Continuous adjustments

Between trying to manage my health for the sake of our growing baby and a busy social calender, I've been working hard to complete as many work-related projects as possible. This has made time for blogging and blog-reading limited, but today I found a new post from one of my fellow pregnant D-bloggers in my mail. It reminded me not only to post a bit myself again, but also how different each and every PWD is in terms of treatment goals and wishes.

Jacquie's post was about how, in the process of pregnancy, she has changed her view on desirable BG and HbA1C values originally sown by a statement of her endo in the early days of her diagnosis. Pregnancy has made Jacquie wish for even a temporary membership of the "5-point-something" HbA1C-club. In the context of pregnancy I fully understand that wish. However, I must say that being a member of that club, which I've been for the better part of the past 15 years isn't always a pleasure.

The perfectionist in me has always strove for close-to-normal values, especially as technology improved and I started testing more frequently to get better HbA1C-results. The first 4 years of my diabetic life I had one of the brick-size meters taking 120 sec. to come up with a result, but in 1994, as I won a trip to the final matches of the World Cup in football (or soccer as you American prefer to call it :-)) in the US, my parents and I decided that it was about time to look for a smaller and faster meter. This became the start of me testing more frequently, and even without much attention to it, I soon found myself with HbA1C-values in the 5-6-point-something range. From then on, my competitive mind wanted to stay there.

I've managed to stay in that HbA1C range, which also made for a carte blanche to get pregnant whenever I felt like it. However, the low HbA1C levels at times also represented numerous hypos, some even requiring assistance from friends, family, colleagues or even paramedics. For many years, I've actually worked hard with my CDE to slightly increase my HbA1C, but I haven't been too successful at it. Also, 5 years ago, an additional autoimmune diagnosis entered my records, namely that of hypothyreoidism. It had probably been going on for a while before I finally got into treatment, as during the process of drug dose titration, I experienced a lot of the issues regarding BG regulation that I'd been experiencing on and off for years before. This, along with study and career choices, made me postpone any attempts to start a family, despite Jimmi desperately wishing to.

When I got pregnant, my HbA1C was at 5.4 and steady for the first three months. Then it dropped to 5.0, and because I knew how many hypos had brought about that number, I certainly didn't feel satisfied, but rather a bit defeated by diabetes and how pregnancy continuously changes all the rules of play in the day-to-day diabetes management game. Last week, my HbA1C came back at 5.1, and this time I feel slightly better about it as the number and intensity of the hypos have decreased over the past months. Yet, I still have work to do to try to slightly increase my overall levels in order to make the hypos less frequent. My insulin needs has gone up - currently about 50% - but I'm still very sensitive to physical activity as well as lack thereof, so it's a delicate balance to dose correctly at all times. It seems like every time we evaluate my sensor downloads some rates and ratios are adjusted upwards while others are adjusted downwards - there's apparently no common sense for the direction of adjustments yet.

Last week, we had another chance to spy on our baby. The ultrasound tech was then convinced that we are to expect a baby girl, and she's fortunately growing just fine with tummy and femur measures perfectly matching the center of the standard curve. Her head measured a bit smaller, so overall she was estimated to be in the low normal weight range, but following the growth curve perfectly well :-)

Junior at week 28 + 2 :-)

I hope that she'll continue like this, and that I - hypos aside - will continue to feel as well as I do now. Then we'll see if I'll let the doctors go ahead with their principled requirement for induction of labor in just 8½ weeks from now :-)