Tuesday, May 15, 2012

Complicated Not Complications

I feel very fortunate to be on my third pregnancy when so many women out there struggle with infertility and having just one baby, so I hope this post doesn't come across as one giant (literally and figuratively- I.Am. HUGE) pregnant lady whine or make it seem like I'm ungreatful.  I just want to write about some of my experiences this pregnancy while they are fresh in my mind as who knows if it will be my last time feeling those sweet baby kicks from the inside.

All things considered, I've had fairly easy pregnancies and this one hasn't been that different.  I haven't had morning sickness in my last two pregnancies and after suffering through it once, I'm VERY thankful for that!  My record of "easy" pregnancies came crashing down this time when in the beginning of my third trimester I was diagnosed with gestational diabetes.  It's by no means an "end of the world" type diagnosis, but it does complicate things a bit the further along I get with the constant monitoring and a ton more appointments to attend.  The positive thing is that the baby is perfectly fine all cozy in my womb, albeit BIG, but healthy and fine.  I'm going to be honest and say that I was in complete denial about this diagnosis when I left my hospital's Diabetes Lifecare unit after my first appointment.  I had very similar test results from the one and three hour glucose tolerance tests this pregnancy and last pregnancy and yet last pregnancy I was given the "you're borderline watch your carb intake" speech by my OB and sent on my way.  This time I was given the diagnosis and sent off to another set of doctors and nurses for monitoring.  Then, I started to take my blood sugars which involves a teeny tiny needle and four sticks a day in any finger I choose at the time.  One stick is right when I get up in the morning (a fasting number) and the other three are two hours after my main meals of the day (breakfast, lunch, and dinner).  My denial ended when all my readings were coming back high except my after breakfast number.  Then I began to wonder if I should have gotten the diagnosis last pregnancy...who knows.  That ship has certainly sailed.

Most concerning to my new Diabetes nurse were my high fasting numbers.  They signified that my body wasn't able to keep up with the placenta's demand for extra insulin for baby.  Leaving this untreated could result in a variety of complications such as too much amniotic fluid (baby gets too much sugar and pees out the extra causing extra fluid), preterm labor, larger baby (extra sugars become extra fat making baby super chubby), early maturing placenta, high blood pressure, etc.  I was shocked when she told me I'd need to go on insulin and I needed to come in right away for an appointment to learn how to administer it.  I was even more shocked that once I got there and she had further reviewed all my sugar readings she decided to put me on insulin TWICE a day as all of my lunch numbers were quite high as well.  The insulin shots actually turned out not to be as bad I had envisioned.  I use the smallest needle on the market, a nano, and there are no viles and syringes.  The insulin dose is in what they call a pen and it is very easy to set up to make sure I get the correct dose.  I get a large dose at bedtime before I go to sleep which lasts overnight and then I get a second dose in the morning before I eat breakfast that will help my lunch numbers.  The insulin is slow acting and takes 4-5 hours to peak in my system, hence I take the dose at breakfast to help my lunch number at noon.
In addition to the insulin and daily glucose readings, I also had to attend a 3-hour training session on what gestational diabetes was all about and get my meal plan designed by a staff nutritionist at the Diabetes Lifecare center.  I was surprised to hear some of the facts and statistics behind gestational diabetes and I was also relieved that while my family history of Type 1 and 2 diabetes and pre-pregnancy weight were/are risk factors, it doesn't mean I did anything wrong or caused the diagnosis.  Gestational diabetes is a hormonal issue in that your body just can't keep up with the placenta's demand for insulin.  Even maternal age can be a factor- older pancreas = may not be as efficient.  Plus, I could have gotten the diagnosis even with NO risk factors.  Also, to hear that I now have a 50% chance of getting an actual Type 2 diabetes diagnosis in the next 10 years is humbling.  Chances are, though, that within 24 hours after delivery my crazy pregnant hormones will settle themselves and my glucose readings will be back to normal again.  I can quit taking my insulin cold turkey as soon as I have this baby and I only have to take my blood sugars twice a day for a week postpartum to make sure they are back in normal ranges again.  I will have to do one more glucose tolerance test (drink the yucky sugary liquid and have blood drawn) 6 weeks postpartum.  Luckily, this test is only a 2-hour one!  I also need to make sure my primary care physician is aware of my gestational diabetes diagnosis and I should have my glucose levels and A1C level tested at least annually in the next ten years to make sure I'm not one of those in the 50% that does get Type 2 after a gestational diabetes diagnosis.
So now for the even more complicated part:  1) getting my insulin doses regulated and 2) appointments, appointments, and yet MORE appointments.  The nurse did a fancy calculation based off my height and weight to determine my initial insulin dosage and after three days I had to report back my numbers to make sure it was working.  Let's just say I started off at 24 units of insulin at bedtime and 12 units at breakfast and now, two months later, I'm on 42 units of insulin at bedtime and 18 units at breakfast.  Regulating my lunch numbers has been the trickiest.  My fasting numbers stayed steady for quite awhile and then at the 33/34 week marks suddenly skyrocketed again.  Come to find out that gestational time frame is when the placenta peaks on its demand for insulin.  Here's hoping my dose doesn't have to go up any higher at bedtime...pushing those 42 units in burns something awful.  I can't put the insulin in a stretch mark (HA!) because there's no fat behind them to help transport the insulin where it needs to go, so I'm running out of non-poked real estate on where to put the injections. I did learn quickly that injecting the top of my baby bump = OUCH + bruises, so I typically alternate sides each day.  I find it incredible that I'll be able to quit the insulin cold turkey once I have the baby.  There's a slight chance I might need a little while I'm in labor, but once the placenta is delivered I should be fine.  Here's hoping!

Now as for the appointments.  I love my doctors.  All of them.  And I definitely appreciate their due diligence, but holy cow do I have to go to a lot of appointments now.  Starting at 33 weeks I started twice weekly appointments with my OB.  I have an NST (non-stress test) early in the week to make sure baby is reacting well to the uterine environment after kicks and sleep cycles and then every Friday I get another NST, then an ultrasound (alternating between just a simple fluid check and a full biophysical profile), and then meet with my OB.  Fridays trio of tests usually takes a total of at least 2 hours!!  In addition to those appointments I also have to fax my blood sugar readings to the Diabetes center once a week and I meet with a nurse every other week. I kind of like the extra ultra sounds and getting to see this little one, but having to rearrange my day off to accommodate my appointments and making sure my in-laws can watch my daughter has been challenging. A.R. can't take the time away from work to come help me as then he'd lose out on his paternity leave postpartum.  He did come to one ultrasound to see our sweet baby at 32 weeks, though.  This baby is BIG.  He/she was estimated to be 5lb 4oz at 32w3d and was estimated to be 7lbs at 34w5d.  I'm actually not that surprised as that puts baby around 9- 9 1/2 lbs at birth and let's face it, I make big babies:  #1 was 9lb 4oz and M was 8lb 6oz. I also have too much amniotic fluid right now. A condition called polyhydramnios which can be due to the gestational diabetes or a bigger baby so I get fluid checks via ultrasound once a week. I like getting to see Baby R 2.0 a little more often.

I also won't be allowed to go past 39 weeks pregnant, so an induction has been scheduled. I'll be trying acupuncture first to avoid the induction. I hope it works and can't wait to try it. It is a relief to know there's an end date in sight now that I'm getting really uncomfortable. I can't wait to meet this baby!