Thursday, June 9, 2011

Back to our regularly scheduled programming: Visit with the CDE!

Monday marked the first time I've been in the same room with anyone from my endo team since November. "But you're pregnant" I'm sure someone is spluttering out there, agog that I could be so cavalier about prenatal Type 1 care. Truth is, I'm a lucky lady and 99% of my endocrinology work - all the basal rates and I:C ratios and food logging I've been doing - has been monitored and exchanged with my CDE and endo through Kevin's kick-ass log and Medtronic's Carelink.

That being said, I'm not sure how the Center makes money this way, so I try to go in for an actual billable appointment every once in a while.

Waiting to be a billable patient!

My goals for the visit - since going over numbers wasn't going to happen, as I send those in every two to three days - were bigger picture stuff:

1. OB mentioned the "protocol" for delivery, but was super dodgy about what it actually is. GOAL: find out what the heck is going to happen to me, my pump, my insulin for delivery.

2. OB is really, really weird about her expectations for my BGs: "Your fasting BG is around 90, right? And you're keeping your post-prandial under 120?" do know I'm Type 1, right? GOAL: Find out what the heck her problem is and whether or not my BGs are actually a problem.

3. My basals are nearly double what they were in November, and all my rates are all over the place. What's going to happen after delivery?! GOAL: Learn what to expect post-delivery and during breastfeeding.

I don't know that I got super-concrete answers, but I got enough information that I have a different set of expectations for this whole process:

The protocol that's in place is going to depend largely on whether or not I have a c-section. (Finding out next Thursday!) Actual labor is apparently a real bitch on blood sugars - not surprising, of course - but I won't need to do that if I'm getting surgery. All of my pump rates and insulin IV decisions will come from the Berrie-affiliated endo team that's at the hospital at that time. They will work with my endo/CDE to come up with the basal rates I should have for the procedure and afterward, using the pattern function ahead of time so we're not fiddling around with my pump while my daughter's being born. So, still technically waiting on the actual numbers for the protocol, but I know a lot more about how that's conducted and I'm relieved to know the Berrie Center will be the source of those decisions.

As for my OB's insane expectations? That's just what happens. Whether it's because endocrinology just isn't her specialty or that she's just used to patients with gestational diabetes numbers I don't know, but per the CDE "Oh, I KNOW - OBs drive all our Type 1s crazy." She said I'm doing just great and that I should keep doing what I'm doing - that part of the reason she hasn't had me come in is that I'm sailing along so well that I didn't need an in-person appointment. I'd assumed things were okay (she does see my logs all the time, after all), but it was still nice to hear her say the OB is nuts and I'm doing just fine. [Caveat: My finger-stick A1c, for those of you waiting to see how Dex stacked up, was 6.2. I went up a tenth of a point, which is just hard to see as BabyH kicks around in my belly. I'm getting an actual blood draw A1c today, though - will be interesting to see how consistent the numbers are!]

Lastly, post-delivery and breastfeeding? Sounds like it's much like the protocol. I'll have rates that will be set up before I leave the hospital by the endo team, and they'll be rates that'll most likely leave me a little high at first so that I'm not in danger from serious hypoglycemia. Rates will just be adjusted from there. Again, not a concrete answer...and certainly one that leaves me scratching my head: "Um, I don't think I'll have time to do all the logging I've been doing for the past year and a half!" But still good to know there's some sort of plan in place, even if it's not fleshed out enough for my Type A personality.

All in all, I was happy I went to see her, and feel a bit calmer about all the questions bouncing around my head. Not actually calm, of course, but we're moving forward!

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