The good doctor :)

I went to the Endocrinologist today. I told him I was frustrated by going through the motions of taking my blood sugars for a week. I knew that I could keep them down, but that turned into moderate ketones, which in turn are bad for the baby. I had to eat more carbohydrates to keep myself out of ketosis, but this made my sugars go sky high. I know he needed to see the sky high numbers in order to get the right amount and types of insulin prescribed.

Yeah... he did what I wanted. I'll take insulin 4 times a day. I'll take a very small amount 5 units before each meal and 12 units of the slow acting insulin over night.

Whew. Now that I know that, I can relax. I can manage the rest.

He also ran every test known to man on my blood and urine. (Thyroid, Cholesterol, Lipid panel, kidney function, proteins, sugars ...) All came back normal. He'll retest me during the pregnancy.

Jacob came with me because our next appointment was the ultrasound. He was excited and anxious to see the baby. We saw two hands, arms, legs... a beautiful spine... 4 chambers of the heart... an 18 cm circumference head... all is well. The nurse sent me home with a DVD clip of the baby and a couple of still shots, digitally. Michael is working on putting the video clip on the Google video with limited access so you all can see it.

No we still don't know the sex of the baby nor did we try to find out. It will have to be a surprise for all of us.

Graduation 2008?

Michael is stressed about his job search - as in it has halted. He is even in limbo with Texas Tech. They have two positions open and have begun their own recruiting process. Therefore we are waiting to hear on their progress in filling a Faculty - tenure tract positions.

If they are not able to fill both, then Michael can be an instructor.
If they are able to fill both positions, then Michael can stay for a 5th year in the PhD program.

Obviously we'd rather the instructor position as he'd make more money and we wouldn't have to take out more student loans. Yes, that means we'll be in Lubbock for another year. Yes this makes the timing of a new baby separate from selling our house, finding a new house, moving, new job, new school, etc. It isn't a bad thing.

Graduation will NOT be May 11, 2007 for Michael. I have canceled the hotel reservations we made in preparations. They have been booked for 3 months - so they were happy to have rooms available again. We do not know yet if it will be August 11, 2007 or not. It will depend on the instructor's position.

If he is a 5th year PhD student - he can defend his dissertation this summer and postpone graduation until 2008. They are very separate events apparently. I thought that once he defended then he'd have to graduate. Nope. He can enroll in independent studies, research projects, etc. with faculty and continue to publish. Defending his dissertation however would be behind him and he becomes a much more attractive job candidate.

I will keep you posted as things develop.

A patient with patience... or trying.

I asked the OB to screen me early for gestational diabetes. My numbers confirmed my gestational diabetic status.

I met with the Endocrinologist, a.k.a. Insulin doctor. I had a list of questions, the information from the registered dietician and the blood results from my tests. I started in with my questions….

When and where do I get a glucose monitor? – He gave me one, and a prescription for more testing strips.
I took Metformin for PCOS 1500 mg/day. Can I take it instead of shots? – No, pill cross the placenta, injections don’t.
Will I have a nurse manager that I check in with periodically? - No, I go directly to him every two weeks.
I don’t know my last Hemoglobin a1c test. When will I have one drawn? Friday morning, along with a bunch of other baseline things he wants on record.
I don’t have a refill for my thyroid medicine after this 30 day period, can you do that? Yes – he’d call it in with the other prescriptions.
Do I need Ketone strips? Yes, 3-times a day. He wrote a prescription and had it faxed in. I didn’t have high Blood Pressure or swelling with Jacob, but I’m starting some mild swelling with this one, is that ok? Yes, swelling is very normal.

He concluded very quickly that I had my act together. I stated the obvious, “I’m a very active patient and involved in what’s going on”. He said “That’s good…”, but I wonder how many doctors really mean that.

He confirmed that I have all the makings of a gestational diabetic. He’s more cautious with insulin than I would like. Before taking that leap and prescribing injections, he wants to see my blood work and a week of blood sugar readings. I will take my blood sugars six times a day for the next week and meet with him again. Based on my blood sugar log, he will then start me on the long lasting – slow release – insulin (NpH). I’ll take the NpH for two weeks and continue keeping a log of my blood sugars six times a day.

If at that time he feels I need to go to the fast acting – meal response – insulin, I’ll start small amounts before each meal and probably move the NpH to the night function.

The treatment plan when I was pregnant with Jacob was the fast acting - meal response – insulin each meal and then NpH overnight. I suppose I will have wait three weeks to get to the same result that the other doctors jumped right into.

Then he started in with my instructions. He made me write it all down on the piece of paper I brought in with his questions. If I could make a list for him, he was surely going to have me leave with a list from him.

He’d like to see my blood sugars in the ranges below:

Fasting 65-95
Before meal 90-105
1 hour after meal 140 maximum
2 hours after meal 120 maximum

Something he’s having me do that I did before, but not with the frequency. He is having me test for Ketones 2-3 times a day. What is a ketone you may ask? If you don’t have blood sugar available to feed the baby, your body will call upon fat reserves to make food. A by-product of that process is Ketones being produced. Ketones are not good for the baby. He doesn’t want me to skip blood sugar, but rather balance enough to feed the baby, without sugars too high.

If I have trace or a positive 1 ketone, I need to add 1 diabetic exchange for carbohydrates.
If I have a moderate level of ketones, I need to add 2 diabetic exchanges for carbohydrates.
If I have a large level of ketones, I need to add 3 diabetic exchanges for carbohydrates and call the office.

With all this in mind…I showed the doctor my meal plan as laid out by the registered dietician. The numbers are the servings of that food group recommended at that meal.

Breakfast 3 starch 1 meat 1 fat
Snack 1 fruit 1 milk
Lunch 2 starch 1 fruit 2 vegetable 3 meat 2 fat
Snack 1 starch 1 milk
Dinner 2 starch 1 milk 2 vegetable 3 meat 1 fat
Snack 1 starch 1 fruit 1 milk

I didn’t eat that much at breakfast. I had a piece of banana bread with a little butter. I came close to the recommendation. My fasting this morning was 120 and I had a 1 hour after the meal reading of 194. I suppose I can give him these numbers tomorrow when I go to the lab. Maybe he can start the insulin a little earlier.

Patience….

Glucose test, Job hunt and diamonds.....

I spent 4 hours at the Dr.’s office today, starting at 7:07 am. Actually the lab is where I spent most my time. I had the pleasure of being poked like a pin cushion. I have horrible veins. The poor guy had to go directly to my wrist and back of the hand. My fasting sugar level was 127, which is 30-40 points higher than they see in normal people. They called the doctor to see if they should proceed, since they can cause harm to me if they let my sugars get too high. Obviously they said yes, or I wouldn’t have spent three hours hanging out for so long. I drank 10 ounces of the awful sugar water. Think of sickly sweet, overly thick, Orange Crush - yummmmmy! On a fasting stomach it just made me nauseated.

Then at one hour, two hours and three hours, they drew blood to see the progress of my body processing (or not) the sugar. Between hours 1 and 2 I went to my OB’s check-in desk. I asked Liz for the name of Endocrinologist in the building. I told her that I was there for my 3 hour test since having failed the 1 hour test on Friday. Knowing I was insulin dependent previously, I wanted to make the appointment now. She showed me the way to Laci. Laci told me there were 2 appointments left for the week. I told her I didn’t want to wait, so let’s take Wednesday. She booked me and gave me the new patient information. I went back to the lab and filled it out. They drew my next round of blood and I returned the paperwork to Laci.

Although my OB’s nurse hasn’t called me with the results yet, I did tell her I had made the appointment in anticipation. She thought that was a great idea.
I am guessing that I’ll start some insulin pretty soon. We’ll see on Wednesday.

I left the lab and went to Pei Wei for lunch. I got Jacob some chicken and noodles, I got honey seared chicken. I sat and ate with him. It was good. He was happy to see me since I hadn’t seen him that morning. He was sound asleep when I left.

Then I went home and took a nap. I slept for about an hour. It was great. I was hoping it would take care of my headache. Food, water, coffee, Tylenol, nap…. I thought would be the combination to make the pounding stop, but it hasn’t yet. I got up and took Barbara to the airport. She had been here for a visit. I headed back to work.

In the meantime Michael sent this note:

The University of Hartford suspended their search for the assistant marketing position today. I am not traveling to Hartford. The dean said it was not me or my curriculum vitae. According to the dean, the college had little problems with the search process for the past month. They will post their opening in May to interview at summer AMA in Washington. He asked that I submit my c.v. in May.

I was told not to take it personally. Maybe they looked at my slide show that I sent yesterday?

It is odd because I received an itinerary this morning and talked with the travel coordinator to discuss the impending nor'easterner slated to hit New York and Connecticut tomorrow night.

In the meantime, I have asked for a meeting with the area coordinator to discuss next year. We talked about next year once already. I have applications in at Middle Tennessee State, Quinnpiac, and Suffolk. I am not holding my breath.

Michael

I am not sure what they were thinking. However, if they have this much trouble communicating within the college, don’t know what they are doing, etc… maybe he doesn’t want to be there after all.

In preparation of his trip, he had written the planned exam and arranged a substitute proctor. At least he’s prepared and doesn’t have to worry about that.

And my 15th wedding anniversary present arrived today….a beautiful diamond guard for my solitaire. I love my husband.

We will keep rolling with the punches and keep you posted.

First Glucose Test

I have a roller coaster of emotions going on right now. First let me say, the baby is fine. I however am going down the same path of gestational diabetes. Michael and I pressured the doctor into an earlier than normal glucose test. I am 18 weeks and they normally test at 24 weeks. He listened and respected our wishes, which is one of the reasons I like this doctor. He didn’t poo-pah his patient’s intuition and go only by statistics.

This morning I went in at 7:30. It was a 1 hour test. I had to fast, so I went in as early as I could. I went in and they took my blood sugar. I drank some pure glucose liquid stuff and in 1 hour they took my blood sugar level again. The poor guy “Goose” had to stick me 6 times. My results came back with a very high number of 174 for blood sugar. Normal people would be around 100, give or take. Basically my body has stopped making insulin to preserve blood sugar for the baby. Well.... isn't that special. Mother Nature built in this response to make sure women have healthy happy babies even if food is limited.

I go back Monday for the 3 hour test. Lovely. I knew this would be the case, but for some reason I’m upset about it. I need to focus on the fact that the baby is fine.

By the way – we opted not to have the amniocentesis. I thought I had said something about that earlier but it was brought to my attention that I forgot.

18 weeks

Jacob came with me to the doctor's office today. All is well. He was very interested in seeing the baby. Although we didn't have an ultrasound today. He did hear the heartbeat... and after 10 beats the baby would move. There was LOTS of moving around today.

In 2 weeks we go for an ultrasound and in 4 weeks we go back to the doctor.

I go this week for my first, 1-hour, glucose tolerance blood test. I'll let you know how it turns out.