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Instability - Karen's Musings
Random Rambling
estherchaya
estherchaya
Instability
So, you know, I was getting really bored with my pregnancy.  I mean, hyperemesis is so last year.  And preterm labor?  Come on!  I've been there done that - it's not exciting anymore.  So I thought I'd mix things up a bit and try for gestational diabetes.   I mean, sure, not eating for five months would seem to free me from that specific concern, but that only makes it MORE interesting, right?

Yeah...  When I was in the hospital last weekend, the OB I saw said, "I don't understand why you're having problems with your blood sugar when you don't eat." (I'm taking that a bit out of context, for what it's worth - he did go on to give me very important information, but that comment happened to be the only relevant piece for this post).  On Monday, I saw a different doctor in the practice and I told him about that comment and he looked at me and said, without missing a beat, "It's because you're diabetic.  Very.  Very diabetic."  Well, duh, I guess.  He's right, of course, but it was interesting to see the difference in approach (both were fine with me, for what it's worth).  The doctor on Monday said the bottom line is that it doesn't matter why this is going on.  Sure, it's an intellectual curiosity, but when it comes down to it, the important thing is that hyperglycemia isn't good for mom or baby, so we have to fix it.  If we figure out the "why" along the road, it's a bonus.  

Glyburide didn't help enough (at all?), probably in large part because I couldn't consistently keep it down.  So I started insulin on Tuesday.  And my BG just keeps going up and up and up.  I talked with the doctor on the phone today because my blood sugar is still all over the place (223 at 5am yesterday!!  223!!).  My perinatologist had suggested moving the insulin to twice per day and I'd left that message with the OB on Wednesday, but didn't hear back.  I checked in today about the high levels and he said to move my dose up by 60%, but not to move to twice a day yet, because he wants to get my early-in-the-day sugars under control first, because if he tries to treat the later-in-the-day levels before he gets the morning ones under control, he could risk over-medicating me and having my blood sugar crash.  He acknowledged that when I go in on Monday with the results from the weekend, we'll probably be considering adding in a morning insulin dose also, so it's not that he's not being aggressive, just that there's logic to his approach.

I noted that the levels just keep going up and he reminded me that as the pregnancy progresses, it's only going to go up and since I can't just shift my (nonexistent) diet, the insulin is going to have to be tweaked regularly as well.  I also just went up on my terbutaline dose, which can also affect blood sugar, so it's something we have to work around and be cognizant of.  Seriously, leave it to me to have hyperemesis and crazy blood sugar at the same time.  Yee-haw!

I will note that it was particularly hilarious to have to go have a nurse show me how to draw up and administer the insulin (a subcutaneous injection). I've probably done a thousand subcutaneous injections on myself. But it was still good to walk through it with the nurse so she could explain what things to be careful of and what symptoms to look for if my sugar crashed. We had to brainstorm a little bit about how to handle it if I do crash- her normal advice is to drink 1/4 cup of orange juice. But I can't do that. But we came up with other solutions, and I was given strict orders to call immediately if I couldn't get it back up.

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Comments
mrn613 From: mrn613 Date: March 12th, 2010 10:31 pm (UTC) (Link)
I'm a little worried about you, I don't think you should be alone until you're stabilized. is that ok to say?
estherchaya From: estherchaya Date: March 12th, 2010 10:42 pm (UTC) (Link)
I'd be more worried if my sugar was crashing - because that can come on without warning and leave me unable to make a phone call. Seth checks in on me throughout the day, particularly if my nanny's out with the triplets, so that's about as good as it gets. (Seth also only works 1.8 miles from home which makes it a lot easier to count on him than when he was working 35 miles away in Baltimore).

I just have this feeling I'm NOT going to stabilize until this baby gets his or her eviction notice. Nothing with this pregnancy has been straightforward.

Definitely appreciate your concern, and yes, it's okay to say.
cleobatya From: cleobatya Date: March 13th, 2010 06:58 pm (UTC) (Link)
I'm becoming very familiar with diabetes and what to do if blood sugar gets low etc., but with your pregnancy and inability to eat, and other complications, it seems even more confusing and difficult to predict/control.
estherchaya From: estherchaya Date: March 14th, 2010 02:01 am (UTC) (Link)
gestational diabetes is kind of a force of its own, anyway (and usually more like Type II diabetes - insulin resistance, than it is like Type I diabetes).

Fortunately, for the moment, I have to worry less about my blood sugar crashing than it skyrocketing. Skyrocketing is bad, but sugar crashes aren't real pleasant.

Hopefully this will all go away once the baby is born.
From: atimesif Date: March 14th, 2010 02:45 am (UTC) (Link)

google searches

I'm sure you've google'd it but here are some links I found that mention HG and hyperglycemia:

1) This link says that hyperglycemia is the most common metabolic complication of parenteral nutrition. Related to rate of dextrose infusion, concentration, level of stress, etc. May cause hypertriglyceridemia which may cause pancreatitis. Close monitoring is important during pregnancy, esp. if using glucocorticoid therapy.

http://www.hyperemesis.org/hyperemesis-gravidarum/treatments/nutritional-therapy/parenteral-intravenous.php

2) This link says that women with HG produce ketones in their urine, a sign that the body is using stored fat for energy instead of glucose. Could that explain the cause of hyperclycemia?

http://www.ehow.com/how_2071820_diagnose-hyperemesis.html

And a book that looks good:
http://www.amazon.com/Beyond-Morning-Sickness-Hyperemesis-Gravidarum/dp/1419640933/ref=cm_cr_pr_product_top

Hang in there!

estherchaya From: estherchaya Date: March 14th, 2010 03:08 am (UTC) (Link)

Re: google searches

I have consulted Dr. Google, yes. Neither of your links really applies, but are reasonable questions.

For #1 - I'm not getting parenteral nutrition. I have hyperemesis and a PICC line, but I'm only getting IV fluids (with 5% dextrose, but that's only 25 calories per hour, so that's not a reasonable explanation). If I were on TPN, I wouldn't have been surprised by hyperglycemia in the least bit. Two of my preterm labor medications can elevate blood sugar, but not to the degree that I'm experiencing.

2. Ketosis wouldn't explain hyperglycemia. Before I had the IV fluids, I was ketotic, yes - but I wasn't hyperglycemic as I had zero intake. The 5% dextrose in my IV fluids is pretty much there to keep me from going into ketosis again - not really for nutritional value. Ketosis isn't good for fetuses, apparently, so the goal is to keep me out of it. But ketosis doesn't cause hyperglycemia.

Thanks for the book suggestion - I hadn't seen that one.
hipstamom From: hipstamom Date: March 19th, 2010 12:15 am (UTC) (Link)
I don't get if you are having little intake that GD decides to crop up. I hope everything is going O.K.


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