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.

Prenatal Genetic Testing: There's a lot ot say.

I put off writing this post for quite sometime because of one of the most scary parts of prenatal genetic testing: the false positive.

My doctor advised, and I wanted to have a first round of non-invasive genetic testing. We had a sequential scan. This involved an ultrasound at 11 weeks to measure the baby's nuchal fold (the skin covering the back of the a baby's neck) and a blood test, followed by another blood test at 18 weeks.

The sequential scan looks at the nuchal fold measurement and four hormone and chemical markers in your blood to help pin down the risk a baby might have Down Syndrome (three copies of chromosome 21) Trisomy 18 (again, an extra copy of chromosome 18), a neural tube defect (like spinal bifida) or a congenital heart defect. This gives more information about risks that maternal age alone.

Every pregnant woman has the opportunity to have these tests done. Diabetic women may be counseled more strongly to have the tests because their risk of neural tube and congenital heart defects are already higher.

But, it's important to remember that the tests are completely your choice. If you know that a result will not change how you feel or what you do with a pregnancy, than by all means forgo the testing.

The second blood draw showed higher levels of a hormone called alpha-fetoprotein. This is an indicator of an increased risk of a neural tube defect. The increase was not high, so my risk for having a baby with a problem changed from 1 out of 150 to 1 out of 140 with the result... not too substantial, but definitely worth some tears.

The high AFP value could also indicate a variety of other situations. They ranged from, in the best case, a baby whose growth was a bit stunted, to, in the worst case, a pregnancy had that ended. Interestingly AFP is also a marker for some cancers.

Needless to say getting the call from the genetic councilor was terrifying, and the two week wait until the ultrasound was tense. My doctor reminded me that 1 out of 140 means that 139 babies are just perfect.

The ultrasound went better than well. We got to see the baby's spine and brain. I've never seen anything more lovely. The weird alpha-fetoprotein reading was an anomaly. The baby is growing well.

I have mixed feelings about the genetic screening process. I learned more information about my child's risk of some conditions, but was worried about another, unnecessarily. However, I think, given the increased concern with diabetic pregnancies, I gained some valuable information and I will likely go for it again if I decide to have another child.

Second trimester: Insulin don't fail me now.

In one of many jokes of the diabetic pregnancy, just as you've become used to the lower insulin needs and increased sensitivity of the late first-early second trimester, your placenta throws you for a loop.

The placenta, masterful organ that it is, has one keen interest... keeping your baby well fed. It releases a hormone cocktail with many baby-promotiing properties, one of which is counteracting mom's insulin to keep more sugar circulating in the blood and consequently more available food for baby.

In non-diabetic moms, the pancreas pumps out more insulin to compensate. For some non-diabetic women, the placental hormones are too much for the pancreas to handle, causing a condition known as gestational diabetes. This is a temporary form of diabetes that goes away after delivery.

For those moms that are already diabetic, the 2nd trimester means you'll be taking more insulin, potentially LOTS of it. My doctors told me to expect to take double my pre-pregnancy insulin or more by the time pregnancy-induced insulin resistance peeks in the third trimester.

Currently, I've had to do one big bump at about 18 weeks. I changed my insulin to carb ratio from 1 unit to 7 grams to 1 unit to 4 grams (at breakfast) and 5 grams (rest of the day). I've also upped some of my morning basal rates. Now, because I'm taking so much more insulin, I'm changing my pump sites out once every two days instead of three. My insurance company understands at the moment, but I may switch back to plain old needles for some meal boluses to save costs.

I'd suggest not waiting too long to talk with the docs about changing your levels. You know it's coming, as do they. I found that making smaller changes more frequently is less traumatic then going for the big jumps, or seeing 200s and higher regularly.