Monday, February 20, 2012

So how did we do?

That's a great question.


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.


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 ( 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. 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


  1. And I thought my nurses were annoying when they saw my bottle synthroid by my bed. Can't imagine how much more annoying they most have been for you. *shudder*

  2. I can't remember any of the nurses at Medical City bugging me at all about my pump and CGM. I'm sure they did, but it must not have been nearly as aggressive as Nurse Chattypants. :-)

  3. Congratulations on your son! And thanks for the play by play - as a nerdy t1 & nurse i find it really interesting.

    Re: the regular in the IV drip. Yes, it sucks. But I'm pretty sure if the insulin is IV, it can only be regular for safety reasons. I don't think they ever give novolog or humalog IV. My guess is that it's cuz if they made an error they'd have like 1 second to correct it, but I could be wrong. It might also just be unsafe for veins? Dunno.

    And I feel you on non-diabetic non-endocrinologist ignorance about type 1 & insulin. It's frustrating. But then again, as a nurse I probably know about as much about the day to day of most medical conditions as your L&D nurses knew about type 1. Though I'd like to think I'd be more sensitive/adaptable to listen to patients and take their cues...

  4. Baylor had stupid vegetarian options, so i feel you on the skimpy meal issue. Glad to hear how well you all did!

  5. So your post title is "so how did we do?" - well that last picture is basically your answer, right?

    So happy to be able to see my birthday buddy this summer. Can't wait for my chance to hold him! ;)

  6. Ahhh....what a chunk of love!!!!! OMGOSH he's adorable :) Hope the big sister is loving her new role as "Lil' Mama" and you guys are in breastfeeding bliss.

    I used to be a L&D nurse, but never had a T1 patient. I was also a doula for a few years, but no T1 mamas for me there either.

    Beautiful family...beautiful life!