Moments of grace

I've had a few days of grace: The infusion set in my arm worked, and the next one, in my other arm, is working now, too (knock on wood). I know I'll need to find more sites that work. But not today!

I like that, with the infusion set in my arm, I don't have to worry when I pick up my daughter and she wraps her legs around me. I still get twinges when I used to put the infusion sets in my abdomen, but then I remember I don't have the set there, and I breathe easier. I probably really do need to let those sites rest for a good, long while. I haven't had the problem of her grabbing the site in my arm, say, when I'm getting her dressed. Maybe I have it far enough back on my arm. Maybe it's just luck.

Why did I use my abdomen so much, when we all have it drummed into our heads that you have to rotate sites? Well, for one, I was rotating all over my abdomen; and it worked quite well for almost 10 years. For another, when I'd tried the other sites before (well before pregnancy), it really, really, really didn't work; my BG went way out of control.I think there were far fewer options for infusion sets at the time. Even with several options during pregnancy, when I had this same problem (apparently not because of having a pregnant belly - some women have the set on their abdomens right up to, and even during delivery), I think it contributed to my BG going higher.

Now, I seem to be doing better, although it's only been a couple of days, and I wouldn't say my BG has been perfect. For example, my BG suddenly went to 49 after a dinner I've eaten often and know the exact card count for. Go figure. That quote comes to mind, "You are not obligated to complete the task, but neither are you free to desist from it." (apparently, this is from the Hebrew, from the Talmud). I feel like Sisyphus. If only the task were less mundane than keeping myself alive. But I guess it is more than that, because I have others to live for.

I feel I need to respond to the recent comment about losing a child (fetus) at 10 weeks (and whether you feel it's a child at that stage or not, the feeling of loss is no less). I have not had that experience myself, but I know several women who have (and at much later stages, too) - none of them diabetic. That stage of things is so emotional to begin with. Add the guilt of diabetes, and you've got a real emotional stew. I hope you come to peace with that, Amy. I can't imagine an A1c of 7.1 would, by itself, cause a miscarriage. Geez, I remember when I was on injections, I would have been overjoyed to get that number. I'm still there sometimes now. Yes, it's clearly still in the diabetic range, but who among us isn't, at least before pregnancy? If you want a straight-up discussion of A1c and pregnancy, there was a decent article in the BMJ a couple of years ago. Of course, the article doesn't convey just how hard it is to get the A1c down below 7!

I was so nervous during my entire pregnancy that I wouldn't tell anyone the sex of the baby until about 7 months along (though we knew it very early). We told our parents a little earlier, but no one else. I was so afraid of others in the extended family getting attached before we were sure there would even be a baby. I was so nervous, right up to the birth; I could not let myself believe it would even be possible, until my pregnancy was about 6 months along. Others seem so cavalier about it - as soon as they're pregnant, they're picking out names, making plans, worrying about exactly which baby items would be just right for them. I think I over-focused on my sugars as a way of avoiding thinking about that. I just figured I would do my best, and that was all I could do. But I could not start making plans until pretty late in the game.

From working in the medical publishing business, I know just how often things can go awry in human development - diabetes or no - so I know that actually having a relatively healthy baby is truly miraculous. Our culture gives us a false sense that it is ordinary. I know that is no great comfort when things go wrong; hey, I'm not happy to have happened to get this thing called diabetes, and no explanation of its cause would make me content about it. It's more like context; just because we have diabetes doesn't mean that's the cause of all our ills, though it sure seems like it sometimes, and it does create a gray zone of uncertainty.

In search of: A functional infusion site!

I often feel as if my diabetes is one of my children. It can behave for stretches of time, especially if I'm watching it closely. But as soon as I think everything's okay, it pulls a trick on me. Case in point: Just when I thought I could make progress with my new CGM, things backslid; every week for the past two months, I've gone through a day or two when I just can't find a spot on my body where the pump infusion set will work. I literally go through sticking myself four or five times in a day, with about an hour or two in between in cases when it seems to be working, only to find it's hit a blood vessel; blood sugar levels go sky high, and it's a fine mess when I take the set out. Needless to say, I haven't used the CGM at all; I'm finding it hard enough to find a spot for the pump.

But I don't like to just sit and complain, so I've found myself the new endocrinologist who specializes in pumps; and I'm going to have a nurse from the pump manufacturer out to my house tomorrow to see if she can't help. Maybe the infusion set where the needle stays in will help. This is what they use for lots of kids, with their small bodies and not a lot of fat.

In fact, I've always had to use the silhouette infusion sets, which go in at an angle, supposedly because I'm pretty thin (though I've only ever been normal weight, not underweight). But then, I lost 5 pounds in December, as I learned when I saw the new endo. What, lost weight, in December?? I know! I wasn't even trying, and it's not something that's ever happened to me before without a lot of effort. I guess the combination of taking care of a two-year-old and trying to get everything done over the holidays had me moving more than I realized.

Still, I'm only now back to my pre-pregnancy weight (almost 2 and a half years after giving birth). I suspect that the problem with my infusion sets is more because of the damage to the subcutaneous tissue from years of insulin injections and infusions (mostly in my abdomen), plus perhaps some residual extra blood vessels in my abdomen from pregnancy. But I don't understand why sites I've hardly ever used, like my arm, are now bleeding so often, without any signs of infection. Too bad! if it were just an infection, I could just take an antibiotic. No, no magic bullets for me, as the new endo said.

Oddly, my A1c is almost as good as during the beginning of pregnancy - it's now 6.3. This should make me happy, but it only makes me more upset to think I might have to go off the pump. What's more, everyone I consult on this - doctors, the pump reps - makes me feel like I'm the only person who's ever had these infusion-site problems. I'd love to know if anyone else has!