Full Circle

Well my friends, it seems that this cycle, if I am to call a successful one that turned it a pregnancy such a thing, has officially come full circle. What began on Christmas Day with an injection of Lupron, and continued with varying injections per day through the end of February, will conclude with a minimum of 2 daily injections and 4 finger pricks for the next 10 weeks. That's right, I'm talking insulin here people. I started it in the middle of last week after checking in with the diabetes clinic on Monday with nearly a week's worth of sugar results and my diet log.

The nurse and the dietitian sell insulin like it's no big deal. Like it will take the stress out of managing my sugars. That I am doing the right thing for my baby. But if it's no big deal, then how come I was immediately scheduled for weekly appointments with MFM starting in two weeks. I will be alternating between non-stress tests and bio-physical profiles every Monday from now until mid-September when I will have non-stress tests on Monday and bio-physical profiles on Thursdays until I deliver. Every Monday, after my appointment, I go to the Gestational Diabetes clinic to check in and see if my insulin needs adjusting. Chances are, it will, as I am fighting an up hill battle against the placenta at this point. If I was able to manage with diet, I would only have an ultrasound at 37 weeks, and would still go to the clinic every Monday.

In some ways, I guess it's reassuring to know that they will be keeping great tabs on Luigi. I mean, what infertile would pass up an ultrasound, right? But at the same time, it's incredibly exhausting. My anxiety level is increasing on a daily basis. I am incredibly irritable, and my fuse disappears if I am too hot. Which unfortunately, is kind of hard to avoid these days. I should be relishing the end of my pregnancy, enjoying every last second of it. Instead, I am an anxious ball of stress, on the verge of tears at any given moment. I feel like all the injections and finger pricks are sucking the joy out of these last few months, as the insecurity of a positive IVF pregnancy sucked some of the joy from the beginning.

Hubby and I both feel like we have so much to do to get ready for Luigi and organize life before he gets here, and we can't help but feel that it's more and more likely that he'll need to arrive earlier than anticipated. We're struggling to live in the moment, and to enjoy life and the last moments we have with each other as just us. We need to slow down and give ourselves a break and be ok with everything not being perfectly prepared.

And let's get back to the confusion and frustration of the GD for a minute. I met the nurse a week ago Tuesday and began testing my sugars four times a day, upon waking up, and an hour after each meal. I also need to pee on a stick each morning to check for something called keytones, which are apparently a bi-product of the body breaking down fat to use as energy. They don't want me to have keytones, which means that a bedtime snack is critical, in order to have enough carbs to make it through the night so that fat stores are not needed. Of course, if one is trying to loose weight, keytones sounds like they would be a good thing. But, they can cross the placenta. So, in pregnancy, keytones are bad. Except, that no one will tell us why it is bad if they cross the placenta.

In order to avoid these mysteriously dangerous to baby keytones, I eat the aforementioned bedtime snack, for which a half cup or so of edy's slow churned vanilla ice cream with some nuts added is recommended as an excellent choice. And I have no keytones. But, my fasting blood sugars were in the range of 95-100, which was indicated on the paperwork I was given as normal. Until I showed up for my first check in appointment, and was told that my fasting sugar was too high. Huh? Then why does the paperwork say it should be between 95-100. Oh, apparently, that's out of date. My levels are borderline, and I need to go on insulin at bedtime. Does this seem weird to anyone? Eat ice cream and take insulin before bed. Why not just not eat ice cream and not take insulin. Why, the keytones of course! But what the fuck is wrong with keytones? The only answer we can get out of anyone is that they want all the nutrition for the baby coming from my diet and not my fat stores. Even though my BMI is borderline obese, so clearly I have plenty of fat stores. It all makes my head spin!

The one pattern that did show up that actually did make sense to me was that my breakfast sugar was chronically over by 3-4 points, no matter what I ate. I did experiment with some different options to no avail. Apparently, there is a natural swell in blood sugar that happens in the morning, or after 4 hours of fasting. The liver starts to produce sugar. It was an evolutionary process that enabled cavemen to have enough energy to literally get up first thing in the morning and either run for their life, or catch their breakfast. So, this seemed to be a battle I wasn't going to win without the help of insulin. I started at 2 units with breakfast and have just been increased to 2 as of today. So far, I don't need to take it with any other meals, thank goodness. I really don't want to have to start carrying it around with me all day. Oh, but you know what I do have to carry around with me now that I take insulin? Glucose tablets in case I get sweaty or light headed because my sugar dropped too low. Again, this feels a bit ridiculous. Don't eat to much sugar, but take insulin to help process it, and eat more sugar if the insulin worked too well.

I did hold off one day in starting the insulin. Hubby was really concerned and wanted to talk to the nurse and the endocrinologist before I did. He would have rather pushed back even more to have them give me more time to work on my diet, but I am so hot, and tired, and worn out that I just didn't want to fight about it. I will admit though, that it felt a bit like the party line. Like we give you less than a week to figure it out on your own because we're pretty sure we're just going to treat you generically and make you take insulin anyway. Hubby, a conspiracy theorist, would blame it on the pharmaceutical companies.

I should say, that all the people at the clinic are really lovely, friendly people. I know their intentions are to take the best care of Luigi and myself. It just seems a bit like we Americans hype certain things to much, and follow too prescriptive a path. Like the old 3 clomid IUIs, 3 injectable IUIs before you even more on to IVF, even though you later find out that ICSI was your best shot and all the IUIs were probably a waste of a year. But that's what we do, so that's what we did.

Now, can I complain for a minute about the sugar testing? I have this little device which snaps a lancet into my finger 4 times a day so I can get a drop of blood on to the test strip. I really struggled with this device for the first several days. When the nurse demonstrated it, she said to pull this lever back once to set it. The little blue button releases it. Now, I don't know if my device is broken, or what, but it wasn't bouncing hard enough into my finger to create a big enough drop of blood, and I was having to stab myself 2-3 times for each test. Finally, I discovered that with the first slide of the lever, the lancet was not clicking into place. Now, I slide it once, release it, slide it again until I hear it click. This started to work much better. I was alternating between my index and middle finger until the got so sore that literally pressing the buttons on my car radio was painful. I switched to my ring finger, and decreased the depth of the lancet from a 7 (the highest) to a 5. I'm getting great drops of blood now and no lingering pain.

My last complaint, which I share with all of you in case anyone out there ends up going through something similar, is to be really careful with the priming of the insulin pen. I take two different kinds, depending on the time of day. Both need to be primed with 2 units each and every time. And damn, if the tiniest drop of insulin is left on the outside of the needle, it stings like hell going in. I am learning to be really careful with my priming, and I blot the tiny drops off the tip of the needle with the corner of my alcohol wipe (how convenient that I had a ton of those, and an empty sharps container leftover from the beginning of this cycle). Otherwise, it's just like a Gonal F pen, which I have more than enough experience with.

So, there you have it. The confusion, chaos and frustration of dealing with GD and insulin. I haven't come across anyone writing about this, so in addition to needing to purge it all from my body, hopefully this might be helpful to someone who's unlucky enough to end up in this position in the future.