Wednesday, March 26, 2008

If little knowledge is a dangerous thing...

...then what can we conclude about the relative danger level of medium amount of knowledge? I know I am completely showing my geekiness here, but I actually spent some amount of time north of five minutes trying to figure this one out. I decided that since we have no closed form for the danger as f(knowledge), I have to give up on trying to solve this theoretically and await empirical resolution of the particular instance at hand.

See, I haven't gained any weight. Since I was rather seriously overweight due to losing almost none of the weight from A's pregnancy (thank you, thyroiditis, thank you PCOS), I would be happy to be happy with this. If I knew this is ok. I have failed a few glucose readings in the past couple of weeks. Only a few, here and there. But the times I am not failing, I am on the low side. Too low, I think.

It's not helping that the last couple of weeks at work I have been writing problems for the midterm and answer keys for same. Yes, I have been staring at the various aspects of glucose metabolism for work. And somehow, while I was sleeping working, a hypothesis has formed in my addled brain. I am worried that I am not playing well with others, that I am not sharing enough of my calories, that I am burning up energy paying for converting what I eat from glucose to glycogen and fat and back to glucose.

[Brief diversion for hand-wavy explanation. All the food we can absorb can be described as fat, protein, or carbohydrates. We like to send the protein we consume straight to be chopped into amino acids and incorporated into our own proteins, and we build different proteins in our cells all the time. If we have enough carbs, we can send fat straight to storage. If not, we'll burn it for energy. We break complex carbs down into simple sugars. And the preferred, easy to use fuel for the cells in our bodies is glucose. Fuel for dummies, so to speak. So we break our carbs down, and we dump glucose into the blood, for easy distribution to all cell types in need. Now, all cells have glucose transporters on their surface, and they take glucose from blood as needed. Neurons have greedy transporters, for example, so they get first dibs even if we haven't eaten in a while.

But after a meal, our blood glucose spikes. Our pancreas is watching this, and the beta cells therein have this special type of glucose transporter on them that only trips when there is a lot of glucose to deal with. So beta cells make and dump insulin, and insulin goes in the blood stream to all these needy cell types, namely muscle and fat, and trips the insulin receptor on the cells, and that trips a somewhat long cascade reaction inside the cells that results in the cells putting more glucose transporters on the surface. Now the party can start-- the cells can take in more glucose than they need to use for basic metabolic functions, i.e. just for survival. High times.

So you know how there could be too much of the good thing? Yeah. So if these cells take up more glucose from the blood, and they pay a certain energy premium to convert it into storage form for later use-- muscle as glycogen, and fat cells as well, fat. The storage form is so that when we haven't eaten in a while, but decide to say take a walk, our muscle cells don't have to go begging to blood for that glucose they need to work, but can instead again pay a premium to get it back out of glycogen. Our liver also stores glycogen, a lot of it. This is so that when other cell types need glucose, and suck it out of the blood, liver can replenish that supply by breaking down glycogen. Again, for a fee.

If your insulin regulation is screwed up, like mine is, it may take too long to shut off production of insulin, resulting in too much glucose being cleared out of the blood stream after a meal, resulting in those reactive lows that I blabbered about a little while ago. Eventually the cells demand glucose, and if you don't react to that by feeding the beast, your liver has to give up the goods.

Um... not so brief with the explanation, I guess.]

So this hypothetical energy waste on paying storing and un-storing/usage fees would all be fine and good, of course, if not for the concern I have developed about whether these reactive lows mean that I am stiffing the creature behind the placenta of the glucose it needs to, you know, grow. If my cells are doing this last call run on the bar thing every time I eat, what gets to the other side? Adding in that at our early risk assessment ultrasound, the measurement was four days behind the due date, and that is the due date they have, which is two days behind the date I know to be correct, well... paranoia is my middle name these days.

Dr.Best is not convinced. Looking at my glucose measurement numbers he said that they look great, except he thinks I may need to up my intake. Ha! How is he to know that I am certainly not skimping? If anything, I stuff myself. Well, I told him, so now he knows. And of course, in my pregnancy with A, I started gaining weight and fast after I stopped taking the insulin-sensitizing meds. This time, I stopped those almost two weeks ago now. And still reactive lows galore, with a few failed readings in spots. Those usually have some inauspicious balance of carbs/fats/protein, although I can't always predict what is likely to bump me over. A cupcake might not, for example. By its lonesome, it is actually more likely to send me to a reactive low.

So Dr.Best is not convinced, but since he knows that I calm the hell down on any particular issue in the face of actual observable data, he is willing to employ modern medical technology to resolve this one. Thus, we have a previously unplanned ultrasound scheduled for Friday morning. Not the big anatomy scan-- that will be another three weeks later, provided things keep going well. This is a quick peak to assess growth. But I am also planning to ask for a check on the placenta, position of said placenta (low-lying I am willing to bet, as I had a little brown spotting episode about ten days ago), and cervix length (because of the selfsame spotting thing).

I will also ask to see whether sex of the occupant can be determined. That last one is not for vanity, I assure you. So tomorrow: the post that explains it, one I have been putting off writing since almost the start of this blog.


c. said...

Knowledge is power? Ignorance is bliss? I tend to believe the latter. Sometimes the former. Depends on the day, really. I can definitely see how, what you know, might cause you a teeny little bit of, um, anxiety.

I hope the unscheduled ultrasound goes well and baby is growing and thriving and is doing all those things that little babies should at this stage.

Janis said...

Reading, and feeling like an ass not grasping everything. Except that my heart and soul wishes the best for you. Fingers and everything crossed.

CLC said...

I hope tomorrow goes well. I hope this is just your mind f-ing with you and that none of what you wrote is actually happening. I agree that knowledge is power, but in times like this, I would prefer to be ignorant. I wonder if there's a low correlation between ignorance and stress. Because knowing what you just wrote and being pregnant sounds stressful.

k@lakly said...

Keeping my fingers and all other digits crossed for good news. I hope you only have an overactive brain and none of the other meddling body functions are copying it.

Beruriah said...

Oh I'm looking forward to that next post. ;)

I so hope your worries are for naught. But I am so so glad Dr. Best is willing to engage them.

I will be waiting breathlessly for the results.

Tash said...

Hmmm. I'm going to go with "it's just a phase and everything will come out in the wash." But that's just me. could it be time to see a Peri for another opinion and insulin regulation? Thinking of you.

Casey said...

Dammit. Now I'm going to spend the rest of the morning trying to graph danger as a function of knowledge.

STE said...

I understand the fear. Especially considering your recent history.

I think knowledge IS power. Fortunately, you seem to have a doctor who considers your questions and intelligence as good things. (Looking back, I don't think I felt like I could push mine.) Keep pushing. I bet it will make you feel better.

Hoping you have a great ultrasound tomorrow!

niobe said...

I'm not going to pretend that I followed your explanation, but isn't the problme with GD babies generally that they're too big, not too small? How does that work?

Karen said...

okay, I'm holding my breath for you over here.

Catherine said...

Here's where I can't give any advice but can give you my own personal experience. I had GD (diet controlled until week 36 when I had to go on insulin)...I LOST weight...I delivered early at 37 weeks because my water broke...and Samuel was 9lbs 6ozs...a full pound larger than his ultrasound estimate. Ultrasounds are not exact and the key is to keep your glucose numbers from doing the extreme high-low dance every day. A few off readings here and there are fine (the occasional milkshake caused me great worry). Try to relax. I think you're fine.

Julia said...

Niobe: GD is when the beta cells can't handle the glucose load more often than not, so they don't make enough insulin, and it isn't cleared out of the blood stream. That causes high glucose levels. Glucose crosses the placenta where the fetus has normal beta cells, that respond as expected, i.e. they make loads of insulin, letting the fetus's muscle and fat cells clear the glucose our of the blood. If that happens a lot, the fetus grows a lot bigger than expected for gestational age. That's called macrosomia. I am for now worried about microsomia-- small fetus due to too little glucose crossing the placenta. Although seeing as I failed the reading after dinner yesterday worse than any reading I failed before, I may not have to worry about that for much longer.

Aurelia said...

Toodles, I think you are overanalyzing all of this. Really.

And geek you may be, but I AM the queen of overanalyzing shit. Welcome to my world. ;)

As for the measurements, pay most attention to bone measurements. discount the soft tissue. That's where almost all of the measuring eff-ups occur. It is reasonable to be off by up to a half a week or so in the second trimester. Mostly due to operator error.

Soooo, where is the gender post? You know I'm obsessed with this, but so far have been unable to find any evidence or a correlation between pg loss and gender beyond the recent hepatitis finding in India, and the environmental poisoning at the native reserve in Sarnia. Do tell Obi-Wan!!!

Snickollet said...

You have such a gift for explaining things.

I'm glad you'll be going in tomorrow for what will hopefully be a reassuring visit.

You have me on the edge of my seat over here about tomorrow's post.

kate said...

I guess it depends on the sign of the gradient of f(knowledge)... ;)

I hope that the ultrasound helps resolve, well, at least this particular worry for you.

Ahuva Batya said...

Is there a sine curve in here somewhere? Because I loved those things. I am impressed with your knowlege, and you wield it well. Although I am really hoping for good news for you at the appointment.