Let the fetal monitoring begin!

Starting at about 32 weeks, my doctor recommended I come in for fetal monitoring to make sure that Cletus and his or her placenta were doing well. This is no small commitment. Between the drive, the 20+ minutes hooked up to the machine and the drive back, we're talking an hour and a half twice a week plus all the other normal appointments (which are now weekly or more than weekly).

At first, I resisted the frequency of this monitoring thinking that if I kept up with my kick counts and made sure Cletus was active I couldn't possibly need to come in for fetal heart rate monitoring every Monday AND Thursday.

But, after going a few times, I realized that the process was just so reassuring that it was worth it. When the uterine real estate market heats up, Cletus' fetal movements changed somewhat dramatically, so it's nice to have a professional me everything is okay.

Monitoring also helped me learn what contractions feel like. One of the sensors tracks baby's heart rate while the other tracks any compression of the uterus. I've been contracting for weeks now! Cervix please take note.

There is also nothing as soothing as lying in a dark room surrounded by the heart beats of fetuses. It's more nap-inducing than the ocean.

Keeping an open mind

With diabetes, you can never positively tell what's going to happen. A banana and coffee for breakfast might get you to 140 mg/dL one day and 248 the next. You just gotta roll with it and be prepared.

Pregnancy also requires the ability to remain flexible. When your kid measures up at the 60th and 66th percentile of his or her peers during the first and second trimester, then jumps up to a shocking 84th percentile at week 32, delivery time frames and strategies, as well as blood sugar and diet controls might need to be adjusted quickly.

And so it went with me and Cletus the Fetus. Although (s)he remains in beautiful proportion, Cletus left her peers in the dust when it came to growth this last trimester. Five pounds 11 ounces with two months to go. My friends have delivered term babies smaller. So, instead of looking at an induction at 39 weeks, we've upped the schedule to 38. April 11th, let the cervix be ripe!

This is a little bit frustrating, obviously. My HbA1c was 5.6 the first trimester, 5.5 the second, and 5.4 so far this third. My control is awesome. My weight gain is awesome. My kid is just big. What can ya do?

Third trimester bolus blues

Oh insulin, we've grown to be on such familiar terms lately. I now take almost twice as much of you as I did before Cletus the Fetus and his or her placenta came into my life. The pharmacy thinks I'm crazy every time I call needing more of you... as if I could be selling you for profit or an addict. Every two weeks my doctor and I keep turning up the dials on my insulin pump. You are a great, great friend, and I thank you for all of your support during this time. You've kept my Hb A1c under 6 for my entire pregnancy. Again, Kudos. But, dear insulin, I am counting the days 'til we can go back to just being friendly, without the same degree of intimacy we have now. Post delivery, I'm gonna quit you... alright, not entirely. But you get my drift. It's just a matter of weeks now.

The pregnant, diabetic head cold

There are few experiences that can make you feel less in control of your health then when a diabetic person gets sick. Before pregnancy, I never really had the traditional 'sick day' effect, when blood sugars spiral out of control, in one direction or the other, as your body both succumbs to then fights off an infection.

However, in the last three weeks I've had two mind blowing head colds, both of which sent my blood sugars to the moon as they were taking hold regardless of how much insulin I threw at them, then made my levels plummet a day of two later. It's a drag!

Usually when I feel this badly, I stock up on Nyquil and the like, treat my symptoms aggressively and try to sleep it off. But there are so MANY medications that are not approved for pregnancy, it's kind of hard to find anything at all to take. So, for the duration of these sicknesses I've experimented with some other remedies including the wildly effective salt water gargle for sore throat, neti pot for nasal congestion and post-nasal drip and chicken noodle soup for grouchiness (personal recommendation: buy in bulk).

With each virus, my blood sugars stabilized within a day or two without my needing to go to the hospital. My doctor recommended I check for ketones, a sign that blood sugars are so high your body is going into ketoacidosis and you need help fast. And, as always, sick days require more blood sugar tests than other days. I know, I know. You're a pregnant diabetic woman, you're already finger sticking eight or more times a day. Well, hopefully there are only a few weeks left!

Quick Vocabulary Guide

Hello all,

It occurred to me that I'm throwing a lot of terms around that a new diabetic or someone who is non-diabetic might not know. Here's a list of some of the most common. Please let me know if you'd like me to include others.

Basal insulin: The programed schedule of background insulin you need to function in a day, excluding meals.

Blood sugar or blood glucose: This is how much sugar is in your bloodstream at a particular time. It's the reading that you get from a glucometer. One hundred is roughly considered normal.

Bolus: The amount of insulin you take with a meal to cover the carbohydrate grams you're about to eat.

Carbs: An abbreviation of carbohydrate grams. This refers to how many grams of carbs you're eating at a particular meal. Diabetics use this number divided by their insulin to carb ratio to figure out how much insulin to take with each meal.

Endocrinologist: A diabetes doctor. More specifically, a doctor specializing in hormones and glands, of which insulin and the pancreas are a very important subset.

Glucometer: Also known as a finger pricker, this is the small machine used to determine your blood glucose level using a drop of blood from your finger and a test strip.


Hemoglobin A1c: Also called HbA1c. This test measures how well you've controlled your blood sugars over the last three months by looking at the surface of your red blood cells to see what percentage of them have been chemically changed by high blood sugar. 7.0 (7 percent of those red blood cells) is ideal for a diabetic, but tighter control is always better. A non-diabetic HbA1c is between 4.0 and 6.0.

Insulin to Carb Ratio: This is the number you use to determine how much insulin to take with each meal. For lunch I'm going to have about 60 grams of carbs in leftover Chinese food. I'll take that 60, divide by my insulin to carb ratio of 4, to get a bolus number of 15 units of insulin.

Pump: A beeper-looking device that automatically gives you insulin through a small catheter you insert about every three days. Pumps provide a daily schedule of background insulin, the basal rate, and let you program in the carbs you're taking with a meal to give you boluses for meals. This is an alternative to taking multiple daily injections of insulin.

Sensitivity or correction factor: The amount of insulin you need to take to get high blood sugars back into to normal range. For me that's about 1 unit to 15 blood sugar points above 100.

Weird Tests

Pretty early in your diabetic pregnancy, your doctor will want to check you for the three major groups of complications that can effect pregnancy: your eyes, your kidneys, and your heart.

Diabetic eye disease can sometimes mean you need a c-section because pushing could further damage your retina. A recent diabetic eye exam can rule that out.

For the heart, I had an EKG to make sure I had experienced

no 'hidden heart attacks' which sometimes strike diabetics, and women in particular. This involved 10 minutes of getting sensors placed on my chest, followed by being hooked up to a machine and about 20 seconds of actual testing. Totally non-invasive.

The worst funny test, by leaps and bounds, was a 24-hour urine collection to make sure my kidneys were working well. Kidney disease and pregnancy can interact to increase high blood pressure or preeclampsia for moms.

During the test, you must collect every single drop of urine for a day by peeing into a toilet 'hat' then running through the house with your 'specimen' to a big plastic jug you keep in the... wait for it... refrigerator! Wrap that sucker up in as many plastic bags as you want, it won't help that icky feeling. I think I ate out for a week afterwards, despite disinfecting everything!

Hopefully you'll only have to do this once and can pick a day when 1) you don't have to go anywhere with your toilet hat and pee jug and 2) no one is coming over to your house.

Diabetic air travel: Welcome to the Champagne Room!

The first time a TSA agent escorted me to a 'private screening area' I was terrified. I truly thought someone had planted something in my luggage or my new paint set had some sort of explosive compound. My heart pounded, I became extremely sweaty, I could not control my breathing... I looked guilty!

But no, it was just a misunderstanding about my insulin pump and protocols with the new full body scanners and department policy.

Since then, I've been escorted to the 'champagne room' as I've dubbed the private screening area, on several occasions with escalating hilarity. Kafka couldn't have dreamed this up.

Many people, I'd wager thousands, travel with insulin pumps, continuous glucose monitors and other medical devices every day. Usually, telling your TSA screener that you have one ahead of walking through the scanner is sufficient. You'll just get pulled out of line and have your hands swabbed.

Occasionally, a particular residue in body lotion can alarm the explosive-meter. In this case, you'll likely be asked not to touch anything, identify your belongings and head to a small, private room with multiple agents. They will pat you down THOROUGHLY. I've offered to simply strip for them, but they're not interested.

Although the process is tremendously frustrating, and at times, rather embarrassing, all you can do is roll with it. Try to have a sense of humor. Don't make jokes about anything explosive. And forgo moisturizing until you reach your final destination.