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.