WEEK 32 - BETTER NEWS

My last post was the bad news from this week, so this will be the good news (and I guess some neutral news too).

On Monday we had another Fetal Assessment (right before the ophthalmologist appointment). The baby is still doing great! She's approximately 6 lbs now, which keeps her right around the 60th percentile like last time. She grew about 1.5 lbs in 2 weeks! It seems like a lot (and it is!), but it's normal for this stage of the pregnancy. She's still tracking perfectly on her growth chart and the Fetal Assessment nurse was very happy with everything she saw. She estimated that she'd be approximately 7.5 lbs by 38 weeks (i.e. when she'll be born). The baby is still breech, but that's kind of a moot point now that we know I'm having a c-section anyway. The nurse actually said that, since she's been in this position for weeks now, there's not a great chance that she'll turn. But that's okay. If she's comfortable like that she might as well stay there :) Her head is up under my ribs on my right side (I can very often feel it there), and her bum is on my bladder (which explains my frequent bathroom trips). She's facing my left side and kind of has her legs folded up. The most exciting thing was that we got to see her open and close her eyes! She was sleeping at first and when the nurse started to prod her she woke up and blinked a few times. :) It was really something else to be able to see that! She has the cutest, chubby cheeks...I've attached pictures below.

I'm starting to get a lot more comfortable with the idea of a c-section. It's not what I had hoped for, but there are definitely some advantages and since it's what's best for me and for the baby, I might as well focus on the positives (e.g. it's quick!!) And really, with the previous scenario (i.e. induction) there was always the possibility that we'd go through an uncomfortable induction that wouldn't work and still have to go for a c-section after a lot of stress, whereas now we can plan for one and know exactly what to expect...and we can definitely have MY obstetrician (who I love!) So I'm starting to get a lot less nervous and a lot more excited!! So soon we'll be able to meet our baby! And I know I'll have a lot of help during the longer recovery period. My husband is able to take a couple of weeks off, and his mom will be staying with us for a while, and my mom will be staying with us for a while...so we'll be well taken-care of. :) It'll just be frustrating that I won't be able to lift the baby carrier and/or take the stroller in/out of the car by myself for quite some time. But I'll just have to exercise patience :)

Yesterday we had an appointment with the OB. I explained the retinopathy situation to him and we talked about the c-section a bit. He actually pulled out his schedule, but it's pretty full so he said he'd have to move some things around and get back to me. He wants to do it between 37 and 38 weeks, barring further complications, which puts us in the week of June 1st - 5th. As soon as we have a solid date, I'll let you all know! We all want to keep her in there as long as possible, as long as it's not threatening her health or significantly threatening mine. We also talked about my bloodpressure (which, incidentally, was EXCELLENT when his nurse checked it...I guess my efforts to slow down and reduce stress this week have been working). He initially wanted to put me on meds (baby-safe), but then suggested that it would be better to first try quitting work...and then go on meds if that doesn't work. So...as of this coming Wednesday, I am on mat leave! I had been anticipating that he might tell me to quit work, so I had spent most of this week cleaning up. After Monday/Tuesday next week, everything should be in order, so I'm feeling alright about it. My boss had a slightly panicked look in his eyes when I told him, but he did also know it was a possibility, and really everyone at work (including him) has been very supportive. My doctor says I don't have to sit around with my feet up all day (i.e. I"m not on "bedrest"), and I can still putter about doing the things I want to do before the baby comes, but I am to take it slowly and easily and relax a lot and keep from doing anything stressful or strenuous. I think I can handle that. :)

So that's the update! My husband and I both feel like we're in a much more positive place now than we were on Monday. We've had a chance to process everything and have some good solutions on the go now, so we're optimistic. And if the rest of this pregnancy plays out well (i.e. with my eyes and my bp), maybe the risks of having another child in the future won't seem so significant. Either way, our focus now is definitely on the exciting event that is only a month away!

In other non-medical news, we have been cleaning up around the house to get the baby's room all ready. Also, my mom and I went to the Welcome Wagon Baby Shower on Sunday. The baby's still moving around a lot, but it's more pushing now than kicking. I think she's going to one day just poke a fist out through my belly. The nurse at the OB's office said my belly is really tight (a comment I would have welcomed when WASN'T pregnant), but it sounds like that's normal based on her position so high up - she's really sticking out. I guess that's why I can feel her pushing so much too. It's neat, though, to be able to rub her little head or pat her little bum. :)

Anyway, here some pictures of our chubby-cheeked cherub. :)

SOME DIFFICULT NEWS

Thankfully the difficult news is NOT about the baby....but it is about the pregnancy. This is a difficult post for me to write because my hope in starting this blog was to be able to be encouraging and inspiring to other diabetic women out there who weren't sure they could have a successful (dare I say "normal") pregnancy. I wanted to show you that we CAN do it. I wanted to be an example of a complication-free diabetic pregnancy. Unfortunately, as of this week, I can't be that example.

It concerns me that posting this may discourage some of you from getting pregnant....or even that it may just discourage you in general. I really don't want that to be the message here. This is a set-back, but it's not a failure. I am still pregnant with a very healthy baby girl, and am determined that she will be a success. This doesn't change that.

So at the risk of being less-than encouraging, I do feel that it's important for me to remain true to the intent of this blog, and give you the whole story - not just the easy stuff. So here it is....


A couple of years ago I needed laser treatments in both eyes for proliferative diabetic retinopathy. For those of you who don't know what that is (or who need/want a refresher), here's the quick explanation of proliferative diabetic retinopathy and the laser treatments - if you already know this, feel free to skip ahead:

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Basically, long-term and/or badly controlled diabetes can lead to problems with blood-flow to the retina. (Note that even people with well-controlled diabetes CAN experience retinopathy, although controlling your diabetes carefully does greatly reduce the chances of this happening. Also note that diabetes care methods are MUCH better now than they were in the 70s, 80s, and even 90s, so those of us diabetes-veterans have lived through a time when it was much more difficult to have tight diabetes control, and unfortunately do have a greater risk of complications like this as a result, even if we have much better control now. Anyway...) When the retina doesn't get adequate bloodflow, it doesn't get adequate oxygen. Because the retina needs oxygen, the brain sends signals to the retina to make new blood vessels to help move the oxygen around. This is called "proliferation" (hence "proliferative diabetic retinopathy"). Sounds good, buuuut....the new blood vessels are weak and fragile. They break easily, and when they do blood leaks into the retina and can cause vision damage. (Also note that not all diabetic retinopathy involves proliferation. In the early stages there may be blood vessel leakage, but no proliferation of blood vessels. I'm not going to go into that here, though.)

Retinopathy is not curable, but it is treatable to help slow (and hopefully stop) the process. Treatment involves getting numbing drops and/or gel squirted into your eye(s), having a glass lens pressed up against your eyeball, putting your face in a machine that makes you feel like you should be on A Clockwork Orange, and then getting a couple of thousand (yes, thousand) of laser zaps on your retina (called pan-retinal laser treatments). It's not as painful as it sounds like it could be, but it is painful, and it's VERY stressful. The light is very bright, and with every zap it takes your breath away and makes your other eye want to roll back in your head. It only lasts a few minutes, but it's pretty low down on most people's list of enjoyable ways to spend a few minutes. :P

The point of the treatment is to kill off a portion of the retina. It sounds counter-intuitive, but it basically allows the less-important parts of the retina to be sacrificed to save the more important central part of the eye (i.e. the macula), and hopefully protect your (my) vision by doing so. You end up with a grid-like pattern of scars on your retina (permanent), and typically a bit of damage to your peripheral vision and your night vision, but the end result is (or should be) that your retina then requires less oxygen, so your brain no longer sends signals to make new (fragile/leaky) blood vessels...reducing the risk of bleeding and vision loss. And that's a quick retinopathy lesson. Now back to our regularly scheduled blog.
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So, this past Sunday, I noticed a new "spot" in my vision of my left eye. I got in to see my ophthalmologist on Monday and the news wasn't great. There is bleeding in my retina that my ophthalmologist says is due to more proliferation (i.e. new growth) of the blood vessels. He said the pregnancy (i.e. the growth hormones running rampant in my body) and the slightly elevated blood pressure that I've been having are likely both coming into play here. (I'm not too surprised re: the growth, given that my baby has grown 1.5lbs in the last 2 weeks according to the fetal assessment - a normal level of growth for this stage of pregnancy.) We knew this was a possibility during pregnancy because of the growth hormones, but we had hoped for the best. Everything was going so well before the pregnancy and during the first two trimesters - no sign of proliferation or bleeding since my last laser treatment in September 2007 - but I guess I just didn't quite make it through the third trimester.

So, I had more laser treatments on Monday - 1000 zaps in my left eye. It sucked. A lot. (I didn't get woozy at all, though, which was a BIG problem for me last go-around.) I'm going back next week Thursday for more, but it should just be the two treatments, and he is just doing my left eye. He has a new machine since last time, though, that does multiple shots at once, so 1000 zaps is much faster now than it was before. I guess that's the silver lining on this cloud. It's still pretty miserable, though, and my eye was sore and a bit red/puffy for the next day or so.

So, I suppose the good news is that, since the ophthalmologist feels it's so directly related to the pregnancy, I don't necessarily have to expect that I will continue to have bleeding every few years for the rest of my life. The bad news is that this calls into question how wise it is for us to try for more children in the future as there's nothing to say it won't happen again with another one - maybe even worse next time. The doctor says not to worry about that now - it's not out-of-the-question. We realize that it will depend a lot on how the next 6 weeks go, how the years after this baby go (i.e. when I'm not pregnant anymore) and how my eyes are doing before we would be ready to try for another one. Either way, it will likely be a very difficult decision to make. For now, though, we are focusing on the fact that we have one beautiful baby on the way and are VERY lucky for that. We refuse to let this setback get in the way of our joy and excitement about our little girl!

Another development related to this is that my ophthomologist doesn't want me to push during labour (i.e. to avoid more bleeding of these weak blood vessels in the retina), so I will be asking my OB for a c-section. The baby is still breech, though (and apparently unlikely to turn since she's been in this same position for so long now), so this is likely a moot point anyway.

I'm seeing my OB on Friday and will discuss the bloodpressure issue with him then. We'll have to talk about ways to reduce it....which may or may not involve leaving work early or figuring out some other work option between now and my scheduled mat leave.

So, it was a less-than-good day on Monday, and a frustrating experience - especially so close to the end of the pregnancy. I feel like we ALMOST had a perfectly successful diabetic pregnancy, but didn't quite make it. But this too shall pass. Anyway, just wanted to keep you all updated.

At the end of the week I'll post more about this week and the new fetal assessment pictures (she's got some chubby cheeks!)

Until then, please don't let my experience this week be a discouragement for you. I just really felt the need to share this here.

WEEK 31 - TRIMESTER THREE DISCOMFORTS

This week I have been really reminded that the "easy" trimester (i.e. T2) is over - most notably with respect to my swollen feet/ankles. We had our prenatal classes last weekend. They were a compressed version that was all evening Friday and all day Saturday. Sitting in a chair for that long without much walking around made my feet balloon up, and unfortunately they didn't want to go back down in size after the classes were over. (As an aside, the classes were actually quite good. We took them through the Youville Centre and found them quite interesting and informative.) I worked from home for a day this week to try to keep my feet up and give myself plenty of chances to walk around, but the thing that finally worked was compression socks. They're expensive and really hard to put on, but they work (and thankfully they just look like regular socks)!! My doctors still aren't concerned about the swelling and tell me it's normal, but since it's uncomfortable, I really needed to do something about it.

In addition to the swelling, I've also had heartburn and indigestion. I had never had heartburn before pregnancy, but now that I have experienced it I have new respect for those who deal with it all the time (including my husband and some of his family). I also no longer sleep restfully as I'm up every two hours to pee. And then on top of all of this I feel big and clumsy. I think it's a bit of a cruel joke to make someone drop things all the time when she can't easily pick them up. :P Oh the joys of the third trimester.....just giving me more incentive to want to get her out in 6 weeks :) Wow....6 weeks....so soon!

The baby is still moving around a lot and seems like she's maybe shifted positions, but it's hard to tell. Apparently it's quite normal to have heartburn and indigestion with new baby positions, so I guess that falls right in line with how I've been feeling. It seems like she may be bum-up now, but I think still feet down (based on where I'm feeling movements), so it's hard to say. She definitely seems to mostly be on my right side, and she seems to think she's cramped in there because she very often is pushing outward on my belly, trying to make more room for herself. (Personally, I think she has plenty of room - more than my organs currently have, anyway.) We have another fetal assessment on Monday, so we'll find out exactly how she's positioned, and how much room she has, then.

I just had one doctor's appointment this week - with my endocrinologist. It went fine. We did a bit more problem-solving, but everything is still going well overall. My insulin needs are still going up, which is causing some evening highs and night-time drops still, but we have a few strategies to fix that.

Other than that, there's nothing much new. I've started back into my prenatal yoga and find it more difficult than it was 5 weeks ago when I stopped doing it, but it still really does feel good. I managed to go for some longer walks this week too, which helped my feet feel better and gave me a good dose of fresh air. :)

And, finally, here is a picture of me at 32 weeks.

WEEKS 29 & 30 - APPOINTMENTS...

The frequency of my various appointments is really increasing now. It's a lot to juggle, and it's making me a bit tired, but it's WONDERFUL to know that I have such a good group of health professionals looking out for me and for my baby!

First, the non-appointment-related stuff.

I've been starting to feel more tired again. It could have to do with this stage of pregnancy, but I've also been very busy, so that could explain it too. Also, the baby has been putting more and more pressure on my bladder, so my visits to the bathroom are becoming more and more frequent - including during the night, which probably also helps to explain the tiredness. I'd really LIKE to be sleeping well NOW because a good night's sleep will be nothing but a memory once the baby is actually HERE - but it's getting more and more difficult to sleep soundly at night. Oh well...such is the life of a pregnant woman, I suppose.

The baby is moving more and more all the time. Lately it's been a lot of pushing by her, instead of so much kicking. Often I can feel exactly where her head is, but I haven't managed to pin-point any other body parts. Just her cute little head that's still on top (I'm urging her to put in down, but she's not listening to her Mom...practice for the future, I suppose). She still has been getting the hiccups from time to time, which is a funny feeling.

Last week I had an appointment with my endocrinologist. It went very well. My bloodpressure was high, but it's always high there, even though it isn't nearly as high at my OB appointments. There's actually not much to mention from this appointment. I had a couple of things I wanted to discuss with her (e.g. I'm having some mild lows at night), but also had a couple of suggestions for fixing these things. She agreed with my suggestions and said she had nothing else to recommend. I'll be back to see her again next week (the schedule is every 2 weeks now).

This week I had an appointment with my OB again. My bloodpressure was still a little elevated there, but he's still not worried about that. It was pretty soon after I got there (walked), so I'm not surprised it was a bit elevated. Like I said, it was much lower than the reading last week at the endocrinologist. The baby's fetal heart rate was good. Fundal height (i.e. uterus length) is 32cm. Interesting b/c I'm 30 weeks, so it would normally be closer to 30cm. Which begs the question.....were we right about the due date the first time?? Hmmm.....more on that in the Fetal Assessment section below. My ankles are swelling a bit, but he's okay with it. Baby is still breech from what he can tell. He showed me how to feel her head and it's definitely on top! I asked him what the reasons would be for inducing any earlier than 38 weeks, and he said if (a) the baby is big (re: diabetes), but he said that is very unlikely given my good control (all my hard work is paying off!), or (b) if she's no longer getting adequate nourishment from the placenta. So it sounds like 38 weeks is definitely what we're aiming for.

We also had another fetal assessment this week. The baby is over 4lbs now (we can't remember if she said 4lbs or 4.5lbs). She is at the 60th percentile, size-wise. She was 40th last time, but they said the difference is due to the margin-of-error, and that her growth is perfect and that she's still definitely the right size for her age (i.e. new due date is still considered correct). This is a much more precise measurement than the fundal height measurement at the OB's office (i.e. a tape measure on my belly). They said everything looked great and there were no concerns. It is SO good to hear this! I know I've been taking very good care of my diabetes, but there's still the worry at the back of my mind - Is it enough? So far it's definitely been enough because she's doing GREAT! She is still breech, and has her feet up by her ears (she's doing yoga already!), but still has plenty of time to turn. We only got one picture and it's very hard to distinguish because she was being very difficult and moving around a LOT. I'm attaching it anyway....you folks can see if you can decipher it any better than we can. The resident doctor who was observing could see my belly moving from about 4 feet away. They seemed surprised, but pleased, at how much she was moving - although it made taking some measurements difficult, and made a good face-picture impossible, unfortunately. Maybe next time.

I also had a massage therapy appointment this week. I can't remember if I've mentioned this previously, but I have been getting massage therapy every two weeks and I HIGHLY recommend it during pregnancy. It really helps my back and my hips during pregnancy, and it's very rejuvenating too! I think I'd be curled up into an achy little ball by now if I wasn't doing this! I also recommend prenatal yoga for the same reason...but I do have to admit that I put off doing it for about 5 weeks (tsk tsk)...so do as I say, not as I do! ;) That said, I did really feel that it was helping in a lot of ways while I was still doing it, and I have noticed some discomfort creeping back since I stopped, so I can definitely vouch for the value of it! I did it again last night finally and am going to aim to do it at LEAST twice/week from now on. (I've even asked my hubby to hold me to it!)

Another appointment I had this week was with a counsellor from the Youville Diabetes Centre here in Winnipeg. I've been seeing her from time to time for a while, and realized that I should be making the most of her services during the pregnancy and in preparation for labour! This week she did a "hypnotherapy" exercise with me that I REALLY liked! (To clarify - "hypnotherapy" is not "hypnosis" as you would see on TV or in the casino or something like that. During hypnotherapy you are fully conscious and know what is happening, but you're in a deep state of relaxation that allows you (and the counsellor) to tap into your subconscious as well. It's very interesting and I have had some amazing success with it in the past too! Email me if you want to know more about it!) Anyway, this session brought me to a deep state of relaxation, and then helped me to "imbed" in my mind a number of positive thoughts about the pregnancy, the upcoming labour/delivery, and about being a mother. My counsellor recorded the session, and now I have it on my blackberry so I can listen to it (and do it) anytime I want! It's really great and really relaxing!

As an aside, I just want to put in a plug for the Youville Diabetes Centre! This week they celebrated their 25th Anniversary, as well as the re-opening of their newly renovated offices (which are BEAUTIFUL)! Congrats to them!! I always have such a great experience at Youville and have made use of so many of their services - from their Certified Diabetes Educator (three cheers for Michelle!), to a dietician, to a counsellor. Everyone there is so friendly and so helpful and they are a FANTASTIC support for me! (And don't forget that they count on donations from the public - they're a very worthwhile cause and you'll get a tax receipt!) There's my plug - RAH RAH YOUVILLE! :)

Anyway. Long post this week, but that's all for now. Here's my latest fetal assessment picture - maybe you can decipher it better than I can!

WEEKS 27 & 28 - SOME IMPROVEMENTS!

Overall, the past two weeks have been pretty good.

My energy is starting to wane a little and I'm definitely starting to feel bigger and more awkward. Sleeping is starting to get less comfortable too. I wake up everytime I have to turn over, and I also wake up to pee a lot. My right hip has been bothering me still, but it's managable. I'm still craving fruit like CRAZY - mmmmm....pineapple! mmmmm....apples! - and the newest craving is now bread & butter pickles (which have a lot more sugar in them than I thought!), and now coffee (decaf) too! The baby is kicking LOTS - unfortunately many of her kicks are directed at my bladder - my poor tiny bladder! Last week I'm SURE she had the hiccups. It's the first time I had noticed a feeling like that, but it was sure funny! Apparently that's very common at this stage.

My mother-in-law was in town staying with us for a while, so she and I did a bunch of baby shopping. We are now ALMOST done with the shopping! The crib and the changetable/dresser are set up in the nursery now too, but the computer desk is still in there. (We'll be losing our "office" when the baby comes.) It's a bit crowded right now, but that will change soon enough.

The baby is still VERY active, and is putting a lot of pressure on my bladder. On Thursday I had an appointment with my massage therapist and the baby got so active during my massage that my massage therapist could actually SEE my belly moving! Crazy! Also, this week without thinking, I gave my belly a little smack with my hand - not hard, but I guess hard enough because she JUMPED inside me! I must have really startled her!

Last night, my husband and I went on a date! We're not sure how many more chances we'll have for that, so we thought we'd better make the most of a free weekend! Thankfully he's not opposed to dating a pregnant woman :) We had a very nice dinner at Joey's and both ate waaay too much. It was just impossible to pass up the banana bread pudding! Mmmmm...... Thankfully I've gotten pretty good at managing my insulin around little indulgences like that and had a pretty stable bloodsugar evening - even after a decadent dessert! (Have I mentioned how much I love my pump and CGMS??)

I've had two baby-related appointments in the last two weeks. Last week was the endocrinologist appointment. It went very well! My A1C was even better than last time, and is now the lowest it's ever been! (Yes, I rock!) Also, my endo signed my Disability Tax Credit forms (yay!) so now all that's left is for the CRA to sign off on it too. I really REALLY hope they do, because the refund could buy me a lot of sensors!

I had been having some problems with high bloodsugars in the afternoons and evenings and then low bloodsugars at night, but my endo and I devised a few strategies to deal with them, which I have put into practice since the appointment and which really seem to be working! Another yay! :) I also realized that I have a surefire way to keep almost completely stable morning bloodsugars. One word: oatmeal. Yes, from now until the baby comes, breakfast is oatmeal and only ever oatmeal. It's boring, yes, but it's worth it. Thankfully I like oatmeal, and thankfully even instant oatmeal seems to work (even though it has a higher GI value than the non-instant stuff), and thankfully instant oatmeal comes in a wide variety of flavours. I'm also subbing in Red River Cereal from time to time because it seems to work too. With this sort of breakfast, I can get my 2-hour post-prandials under 7.0 and still not go low before lunch! I really never would have thought that I could do that! Thank you Mr. Quaker! :)

The small bit of bad news at my appointment was that my bloodpressure was a little elevated. We're going to keep an eye on that. Hopefully it was an anomoly. It wasn't way too high, or anything, but definitely something to watch, especially because I am seeing some occassional swelling in my ankles. (None in my hands/face, though, so I have no reason to suspect pre-eclampsia or anything.)

My baby-related appointment THIS week was the OB. Everything was A-OK! I'm still healthy and the baby's still healthy! He checked my bloodpressure too and said it was fine. It was still a tiny bit high, but he wasn't worried about it. All of my latest bloodtest results came back just fine too, which is always a relief!

I'm at the point now where I'll be having OB appointments every other week, endocrinologist appointments every other week (not the same week as the OB), and fetal assessments every other week! Ack! Busy! And at some point at least some of these will be moving to EVERY week! Thank goodness my boss is very understanding and accommodating! I'm very lucky in that respect!

Another piece of good news is that my infusion sites are working again! Yay! I'm still using thigh sites with the Silhouette sets. If I put them in too shallow they can be uncomfortable and bruise, but as long as I get them in at a deep enough angle, they've been good! I haven't pulled any out yet either! I still am putting the CGMS sensors in my abdomen, but it's really been a good break to not have the infusion sites in there too!

And now for something I have learned this week: Accurate Carb Counting Makes A Difference!

I was having a lot of trouble understanding why I kept going high in the evenings. I weigh a lot of my food on a food scale (the kind with the database of foods in it that'll tell you how many carbs a certain weight of food has), but I"ve taken to eyeballing a lot too. It turns out that, even when you're a good eyeballer (or think you are), it's worth checking from time to time. It also turns out that some of those standard carb-values we're taught in Carb Counting 101 aren't always accurate. Just to test it out, I measured absolutely everything carb-y on my scale for one meal. It was 20g of carbs more than I would have counted it!! Ridiculous! These days I'm on a 1:5 ratio at supper, so that would have meant I would have underbolused by 4 units!!! That's a big difference! Some of the biggest mis-counting culprits were fruit! A small apple (emphasis on small) was 20g of carbs! I figured a medium apple would be 15, so a small might be 10! I was also miscounting pineapple, and TOTALLY underestimating the carbs in bread & butter pickles! When I actually counted the carbs right and took the correct bolus for them, my bloodsugar was fantastic in the evening! Who would have guessed?!

So, from my lesson, here are some suggestions I would like to offer to you other carb-counters out there who are looking to refine your carb-counting (and, in turn, your diabetes control). Take 'em or leave 'em, but they're making a big difference for me!:

1. Invest in a good food scale - the kind with the database. Mine was about $40 at Canadian Tire, so they're not TOO terribly expensive. They are FAR more accurate than the measuring-cup method. For example - how do you measure a cup of spaghetti? How do you squeeze those wiggly noodles into a measuring cup, and how tight do you pack them in? How do you measure a cup of Corn Flakes when they're at the bottom of the box and broken up vs. the top of the box and whole? A good food scale makes this SO much easier and SO much more accurate! It's also good for measuring anything that has nutritional information on the package, if it's not in the database (or even if it is). For example, a big container of yogurt tells you how many carbs are in 125g of yogurt. Instead of looking it up in the database, you can just weigh 125g and figure it out that way. The one caveat to all this is that you have to make sure you're only weighing the part of the item that you're eating. This is particularly important to keep in mind for fruit. For example, if you put a whole apple on the scale it will count the weight of the core and include those carbs, even though you're not going to eat the core. To weigh it properly, you really have to cut out the parts you aren't going to eat and just weight the parts that you are. But then, if you have a whole bag of apples all the same size, you really only have to weigh one like that, and then you can assume that the rest will be the same. Anyway, I'm a big supporter of the food scale! Rah rah food scales! :)

2. Don't assume that the "standard" carb values we're given in Carb Counting 101, or even on packages of food, are accurate. Don't get me wrong, these standard values are a GREAT place to start, and are MUCH better than nothing, but if you're looking to fine-tune, they may not cut it. My apple example is a good one, but also a piece of bread. There are so many types of bread out there now, and so many sizes of slices, that you can't really assume they're all going to be a standard 15g of carbs (and most of them aren't!) Even when you're reading the bag for nutritional information, you need to consider if all the slices are the same size. With rye bread, for example, they usually aren't. This is another place where a food scale comes in handy.

3. When you think a food is likely low enough in carbs not to matter, read the label anyway! I thought bread & butter pickles would have negligible amounts of carbs - I mean how much sugar could they REALLY pick up from the brine? Well, it turns out that one slice has 2g of carbs! So if I eat 6 little pickle slices, I've just eaten 12g of carbs! That's significant! The same applies to sauces - e.g. BBQ sauce. There are carbs hidden everywhere!

Anyway, if what you're doing is working for you, feel free to ignore all that, but if any of you are trying to fine-tune and could benefit from the lessons I've learned, then great!

(It's funny how I'm still learning so much even after 27 years with this disease.)

Alright, that's enough rambling for this time. Finally, here's a picture of me at 29 weeks, ready for my date last night :)

WEEKS 25 AND 26 - INFUSION SITE FRUSTRATIONS, ANOTHER FETAL ASSESSMENT, AND THE DISABILITY TAX CREDIT

First with the non-diabetes stuff.... I'm still doing well. I'm starting to get a bit more tired, but I've been waking up more at night lately, so that could be why - perhaps because the baby's kicks are getting stronger now. My ankles started swelling a bit too, but I'm finding ways to reduce that (including elevating my feet a bit at work and sleeping with a pillow between my knees).

I'll start with the bad news and move on to the good news.

Bad news is that I have been having SO MUCH TROUBLE with infusion sites! ARGH! I decided that my abdomen needed a break because it is so holey (between infusion sets and CGMS sensors) that I'm afraid soon I'll take a drink and leak like a sieve! Plus, it's kind of a pain to have to move (or remove) sites when I go for fetal assessments, and even if I don't move them they're totally in the way. I don't want to start moving my sensors around because I don't want to pay $50 just to find out that a new site doesn't give as accurate readings and/or is uncomfortable, so alternate infusion sites it is!

I started with upper buttocks. Problem #1 - VERY easy to pull out when taking down my pants to go to the washroom. Problem #2 - Painful! Problem #3 - Slow slooooowwww absorption. Bah. To be fair, I only tried one type of infusion set in this site, so maybe I should have given some others a try before giving up on my butt, but I'm pregnant and impatient for my bloodsugars to normalize again! I have been using the Sure-T sites, which are a 90 degree steel set. That's right folks - an actual NEEDLE stuck in me all the time. I suppose I shouldn't be surprised that having a "thumb tack" stuck in my butt is uncomfortable - especially considering that my butt moves a lot when I walk, sit, etc. (Don't laugh - yours does it too!) So even taping the site down with loads of adhesive dressing, while taking care of Problem #1, didn't make the butt a successful or desireable alternate site. I'll spare you all the details, but suffice it to say I wasted about 6 sets trying to make it work and experienced pain, yanked-out sites, and unusually high bloodsugar levels. I gave up.

The next alternate site I tried was my thigh. I don't have a ton of excess fat on my thigh, so the thought of those little thumb-tack-like Sure-T's didn't appeal to me. Instead I switched back to Silhouettes. I had been using these prior to my pregnancy and had switched to the Sure-T's because I suspected that the teflon sets were causing "tunnelling" (i.e. absorption problems) when I had to start changing them every 2-3 days. But even 2-3 days is better than the 1 day at a time I've been getting out of Sure-T's lately. So, I've now had a Silhouette (i.e. angled teflon set) in my thigh for about 2 days. I've taped it down very well, otherwise I'm sure I would have pulled it out by now. It's been a little uncomfortable from time to time, but definitely better. The absorption does seem a little slower than in my abdomen, but definitely not as bad as the butt sites. And who knows...it may be that my insulin needs are just starting to increase again now that I'm heading into the 3rd trimester. So, I'm cautiously optimistic. It's definitely nice to give my abdomen a break. It will also be very good for me to be able to use alternate sites for the actual delivery of the baby - particularly if a c-section becomes necessary.

So now the good news! Yesterday was our 2nd Fetal Assessment. It went VERY well. The nurse said everything looked great - heart-rate, size, placenta,etc - and she said that I must be taking very good care of my diabetes, judging by the health of the baby. This was SO GOOD to hear, especially after a frustrating diabetes-week. It's so nice to know that my hard work is really paying off and that my baby is healthy because of it! The nurse estimated her weight at about 2 lbs which is apparently exactly where she should be. According to her growth chart, the baby is tracking perfectly just below the 50th percentile. Again, it's good to see that we don't have a big-baby situation because of the diabetes - at least not so far.

The baby was very responsive to being "prodded" by the nurse and kicked the ultrasound machine a number of times. It was really neat to be able to actually watch her move around instead of just feel her! The nurse said she had a "very sweet face", but I'm not sure how she could tell in all that wavy black and white :) All of this just makes us SO excited to be able to meet her in a few months!

Another new (but far less interesting) aspect of the past couple of weeks is that I have been working on proving my eligibility for the Disability Tax Credit. To do so, I need to be able to show that I spend a minumum of 14 hours per week on "life-sustaining therapy" - which basically means "diabetes management"....except that you can't count carb-counting, which seems a bit unfair to me. Anyway, it's the first time I've tried to claim it because, in the past, I could never have honestly said I spend 14 hours per week on "life-sustaining therapy" (just being hooked up to an insulin pump doesn't count), but now that I'm pregnant and controlling my diabetes as tightly as I know how, it turns out that I DO spend that much time! So I've got the form in to my endo to sign. Hopefully she likes the support I gave her and fills out the form for me, and then hopefully the CRA accepts my application! Fingers, toes, and everything else crossed! If any of you have any experience with claiming the Disability Tax Credit for diabetes, I'd love to hear from you! Write me a comment or drop me an email (email address is in my profile).

Lastly, here's a picture of me (taken today) and some pictures of the baby from yesterday.

Week 24 - Take Two

Yep, you read the title correctly....we have a new due date! It's now June 19th. This puts the 38-week mark (i.e. induction time) around June 5th...which just happens to be my husband's birthday! Perhaps I will only have to make ONE birthday cake every year for the two of them. :) (Who am I kidding, I've never made my husband a birthday cake!)

Long story short, between the first ultrasound, the first fetal assessment, and clearing up an earlier miscommunication about cycle-length, my OB did a recalculation at my appointment on Tuesday, and we came up with our new date. Under this new date, the baby is tracking perfectly size-wise. :)

Also during the appointment, the nurse was using the doppler machine to listen to the baby's heartbeat, and the baby kicked the doppler machine! She's feisty! The good news is that her heart rate accelerated exactly as it was supposed to when she exerted this little effort, so it was a very healthy response.

Speaking of kicks, this week I SAW a kick for the first time! She is very very active still, and has started a slightly annoying habit of kicking my bladder. I get to feel her movements lots, but every time my husband tries to feel her, she stops moving. I think her Daddy has a calming effect on her, but I think it's starting to make him question whether I'm making all this up about her being so active! ;) The other day I could actually pinpoint where her head was, and when I gave it a little push, she responded by kicking me! I'm really looking forward to being able to "interact" with her more now if that happens more often!

I've still been having a lot of energy lately which is very good. I'm hoping that lasts for a while, but with the 3rd trimester looming, I'm not so sure it's going to. I've still been trying to keep at least mildly active with walks over my lunch break, a few walks after work, and some yoga on the weekend. It actually really seems to help with my energy levels, my bloodsugar, and with the comfort of my joints.

Speaking of bloodsugar, I have had some major frustrations this week! Augh! My infusion sites just don't seem to be lasting as long as they used to. I don't know if it's pregnancy hormones, my stretching belly (I'm still using my abdomen), or developing scar tissue, but I'm starting to only get about 2 days out of them. (I usually lasted about 4 pre-pregnancy, and then I just changed it because the site was getting irritated.) After the 2 days my bloodsugar starts creeping up. I think it's time to start trying alternate sites...

Just this week I had remarkably high bloodsugars this week for seemingly no good reason, and every effort I made to bring it down just wasn't working as well as it should. It wasn't a complete lack of insulin, but there was definitely something wrong. Even after changing the site it was still bad, so I ended up changing the whole reservoir/tubing/infusion site - everything. So finally it worked, but by that point I was up around 17, and then when the "good" insulin hit, I dropped to an uncomfortable 2.5 in the middle of the night. Ugh! (Thank goodness my CGMS woke me!) I know it was just one day, but it's hard not to think about the effects a bad day like this could be having on my baby. Plus it just felt miserable to have high bloodsugar all day. (Not up at 17 all the time...but above 12 pretty much all day.) Yuck yuck yuck.

On a somewhat unrelated note, I have a hint for those of you who are somewhat new to the whole CGMS thing. I have found that the CGMS isn't especially good at keeping up with quickly dropping (or rising) bloodsugars, so to keep me safe at night, I've actually set my low bloodsugar alarm a bit high. I have it at a 4.0 right now. It does mean that sometimes it alarms when I really don't need it to (i.e. I don't need it to tell me if I'm a nice stable 4.0), but it has really come in handy a few times. For example, this last week when I dropped so fast at night, the CGMS alarmed at 4.0 when I was actually 2.5 - I was just dropping too fast for it to keep up. If I had left it set for 3.5 or 3.0 I might have been a lot lower by the time I woke up (unless I would have woken up on my own, which does eventually happen too). It might not work for everyone, but I do find it's a good workaround for one of the CGMS's quirks....it works well for me.

All for this week! I have another fetal assessment coming up later in March, so I'll be posting again in a couple of weeks!