The tricky part with this round of GDM has been my fasting glucose (the sugar you check first thing in the morning before you eat anything). I tried all the tricks that I used last time plus several other things in order to lower it overnight, and none of it worked. In December, I started oral medication (including many experiments with dosage changes) + careful dietary choices, which worked until I hit third trimester (when the placenta begins producing the complicating hormones in earnest). At that point, there was nothing between diet and oral medication that would keep my fasting glucose within the desired range. So, I was classified as having GDM with IFG (impaired fasting glucose). This led to starting insulin.
You should know that I had been dreading starting insulin for a couple months before it actually happened. Insulin is administered via injection, so I was reluctant to be put on daily injections. I mean, no one looks forward to that, right? In addition to all the finger pricks, to boot. To say that I was determined to try everything I could before starting insulin would be an understatement. Starting insulin also puts pregnant gals into a higher risk category, which I also wanted to avoid. Every time I went for an appointment, I held my breath until they put it off once again.
Eventually, though, they just kinda ran out of other options and had to pull the insulin trigger. Funnily enough, I had been dreading it/thinking about it for so long that, apparently, I'd made my peace with it. I started wrapping my mind around what my new nightly routine would look like.
Does anyone reading this remember way back when I was expecting Claire and had to have the initial tests run for preeclampsia? I ended up with this story where I had the weirdest conversation with a health care professional about what supplies I would need to a 24-hour urine collection. And where I wasn't given a hat for said urine collection.
I had another weird "how do you expect me to know what I'm doing" experience with insulin.
First note: I was given zero instruction by the office staff on how to administer these injections. I assumed a nurse would come in after the doctor to explain the process or that the pharmacist would explain at pickup.
Second note: I was told nothing about what supplies I would be receiving at the pharmacy. Once again, I assumed the pharmacist would know all the things and would provide me with that information.
Third note: Should you find yourself given an insulin prescription, do yourself a favor and learn from my assumptions. ASK BEFORE LEAVING THE DOCTOR'S OFFICE.
Otherwise, you might end up with a sack full of 100 empty syringes and nothing else.
No instructions from the pharmacist, no INSULIN to put in said syringes, and no idea of what you don't know.
Brad stopped by to pick up my prescription and was hurried along with no information from the pharmacy. When he got home and I opened the gigantic sack, expecting pre-filled syringes (which is what my doctor said she was going to try to get for me) and a detailed sheet of instructions on how to administer my injections, I was a little confused that all I found was 100 empty syringes.
I called the pharmacy:
"I was just prescribed insulin injections today and don't exactly know what all that entails...but there was no insulin in my bag, and I'm pretty sure I need that."
Pharmacy: "Uh, what kind of insulin do you use?"
Me:"Well, I was just prescribed insulin today, so I know almost nothing. Is that information not included in the orders from my doctor?"
Pharmacy: (deep sigh) "Let me check...oh...yeah, we don't have that in. Do you need it today? Are you out of insulin?"
Me: "Ok, I was just prescribed insulin today, so I currently don't have ANY, and I'm sure they want me to start today."
Pharmacy: (impatient sigh) "Well, we won't have it until tomorrow. Can you pick it up from a different pharmacy? It looks like they have some at [a different nearby CVS]."
Me: "Yes, I can get it from there."
Pharmacy: "Ok, they should have it for you in an hour or so."
Wow. Really?
I got a text from the other CVS not long after, indicating that my order was ready. Brad went to pick it up, and I called my brilliant and informed father who is an ACTUALLY HELPFUL HEALTH CARE PROFESSIONAL (if you happen to be reading this and don't know my dad, he's an incredible pediatrician, a fact I for sure took for granted until I was in my 20's) to ask the questions I should have asked earlier.
I started with just asking..."um, so how do I give these shots?"
Dad: "Did the nurse not give you instructions?"
Me: "No..."
Dad: "Or the pharmacist?"
Me: "No...the pharmacy actually only gave me 100 empty syringes." (filled him in on the above story)
Dad: "Ok, well, the basic process is to start by wiping off the insulin bottle with one of the alcohol pads."
Me: "Alcohol pads?"
Dad: "They didn't give you those?"
Me: "No, just the syringes."
Dad: "Make sure they give you alcohol wipes when you pick up your insulin. Use those to wipe the bottle before you fill the syringe. Before you puncture the bottle with the needle, pull the plunger down to your prescribed unit so you can push that air into the bottle, otherwise, there's a vacuum when you try to fill the syringe. Pinch a fatty area of your thigh or back of your arm. Then, use alcohol to wipe your skin. When that's dry, just breathe out and give yourself the shot."
Me: "And what do I do with the used syringe?"
Dad: "Put it in the Sharps Container."
Me: "100 EMPTY SYRINGES, Dad. I know nothing about this container of which you speak."
Dad: "They just failed all the way around, didn't they? Make sure they give you a Sharps Container."
Brad walked back in near the end of my conversation with Daddy and said, "Well that first CVS failed all the way around. This pharmacy gave me these alcohol pads, insulin, and this container for you to collect your used syringes in. The pharmacist also told me about how you need to fill the syringe with air before you puncture the insulin bottle..."
Guys. What in the world?? How do these things happen?
Despite all these little setbacks, I successfully started giving myself insulin injections and have been for almost a month. I'm a survivor of incompetently-handled situations.
I've had to have my dosage increased several times to find the right amount, but it seems that, with 2 weeks to go, we've landed on the right combo of dieting and medication.
In addition to the insulin update, my number of visits to the doctor increased A LOT around 33 weeks. Because of my new, higher risk classification, I earned Frequent Visitor Status with twice weekly appointments until the end of the pregnancy. I go either Monday/Thursday or Tuesday/Friday, and each time, I have a non-stress test (NST), an amniotic fluid index (AFI), and a check-in with an OB to evaluate my glucose readings and medication dosages (I'm still on an oral medication in the mornings, as well as insulin before bed). I spend a big chunk of time there these days.
For anyone who may not know, an NST means I recline in a chair with monitors wrapped around my stomach, and I click a sensor every time I feel the baby move. NST's are supposed to last 20 minutes, but I regularly get left in there for 30-40 minutes, depending on when a doctor or midwife can come read my measurements. Before my first NST, I thought, wow, I can get reading done while I just sit and chill. Then I learned that I have to track her movement. Can't really read and track at the same time. So, I listen to podcasts instead (which works out, given that my reading motion sickness is back in full force).
An AFI is a quick ultrasound to check and make sure the baby's fluid levels haven't gotten too low. Apparently, that can happen really quickly with GDM babies and can be really dangerous if it does. I'm becoming good friends with the Ultrasound Tech. She's lovely.
So that's my Diabetes Update this week. Kind of a long one, but a lot has transpired, it seems.
I'm less than 2 weeks out from my scheduled c-section, so there's not too much longer of insulin and Metformin and NST's and AFI's...
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