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.