So how did we do?

That's a great question.

Pre-Operation:

My Blood Sugar: flatlined for 12 hours between 108-117 leading up to c-section (see 6 hr graph above). Perfection!

My Pump: removed just before surgery and replaced with an IV insulin drip

My Insulin: They put me on a Novolin R drip of 1 unit/hour. (Really? R?) They also started a D5 (dextrose) drip. Yin and Yang!

My Blood Pressure: All over the place - the systolic would be too high, then just the diastolic. Then it would normalize. Nervous much? My blood pressure never had a problem during either pregnancy, but before both surgeries, this happened.

Epidural went in easily, but before they pushed any Fentanyl through it, I was struggling with horrible nausea. My nurse and anesthesiologist determined it was from being flat on my back under the unusually large weight of my uterus. Once they dosed the Fentanyl, I got the shakes something fierce. (This is one of many reasons why I don't regularly do opioids.)

During the Operation:

My Blood Sugar: I lay with my arms out to each side, BP cuff on right arm and Dexcom receiver in my left hand where I could check it as I liked. My BG immediately started climbing. Before the incision was made, I was 134 and climbing. As they sewed me up, 169.

My Pump: I was missing it.

My Insulin: R is a joke. I should have put some of my own insulin on board before disconnect. If Apidra/Humalog/Novolog are jet airplanes, R is a kid on a bicycle.

My Blood Pressure: It was normal throughout.

The nausea from the weight of my belly as I lay on my back was so overwhelming that I requested a vomit bag and had to use it. They pushed some Zofran through my IV and that helped, but honestly, I just needed the kid and all his fluid OUT. This time the epidural knocked out any sensation from my ribs down. I felt even less than I remembered feeling during Sweetie's birth. The catheter didn't tug or hurt like before. It was just...easy, quick, painless. There was immediate relief when they removed my 10 1/2 pound son and they couldn't stop talking about the large volume of fluid in there with him.

Post-Op:

He was born at 8:23 and, by 8:51, he was skin to skin with me being wheeled into post-op where we were encouraged (!) to immediately start breastfeeding.

He seemed a little jittery, so I was curious about his BG, but when they finally tested it, it was 50. Totally newborn normal. (Sweetie had been 54 at birth.)

We were held up in post-op for a couple of hours while they got a room ready.

Because of my recent MRSA infection, there were lots of "contact isolation" procedures they had to follow as far as our room was concerned. Throughout the week, every hospital employee who entered had to wear a plastic gown and rubber gloves. Infectious Diseases says I can be retested a year after my infection, and after three negative tests, I'll be scarlet letter free, so to speak. Until then, plaguesville, population me.

My Blood Sugar: By 9am, I was 196. 10am, 236. 11am, 224.

My Insulin: I took an injection of 5u Apidra (secretly) to correct the 235. But as I continued to hold there over the next hour, it was clear to me that I needed to trash the dumb bag of R and get my own Apidra going.

My Pump: At 11am, I filled a pod and kick-started my Omnipod PDM at my new basal rate. I also bolused another 2u of correction. By the time we got to our room around noon, I was 183. Better.

I could give you all a lot more details about my management through my stay (see log below), but the long and the short of it is that, once I brought the post-op high down, my blood sugars stayed between 68 and 173 the whole hospital stay. My goal was between 80 and 200, so I feel great about that.

The nurses ranged from curious to impressed to downright marveled in response to my continuous glucose monitor (Dexcom Seven+). My L&D nurse wanted it right by me throughout surgery rather than have my husband hang on to it, and my postpartum nurses would bring other nurses in to see it.

They were a little unsure what to make of my self-monitoring and pumping though. They all wanted to stay abreast of my most recent BG reading, but some nurses bugged me about how much I was bolusing and when. I felt less comfortable sharing that - probably because I regularly 'adjust' suggested dosages based on my CGM graph trends, how I feel at the moment, or whether or not I trust the aggressiveness of a particular correction factor. And I was also tweaking basal insulin rates as necessary each day on the advice of my endo (who stopped by my room daily).

The only nurse who drove me CRAZY was Nurse Chattypants. She was so insistent that I touch my incision scar that she grabbed my fingers and forcibly jammed them along my pubic line - um, thanks, but NOT cool. Anyway, she comes in for her first shift with me and rolls me on my side saying she needs to inspect my pump dressing (pod was on my lower back). I was like "what the HELL??!!" and then she kept asking if I needed her to tape it up for my shower. She's so lucky that I don't punch people in the face as a general rule. I told her that my diabetes care was my concern and that I trusted my nurses to be there to care for my postpartum needs. Didn't stop her though. I was in her care twice during my stay for 12 hrs each time. She. Never. Shut. Up.

When I called to place my first dinner order to the Dining Services desk and asked about meal delivery times so that I could time my insulin, the dining crew asked if my doctor meant to order me the "diabetic diet." I skipped the teaching opportunity, rolled my eyes and laughed. "No, I'm breastfeeding. Thanks. The regular menu order is correct." It was skimpy to begin with - can't imagine what their idea of "diabetic diet" was.

Everyone but me and my endocrinologist seemed concerned about whether my diabetes was "stable" after having the baby. Even despite blood sugar values that were almost non-diabetic. When I asked when the earliest I could be discharged was, even my OB said it depended on what Dr. M thought. When I told Dr. M that, she laughed. My numbers were boringly stable (um...no highs AND no lows - practically cured) and, as usual, there was nothing to indicate I couldn't roll with it if they weren't. I had less swelling in my feet than anyone else on my recovery floor. I was lucid, responsive, wearing regular clothes. I was walking the halls and to the nurses' desk, even when my epidural had fallen out and I didn't realize it.

Come ON, freaking hospital people. Stop micromanaging shit you have no more than a cursory textbook understanding of and watch a HOSS living it.

We eat like you, we usually test our blood sugars WAY more often than you think we should, and I resent your help. It's much more complicated than "Oh, you're on insulin? What's your dose?" Asked of me twice. Ummm...how much time have you got? I'll explain my four basal rates, my four variable insulin:carb ratios, my three target glucose levels by time of day, and the four different correction sensitivity factors. Then we'll take my average total daily dosage and discuss the average bolus/basal breakdown by percentage, factoring in the difference between correction bolus and meal bolus. After that, we will talk about how my faster acting analog that none of you have ever heard of peaks differently than the insulin you're used to dosing here and at no point will I allow you to even touch my pump. Got it? Now ask me again how much insulin I take as though it's a pill I swallow before meals.

Anyway, the staff at Dallas Presby really did take excellent care of me. The surgery was quick and painless, the recovery is going well, and I'm home with my 1-week-old and Hubster and Sweetie where I belong.

My Current Blood Sugar: 73 and steady for the last hour with an anticipated low in another 1-2hrs due to recent breastfeeding session. Snack is imminent.

My Pump: pluggin' away

My Insulin: currently running a basal of .90u per hour, which I lowered 10% from where it was two days ago due to going through half a bottle of glucose tablets in a day

My Blood Pressure: eh, feels okay to me

This Time

I'm curious as to how my expectations will match my experience this time.

The last time that I had a baby, I stayed up too late on Sunday night washing pots and pans because I wanted to come home to a clean kitchen. I ended up throwing my back out doing it, too, and that made for an even more uncomfortable week in the hospital.

Tonight? I'm going to try to get some sleep. I know I'll stay up late going over details in my head - mostly worrying about Sweetie. Making sure she has sippy cups in the fridge and a lunch packed. Being anal about laying out her clothes so that Daddy doesn't bring her up for her first sibling photo op in her Christmas pajama pants.

Last time, I went into my c-section worried about what Sweetie's blood sugar would be at birth and how big she'd be. This time, I'll still worry about those things, but I know that (a) Sweetie was normal size with normal blood sugar and all the worry was unfounded and (b) I have to let go of guilt if his stats highlight a different set of circumstances. I know he is going to be bigger than she was. By a pound or more. I'm prepared for that. I also know I achieved some beautiful numbers. And that, even if he has a low blood sugar at birth, we will rectify it quickly because I'm a badass at breastfeeding after 18mos of rocking it with Sweetie. (Confidence. Yeah. Right on.)

Last time, I made a couple of innocent Diabetes mistakes. I wore my continuous monitor sensor on my left arm and my insulin pod on my right, thinking I wanted them out of the way of the surgeons, but I had forgotten they'd need to use an arm for my blood pressure. The blood pressure cuff squeezed the living hell out of my pod and I was preoccupied with that discomfort (and that of the Foley catheter - aye carumba) throughout the whole surgery. The cutting didn't bug me. (Epidural = good stuff.)

This time, I'm going in with the sensor on my lower back and an infusion set for my Cozmo pump on my tushie. As long as the device placements don't interfere with epidural placement (and don't cause me any more MRSA staph infections!), we should be good. I've got my Omnipod PDM preset for postpartum, so I can actually just remove my Cozmo if it will be in the way during surgery.

Last time, when I arrived at the hospital, my endocrinologist ordered 12-24 hours of pump suspension (meaning no insulin) and a dextrose drip (meaning lots of sugar). I didn't need food until 9 hours after surgery, but the dextrose had me skyrocketing two hours after the initial suspension began, so I secretly kicked my basal insulin back on post-op. It pissed off my L&D nurse because she didn't want me disobeying the orders she got from my endo, but I knew I needed insulin.

This time, I've requested an insulin drip during surgery and we will see what I decide to do with my pump based on my post-op readings. I've thought about using Cozmo's disconnect feature and secretly slipping myself the anticipated missed basal insulin before I disconnect. (hee hee) But that makes Hubster nervous about lows, so I won't. I've got my Omnipod PDM set up with all of my initial postpartum factors, basals, and targets (thanks to the Evil Genius). All I will have to do is slap a fresh insulin pod on and go. We'll just have to see what happens. I'm not one of those freak women (i.e. most of them) whose pancreases suddenly remember how to produce insulin for a day or two after delivery (because the immune system suppresses the autoimmune attack on beta cells and can allow them to produce insulin briefly). I KNOW that I'll need to reconnect my pump and that it will take tweaking with my doses and that that may mean I will have a lot of lows at first. That's okay. I welcome the challenge. I have a great team on board for that.

Last time, there was a lot I didn't know about my rights and restrictions in a hospital. I didn't know how to demand lactation help (and didn't get it until she was 4 days old and getting sick). I didn't know that I could ask for breakthrough pain meds besides the epidural. I didn't know I wouldn't be able to get real people clothes on over all of the IV tubing and should just plan to stay in the hospital gown.

Last time, I didn't bring small enough clothing for the newborn photos (may not be an issue this time with a chubster). I didn't plan what we would eat for lunches at home the first week and didn't have enough meals prepped in the freezer.

This time, I am armed. Multiple outfit options for Baby. Multiple people I can call if I'm denied consultation with a lactation specialist (thank you, La Leche League and badass breastfeeding friends). A medicine cabinet at home already stocked with Motrin and awaiting a fresh Rx for Darvocet. This time, I've got my mommy friends signing up to bring us meals. (Oh, sooooo thankful! You girls will be the greatest help to us and I can't wait to sample your cooking.)

Life is learn-as-you-go though. There will be things that happen this week - new people I encounter and unforeseen obstacles this time, too. It's the same hospital, but it's different doctors, nurses, circumstances. This time, I'll be in a rush to get home to my daughter. I'll be shooing Hubster to go home with her rather than stay even though I'll be desperate for help overnight at the hospital. I'll be worried about both the kids and what they each need.

Last time, I was confident. Excited. Felt I had it together. This time, I'm confident and focused...but impatient. I want this part to be over with. I want the pain of these last couple weeks to let up. (My abdomen is measuring over 50" around and I'm distended from the extra fluid and enormously plump resident.) I want to get started with the next chapter.

And this is the inevitable passageway I have to cross through.

We are excited to meet the little guy. But I know we are far more excited to nestle into our new routine at home.

I expect he will be bigger than a Cabbage Patch Kid...

Two

My beautiful Little Sweetie. This week, you turned TWO.

You're such a funny monkey. You climb everything, you're utterly fearless, and you're rarely sitting still. Watching you in a group of kids is a lot like watching a short tornado. A giggling one.

You're chatty. You've got more than 150 words to your credit and are adding them at the rate of 2 per day. Including the entire alphabet (though you often skip E and you pronounce Fa, Mimma, Nimma, See, and voW with your own creative stylings). You can count from 1-10 forwards and backwards (often ending with blast off - "Toff!").

And as of the last week or so, you're finally making simple 2 word sentences. "Bye bye wawee!"

You still love the wawee...I mean, water. Showers, baths, pools, spray grounds, water tables...you love to be surprised and splashed. And your laugh is probably my favorite sound in the whole world.

Your favorite toys all come in 2's - the Mickey & Minnie we bought you on our Disney Cruise (see below), the Hello Kitty and Choco Cat we got at Build-a-Bear (see above), the small hand sized green basketball and white baseball you got at your visit with Santa. And you make them go on all kinds of adventures. Although Mommy and Daddy are adamant that none of those friends join you in the tub.

When you give hugs, you say "Awwww" every time (because that's what we say.) And if someone leaves the pantry or fridge open even a crack, you pull out potato chips or hot dogs and declare it time to "Nack." I'm convinced that there's never been a toddler who can eat like you. You love chicken, grapes, sausage, PB&J, bratwurst, pretzels, broccoli, grilled cheese, and strawberry milk.

You're taller than most of the kids your age. Don't know where that comes from. You're just under 35 lbs and nearly 3 feet tall. Already wearing 3T clothes. Your favorite shirt has a monkey on it. "Mummies - Eeee Eeee Aaah Aaah."

You are obsessed with colors lately. All of them. So I don't know exactly what your favorite is right now. You love to recite them and tell us what colors you see. "Wyeet Pat Shed Gee Boo Yeddo Poople Peek Oge Brow..."

Your favorite book right now is "Brown Bear, Brown Bear, What Do You See?" or "Baabee baabee see." You know it by heart and when we get to the page with the teacher with the brown hair and glasses, you always call her Mama. And I'm secretly amused by that.

Your next year is going to bring some HUGE changes. We're going to start working on ditching the "pahshy" and using the "pobby." And the biggest change is that your status as center of the universe is about to shift ever so slightly. It's a good thing we've been working so hard on "share-bing."

Your brother will be here next week.

Betcha didn't see that coming.

We have tried to talk to you about babies. You know that they are little. That they cry. That they go "night night." That we expect you to be soft. What you don't yet know is that it's about to go from vague concept to everyday reality.

I think you'll adjust and ultimately enjoy big sisterhood. He's going to need someone to teach him how to climb over the furniture and throw balls and pull the cat's tail.

Ahem.

Anyway, your daddy and I are amazed by you. Amused by you. And you have us wrapped around your long and lovely little fingers.

You are my everyday sidekick, my nap buddy, my constant companion every minute of every day. You share my pillow, my iced tea, my nose. Your fingers are so often twirled in my hair.

I will always love you and be excited for the ways in which you're growing up and discovering the world.

You are our monkey. Our princess. Our two year old.

Two.

My D-Brother

Any time we PWD get the chance to make in-real-life connections with those we know and love from online, there is cause for celebration.

So I was giddy when I found out that my friend Bradford was coming to Dallas for the White Rock Marathon weekend events on behalf of Team Type 1.

Bradford is like my online brother. We're both admins on TuDiabetes. We use the same insulin, the same pump, and we used the same CGMS until we both switched to a different CGMS. We even both got the new iPhone together (sadly, insurance doesn't consider that durable medical equipment). When one of us comments in a discussion thread on TuDiabetes, the other usually comes in with a vote of support to back up whatever suggestion or theory the first has made.

The similarities pretty much stop there though.

I'm in awe of the way he manages his health so that he can participate in the athletic events he does. The man just ran a 5K this weekend in under 20 minutes.

To put that in perspective, at the rate I'm waddling lately, it takes me 20 minutes to walk up and down my street.

I have always had trouble motivating myself to be more active. I've used diabetes (low blood sugars, in particular) as an excuse as to why I am not more athletic. But when I hear Bradford talking about half Ironmans and bicycling, I realize that I let my fears about blood sugar management get in the way of having a healthier active lifestyle for far too long and that plenty of people are out there doing impressive physical feats. It can be done. And I should figure out what works for me. That's part of Team Type 1's message.

I stumbled all over myself, like a hyper teenaged sister, to actually get to sit down to dinner and chat it up with Bradford and his teammate, but I'm so glad to have made the connection. To have one more online relationship with more than just a profile image and hundreds of typed words to its credit.

So thanks for meeting up with my family and me, Bradford. We loved getting to meet you. And, though I'm sure it was never your intention, we were all inspired by you and your teammate to try to be more active.

Especially the 22-month-old. I mean, she has been running around the house full speed ever since. I'm just sure it's your fault.

Sober

There's a sobering Part Two to my greeting card post from last week. Jess's post yesterday drove it home for me. She was talking about recently having a really positive A1c result and how it was juxtaposed in the same week against Kerri's crushing negative results.

I was going to leave a comment on your blog, Jess, because I thought the post was amazing, but I think I have a lot more to say. It really got me thinking about something I have kept to myself for a long time.

To treat your A1c or your blood sugar as data to be acted on - rather than a mark of failure or a judgment of your efforts or your worth - is only half the battle.

We have to learn to give the "good" numbers less power, too.

That means no congratulatory end zone dance when yout A1c result is in range. It means treating a 100 like it's just data, too. Because to really believe the highs are just numbers to act on, don't we need to treat in-range values in much the same way?

I've been doing that for the last year or so, I think. Or I've tried. I still join in congratulating others for a "good" A1c, and I post my own on Twitter, but it's not for the back pats and the high fives. It's just part of owning up to the fact that I know where it is. (Or sometimes it's to get people off my back.)

Because the second that I throw a party for my 6.0%, the bigger the pity party when it slips back over 7.0%.

We don't need that guilt. Pressure. Depression.

So it's 6.0%. Okay. That means my average is where it's supposed to be for pregnancy.

But it's not a blank check to slack off. It's not an indicator of how hard I'm trying - because you and I both know that sometimes we work our asses off and it comes back higher than we believe it should.

And it doesn't even mean I'm nailing it. My standard deviation is too high and I've got swings from 40-240 mg/dL to average out to that lovely 130 mg/dL.

I try not to treat my 6.0% as anything other than data. So when I inevitably cross back into the "life is hard and I'm trying but it came back over 7.0%," maybe I'll beat myself up less.

I often remind PWD (and parents of CWD) that I didn't see my first A1c under 8% until I was 26 years old. I remember getting that 7.3% in the mail from my doctor. I hung it on our refrigerator. I called people who didn't have a clue what I was talking about and I cried. Tears of joy and relief.

I had had diabetes over 16 years by the time I saw that 7.3%. I'd spent my teen years over 10.0% (usually over 12%), topping out once at 15.4% at the age of 13. (That means my average blood sugar had been around 500 mg/dL.) It took me two more years to cross into the 6's. Two. More. Years.

That's when we started trying to conceive Sweetie.

And I've stayed there, at or below 7.0%, for the last four years now. But my circumstances are not any of yours, DOC friends. I've been trying to conceive, pregnant, nursing, and pregnant again for the last four years. I've kept my A1c so "good" during that time because I've had to. It's required a degree of intense monitoring and a singular focus on a very important goal.

But I'm no fool.

I know it will someday climb up into uncomfortable areas again, despite my efforts. Because this f-ing disease is like that.

So let's look at that 93 or that 104 on the meter screen, take our appropriate action, and zip up the case.

If the 215s and 347s are just pieces of information, then that 104 isn't worth any confetti.

Zip up the case and walk away.

Horn Tooting

Today’s Prompt: Play that horn. Want to hear a secret? You’re awesome. (It’s actually not even really a secret.) This is going to be hard for you, O Modest One, but you gotta give yourself props today. Write three things you love about yourself – things you’re great at – or just want to share. Don’t you dare signpost or undercut those self-compliments!

Actually, between November's prompts and last April's prompts, I'm growing weary of describing my awesomeness. I have a healthy enough self-esteem without all of this back-patting and high-fiving. But since I'm also committed to completing this challenge...

1. I can communicate.

I'm articulate, expressive, and a tad verbose. Tome is a word used more than once to describe my emails to colleagues. I prefer thorough.

I'm awkwardly capable of understanding/speaking/reading in multiple languages without really being able to say I'm fluent in any of them but English. It makes for cute and clumsy dialogue between me and the international party. Like the poor employee in the produce section to whom it was imperative on Sunday that I explain that the parsley had been marked as cilantro. (I learned I don't know the word for parsley in any other language and that I couldn't remember the word for 'to taste' in Spanish - which totally ruined the flow of the story I was trying to tell him about tasting what I thought was cilantro and discovering it was parsley before not deciding not to add it to my soup.)

2. I am funny.

See above story about making small talk with the produce employee.
Or yesterday's blog post.
Also, meet my daughter. The apple doesn't fall far from the tree.

3. I am compassionate.

I often think of myself as possibly too selfish. I worry, after a conversation - did I refer to myself or my own experience too much? Did I make the other person feel heard? Valued?

But the fact that I worry so much, I think, indicates that I really care about that person. As a teenager, I hated when adults would make me feel like they thought my problems were petty or mundane. I hated feeling dismissed. As a high school music teacher for the last decade, I've tried to offer kids both the perspective I feel those adults meant to give me AND the feeling like their experience or their perspective is valid. Yes, it's true that, ten years from now, they probably won't remember the spat they had with their substitute teacher or the thing that guy said in the hallway that made them cry...but what matters is that it weighs heavily on their minds today. They need someone to listen, evaluate, offer advice, make them laugh about it. And the advice should never be that none of it matters.

With my health community - online and off - I want people to know that I am involved because I care. I want to see that guy less stressed. I want that girl to have a healthy pregnancy. I want that mom to find a solution for her son. I want everyone to sleep more peacefully, get along with their health care practitioners better, and feel more empowered about their own health.

And that's a large part of why this monthly challenge brought me back to the keyboard day after day, night after night. I feel for you. I know what it feels like to deal with the kinds of issues you deal with. And I want to share my thoughts with you. Maybe none of it matters once you've finally started that insulin pump or birthed that baby or gotten that clean bill of health about your vision...but you'll remember that I talked to you, that I made you laugh, that I cared enough to offer my experience and perspective.

And if that made something weigh less heavily on your mind today, then I know I did my job.

This post was written as part of NHBPM - 30 health posts in 30 days: http://bit.ly/vU0g9J.

Sorry about your crappy doctor visit...

Today’s Prompt: Greeting card post! The greeting card industry is all about writing generally universal feelings in a presentable way that you can use to express yourself when you just can’t think of the words to say. Write a greeting card for someone in your community to help them express themselves about a new diagnosis, treatment, or experience.

You just found out your A1c.

It's higher than you'd thought.
You cried alone where no one could see.
Your self-esteem is shot.

You felt like you'd been doing better.
It isn't fucking fair.
Compliant to the letter...
Now too ashamed to share.

But get your attitude adjusted
and ease up just a touch.
Your pancreas is busted
and you can only do so much.

If that number's all you consider
to measure your success,
you'll soon grow tired and bitter
of the anger, pain, and stress.

It's a measure, and it's minor.
It's not your overall control.
It's just some data to help refine your
many health-related goals.

You're here to fight another day,
each meal, each test - a chance
to see things in a brighter way
and dance this awkward dance

of matching carbs to every dose
and checking before and after.
Each test a chance to make the most
of happy ever after.

Dust yourself off and admit it sucks.
You went, you checked, you know.
And reach your hand out to those poor schmucks
who were too afraid to go.


This post was written as part of NHBPM - 30 health posts in 30 days: http://bit.ly/vU0g9J.