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Bionic Woman - Karen's Musings
Random Rambling
Bionic Woman
So, I'm not quite the six million dollar man.  And I can't say I have much in common with Lindsay Wagner (of the original "Bionic Woman"), but I'm beginning to feel like I ought to have a fancy name like that anyway.  I currently have a PICC line, two infusion pumps (one that runs through the PICC line and one that is run subcutaneously), IV Fluids and medications, and a home uterine contraction monitoring system that I have to strap myself to a minimum of two hours a day (it's usually 4-5 hours per day).  Going to the bathroom is... an ordeal, to say the least.  It's so easy to get tangled up in tubing and wires, and it's frankly too complicated sometimes to figure out what has me attached to what.

So imagine my amusement today when I went to the OB's office and got threatened with an insulin pump.  Because I didn't have enough infusion pumps.  Oh well,  at least insulin pumps are small.

Here's the thing, though:  how exactly does a woman who doesn't eat end up with gestational diabetes?  HOW?  My blood sugar levels have been ridiculously high.  The first few days that I was checking my blood sugar 4x a day, they were a little high sometimes, but on average were basically okay, if borderline high.  But after the first few days, my levels kept creeping higher.  And higher.  And higher.  Yesterday I was at 181 at noon.  I'd had IV fluids running all day, yes, but that's (at most) about 25 calories per hour.  That's not enough to blow my sugar that high.  Terbutaline can raise blood sugar, but how much?  Steroids can raise blood sugar - but I haven't had steroids in nearly a month, so that's not what's effecting it either.

Ultimately, it doesn't matter WHY or HOW my blood sugar is elevated.  What matters is that hyperglycemia isn't good for moms and growing babies.  So whatever the cause, it has to get under control.

So my doctor has prescribed Glyburide, with the curious instruction to take one tablet every morning before breakfast.  Um, before WHAT?  Yeah.  I told him I wasn't sure I'd be able to keep it down regularly enough to matter (though now that I have them at home, I can see it's a TEENY TINY pill, so at least it has that going for it).  So if I can't keep the glyburide down (or it doesn't work), I get to get an insulin pump.  He also ordered labs to check my hemoglobin A1C level.

Of course, the OBs office does not coordinate an insulin pump - they'll send me to an endocrinologist to handle that.  Because I don't have enough doctors and specialists in my life.   Oh, and I get to start having weekly appointments with the OB (in addition to my appointments with the perinatologist).  Because I don't have enough appointments in my life.

Someday I'm going to write my memoir and no one will buy it because they'll say "this chick made up every word of this!  It's too preposterous to be fact!"

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15 comments or Leave a comment
yeishlitikvah From: yeishlitikvah Date: March 2nd, 2010 04:07 am (UTC) (Link)
Super Mommy? or does the title need to be cooler.

Stupid question.... why are they giving you oral medication, why don't they have you administer insulin, either from an insulin pen or a syringe.

Also why do you have to go to an endocronolgist, can't the perinatologist handle that and your overall dosage?

I know with my gd, my ob made it clear any and all questions regarding the medications were to be directed to the perinatologist.
estherchaya From: estherchaya Date: March 2nd, 2010 04:30 am (UTC) (Link)
oral medication is the least invasive option. If I *can* keep it down and it works, that's the best possible solution. This is a first step that many OBs turn to. If this doesn't work, they'll move to an insulin pump. Injecting individual doses of insulin is less effective in general, but also in my case it would be hard to know when I should use the insulin - I can't time it around meals, because I don't eat meals. An infusion pump has the advantage of giving very small amounts constantly over time, which leads to more consistent levels, vs. the injectable insulin where you'll get peaks and valleys in the levels.

A lot of OBs refer this stuff out to an endocrinologist. Can the perinatologist handle it? Maybe. But this is the stuff that endocrinologists do every day, so they're not a bad option either. Frankly, I'm not going to address the issue of which specialist should handle it until (or unless) it comes down to needing the pump. If the glyburide works, it's a moot point. It's just a question of whether I can keep the glyburide down.

Every practice works differently, it doesn't make one right and the other wrong. They are both valid approaches.
yeishlitikvah From: yeishlitikvah Date: March 2nd, 2010 02:01 pm (UTC) (Link)
I just meant that as you had said, you need to see ANOTHER DOCTOR.

iyh the glyburide works, and you can keep it down.

I think I know you're NOT EATING, but at times forget that doesn't mean you're nibbling and noshing, but rather YOU'RE NOT KEEPING ANYTHING DOWN!!
estherchaya From: estherchaya Date: March 2nd, 2010 02:13 pm (UTC) (Link)
I don't plan to jump straight to an endocrinologist if it comes to that - I'll first as my perinatologist if he can handle it. But if he'd rather jump out of it since this is such an unusual case, I'll go to the endocrinologist. Hey, at least doctor's appointments get me out of the house... :)

so far haven't kept the glyburide down, but I've only tried once.

I do occasionally nosh or nibble when I'm hungry. Usually on something bland (but unfortunately, that often means carbolicious, like toast or rice). But I nearly never keep it down. Even if I did keep it down, the number of calories I'd be consuming is still probably less than 600-800 per day (including the IV Fluids which make up as much as 600 calories per day if I get 3 Liters in per day). The reality is that I don't keep much of anything down, so it's probably closer to 600 on a good day. Not enough to warrant changing my "diet".
yeishlitikvah From: yeishlitikvah Date: March 2nd, 2010 02:31 pm (UTC) (Link)
I think last nite in my exhausted stupor I read it as you were being referred to an endocrinologist asap.

I hear you all about getting out of the house. The highlights of my day were going to a doctor's appointment and then doing a small food shopping. ie I would take a cart and once the top basket was full I was done shopping. Basically my rule of thumb was three bags. Then again my doctor's wanted me 'active' grr

I can't fathom that low intake of calories, do you feel light headed or unsteady? How often are you actually hungry?

I bitched and moaned about 1,800 calories, but that was while being able to keep food down.
estherchaya From: estherchaya Date: March 2nd, 2010 02:51 pm (UTC) (Link)
they'll refer to an endocrinologist if the glyburide doesn't work.

I do get hungry occasionally, but I'm so nauseated most of the time, that hunger takes a back seat to the nausea. I am often light-headed, but my body has pretty well adjusted to the lower calorie intake.

With the triplets, I was put on a 2200 calorie diet when I blew my 1 hour test. I kept trying to explain that I would never be able to get that many calories in me - I would have been lucky to get half that. The answer I got was "once you start measuring your portions, you will find that you've been eating a lot more than you thought you had been." Nothing ticked me off more than that patronizing attitude!

My doctors do *not* want me active. The more active I am, the more contractions I get, and the more I throw up. So changing diet and exercise won't cut it, as it does with many women with GD.
From: atimesif Date: March 2nd, 2010 06:08 am (UTC) (Link)
I wonder if they'll write up your pregnancy in medical textbooks!
If you ever write your memoirs I'll buy it! When you commented about living in Italy that sure sounded cool!
I hope Purim was nice and the kids enjoyed!
estherchaya From: estherchaya Date: March 2nd, 2010 12:46 pm (UTC) (Link)
I'm guessing I'm not going into any medical textbooks - I am, as they say, not a textbook patient. ;)

When I was a kid - maybe 10-12ish?- I got written up in an ophthalmology paper (a case report, maybe?) that was written by someone at NIH and presented at Bethesda Naval Hospital. That's really all I remember about it - I remember going to the hospital when the paper was being presented and having a lot of doctors poking me. (Okay, they weren't poking me, but they were observing something or other with my eyes. Who knows what... I can't remember. (My mom would know)
childlight From: childlight Date: March 2nd, 2010 02:09 pm (UTC) (Link)
I was on Glyburide. I started it once a day and it still didn't help lower my numbers which were in the 200's. So they had me go to twice a day which seemed to help at first and then it was helping too much as I ended up with numbers in the 40's-70's We never did get my numbers where we wanted them they were bouncing back and forth. And I was following a very strict diet like I was suppose to.
Alex was born with slightly low blood sugar so they gave him a bottle immediately. It took about 12 hours for his levels to get where they wanted it. But his levels have been fine ever since.
I am still shocked you have GD. You have to get a break soon.
estherchaya From: estherchaya Date: March 2nd, 2010 02:39 pm (UTC) (Link)
I've got two very important breaks in this pregnancy: 1. my cervix isn't budging (yet?) and 2. the baby is growing just fine. If I get to the end of this pregnancy with a healthy baby, that's the only break that matters.
childlight From: childlight Date: March 2nd, 2010 03:36 pm (UTC) (Link)
That is true.
mrn613 From: mrn613 Date: March 2nd, 2010 02:31 pm (UTC) (Link)
Hmmm I definitely think you should consult with an endocrinologist before you start the pump. I would be really really suprised if you need a pump for six weeks of therapy. The benefit of a pump is that it is dyanamic so as your blood sugar level changes the insulin dose can adjust. However you are on almost constant IV feeds with no meals. Why can't you use a long-acting injectible like Lantus (spelling?) I am not an expert on GD but your husband probably is and can explain the different types of insulin and when they are used to you.
estherchaya From: estherchaya Date: March 2nd, 2010 03:23 pm (UTC) (Link)
I'm really not going to argue about it. whatever they say to do is what I'll do. Honestly a daily long-acting injectible is as much (if not more) trouble than having a continuous infusion pump. Pumps have more than one benefit - the continuous low-dose infusion ensures a more constant level of medication and since my glucose levels seem to be pretty random, a constant level is not a bad deal. Not all insulin pumps automatically adjust to changes in blood sugar levels - but the ability to administer a demand dose as needed - without an additional injection.

Hopefully it will be a non-issue and I'll be able to take the glyburide and it will be effective enough. I also hopefully have more than 6 weeks left in this pregnancy.
yermie From: yermie Date: March 2nd, 2010 11:45 pm (UTC) (Link)
Someday I'm going to write my memoir and no one will buy it because they'll say "this chick made up every word of this! It's too preposterous to be fact!"


As someone famous once said, Truth is stranger than fiction, because fiction has to make sense.

So, the sheer incredulity of your tale will help lend authenticity to the story.
cleobatya From: cleobatya Date: March 5th, 2010 04:29 pm (UTC) (Link)
wow you really are bionic. I just hope you have no more challenges to overcome, and everything else just goes much smoother from now on. When are you due?
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