November 22, 2004
Gestational Diabetes Update 3
Since I began insulin, I've had to call in and have my dosages increased on almost a daily basis. I started at 2 units of Humalog (fast acting, short duration) before each meal and 2 units of Humulin N (slow acting, long duration) before bed. As of today, I'm up to 20 units of Humalog before breakfast, 18 units before lunch, 12 units before dinner, and 22 units of Humulin N before bed. For several days, I also had ketones in my urine in the mornings, so I've had to start eating a middle of the night (4 am) protein snack in addition to the three regular 'snacks' I'm supposed to have between meals.
I'm eating WAY more than I'm used to, and I'm still only gaining about 1pound/month instead of the 1pound/week that I should be.
Anyway, the increased insulin dosages meant that my first pen ran out on Saturday, so I went to the pharmacy to get a refill. I was told that insurance wouldn't cover it because they deemed it too soon for a refill. Apparently, the prescription on file stated "2 units, 3x day," instead of "PRN" (which means 'refill as necessary'). So, I had to pay for the pen, but the pharmacist said they'd call the clinic and have the doctor update the prescription. If he authorized multiple pen refills at one time, then the pharmacy would probably be able to refund what I paid for my pen instead of me having to file a claim with my insurance for reimbursement.
This morning, my endocrinologist's nurse called. I told her about the pharmacy situation and she sounded annoyed (with them). She said they were supposed to dispense one BOX of (5) pens at a time, not just one pen at a time. So she said she'd call them after we finished talking and update the prescription. That's good, because I need to pick up more pens since we'll be in Virginia for the next week, and running out then trying to find a place where I can get a refill would not be fun.
Some good news is that the current dosages of insulin seem to be working. My last four post-meal glucose levels have all been below the limit.
31 Week Prenatal Appointment
Today's appointment went fine. The baby's heartbeat was good and we're measuring on schedule. Dr. Litzinger gave my belly a quick squeeze and determined that the baby is head-down (right now). She may still turn around. Dr. Litzinger said they don't usually settle and stay head-down until about 36 weeks.
Austin Heart Hospital sent the results of my echocardiogram to Dr. Litzinger. Everything looked fine, so that's one less worry.
After the exam, Dr. Litzinger surprised me by saying she wanted me to go in for an ultrasound before my next appointment. They aren't normally done after 20 weeks, but she said she always likes having an excuse to do one, and in this case, my low weight gain was the reason. They just want to double-check the baby's measurements since I've only gained about 1/3 of the weight I was expected to. (I was up only another pound since my last appointment, 3 weeks ago.)
I mentioned being concerned about the baby's size because of the gestational diabetes and Dr. Litzinger said, "oh, thank you for reminding me of that." I told her how it was going, how they had to start me on insulin just days after my "class," and how they've had to increase my doses nearly daily because I kept getting high readings. That didn't please Dr. Litzinger very much because the endocrinology clinic hadn't bothered to contact her and tell her they'd started me on insulin. Apparenlty, if you have gestational diabetes and are taking insulin, they want to see you WEEKLY. So, starting in December, I'll be going in to the clinic once a week.
The somewhat plus side to this is that I'll be getting an ultrasound before each visit. They want to visually monitor the baby. I'm actually excited about my next appointment, which is December 3rd. As Dale pointed out, we might be able to confirm that I'm carrying a girl.