Well... it's been a busy 48 hours since I've hit the 16 week mark. It started Wednesday night with projectile vomiting that continued into the early morning hours! Poor Charlie, I couldn't make it to the bathroom in time no matter how hard I tried so finally he just slept on the bathroom floor with me so that he could help me. I had a difficult time keeping much of anything down, which makes controlling my diabetes even more difficult because every time I would get sick my blood sugars drop very quickly so I have to eat and drink to keep them up (well this would usually just make me throw up more... you see the problem.) Anyways be morning I had stopped getting sick but still had a severe headache and was very dehydrated but I managed to make it downtown for my 16 week appointment.
Unfortunately because of the dehydration, and messed up blood sugars, I was spilling ketones in my urine by the time I got to the office (my bodies last resort to try and compensate for elevated blood sugars when not enough insulin is available or able to be used). Due to the dehydration, and ketones, and my inability to stand up straight without having my heart race and getting dizzy and out of breath my doctor decided to start an IV to rehydrate me. Well after 3 failed IV attempts and 3 failed attempts by lab to draw some blood work that IV turned into a full hospital admission... 24 hours later I am still here, hooked up to an IV, continuous EKG monitor, and hourly blood sugar checks (I thought I looked crazy and bionic before, now there are more wires and tubes attached to me than I can count). I was hoping to be able to leave this morning but the nurse I talked to told me 24-48 hours, which means maybe if I'm lucky later tonight but I will definitely be here for a while still.
Charlie has been amazing, he came home early yesterday to bring me the things from home I needed and stayed with me here last night (which involved eating hospital food, sleeping on the floor next to my bed for an hour or two before we got a guest bed pulled out, and hourly wake up calls through the night by my nurses, poor guy). The good news is I'm feeling much better now, just tired but I'm really hoping to get out of here sooner rather than later but I'll keep you updated once I see the diabetes educator and the cardiologist this morning.
-Cait
060812 1020
P.S. Stay tuned for a new photo and some exciting news about the sex of our little one!!!
Showing posts with label Diabetes. Show all posts
Showing posts with label Diabetes. Show all posts
Friday, June 8, 2012
Monday, June 4, 2012
Electronic Upgrades
This post could also be called "Turning me into the Bionic Woman" because sometimes lately that is what I feel like!
It's been a busy weekend around here at the Akes' household... well kind of. I have been working most of the weekend which means I sleep all day and am gone all night, but that feels busy to me. The exciting part though is that I had a doctors appointment last Thursday and found out that my insurance approved me for a new pump and continuous glucose monitor!!! This is a big deal!
The first time I talked to the MiniMed rep about getting a new pump he told me that in all his years doing this he has never seen my insurance company approve a new pump when the old one was still in warranty. But, thanks to a well written letter from my diabetes educator and my high risk OB explaining my severe lows resulting in multiple 911 calls they approved me for both (probably because in the end it's going to be cheaper for them than continuing to have to pay ambulance bills). After a long day stuck at home on Friday waiting all of the new supplies got delivered to our apartment.
Over and Over and Over again it warned you not to put the sensor in without your provider present! So... much to my dismay I decided to wait until my appointment on Friday to start using the sensor.
Well, that was the original plan. Then I went to work last night and it was kind of overwhelming, I had so many patients and so much to do, I was running around like crazy! I had checked my blood sugar and it was okay but by 9:30 at night things started to get even more overwhelming for me. I kept dropping things when I was in a patients room so I knew I needed to leave, I went out to the nurses station and I don't remember much of what happened after that. One of the midwives I don't know well came up to me, as I sat staring blankly at the clock on the wall, and apparently started talking to me but I was unresponsive so she got one of the other nurses. Within minutes half the nurses on the floor were surrounding me trying to get me to eat or drink something, test my blood, and wipe the sweat out of my eyes. This, while you think would be helpful just overwhelmed me more and I shut down (not like I was really with it in the first place). But they got me to eat and drink finally and one of the nurses had called Charlie to come get me.
By the time I had gotten myself together and changed out of my wet clothes a few doctors had showed up each with their own opinion about what I should be doing (most of which was ignored... sorry). But the general consensus between all the nurses (And the midwife, And the doctor) was that I needed to have my sensor in place before I came back to work. So... that is what I have spent most of today doing!
For those of you who don't know what the Sensor is (also called a Continuous Glucose Monitor) it is another small device with a sensor that I inject underneath my skin and wear on me at all times. It communicates wirelessly with my insulin pump and checks my blood sugar level every 5 minutes. I can set parameters for it on my pump and it will alarm if my blood sugar goes above or below a certain level. In addition to that, it also has more emergent alarms that sound if my blood sugar is dropping too quickly (even if I am still within the 'good' range) notifying me in advance of possible severe lows. The idea is that this will give my doctors a much better idea of what is going on inside my body before and after meals, severe lows, highs, and while I'm sleeping. This will also give me the ability to know when I am going low and to be able to do something about it before I get to the point where I am so disoriented I am unable to take care of myself.
So... here it is:
It's been a busy weekend around here at the Akes' household... well kind of. I have been working most of the weekend which means I sleep all day and am gone all night, but that feels busy to me. The exciting part though is that I had a doctors appointment last Thursday and found out that my insurance approved me for a new pump and continuous glucose monitor!!! This is a big deal!
The first time I talked to the MiniMed rep about getting a new pump he told me that in all his years doing this he has never seen my insurance company approve a new pump when the old one was still in warranty. But, thanks to a well written letter from my diabetes educator and my high risk OB explaining my severe lows resulting in multiple 911 calls they approved me for both (probably because in the end it's going to be cheaper for them than continuing to have to pay ambulance bills). After a long day stuck at home on Friday waiting all of the new supplies got delivered to our apartment.
Multiple boxes, books, computer updates and supplies... a little overwhelming!
It took me about 2 hours to set up my new pump. After reading the updates and checking out the new changes I got started on changing all the 8 million settings to be the same as my old pump. I was really surprised at how long it took me because I know how to use the pump and I've been doing this forever, so you can imagine how long it took me to go through all the sensor information!!
My new pump, much darker than my old one.
Charlie likes it though because I didn't pick the pink, purple or neon blue option!
I started reading through the instructional booklets on Friday (240 pages long, I skipped a few sections), then on Saturday I found the Sensor Startup Folder and the two page long to-do list which included an online training class (to be completed prior to attending the training with my diabetes educator). So I spent the next two days reading through that class online and taking the tests. My initial plan was just to read the instructions and put the new sensor in, but after reading huge warning signs on every other page saying:
Do not attempt to enter your insulin pump or glucose sensor settings without the direction of your health care provider.
Warning: DO NOT start using the system until medical personnel trained on the system teach you how to use it. Your health care provider will provide you with settings to program into the system.
Over and Over and Over again it warned you not to put the sensor in without your provider present! So... much to my dismay I decided to wait until my appointment on Friday to start using the sensor.
Well, that was the original plan. Then I went to work last night and it was kind of overwhelming, I had so many patients and so much to do, I was running around like crazy! I had checked my blood sugar and it was okay but by 9:30 at night things started to get even more overwhelming for me. I kept dropping things when I was in a patients room so I knew I needed to leave, I went out to the nurses station and I don't remember much of what happened after that. One of the midwives I don't know well came up to me, as I sat staring blankly at the clock on the wall, and apparently started talking to me but I was unresponsive so she got one of the other nurses. Within minutes half the nurses on the floor were surrounding me trying to get me to eat or drink something, test my blood, and wipe the sweat out of my eyes. This, while you think would be helpful just overwhelmed me more and I shut down (not like I was really with it in the first place). But they got me to eat and drink finally and one of the nurses had called Charlie to come get me.
By the time I had gotten myself together and changed out of my wet clothes a few doctors had showed up each with their own opinion about what I should be doing (most of which was ignored... sorry). But the general consensus between all the nurses (And the midwife, And the doctor) was that I needed to have my sensor in place before I came back to work. So... that is what I have spent most of today doing!
For those of you who don't know what the Sensor is (also called a Continuous Glucose Monitor) it is another small device with a sensor that I inject underneath my skin and wear on me at all times. It communicates wirelessly with my insulin pump and checks my blood sugar level every 5 minutes. I can set parameters for it on my pump and it will alarm if my blood sugar goes above or below a certain level. In addition to that, it also has more emergent alarms that sound if my blood sugar is dropping too quickly (even if I am still within the 'good' range) notifying me in advance of possible severe lows. The idea is that this will give my doctors a much better idea of what is going on inside my body before and after meals, severe lows, highs, and while I'm sleeping. This will also give me the ability to know when I am going low and to be able to do something about it before I get to the point where I am so disoriented I am unable to take care of myself.
So... here it is:
The sensor injected under my skin, and the transmitter (white part) attached to it.
It takes two hours to get set up initially before it will have any readings to display on my pump, so I am still waiting to calibrate it for the first time (hopefully in about 15 minutes) then it will start working. I will get a continuous reading and graphs on my new insulin pump (this is why I needed the new pump) showing what my blood sugar is and what direction it is trending in! It's exciting and will hopefully be very helpful for me and it will allow Charlie to breathe a huge sigh of relief while I am home sleeping and he is at work all day!
We'll see how it goes and I hope to have an update later in the week to show some new graphs and charts and such (the really exciting part for me!)
-Cait
060412 1006
Monday, April 30, 2012
The First Few Weeks
I want to start out by apologizing for what will be a likely very lengthy and boring post (for those without a strong medical background or understanding of type 1 diabetes). But I wanted to post this for family who will likely have lots of questions and concerns about how Charlie and I are managing not only the pregnancy but my diabetes. So please feel free to ignore this post if you don't fit into one of the categories above (or just peek at the photos at the bottom :).
I was told at a pretty young age that if I was ever to get pregnant that I would be considered high risk. This isn't news to me. I have been working as a labor and delivery nurse for the last 5 years so I have seen both ends of the spectrum but walking into this pregnancy I knew there would be changes and challenges but I thought that I was over all pretty healthy so I wasn't too worried. But sitting here today I can honestly say that I was very unprepared for how big these changes would be and how quickly they would happen.
Prior to pregnancy I had talked with my obstetrician about things to look out for, precautions to take, plans for when I was pregnant, so I had been doing all the "good patient" things like taking daily vitamins and folic acid just incase. I had also had an appointment with my endocrinologist shortly after I was married at which point he very bluntly told me that he didn't trust my current birth control methods (smart man) and took me off all of my medications that were considered unsafe in pregnancy.
Jump forward a few months and Charlie and I are preparing for our first mission trip as a married couple to Port-au-Prince, Haiti. In my frantic and last minute planning I realized that I probably should pack some "personal hygiene products" (as my mom would say) just incase. As I was going though the cabinet I found a pregnancy test that I had gotten a few months earlier and figured I'd just take it to make myself feel better before leaving. Much to my surprise two lines showed up before I could even set it down on the counter! Talk about feeling unprepared, I didn't even have time to process this news before our flight left the next day, not to mention prepare for the things I might need while I was over there! I stocked up on vitamins, folic acid, test strips and extra synthroid medication just like I'd been told by my docs. Long story short after a very long and somewhat trying week working with orphans in one of the worst slums in the world we returned to the states. By this time I had told Charlie I was pregnant and had been feeling pretty sick for a few days, I was seriously dehydrated, exhausted and all around overwhelmed. At the pleading of the nurse we talked to in Haiti (after my feet swelled up to the size of grapefruits because of dehydration) the first thing we did when we got back was to call my OB.
Not surprising after giving them my symptoms (which had at this point included sever right lower quadrant pain and insane blood sugars) they wanted to see me right away that day for an ultrasound and exam. Charlie came home in the middle of the day to come to the appointment with me, as we both very quietly and nervously walked in to the US room we were blessed to see immediately on the screen a little tiny blob situated on the left side of my abdomen (the baby wasn't implanted in my right fallopian tube as I had been panicked for days that it was) and as she focused more clearly we saw a heart beat of 122 beats per minute. We were ecstatic, at not even 6 weeks pregnant (and only 4 weeks post conception) there was a chance we wouldn't have seen any of that! But there he was! (just an FYI we have been referring to him as a boy for unexplained reasons ever since the first time we saw him, we might be in for a rude awakening 8 weeks from now but thats okay!)
After the ultrasound we saw my doctor together which was very reassuring for both of us. We got prenatal vitamins, a prescription for an obscene amount of folic acid, blood work drawn, and an outlined plan for what the next few weeks would bring, this is where the shocks began! I was told to get in to see my endocrinologist ASAP, I was scheduled for check-ups, appointments, and ultrasounds every two weeks until at least week 14.
By the time we made it to my second appointment, at week 8, I had been sicker than I have ever been with a fever for 9 days, a cough that made it difficult to breath, one panicked trip to the ER, an emergency visit to a dentist. I was diagnosed that week with bronchitis, treated for influenza, and after I just started to get rid of the fever, a sinus infection. I had also been told by my Endo that they could not see me for two months even after I called them crying because my blood sugars with the illness had been so out of control that I had passed out while sitting up attempting to hold a conversation twice within the last week and then had other numbers running in the 3 to 4 hundreds with all the stress.
At the second appointment I brought my blood sugar log (amazing right!) that showed the last 3 weeks of my blood sugars listed hourly throughout the day and night! It was at this appointment that I was referred by my OB to see a High Risk Perinatologist, Dietitian, and diabetes educator. And let me tell you these people don't mess around! By early this week, now at week 10, I had had my 3rd ultrasound (baby is looking great, Charlie says he has his families health and resilience, and I am praying he's right!) I spent 4 hours at the perinatology clinic and I wasn't sitting out in the chairs I was going from one doctor to another.
I found out a lot of good stuff that afternoon, albeit overwhelming but good. The high risk docs want me in their office for growth studies (ultrasounds) every two weeks in addition to meeting with my OB. They talked to me about plans for later in pregnancy, my increased risk of developing pre-eclampsia, and the babies risk of having heart problems. They scheduled me for some sort of special ultrasound to check more closely the babies anatomy next week, and walk me through all the other type of diagnostic testing they wanted to do. I refused most of it to be honest, I told them they could take as much of my blood and as many ultrasounds as they wanted but I was not doing anything that involved taking anything from the baby (cord blood, amniotic fluid, part of the placenta??? are they crazy?) So although I refused a lot of the tests they wanted they are still having me meet with a pediatric cardiologist after they do an echocardiogram on the baby at week 20 due to high risk of heart problems. They also talked to me about delivering and whether it would be best to do it at my hospital, or their high risk unit. They told me that if all goes well that is a discussion I could have with my primary OB later on but if I for any reason need to be hospitalized for any complications before 34 weeks they want me at their hospital incase emergency delivery is necessary they have a Level 1 NICU (which my hospital doesn't).
After all that, I went on to meet with the diabetes educator, who was amazing. She was able to print out literally a minute-by-minute account of my last 4 weeks through my pump, it was incredible (and kind of creepy!). She worked with me for 2 hours changing everything from basal and bolus rates, correction factors, carb counts, everything! She also explained to me that these changes were temporary. At the place I am in right now with the pregnancy my insulin requirements are dropping severely (hence all the crazy lows), but that will all change in about 5-6 weeks when they will start to climb as the placenta makes my bodies ability to utilize insulin go way down. By the middle of the second trimester my insulin needs will double, by the third trimester they will triple and within minutes of delivery I will literally be able to turn my pump off for a few days as my body adjusts to single life again (with the added burden of providing massive amounts of calories to my little one through breastfeeding). Oh the CRAZINESS!!! She also wants me to get a new pump, so that it will function well with the continuous glucose sensor she wants me to have for the remainder of the pregnancy! (I though checking my blood sugar every 1-2 hours was a lot, she's talking about every 5 minutes, 24 hours a day!) I smell an insurance battle brewing to say the least! Despite all of these changes I left the office feeling really good about suggestions made (and so far my blood sugars have significantly improved over just the last 5 days). Due to all the changes however, I need to go back to see her weekly until things get under good control with the sensor. I feel like I am going to need a personal secretary just to schedule and remind me of all my appointments!
I'm assured though that this is just until things get settled, for most of the second trimester I can go back to seeing just one doctor every other week (if my doctors can decide which one of them should take that primary role). Then if things stay okay I will be set until the third trimester, when they will want to start twice weekly non-stress tests... I can't even go there right now!
Very long story short, things are changing fast, but as far as I can tell the little one is a fighter and so far doing great! Enjoy the pictures.
-Cait
043012 1444
I was told at a pretty young age that if I was ever to get pregnant that I would be considered high risk. This isn't news to me. I have been working as a labor and delivery nurse for the last 5 years so I have seen both ends of the spectrum but walking into this pregnancy I knew there would be changes and challenges but I thought that I was over all pretty healthy so I wasn't too worried. But sitting here today I can honestly say that I was very unprepared for how big these changes would be and how quickly they would happen.
Prior to pregnancy I had talked with my obstetrician about things to look out for, precautions to take, plans for when I was pregnant, so I had been doing all the "good patient" things like taking daily vitamins and folic acid just incase. I had also had an appointment with my endocrinologist shortly after I was married at which point he very bluntly told me that he didn't trust my current birth control methods (smart man) and took me off all of my medications that were considered unsafe in pregnancy.
Jump forward a few months and Charlie and I are preparing for our first mission trip as a married couple to Port-au-Prince, Haiti. In my frantic and last minute planning I realized that I probably should pack some "personal hygiene products" (as my mom would say) just incase. As I was going though the cabinet I found a pregnancy test that I had gotten a few months earlier and figured I'd just take it to make myself feel better before leaving. Much to my surprise two lines showed up before I could even set it down on the counter! Talk about feeling unprepared, I didn't even have time to process this news before our flight left the next day, not to mention prepare for the things I might need while I was over there! I stocked up on vitamins, folic acid, test strips and extra synthroid medication just like I'd been told by my docs. Long story short after a very long and somewhat trying week working with orphans in one of the worst slums in the world we returned to the states. By this time I had told Charlie I was pregnant and had been feeling pretty sick for a few days, I was seriously dehydrated, exhausted and all around overwhelmed. At the pleading of the nurse we talked to in Haiti (after my feet swelled up to the size of grapefruits because of dehydration) the first thing we did when we got back was to call my OB.
Not surprising after giving them my symptoms (which had at this point included sever right lower quadrant pain and insane blood sugars) they wanted to see me right away that day for an ultrasound and exam. Charlie came home in the middle of the day to come to the appointment with me, as we both very quietly and nervously walked in to the US room we were blessed to see immediately on the screen a little tiny blob situated on the left side of my abdomen (the baby wasn't implanted in my right fallopian tube as I had been panicked for days that it was) and as she focused more clearly we saw a heart beat of 122 beats per minute. We were ecstatic, at not even 6 weeks pregnant (and only 4 weeks post conception) there was a chance we wouldn't have seen any of that! But there he was! (just an FYI we have been referring to him as a boy for unexplained reasons ever since the first time we saw him, we might be in for a rude awakening 8 weeks from now but thats okay!)
Our first view of the little guy at 5 weeks and 6 days.
(I hijacked this photo from the computer at work, if I'm suddenly unemployed this is why)
By the time we made it to my second appointment, at week 8, I had been sicker than I have ever been with a fever for 9 days, a cough that made it difficult to breath, one panicked trip to the ER, an emergency visit to a dentist. I was diagnosed that week with bronchitis, treated for influenza, and after I just started to get rid of the fever, a sinus infection. I had also been told by my Endo that they could not see me for two months even after I called them crying because my blood sugars with the illness had been so out of control that I had passed out while sitting up attempting to hold a conversation twice within the last week and then had other numbers running in the 3 to 4 hundreds with all the stress.
Our second photo of him at 8 weeks.
At the second appointment I brought my blood sugar log (amazing right!) that showed the last 3 weeks of my blood sugars listed hourly throughout the day and night! It was at this appointment that I was referred by my OB to see a High Risk Perinatologist, Dietitian, and diabetes educator. And let me tell you these people don't mess around! By early this week, now at week 10, I had had my 3rd ultrasound (baby is looking great, Charlie says he has his families health and resilience, and I am praying he's right!) I spent 4 hours at the perinatology clinic and I wasn't sitting out in the chairs I was going from one doctor to another.
I found out a lot of good stuff that afternoon, albeit overwhelming but good. The high risk docs want me in their office for growth studies (ultrasounds) every two weeks in addition to meeting with my OB. They talked to me about plans for later in pregnancy, my increased risk of developing pre-eclampsia, and the babies risk of having heart problems. They scheduled me for some sort of special ultrasound to check more closely the babies anatomy next week, and walk me through all the other type of diagnostic testing they wanted to do. I refused most of it to be honest, I told them they could take as much of my blood and as many ultrasounds as they wanted but I was not doing anything that involved taking anything from the baby (cord blood, amniotic fluid, part of the placenta??? are they crazy?) So although I refused a lot of the tests they wanted they are still having me meet with a pediatric cardiologist after they do an echocardiogram on the baby at week 20 due to high risk of heart problems. They also talked to me about delivering and whether it would be best to do it at my hospital, or their high risk unit. They told me that if all goes well that is a discussion I could have with my primary OB later on but if I for any reason need to be hospitalized for any complications before 34 weeks they want me at their hospital incase emergency delivery is necessary they have a Level 1 NICU (which my hospital doesn't).
Week 10, with a strong heart beat!
After all that, I went on to meet with the diabetes educator, who was amazing. She was able to print out literally a minute-by-minute account of my last 4 weeks through my pump, it was incredible (and kind of creepy!). She worked with me for 2 hours changing everything from basal and bolus rates, correction factors, carb counts, everything! She also explained to me that these changes were temporary. At the place I am in right now with the pregnancy my insulin requirements are dropping severely (hence all the crazy lows), but that will all change in about 5-6 weeks when they will start to climb as the placenta makes my bodies ability to utilize insulin go way down. By the middle of the second trimester my insulin needs will double, by the third trimester they will triple and within minutes of delivery I will literally be able to turn my pump off for a few days as my body adjusts to single life again (with the added burden of providing massive amounts of calories to my little one through breastfeeding). Oh the CRAZINESS!!! She also wants me to get a new pump, so that it will function well with the continuous glucose sensor she wants me to have for the remainder of the pregnancy! (I though checking my blood sugar every 1-2 hours was a lot, she's talking about every 5 minutes, 24 hours a day!) I smell an insurance battle brewing to say the least! Despite all of these changes I left the office feeling really good about suggestions made (and so far my blood sugars have significantly improved over just the last 5 days). Due to all the changes however, I need to go back to see her weekly until things get under good control with the sensor. I feel like I am going to need a personal secretary just to schedule and remind me of all my appointments!
Week 10 again. He's waving Hi!
(The sonographer told me like three times that he was cute, I agree with her!)
I'm assured though that this is just until things get settled, for most of the second trimester I can go back to seeing just one doctor every other week (if my doctors can decide which one of them should take that primary role). Then if things stay okay I will be set until the third trimester, when they will want to start twice weekly non-stress tests... I can't even go there right now!
Very long story short, things are changing fast, but as far as I can tell the little one is a fighter and so far doing great! Enjoy the pictures.
-Cait
043012 1444
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