. Unfortunately the smear I had a couple of months ago was no good (due to an 'insufficient sample') so I'm supposed to have it repeated. However, circumstances have intervened, and now I'll have to delay, since you're not supposed to have a smear whilst you're pregnant, according to advice from the NHS. Dr I's secretary managed to bring forward my clinic appointment to next Thursday, whilst I'm on leave, which is great. I explained I'd been told to keep the appointment I already have booked for later in the month, but she told me that the clinic appointments staff wanted me to get it cancelled since it's an appointment for pre-pregnancy counselling don't you know! Barmy - surely they can just re-label it, since it's for the same clinic and with the same staff. She said she'd check with Dr I and let me know. If I do have to get the appointment cancelled they'll be able to rebook me when I see Dr I next week.
So far my pregnancy symptoms seem quite mild. I've already mentioned the tender boobs (although I think I'm getting used to it, when S gives me a hug I sometimes feel like I'm going to jump out of my skin). I'm also visiting the loo a lot, although I'm not peeing any more (in terms of quantity) than normal. Once in a while I feel a little crampy thing going on, but nothing more than twinges. Also apparently quite normal. I'm a big one for normal!! :) I've been eating really well, getting all my fruit and veggies, and sticking to high fibre, healthy options - except when I fell off the bbq wagon at the weekend. This morning I was down three pounds on where I was when I weighed myself a couple of weeks ago. I wouldn't expect to have gained, but losing was a bit of a surprise. I've also had some interrupted nights' sleep - and have needed to visit the loo in the wee small hours. It does give me the chance to test my sugars and correct if necessary - every cloud has a silver lining, huh? Otherwise nothing much to report. I can't wait to have my next clinic appointment and find out what's on the horizon for me. I know the next few months are going to be full of appointments, and I'm really looking forwards to the journey.
This week's been my first at work since finding out I'm pregnant, and I'm not sure if I'm imagining things, but I'm pretty tired. One more day to go before I have a few days' holiday, and to be honest I can't wait! Unfortunately S has to work, so it's going to be a bit of a 'staycation' and I'm really looking forwards to a few days of chilling out and relaxing at home. Our trip to Cambridge at the weekend (via my parents' house) was great, but it was a long drive and Saturday was a late night catching up with all of S's old friends, including lots of people I haven't met before. At one point the conversation came around to babies and S and I spent the next few minutes nudging each other under the table and giving each other meaningful looks, but we didn't crack. So far, so good. We managed to keep quiet! On the downside, I found myself surrounded by smokers, and just wanted to make them stop. It's one thing to blow smoke in my face, another entirely when I have a little sprog on board. I did my best to keep away from the worst of it, without being antisocial. I also managed a pretty good set of sugars considering that I was eating to someone else's timetable (ie. later than usual) and snarfing down sausages and bbq chicken. Scoreline: Me - 1; Diabetes - 0!
It was lovely visiting my parents on Friday night, and the look on my Mum's face when we told them our news was priceless. Total shellshock. They're both delighted, although Mum can't quite stop herself from worrying about me, what with the diabetes and my crazy job. S did a slightly less effective job of telling his parents when we got home on Sunday evening. I cooked dinner whilst he had his regular phonecall with his folks, and when the food was ready I called him. 'So, what did they think?' I asked. 'Oops - forgot to tell them!' said he. Talk about laid back. My husband could win the gold medal if it were a sport!!
The last couple of days I've worked extra hard on keeping my sugars in check, and so far things are pretty good. My averages aren't back to where they were, but they're going in the right direction, and I'm planning to be pretty aggressive with my adjustments and correction doses. Only 246 more days to go! Eeek - that's terrifying in so many ways. I have noticed that I'm needing slightly more insulin than usual though. According to one of the pregnancy books I'm reading that can happen, although typically requirements will go down for a while in early pregnancy. I can see that this is going to be quite a balancing act! I also managed to book an appointment with my GP, and to speak to Dr Inspiring's secretary as requested. So, I'm seeing my GP on Thursday afternoon, and will be able to give him the big news, ask him to up the amount of Novorapid and Levemir on my repeat prescription, and put off my smear test until after the big event. Unfortunately the smear I had a couple of months ago was no good (due to an 'insufficient sample') so I'm supposed to have it repeated. However, circumstances have intervened, and now I'll have to delay, since you're not supposed to have a smear whilst you're pregnant, according to advice from the NHS. Dr I's secretary managed to bring forward my clinic appointment to next Thursday, whilst I'm on leave, which is great. I explained I'd been told to keep the appointment I already have booked for later in the month, but she told me that the clinic appointments staff wanted me to get it cancelled since it's an appointment for pre-pregnancy counselling don't you know! Barmy - surely they can just re-label it, since it's for the same clinic and with the same staff. She said she'd check with Dr I and let me know. If I do have to get the appointment cancelled they'll be able to rebook me when I see Dr I next week.
So far my pregnancy symptoms seem quite mild. I've already mentioned the tender boobs (although I think I'm getting used to it, when S gives me a hug I sometimes feel like I'm going to jump out of my skin). I'm also visiting the loo a lot, although I'm not peeing any more (in terms of quantity) than normal. Once in a while I feel a little crampy thing going on, but nothing more than twinges. Also apparently quite normal. I'm a big one for normal!! :) I've been eating really well, getting all my fruit and veggies, and sticking to high fibre, healthy options - except when I fell off the bbq wagon at the weekend. This morning I was down three pounds on where I was when I weighed myself a couple of weeks ago. I wouldn't expect to have gained, but losing was a bit of a surprise. I've also had some interrupted nights' sleep - and have needed to visit the loo in the wee small hours. It does give me the chance to test my sugars and correct if necessary - every cloud has a silver lining, huh? Otherwise nothing much to report. I can't wait to have my next clinic appointment and find out what's on the horizon for me. I know the next few months are going to be full of appointments, and I'm really looking forwards to the journey.
Friday, 20 August 2010
BIG NEWS!
I don't know how to start this post as my brain's all of a whirl! So I'm just going to plunge in with a stream of consciousness...
I was expecting my period to start on Wednesday (two days ago), but it didn't appear. Nor did it arrive on Thursday. I've had extremely tender boobs for the last couple of weeks, which could have been an early pregnancy sign, or might just have been the normal hormonal stuff. On Tuesday, Wednesday and Thursday I was getting little gripey stomach pains, and I had a slightly upset stomach - both of which can be a pre-period sign for me, so I assumed that it was on it's way and started gearing myself up for disappointment. I was desperate to take a pregnancy test, but since I was sure I was going to get my period I did my best to wait.
Yesterday morning I woke up, and seeing no sign of my period at all (it usually arrives slowly with a bit of a stain on my knickers) I got as far as peeing in a cup, before talking myself out of doing a test. This morning, I woke up at 7.30am (it's my day off) and thought, what the hell. Pee... cup... 3 minute wait... whoa... hold on... I see something... it's faint, but darkening... two pink lines... TWO. The leaflet says that means... I'M PREGNANT!
Thinking I was hallucinating (yep, always assume the worst), I went and got my camera to take some photos. Nothing like corroboration, I thought. Besides, the line might disappear again (!) By the way, I know that's not a terribly rational response!! :)
Here's the picture.
S was still dozing as he's working from home today and didn't have to leap up to cycle to work. Kind wife that I am, I kind of woke him up to tell him the news. I even let him have a little 'I told you so moment' - since he did. "I guess you're not dried up after all" he joked! It does make me realise that all the worry was unneccessary - after all, four months isn't so long to be trying. I feel soooooo lucky (and strangely I always used to say 4 was my 'lucky number' when I was a little girl). Personally I think the ovulation strips were the thing that did the trick, so L at the clinic will be getting a very big thank you from me when I see her next.
We are so happy and excited. I went onto the internet to look at EDD (estimated due date) calculators. Assuming that we conceived on 4 August (I had the positive ovulation test and we did the deed late on 3 August) then my EDD is 27 April 2011. If you go by the date of my last period then it's 1 May 2011. I'm working on the earlier date, since I didn't ovulate in the middle of my cycle, but instead on day 12.
Once my head had stopped spinning we treated ourselves to breakfast in bed and had a little cwtch (welsh for cuddle, don't you know). I have to admit that I keep looking at the lines to make sure they're still there. As S points out, they will fade within 48 hours, so really I should stop checking every 10 minutes and start to believe it. Blimey. Still doesn't feel real, though.
At 10am I called Dr Inspiring to let him know. As I explained in an earlier post, he gave me his mobile number at our first appointment and said I could call whenever I needed to. I had assumed that he used this as a sort of mailbox, always letting it go through to voicemail, listening to messages and then calling back. But no, he answered on the second ring! We had a quick chat about the fact that my next appointment is due on 23 September, and he said I should keep it. I should be around 8 weeks by that point. He said that he'd try to squeeze me in for an appointment in a couple of weeks' time, but that it might be too early for an ultrasound to confirm a viable pregnancy. He gave me his secretary's number and suggested that I call her on Tuesday when she's back from leave, to give her my name and hospital number and let her know that I have a confirmed pregnancy. Then they'll try to find me an appointment. He asked how my sugars have been, and I explained they've not been bad, although I have had a couple of really high readings either in the middle of the night or early in the morning. My two week meter average is 7.9 which is rubbish compared to the earlier averages I've had of 6.5 or so. But I know that two or three very high readings have skewed this average, and as Dr I says, these things happen. Just keep testing and tweaking, testing and tweaking. I think I might have had a little infection as I have had a pretty sore throat recently, and even more nosebleeds than normal.* Dr I congratulated me and told me to have a good weekend. "I think I will" said I!
We're off to visit some of S's friends in Cambridge over the weekend, which involves a fairly long drive,** so we're intending to stay with my parents tonight. We talked a little bit about who to tell and when. "You'll burst if you don't tell your parents tonight" S pointed out. Probably true. If we weren't seeing them I'd probably try to go another month or so before saying anything, but as it is I don't reckon I'll be able to hold it in. I know that this might not work out - it's very early days, and there are no guarantees, after all. If we do tell my folks then we'll also tell S's. Otherwise we'll be keeping schtum until the 13 week point. Only 9 weeks to go then! The only other person I might tell a little earlier is my friend L, who has been such a support to me. Part of me wants to shout it from the rooftops, and part of me wants it to be a little secret for S and I to share. Oh, and my blog, which I always intended to de-cloak once I had some good news to share (writing under my pseudonym, of course)!
NOTES
* I haven't mentioned this before, but I have a bit of a track record with nosebleeds. I had a huge operation (a septoplasty) on my nose when I was 20, and since then it's been a little dodgy. In the last 12-18 months I've had loads of spontaneous nosebleeds - sometimes as many as 3 a day - which can happen at the most inconvenient time (including during meetings, whilst driving to work, etc). Have had the 'bleeding patch' cauterised twice (horrible procedure, hasn't worked) and even had a CT of my sinuses (nothing worrying found). I have the slight fear that being pregnant is only going to make this worse, since bigger blood volumes can cause nosebleeds and bleeding gums etc. in pregnant women anyway. Oh well, what can you do?
** I'll be driving S's car, since I had to be rescued by the AA last night when my car broke down outside work. Some clever rewiring later and I was back on the road. When I called the AA, I explained I was diabetic and asked them to make sure I didn't have to wait too long. They were fab - a lovely AA man arrived within half an hour and chatted with me whilst he fixed the car. He made sure my sugars were okay and offered me a Kit-Kat, which he keeps just in case of diabetic customers and we talked a little bit about what it means to have T1. I wonder if they'd have arrived even earlier if I'd known I was also a tiny bit pregnant??? ;)
I was expecting my period to start on Wednesday (two days ago), but it didn't appear. Nor did it arrive on Thursday. I've had extremely tender boobs for the last couple of weeks, which could have been an early pregnancy sign, or might just have been the normal hormonal stuff. On Tuesday, Wednesday and Thursday I was getting little gripey stomach pains, and I had a slightly upset stomach - both of which can be a pre-period sign for me, so I assumed that it was on it's way and started gearing myself up for disappointment. I was desperate to take a pregnancy test, but since I was sure I was going to get my period I did my best to wait.
Yesterday morning I woke up, and seeing no sign of my period at all (it usually arrives slowly with a bit of a stain on my knickers) I got as far as peeing in a cup, before talking myself out of doing a test. This morning, I woke up at 7.30am (it's my day off) and thought, what the hell. Pee... cup... 3 minute wait... whoa... hold on... I see something... it's faint, but darkening... two pink lines... TWO. The leaflet says that means... I'M PREGNANT!
Thinking I was hallucinating (yep, always assume the worst), I went and got my camera to take some photos. Nothing like corroboration, I thought. Besides, the line might disappear again (!) By the way, I know that's not a terribly rational response!! :)
Here's the picture.
S was still dozing as he's working from home today and didn't have to leap up to cycle to work. Kind wife that I am, I kind of woke him up to tell him the news. I even let him have a little 'I told you so moment' - since he did. "I guess you're not dried up after all" he joked! It does make me realise that all the worry was unneccessary - after all, four months isn't so long to be trying. I feel soooooo lucky (and strangely I always used to say 4 was my 'lucky number' when I was a little girl). Personally I think the ovulation strips were the thing that did the trick, so L at the clinic will be getting a very big thank you from me when I see her next.
We are so happy and excited. I went onto the internet to look at EDD (estimated due date) calculators. Assuming that we conceived on 4 August (I had the positive ovulation test and we did the deed late on 3 August) then my EDD is 27 April 2011. If you go by the date of my last period then it's 1 May 2011. I'm working on the earlier date, since I didn't ovulate in the middle of my cycle, but instead on day 12.
Once my head had stopped spinning we treated ourselves to breakfast in bed and had a little cwtch (welsh for cuddle, don't you know). I have to admit that I keep looking at the lines to make sure they're still there. As S points out, they will fade within 48 hours, so really I should stop checking every 10 minutes and start to believe it. Blimey. Still doesn't feel real, though.
At 10am I called Dr Inspiring to let him know. As I explained in an earlier post, he gave me his mobile number at our first appointment and said I could call whenever I needed to. I had assumed that he used this as a sort of mailbox, always letting it go through to voicemail, listening to messages and then calling back. But no, he answered on the second ring! We had a quick chat about the fact that my next appointment is due on 23 September, and he said I should keep it. I should be around 8 weeks by that point. He said that he'd try to squeeze me in for an appointment in a couple of weeks' time, but that it might be too early for an ultrasound to confirm a viable pregnancy. He gave me his secretary's number and suggested that I call her on Tuesday when she's back from leave, to give her my name and hospital number and let her know that I have a confirmed pregnancy. Then they'll try to find me an appointment. He asked how my sugars have been, and I explained they've not been bad, although I have had a couple of really high readings either in the middle of the night or early in the morning. My two week meter average is 7.9 which is rubbish compared to the earlier averages I've had of 6.5 or so. But I know that two or three very high readings have skewed this average, and as Dr I says, these things happen. Just keep testing and tweaking, testing and tweaking. I think I might have had a little infection as I have had a pretty sore throat recently, and even more nosebleeds than normal.* Dr I congratulated me and told me to have a good weekend. "I think I will" said I!
We're off to visit some of S's friends in Cambridge over the weekend, which involves a fairly long drive,** so we're intending to stay with my parents tonight. We talked a little bit about who to tell and when. "You'll burst if you don't tell your parents tonight" S pointed out. Probably true. If we weren't seeing them I'd probably try to go another month or so before saying anything, but as it is I don't reckon I'll be able to hold it in. I know that this might not work out - it's very early days, and there are no guarantees, after all. If we do tell my folks then we'll also tell S's. Otherwise we'll be keeping schtum until the 13 week point. Only 9 weeks to go then! The only other person I might tell a little earlier is my friend L, who has been such a support to me. Part of me wants to shout it from the rooftops, and part of me wants it to be a little secret for S and I to share. Oh, and my blog, which I always intended to de-cloak once I had some good news to share (writing under my pseudonym, of course)!
NOTES
* I haven't mentioned this before, but I have a bit of a track record with nosebleeds. I had a huge operation (a septoplasty) on my nose when I was 20, and since then it's been a little dodgy. In the last 12-18 months I've had loads of spontaneous nosebleeds - sometimes as many as 3 a day - which can happen at the most inconvenient time (including during meetings, whilst driving to work, etc). Have had the 'bleeding patch' cauterised twice (horrible procedure, hasn't worked) and even had a CT of my sinuses (nothing worrying found). I have the slight fear that being pregnant is only going to make this worse, since bigger blood volumes can cause nosebleeds and bleeding gums etc. in pregnant women anyway. Oh well, what can you do?
** I'll be driving S's car, since I had to be rescued by the AA last night when my car broke down outside work. Some clever rewiring later and I was back on the road. When I called the AA, I explained I was diabetic and asked them to make sure I didn't have to wait too long. They were fab - a lovely AA man arrived within half an hour and chatted with me whilst he fixed the car. He made sure my sugars were okay and offered me a Kit-Kat, which he keeps just in case of diabetic customers and we talked a little bit about what it means to have T1. I wonder if they'd have arrived even earlier if I'd known I was also a tiny bit pregnant??? ;)
Friday, 13 August 2010
Waiting, waiting and more waiting... all the time impatiently
Must be about time for another update. As my last post explained, my period eventually turned up, so it was back to the drawing board for another month - or should that be back to bed? :) TMI!!
However, galvanised by my last trip to the pre-pregnancy clinic, I ordered some ovulation strips from Amazon and decided to get proactive (as if TTC every two days doesn't count already!) The strips are much smaller and less elaborate than the expensive ovulation tests you can get in UK pharmacies, so I was curious to see what they'd be like (and to be honest, whether they'd work!)
First step in the instructions. Pee in a clean cup - don't do it first thing, like with a pregnancy test, and don't do it immediately after drinking in case you dilute your urine too much. Save up a full bladder and then go for it! So, on day 10 of my cycle, as suggested in the little leaflet that came with the strips, I came home from work and set about it. Step two - wait for twenty minutes and allow your pee to come to room temperature. Ick. That's attractive. Step three - dip the stick in the urine for ten seconds, but don't allow the urine to go above the line indicated on the strip. Step four - sit back (or perch on the loo/side of the bath) and wait for up to ten minutes to see a result. You need to see the control stripe turn pink, otherwise the test hasn't worked. A second stripe that's paler than the control stripe, or no second stripe at all, means a negative. A second stripe that's as dark or darker than the control stripe and you're in business. Ovulation will occur within 24-36 hours, and you're recommended to have sex any time within that 12-24 hours of a positive test to have the best chance of conceiving.
So then, how did the first test go? Well, after about 30 seconds the first control stripe appeared. I waited, and waited, and waited some more. After 10 minutes there was only one stripe. Not too surprising really. After all, if you have a (reasonably) regular 28 day (ish) cycle, you'd expect to ovulate on day 14. Of course the reason for the strips is that cycles vary in all kinds of ways. You can have a long or short regular cycle. You can have an all over the place kind of random seeming cycle. You can have a 28 day cycle but ovulate early. You can have a 28 day cycle and ovulate late. So many possibilities... but the strips are supposed to take some of the guesswork out of all this. Last month's cycle for me was 30 days, and the one before was 26. I'm averaging about 28 days, or thereabouts, plus or minus a couple.
On day 11 of my cycle I did a second test. 45 seconds after dipping the stick I saw not one, but two lines. Hallelujah. My ovaries might actually work! (Paranoia, much?) Jumped on S when he came home (let's draw a discreet veil over that, shall we?) So then, according to the pee sticks, I'd be ovulating not on day 14 of my cycle, but probably more like day 12-13. Does that mean this is a going to be a cycle that's on the shorter side? Curious minds want to know.
On day 12 of my cycle I did a third test. Would it still show positive, or would my luteal surge (see, I can rock the technical language) have been and gone? Well, a second stripe did appear after about three or four minutes, but it was much paler than the day before. That seemed to confirm that I was more likely to have ovulated on day 12 than day 13.
At that point I stopped using the ovulation sticks, saving my 57 remaining ones for the next and subsequent months. And, I started waiting. Yes, waiting seems to be a real feature of the whole TTC journey. It's also, frankly, a real feature of being diabetic:
I have a pretty demanding job, and have been in a number of high level ongoing negotiations recently, so this little bunny may well count as being stressed. So, I'm trying to be a bit more proactive. I'm going to be more hardline on what time I'm willing to set off in the mornings. 'A meeting in London, you say? Well, that's fine, but I won't be able to get there until 10 am at the earliest' (and even that means being on the 7.30 train from Bristol, and getting up at about 5.45 in order to inject, eat and make it to the railway station). I'm also going to try to make sure that meetings finish no later than 4pm, so that I can be home by 8pm at the latest and eat at a sensible time. I'm on the flexi clock, and when I've accrued 7.5 hours I can take a day off. If I have more than 15 hours at the end of the month then I'll lose the excess. So, I'm being diligent about using my flexi time. Finally, once in a while, especially when I have lots of documentation to digest, or an important draft to write or meeting to prepare for, I have a day working from home, instead of travelling 40 miles to my distracting open-plan office, where the phone never stops ringing.
I'm sure there's more I could do, but it's a start. It's the weekend tomorrow, and I intend to have a quiet one, slobbing around the house. Next week we're visiting some of S's friends in Cambridge (a very long drive) and stopping over at my parents' house (about a third of the way there), so we're not going to have a lot of 'us time.' Still, at least by then the waiting will be over and I should know if I'm pregnant or back to square one.
However, galvanised by my last trip to the pre-pregnancy clinic, I ordered some ovulation strips from Amazon and decided to get proactive (as if TTC every two days doesn't count already!) The strips are much smaller and less elaborate than the expensive ovulation tests you can get in UK pharmacies, so I was curious to see what they'd be like (and to be honest, whether they'd work!)
First step in the instructions. Pee in a clean cup - don't do it first thing, like with a pregnancy test, and don't do it immediately after drinking in case you dilute your urine too much. Save up a full bladder and then go for it! So, on day 10 of my cycle, as suggested in the little leaflet that came with the strips, I came home from work and set about it. Step two - wait for twenty minutes and allow your pee to come to room temperature. Ick. That's attractive. Step three - dip the stick in the urine for ten seconds, but don't allow the urine to go above the line indicated on the strip. Step four - sit back (or perch on the loo/side of the bath) and wait for up to ten minutes to see a result. You need to see the control stripe turn pink, otherwise the test hasn't worked. A second stripe that's paler than the control stripe, or no second stripe at all, means a negative. A second stripe that's as dark or darker than the control stripe and you're in business. Ovulation will occur within 24-36 hours, and you're recommended to have sex any time within that 12-24 hours of a positive test to have the best chance of conceiving.
So then, how did the first test go? Well, after about 30 seconds the first control stripe appeared. I waited, and waited, and waited some more. After 10 minutes there was only one stripe. Not too surprising really. After all, if you have a (reasonably) regular 28 day (ish) cycle, you'd expect to ovulate on day 14. Of course the reason for the strips is that cycles vary in all kinds of ways. You can have a long or short regular cycle. You can have an all over the place kind of random seeming cycle. You can have a 28 day cycle but ovulate early. You can have a 28 day cycle and ovulate late. So many possibilities... but the strips are supposed to take some of the guesswork out of all this. Last month's cycle for me was 30 days, and the one before was 26. I'm averaging about 28 days, or thereabouts, plus or minus a couple.
On day 11 of my cycle I did a second test. 45 seconds after dipping the stick I saw not one, but two lines. Hallelujah. My ovaries might actually work! (Paranoia, much?) Jumped on S when he came home (let's draw a discreet veil over that, shall we?) So then, according to the pee sticks, I'd be ovulating not on day 14 of my cycle, but probably more like day 12-13. Does that mean this is a going to be a cycle that's on the shorter side? Curious minds want to know.
On day 12 of my cycle I did a third test. Would it still show positive, or would my luteal surge (see, I can rock the technical language) have been and gone? Well, a second stripe did appear after about three or four minutes, but it was much paler than the day before. That seemed to confirm that I was more likely to have ovulated on day 12 than day 13.
At that point I stopped using the ovulation sticks, saving my 57 remaining ones for the next and subsequent months. And, I started waiting. Yes, waiting seems to be a real feature of the whole TTC journey. It's also, frankly, a real feature of being diabetic:
- It's the second half of your menstrual cycle. Wait to see if your period will come, or if you're pregnant.
- You're hypo. Eat 15g of carbs wait 15 minutes and test. Repeat until your sugars return to normal.
- You've had a blood test for your HbA1C. Wait for your results (and boy does the time drag). [Although, see my last post for just how awesome my current Diabetes clinic is, when it comes to sharing results!]
- You wake up in the morning with your Dawn Phenomenon at it's worst. Inject and then wait a full hour before breakfast.
I have a pretty demanding job, and have been in a number of high level ongoing negotiations recently, so this little bunny may well count as being stressed. So, I'm trying to be a bit more proactive. I'm going to be more hardline on what time I'm willing to set off in the mornings. 'A meeting in London, you say? Well, that's fine, but I won't be able to get there until 10 am at the earliest' (and even that means being on the 7.30 train from Bristol, and getting up at about 5.45 in order to inject, eat and make it to the railway station). I'm also going to try to make sure that meetings finish no later than 4pm, so that I can be home by 8pm at the latest and eat at a sensible time. I'm on the flexi clock, and when I've accrued 7.5 hours I can take a day off. If I have more than 15 hours at the end of the month then I'll lose the excess. So, I'm being diligent about using my flexi time. Finally, once in a while, especially when I have lots of documentation to digest, or an important draft to write or meeting to prepare for, I have a day working from home, instead of travelling 40 miles to my distracting open-plan office, where the phone never stops ringing.
I'm sure there's more I could do, but it's a start. It's the weekend tomorrow, and I intend to have a quiet one, slobbing around the house. Next week we're visiting some of S's friends in Cambridge (a very long drive) and stopping over at my parents' house (about a third of the way there), so we're not going to have a lot of 'us time.' Still, at least by then the waiting will be over and I should know if I'm pregnant or back to square one.
Sunday, 1 August 2010
Three Part Update
Part One: My period...
...did arrive, but it was a couple of days late. It finally appeared on Saturday 24th, which makes a 30 day cycle. I'm glad the mystery was solved, although it was a slightly strange period - less bright and fresh looking than usual, and slightly clotted and lumpy. Erm... TMI?? Let's see how things work out next month.
Part Two: Fifth appointment at the Pre-Pregnancy/Diabetes Clinic
I went for my fifth visit to Dr Inspiring and co on Thursday 29 July. I spent most of my time with L, the dietician. She thinks I'm doing really well, although a look at my log book confirns that my biggest struggles are still around the dawn phenomenon (things are much better than they were, but it's definitely my biggest challenge). L suggested taking my evening Levemir at bedtime rather than dinnertime, in order to see whether moving the peak action to a different part of the night would help. This might also require some changes in the daytime dose, involving a certain amount of experimentation.
My appointment was a little later than usual. Normally I opt for the first appointment of the clinic, at 8.45am, which allows me to get into work reasonably early, and means that I don't get caught up in any clinic delays (they routinely overbook appointments, so Dr I suggested that the early appointments are better for someone like me who has a longish commute to work). My appointment was originally supposed to be on 9 July, but got cancelled and reorganised (initially for a date at the end of June, which I was unable to make as I was on holiday) and I ended up with a later time slot as a consequence. The hospital where I go for my appointments is currently experiencing a lot of rebuilding work, and as a result the walk from the main car park is now about ten times as long as it used to be (which I wasn't expecting), so by the time I arrived for my appointment I was huffing and puffing and my blood sugars were dropping. After a half hour wait before being called through I was just starting to go hypo (not badly, but enough that I'd need to treat). As L arrived in the room I was just crunching up my third glucose tab, and explained that I'd need to test in 15 minutes to check I was back on course. L suggested taking not three but seven tablets! Apparently I'm undertreating. But I'm keen not to overtreat, and three seems to work for me (when I'm not being naughty and using other less revolting options like chocolate drops from my baking stash, or mentos, or licorice!) L also told me that there's a local shop which stocks the big round yummy glucose tablets - which the clinic staff apparently reach for in the afternoons when their blood glucose dips! The idea that anyone would choose to eat glucose tablets suggested to me that these yummy ones might be the holy grail, but after a drive out to the said shop I struck out (none in stock).
We also talked about how I'm trying to even out the peaks and troughs in my blood sugars, and how I've been trying to work out my ideal doses, carb ratios and correction factors by using the methods suggested in the brilliant book I just got (Using Insulin by John Walsh). I've started by trying to identify my overnight dose via basal testing, and L said she'd email me the advice sheet that the clinic uses with patients on pumps (which also works for non-pumpers, with a few tweaks). We agreed that my swings appear to be reducing, and L thinks I should keep on with what I'm doing. She couldn't think of any changes to suggest beyond trying shifting my Levemir injection for a few days, and agreed that there aren't any clear patterns of hypos emerging from my log book.
We also talked a little bit about how long S and I have been trying (three months). I said that all I seem to do is count stuff and wait - either glucose tablets and 15 minute waits following a hypo, blood sugars and insulin doses every single day, or cycle days and two week waits! Dr Inspiring stuck his head round the door at this point in the appointment to say hi, and find out how things are going. He joked with L that I'm their 'star pupil'. They agreed that I should have the full pre-pregnancy bloods panel again (including the thyroid function tests), and after a quick conflab about how long we've been trying, they said that whilst there's nothing unusual in trying for three months without success, if I'm still not pregnant next time I come for an appointment, they'd start doing some blood tests and fertility investigations and will involve the obstetricians. They both recognise what hard work it is to keep your sugars in the narrow corridor needed for a healthy pregnancy, so are happy to get the ball rolling just in case. These people are great! Dr I suggested I come back in eight weeks, by which time we'll have had another couple of full cycles and will know the outcome of both. When Dr I had gone L suggested that I think about using ovulation prediction sticks - can't hurt and will make me feel like I'm doing something to take control! Apparently they're much less expensive if you buy them through Amazon, of all places! :)
I finished my appointment by having my bloods taken by the lovely nurse who has T1. We had a really good natter whilst she was searching for a worthwhile vein (mine are both tiddly and move around a lot under the skin). She was feeling a bit the worse for wear after a night time hypo, and I was able to sympathise. We talked a bit about all of the complex variables involved in good control, and how it's about much more than food, insulin and exercise. Things like stress, and illness, and god knows what else! We also talked about how isolating having T1 can be, and the fact that I've only ever met one other T1 of my own age. She's been trying to convince the clinic to set up some kind of a support group, and I agreed that this would be great. Hell, I'd even volunteer to help run it, and I said so! She said that she finds working in the clinic great because it means she can meet diabetic women. I asked whether she'd found the D.O.C., She hadn't, although she's been in contact with Ginger Viera via facebook. I suggested that she find Six Until Me - both because Kerri Sparling is great, and because she's so central to the D.O.C. and has such a complete blogroll! (I did warn her not to start reading that night though, on account of her needing a good night's sleep and the risk that she'd do what I did, and not be able to stop clicking on links!)
All in all, it was a good appointment, and I rolled out of the clinic very happy (if a bit late for work, and an important meeting. I arrived with three whole minutes to spare!)
Part Three: My HbA1C.
When I got to work, I had an email from L waiting for me with the clinic's basal testing sheet. What service! It occured to me that I hadn't asked if I'd be able to get my blood test results before my next appointment, like last time, so I emailed back to ask. 'No problem', came the answer - 'just call or email me tomorrow'. No clinic I've ever attended has done this, and I love it. It would be utter torture to wait eight weeks to find out my result! Instead I emailed back the next day, and found out that my HbA1C was 6.5%, down slightly from 6.6 last time. WA-HEY! :) So exciting. It's not been easy, but here I am, maintaining. L also wished me luck and said that she'd see me in eight weeks (if not before). FINGERS CROSSED. I just want to be pregnant now. It seems like everyone else is. Another friend who had her first exactly a year ago is now pregnant with number two and due in November. Please let us get pregnant soon, and let me be on top of my sugars, and let us have a happy and healthy littl'un that's part me and part S (it's our first wedding anniversary today, and pregnancy feels like the next step in our wonderful life together).
Here endeth the update. Had curry for dinner this evening (romantic meal with my lovely husband) which can play havoc with the sugars, so I'm off to do a blood test before bed, and an early start in the morning for yet another London meeting. Night night.
...did arrive, but it was a couple of days late. It finally appeared on Saturday 24th, which makes a 30 day cycle. I'm glad the mystery was solved, although it was a slightly strange period - less bright and fresh looking than usual, and slightly clotted and lumpy. Erm... TMI?? Let's see how things work out next month.
Part Two: Fifth appointment at the Pre-Pregnancy/Diabetes Clinic
I went for my fifth visit to Dr Inspiring and co on Thursday 29 July. I spent most of my time with L, the dietician. She thinks I'm doing really well, although a look at my log book confirns that my biggest struggles are still around the dawn phenomenon (things are much better than they were, but it's definitely my biggest challenge). L suggested taking my evening Levemir at bedtime rather than dinnertime, in order to see whether moving the peak action to a different part of the night would help. This might also require some changes in the daytime dose, involving a certain amount of experimentation.
My appointment was a little later than usual. Normally I opt for the first appointment of the clinic, at 8.45am, which allows me to get into work reasonably early, and means that I don't get caught up in any clinic delays (they routinely overbook appointments, so Dr I suggested that the early appointments are better for someone like me who has a longish commute to work). My appointment was originally supposed to be on 9 July, but got cancelled and reorganised (initially for a date at the end of June, which I was unable to make as I was on holiday) and I ended up with a later time slot as a consequence. The hospital where I go for my appointments is currently experiencing a lot of rebuilding work, and as a result the walk from the main car park is now about ten times as long as it used to be (which I wasn't expecting), so by the time I arrived for my appointment I was huffing and puffing and my blood sugars were dropping. After a half hour wait before being called through I was just starting to go hypo (not badly, but enough that I'd need to treat). As L arrived in the room I was just crunching up my third glucose tab, and explained that I'd need to test in 15 minutes to check I was back on course. L suggested taking not three but seven tablets! Apparently I'm undertreating. But I'm keen not to overtreat, and three seems to work for me (when I'm not being naughty and using other less revolting options like chocolate drops from my baking stash, or mentos, or licorice!) L also told me that there's a local shop which stocks the big round yummy glucose tablets - which the clinic staff apparently reach for in the afternoons when their blood glucose dips! The idea that anyone would choose to eat glucose tablets suggested to me that these yummy ones might be the holy grail, but after a drive out to the said shop I struck out (none in stock).
We also talked about how I'm trying to even out the peaks and troughs in my blood sugars, and how I've been trying to work out my ideal doses, carb ratios and correction factors by using the methods suggested in the brilliant book I just got (Using Insulin by John Walsh). I've started by trying to identify my overnight dose via basal testing, and L said she'd email me the advice sheet that the clinic uses with patients on pumps (which also works for non-pumpers, with a few tweaks). We agreed that my swings appear to be reducing, and L thinks I should keep on with what I'm doing. She couldn't think of any changes to suggest beyond trying shifting my Levemir injection for a few days, and agreed that there aren't any clear patterns of hypos emerging from my log book.
We also talked a little bit about how long S and I have been trying (three months). I said that all I seem to do is count stuff and wait - either glucose tablets and 15 minute waits following a hypo, blood sugars and insulin doses every single day, or cycle days and two week waits! Dr Inspiring stuck his head round the door at this point in the appointment to say hi, and find out how things are going. He joked with L that I'm their 'star pupil'. They agreed that I should have the full pre-pregnancy bloods panel again (including the thyroid function tests), and after a quick conflab about how long we've been trying, they said that whilst there's nothing unusual in trying for three months without success, if I'm still not pregnant next time I come for an appointment, they'd start doing some blood tests and fertility investigations and will involve the obstetricians. They both recognise what hard work it is to keep your sugars in the narrow corridor needed for a healthy pregnancy, so are happy to get the ball rolling just in case. These people are great! Dr I suggested I come back in eight weeks, by which time we'll have had another couple of full cycles and will know the outcome of both. When Dr I had gone L suggested that I think about using ovulation prediction sticks - can't hurt and will make me feel like I'm doing something to take control! Apparently they're much less expensive if you buy them through Amazon, of all places! :)
I finished my appointment by having my bloods taken by the lovely nurse who has T1. We had a really good natter whilst she was searching for a worthwhile vein (mine are both tiddly and move around a lot under the skin). She was feeling a bit the worse for wear after a night time hypo, and I was able to sympathise. We talked a bit about all of the complex variables involved in good control, and how it's about much more than food, insulin and exercise. Things like stress, and illness, and god knows what else! We also talked about how isolating having T1 can be, and the fact that I've only ever met one other T1 of my own age. She's been trying to convince the clinic to set up some kind of a support group, and I agreed that this would be great. Hell, I'd even volunteer to help run it, and I said so! She said that she finds working in the clinic great because it means she can meet diabetic women. I asked whether she'd found the D.O.C., She hadn't, although she's been in contact with Ginger Viera via facebook. I suggested that she find Six Until Me - both because Kerri Sparling is great, and because she's so central to the D.O.C. and has such a complete blogroll! (I did warn her not to start reading that night though, on account of her needing a good night's sleep and the risk that she'd do what I did, and not be able to stop clicking on links!)
All in all, it was a good appointment, and I rolled out of the clinic very happy (if a bit late for work, and an important meeting. I arrived with three whole minutes to spare!)
Part Three: My HbA1C.
When I got to work, I had an email from L waiting for me with the clinic's basal testing sheet. What service! It occured to me that I hadn't asked if I'd be able to get my blood test results before my next appointment, like last time, so I emailed back to ask. 'No problem', came the answer - 'just call or email me tomorrow'. No clinic I've ever attended has done this, and I love it. It would be utter torture to wait eight weeks to find out my result! Instead I emailed back the next day, and found out that my HbA1C was 6.5%, down slightly from 6.6 last time. WA-HEY! :) So exciting. It's not been easy, but here I am, maintaining. L also wished me luck and said that she'd see me in eight weeks (if not before). FINGERS CROSSED. I just want to be pregnant now. It seems like everyone else is. Another friend who had her first exactly a year ago is now pregnant with number two and due in November. Please let us get pregnant soon, and let me be on top of my sugars, and let us have a happy and healthy littl'un that's part me and part S (it's our first wedding anniversary today, and pregnancy feels like the next step in our wonderful life together).
Here endeth the update. Had curry for dinner this evening (romantic meal with my lovely husband) which can play havoc with the sugars, so I'm off to do a blood test before bed, and an early start in the morning for yet another London meeting. Night night.
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