Insulin...and the start of nighttime feedings already?!

Just to keep things interesting, I started on a long-acting form of injectable insulin late last week.

I saw my OB, who blessedly came back from her two-week vacation, and she agreed with me (and the nutritionist....and some of you...) that my blood sugar was not adequately controlled - most particularly the fasting levels, which were often mid-90s, with occasional spikes into the low 100s.

So insulin it is. I started on a low dose - 2 units - last Thursday night.

And instant amazingness!! My fasting numbers were great!! Around 90. Sometimes in the high 80s! (The goal is below 95.) All my post-prandial (after eating) levels were also awesome!

Sounds wonderful, doesn't it? Enter the next major snafu...

Ketones

Ketones: they look pretty, but are not a good thing at all.

I started having ketones in my urine, which means I am breaking down fat instead of glucose for energy. The highest levels were first thing in the morning (often measuring "moderate," but once measuring "large"--akkk!), and there were small amounts present when I tested throughout the day as well.

I tried reading up on this and found that ketones + baby = badness, particularly for later intellectual functioning of said baby. Many websites referred to this information...but I couldn't find any actual research discussing exactly what we were talking about here - how severe are these cognitive problems? what levels of ketones in the urine are an issue? Is a day or two of high ketones dangerous or is it more a problem over the long haul? Who knows... because pubmed.gov failed me, or I failed to use the right search terms.

I do know that my OB has gotten very aggressive with me all of the sudden, which is both comforting and a little alarming. I saw her last Thursday. And she wanted to speak to me Saturday and then again yesterday on the phone. She also wants to talk tomorrow. And she wants to hear every glucose number throughout the day and to hear about the ketone levels. And she has upped my antenatal monitoring to twice a week. And I'm referred to an endocrinologist, who I will be meeting with this Friday.

So yeah, based on her behavior, this is clearly something not to be messed with. (Not that I'm messing with anything; I'm truly trying my darndest. I just have been trying to figure out how worried to be).

Right now I'm experimenting with adding a middle-of-the-night snack to see if it helps with the ketones.  It is pretty weird to set an alarm for the wee hours of the morning and to then get up and eat. And my heartburn...well, yeah, not so great.

Will has set an alarm that actually talks, because he was worried I'd be so disoriented with just a tone that I wouldn't remember why it was going off. So at 2am or 3am, suddenly this mechanized voice says, "It's 2am, time to get up and eat your yogurt." It's rather strange, but effective. Who knew I would be doing middle of the night feedings for the baby already?! The midnight feedings helped some the first couple of days, but not enough. I was still testing positive for ketones.

This morning, I thought I struck the magic point finally - no ketones!! But...sigh...today's fasting glucose was a smidge high again at 95. Aaargh.

I am feeling a bit exhausted and also somewhat mystified and frustrated. But I will get this under control, no matter what it takes. I will do anything to try to help this little one be as safe and snug as possible until she's ready to join us.

Mo

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