I Get It Wrong Often

Last night my Middles, (13 year old teen boy) was over 400 before going to bed.

He was 238 before dinner and bolused (used his insulin pump to deliver insulin into his body) for dinner with extra insulin to correct the high.

That was 4 hours before he was going to bed.

He was surprised by the high blood sugar before going to bed.

The infusion site he had on was only 36 hours old.

I chose not to drill him regarding what he might have eaten after dinner that could have resulted in the high but I did assume he had eaten something or somethings.

I just told him to correct (bolus insulin for the high) and to go to bed.

I set alarms (two) on my phone to wake up and check his blood sugar around midnight.

I don’t remember hearing the first alarm.

I do remember hearing the second alarm and I remember silencing it.

I awoke with a start at 4:11am realizing my neglectfulness.

In the moments walking between my bedroom and my sons bedroom my heart pounded against my ribs. The fear parents of children with diabetes experience when we know there is the slightest possibility our kids could have experienced a sever low at night can be monstrous. The relief when we see our child sleeping peacefully while their chest slowly rises and falls with each breath is equally as immense.

My boy was sleeping soundly and breathing normally. Exhale.

I checked his blood sugar.

403.

Fuck.

My assumption that he had eaten some rogue food between dinner and bed was incorrect. Instead the high before he went to bed was very likely due to a failed infusion site (place that insulin from his pump is infused into his body). The site needs to be replaced a minimum of every 3 days – his most recent site was only 36 hours old and shouldn’t have failed.

I had to wake the child and ask him to come downstairs to replace the site and insulin in his pump.

He didn’t complain. He felt like crud and he knew that insulin was the only way he would feel better.

Ok he whined a little. It was 4:15am and he didn’t sleep as soundly as I had first imagined.

New site, new insulin in his pump and a large bolus to correct his blood sugar.

We don’t own a ketone meter (a small device similar to a glucometer that checks the amount of ketones are in the blood via a finger stick/drop of blood), ketones are often present during periods of extreme high blood sugars. Ketones are produced when the body burns fat for energy, excessive ketones poison the body and when combined with dehydration can result in ketoacidosis, a life threatening condition.

Before he came into the kitchen to get his new site and insulin I heard him in the bathroom. It was too late to ask him to use the ketostix (paper strips with a small patch on the end that is chemically treated to change color if ketones are present). The ketostix are not a very accurate way to test for ketones – because the paper sticks check the urine for ketones the result is about 4 hours delayed, meaning not the most accurate ketone level, but at least it is an indication of what was happening in this body. Alas – he used up all his urine so no ketone check.

Sent the boy back to bed.

He will need to go to school regardless today. I am scheduled to work.

In the hour since I awoke with a panic I have been berating myself for yet another fail.

We own Dexcom CGMs (continuous glucose monitors). CGMs check a person’s blood sugar every 5 minutes and have alarms that can alert the wearer and others that blood sugars are high or low. Had he been wearing his CGM we likely wouldn’t have ever got to be in the 400s last night and certainly wouldn’t have stayed in the 400s all night as I slept through phone alarms.

Had I done the nagging parent thing at bedtime to determine if he had actually eaten between dinner and bed I might have been able to determine that the high was in fact due to a failed infusion site rather than by a teen that likes to snack and forgets to bolus.

Had I just stayed up between 10pm and midnight I would have not been sleeping at midnight and I would have been able to replace the failed infusion site 5 hours ago vs. letting my son sleep with such dangerous numbers.

Like I said, I get it wrong often.

I’m sorry middles.

Ps. In the 40 minutes since I wrote this and went to take a shower for work I spoke with my husband. He confirmed that he observed Middles eating multiple tangerines before checking his bedtime blood sugar. Thus, it is likely he was high before eating the tangerines but also likely he forgot to bolus for the tangerines. Suggesting that while he bolused for the high before bed he neglected to take insulin to cover the tangerines.

Sigh……

The Butterfly Effect

A man allegedly committed felony assault and my daughter ended up in the ER in DKA (diabetes ketoacidosis).

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While this story will in no way be as sexy as the Ashton Kutcher movie The Butterfly Effect you may still want to grab some popcorn and a soft drink because it will likely be long and wordy.

The story begins with a man whom I’ve never met. He allegedly committed an act of felony assault. The man needs to stand trial and so a panel of jurors are needed. My number is called and thus begins a two-day process of selecting the best panel of jurors to decide the fate of the defendant. Day one of the process passes without any issues back on the home front with three kids with diabetes managing themselves while mom is away in the city dutifully participating in our judicial system.

To make it possible for me to attend to my civic duty, my husband agrees to stay home an extra hour in the mornings in order to get the kids off to school on time. Day o1 everyone did exactly as directed. Day 02 dad thought it would be nice to treat the youngest kid to a Starbucks sandwich before school. Sweet of him, right? Well yes, but he made one (almost could have been fatal) mistake – he mentioned Starbucks to my youngest while in ear shot of the oldest. My oldest has a bit of a Starbucks addiction, so of course she sweet talks daddy into taking her as well and then dropping her at school rather than insisting she ride the bus. Shouldn’t be an issue right?

Well lets back up to just 45 minutes prior when I check in with my daughter while she is getting dressed for school. I asked a reasonable question – the same question I asked of all my kids that morning.

“How much insulin do you have in your pump?”

Why did I want to know? Because I was going to be 45 minutes away in a court room with no cell phone. I didn’t want any of the kids to find themselves without insulin. True they all have insulin and pump paraphernalia in their health offices but its easier to be proactive before school.

The boys each had plenty of insulin for the next 48 hours.

My daughter had just 33 units of insulin in her pump. I asked her what her thoughts were. She believed it would be sufficient to last the school day.

Her calculations were based on her typical grab & go breakfast of a banana and granola bar. <<<this is important in the story.

So off I went for day two of Voir Dire. (It sounds super sexy but is a painfully slow but a necessary process in selecting a panel of jurors.)

My husband takes my daughter to get Starbucks and drop her off at school. The youngest chooses to skip Starbucks to instead play on his computer for an additional 30 minutes and then walk himself to the neighbors for a ride to school.

Ahhh Starbucks with your delightfully delicious breakfast sandwiches and steamy creamy sweet beverages of pure bliss. This story wouldn’t have been possible without you.

Breakfast sandwiches and beverages received, my husband dropped my daughter off at school – likely a tad bit after the bell.

Meanwhile in Seattle I am checking in with the bailiff and ordering my own cup of coffee from a machine in the juror pool room.

The potential jurors are called to the court room. In the elevator up I send a group text to the kids reminding them to have a good day and check blood sugars. Then phone silence.

While I was listening to an older gentlemen/potential juror explain to the court that we never actually landed on the moon, my daughter was back in class discovering she had forgotten to bolus for her Starbucks.

Here is where the grab & go breakfast plays a role – she based her daily insulin need calculation on a 30 gram breakfast, 45 gram lunch and daily basal needs. 45 minutes before she left she didn’t know she would get her fix at Starbucks or that her breakfast would actually be closer to 100 grams of carbohydrates. This changed everything. While she woke up with a pretty blood sugar of 124, she was already above 500 when she checked her blood sugar in class. Based on her blood sugar correction factors she barely had enough insulin to correct. That was before lunch.

Now at this time I would like to say my daughter is a teen. She isn’t all consumed with diabetes management. She typically makes good decisions regarding food, insulin dosing, and general diabetes care. Yet she is a teen. She also knows I am in a court room and my phone is off. So she makes a decision that she will likely never make again and it was a learning opportunity. She decided to ration her insulin rather than refill her pump at school.

She decides to take 3/4 of the insulin needed for the blood sugar correction. Thus leaving insulin available for her basal insulin. (I know for those not using an insulin pump or those that have no experience with diabetes some of this may all be mumble jumble – sorry). She eats only 1/3 of a her lunch and uses the last of her insulin. She is still well over 500 at lunch.

When she arrives home she refills her pump with fresh insulin. That was at about 3pm.

I was home but catching a 15 minute cat nap before heading out for a quick birthday celebration with friends. It had been an exhausting day listening to the prosecuting attorney and defense attorney ask the same questions repeatedly. I had been dismissed from the case for reasons not explained to me. (although I have some good ideas as to why)

At 6pm she checks her blood sugar and is now over 600. She decides her pump site has gone bad and replaces the pump site but uses the same infusion site tubbing from the previous site.

I am unaware of most of this. She did tell me she was high and was doing what she needed to do. There was no need for me to ask questions or try to micromanage her. She has done it all before and I was proud she was doing what she needed to do.

She asked for a ride to the talent show at her high school. I obliged.

Two hours later I get a panicked phone call.

“Mom. I need you to come now. I need you to come get me. I feel so sick. I can’t hardly see and my legs are killing me. I need you to come get me now.”

I had been out shopping with the middle kid so we rushed the check out line and sped towards my daughter.

In the car she said “I need to go to the hospital”

We dropped the boy at home, she grabbed some comfy clothes and I grabbed a bucket and a blanket.

She was in the bathroom vomiting. She held a Keto stick that showed massive ketones. (A Keto stick is a strip of paper with a color changing tab that a person with diabetes pees on to check for ketones – I can’t explain it all so if you don’t know – ask) And yes I know a ketone meter is more accurate but tell that to my insurance company would you – thanks.

We rushed to the hospital. The whole ride to the hospital my daughter looked as if she was about to drift out of consciousness. I drove faster. All the while rotating scenarios in which I would get pulled over for speeding while my daughter went into a coma and how I could possibly end up being the most knowledgable person in the ER about DKA. Crap – drive faster.

We arrive and rush into the ER. It was a ghost town thankfully. It takes only 3 minutes to get her checked in and back in a room with a nurse looking for veins in her severely dehydrated arms while another asks questions.

What is her blood sugar? Above 600

Has she vomited? Yes

Do you know if she is positive for ketones? Yes

When was her last dose of insulin? 30 minutes using her brothers pump. 6 units

Is she wearing a pump? Yes but it’s disconnected – we think somethings wrong with it or her site.

Holy crap they speak my language. Amen.

4 attempts and the IV is in.

6 vials of blood are collected

Fluids are descending to hydrate my girl. Another 6 units of insulin is administered.

Heart rate 124

Pulse Ox 69

30 minutes later her color is improving and her heart rate is going down while her pulse ox is going up.

1 hour in and her blood sugar is in the 400s.

Ketones still very large.

Electrolytes improving.

While waiting on the doctor I did exam her insulin pump. There was no insulin coming from the tubbing. There was a smell of insulin coming from where the site tubbing attaches to the pump cartridge. Perhaps it wasn’t attached properly. I removed the old tubbing and replaced it with a set I had brought with. I primed the tubbing until insulin drops dripped from it. I attached it back on my daughter so she would be receiving her basal insulin.

The doctor came in then. He was ending his shift. He suggested once she is more stable we transfer to the children’s hospital in Seattle. It was a longer drive which is why I chose to go to the Swedish hospital only 15 minutes from our home. Plus my daughter is nearly 16 and prefers to be treated as an adult.

I expressed how impressed I was with her care so far and didn’t feel the need at that point to transfer her to children’s hospital. He left to chat with someone at children’s hospital. Then he returned with another doctor replacing him.

The other doctor and I chatted about ketones, hydration, blood sugars, and our prior experiences with DKA.

We didn’t really have any. When my youngest was diagnosed at age 2 he was in DKA because we didn’t even know kids could get diabetes – we thought it was flu-like.

Aside from that, the kids would occasionally have trace ketones if they forgot to dose for a meal but we would always handle it at home. Once when my daughter was 12 she got the flu and we went in to keep her hydrated after a few times vomiting. But she wasn’t in DKA.

After the staff had checked her level of ketones again and noted they were not going down very quickly I asked for crackers and jello. I explained that to get rid of ketones, carbs are also needed. I knew it sounded silly to the nurse but she obliged. My daughter happily ate 4 crackers and some red jello.

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I was impressed with how professional, compassionate and mostly knowledgable the ER staff were regarding DKA.

Still when they hung up the second bag of sodium chloride solution I stepped out to chat with the doctor (not to be confused with The Doctor, the last time lord).

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I questioned him about the possibility of cerebral edema. (I shouldn’t even know those words. I don’t want to know those words. I have not shared a link to explain cerebral edema because I am not qualified to determine which sites contain the most accurate information)

He said he was monitoring things and felt that a second bag would be beneficial and wasn’t concerned about cerebral edema.

I learned about cerebral edema a couple of years back when reading a story of a child lost in the ER because of the aggressive treatment of DKA. I don’t recall the article or any details aside from the idea that aggressive treatment of dehydration combined with aggressive insulin may have resulted in swelling in the brain. I am still not sure there is any consensus on what exactly causes cerebral edema in people (kids especially) during treatment of DKA. There is a whole lot of medical mumble jumble out there that talks about it but much of it goes over my head. I just knew I wanted to ask about the possibilities, especially in an ER that does not specialize in children or DKA.

My daughter fell asleep as the second bag of sodium chloride slowly dripped into her IV while I watched another episode of Doctor Who on my phone. Thank you Hulu.

Each hour a nurse named Don had come in to check her blood sugar. He was gentle and kind and did his best not to wake my daughter.

We had been in the ER for 4 hours thus far. Her blood sugar was still in the 300s. The doctor came in and administered another 4 units of insulin via her IV.  She still had half a bag of fluids to finish off.

Another 2 hours of sleeping for her and The Doctor for me.

When the fluid was finished, her blood sugar was under 200 and her ketones were down to moderate the doctor asked me what I wanted to do. I said “take her home”.

We checked out with her wrapped in the blanket I had brought.

Once home she climbed into bed and I got comfy on the couch to watch more Doctor Who while I waited another hour to check her blood sugar again.

I fell asleep after I checked her at 4am.

On Friday she slept most the day. I napped for a few hours too. She still was showing small ketones throughout the day but they were going down gradually.

It was a scary exhausting night.

As for the Butterfly Effect also referred to as Chaos Theory:

“In chaos theory, the butterfly effect is the sensitive dependence on initial conditions in which a small change in one state of a deterministic nonlinear system can result in large differences in a later state.”

Would my daughter have ended up in the ER had I not been miles away at the court-house in a court room with my phone off? Would she have called me from school to alert me to her lack of insulin? Would that phone call (had it taken place) stopped the perfect storm of questionable decisions and tech failure? If the defendant hadn’t allegedly committed felony assault would I have still been in a court room? Maybe I would have served on a municipal case involving a red light violation and been done before all the crazy started? Would the chaos have happened if she had boarded the bus with her grab & go breakfast rather than going to Starbucks?

No one can say. My daughter is well and has also learned a life lesson. Better for her to have learned that lesson now when she has a support system to deal with the big issues than when she is an adult on her own without as much support or financial resources. A friend of mine has always said home is a safe place to fail.

Parents – DKA is nothing to shrug off. It is beyond scary how quickly a missed bolus and a few mishaps can escalate into true danger. I know many don’t always check ketones as prescribed by our child’s endo. At least we don’t. Blood sugars fluctuate frequently and a missed meal bolus can usually be corrected within a couple of hours with minimal immediate harm.

Our take-away: If high due to a missed meal/snack bolus – correct by administering insulin. Do the recheck in an hour to be sure the correction bolus is lowering blood sugar. If it is not, trouble shoot other possibilities such as a bad infusion site or bad insulin. Give a second correction preferably by injection to be sure insulin is indeed administered. Then work to fix pump issues. Always plan for emergencies – maybe don’t leave the house with just enough insulin to squeak by with. Check ketones when high for an unknown reason or after staying high despite correction bolus. Be sure someone knows what’s going on other than yourself. My daughter was in a school full of folks who are able and willing to assist her even if she couldn’t contact me. Pride always comes before a fall.

If you actually made it to the end of this post you are a rockstar or need to get out more. But seriously – thank you for reading.

PS.

It was very bright in the room. I tried all the normal white light switches and was able to turn off some small lights but the huge florescent light directly above my daughter wouldn’t turn off. Then I noticed two light switches on the back wall that were red. My daughter told me not to touch them, that they looked important. Was that a dare? 

IMG_5727The large florescent light went out. The hospital continued to function. Plus I had already plugged my phone into the red power outlets labeled “emergency” which were clearly a gateway to my reckless behavior.

 

Oh Be Careful Little Mouth What You Say

I am forcing myself to share this very very unflattering photo. It's my punishment for stupidity. You'll understand after.

I am forcing myself to share this very very unflattering photo. It’s my punishment for stupidity. You’ll understand after.

So last night. Wait I should start earlier. (quick warning – when I got to 1356 words I realized how long a post this would be. It is more than 1600 words. If you would like to skip the story and go straight to the moral feel free to scroll down – it’s an important lesson IMHO for all parents of kids with diabetes)

So yesterday afternoon I took Sugarboy up to Stanford to get started in a diabetes technology study. Since it’s a study I can’t/won’t share what he is wearing for the study or really any details. But I will say that his bedtime blood sugar needs to be under 260 for him to complete the study each night. The study is many nights long.

After the visit to Stanford he was starving. It was early, maybe 4pm. He wanted a personal pan pizza from Target (they sell Pizza Hut personal pan pizzas). While they are delicious they are also the antiChrist when it comes to diabetes management. Not only are they 80 grams of carbs but also loaded with thick gooey cheese and I’m certain they must use a good deal of butter/oil in the crust because multiple napkins are necessary. Of course he gets the pepperoni which adds an additional layer of fat.

A bit about carbs mixed with protein and fat. They (the carbs) are digested at a painfully slow rate. It takes a great deal of experience in the diabetes world to determine how best to dose insulin for meals that are what we call the triple threat (high carbs, high fat, high protein). Sometimes we are able to win the battle – extended doses of insulin over a 4-8 hour period after consumption usually does the trick. If you are a newbie to the diabetes world don’t fret about not figuring it out the first 27 dozen times – its something that takes time to figure out and every person with diabetes digests food differently – also not all pizza is created equal. Thick crust will take longer to digest than thin crispy. Veggie vs. Meat lovers – game changer.

Anyway – it was early enough in the day I thought all would be well. Eat at 4pm, do an extended bolus (insulin pump jargon for those taking multiple daily injections) and all should be well by bedtime in 5 hours.

I could not have been more wrong.

Bedtime blood sugar: 457 (see even those of us that have been dosing for pizza for over 7 years get it wrong and diabetes goes all wonky) (also note that we had neglected to check his blood sugar from 4pm to 9pm – not great after eating pizza)

I asked Sugarboy to dose for the elevated blood sugar (y’all do know that I don’t talk like that to my kids – that’s for y’alls benefit – what I actually say to my kids is “ok correct” but that wouldn’t make sense to some readers – then again most my readers are seasoned and would know so I could easily just type what I say and y’all would know but what if a newbie is here reading – imagine how “ok correct” would sound to them – holy crap I digress – also I might have used the word ‘y’all’ a few times and I’m not sure I took a breath while writing all this – can you say run-on)

Ok so Sugarboy dosed insulin to correct the high. He asked if he could sleep in my bed. With hubby away I love having him sleep in my bed. Also it makes for checking his blood sugar easier when he’s near me. (well it does but I still need to get up to check two other cwd so really thats a non-point)

He wanted me to go to bed with him. This is where mistake #1 was made.

I said I couldn’t because I would need to stay up and check his sugar in two hours so I could start the study computer.

His face dropped. He looked so sad. I thought because he wanted me to cuddle with him. I couldn’t cuddle – I would’ve fallen asleep – it wasn’t that I didn’t want to cuddle.

He then announced I could go to sleep. HE would stay up and check his sugar and start the study computer.

What? No. I tell him he needs to sleep and I have things to do so it’s all good.

It didn’t register right away. I mean it didn’t even register last night. It took till this morning to register what was happening. But Ill get to that in a second.

Two hours after he dosed insulin I checked his blood sugar. 431. #&@!

Ok so we likely didn’t screw up the dosing of the pizza. Clearly his infusion site (place where pump tubing attaches to body to deliver insulin) went bad. It was only at the tail end of day 2. The sites are normally good for 3 full days even longer sometimes if we forget to change it out.

Participating in the study last night was off the table. No big deal. Only it is since we are kinda on a time crunch since the study takes 3 months and we are moving at the end of 3 months. Each night we miss leaves us less of a window to finish the study.

Again no longer concerned about the study I focused on changing his infusion site. Sometimes I can get this done without waking him. Sadly we are out of the quickset infusion sets that are easiest to place IMHO. I had to use a different type of infusion site that I am not entirely familiar with.

I fumble around with placing the sensor in the applicator device for a good 7 minutes. I cock the device, remove the little plastic piece that protects the needle (or my fingers which ever), place it on his skin and press the release buttons that plunge the needle and flexible cannula into his skin. He woke up. He screamed in pain. He tried to grab at the applicator which I had not yet removed from his skin. I patted his hand and apologized. He went back to sleep. I gently lifted the applicator. @&#@

I had not removed the tiny pieces of paper that cover the adhesive parts of the infusion set. Thus the site came up with the applicator. I just punctured my kids skin for nothing. And worse, I’ll need to do it again.

Back downstairs. Another infusion set. Less time to place it in the application device this time around. Back up stairs. cock, remove paper, remove needle cover , place on skin, press, pull – Success – he did stir again but no scream this time. (I should note to any newbies or veterans considering a pump – very very rarely do my kids complain about pain when inserting a new infusion site. They agree it isn’t really painful and if it is, it only lasts a micro second. Now being lanced with a needle while in the middle of REM – well who the heck wouldn’t occasionally scream).

I fill the pump tubing with insulin then attach to his body. I dose him with insulin to correct the high. Keep in mind he has now likely been really really high (400+) for 7 hours.  The correction is a very large amount of insulin. If he had received any of the previously dosed insulin I could be putting him in danger. Thus I set an alarm to wake up in 2 hours.

At 1am my alarm goes off and I check his blood sugar. 301. I give him another correction. sometimes the longer a pwd is high the more difficult it is to correct. I don’t know the science behind it – I just knows it happens.

I set another alarm. 3am – 238. There is still a good deal of insulin working in his body so I do not do another correction.

This morning he is a very pretty 113. Of course he feels like crapola.

Meanwhile my other dear son is babbling (in his sweetest little voice) about a scooter he wants for Christmas. By this time I have heard about the scooter a dozen times in less than 24 hours. I’m fairly exhausted from the previous nights wompus with diabetes and I tell him so. I did this without thinking. I didn’t do it in an angry voice. I was sure to say “I’m sorry Middles I just can’t focus on the scooter right now because blah blah blah Im exhausted I didn’t get much rest can we talk later?” Middles understood and all was well, right?

No.

Sugarboy heard it all. He sat with his toast hanging limp in his hand half way to his mouth with a tear rolling down his cheek. He looked crushed.

He wiped his little tear, put down his toast and announced that he will stay up next time so I can go to bed.

Did you hear my heart break? I’m fairly certain it shattered on the floor.

I told him it wasn’t his fault. I told him diabetes is stupid. I told him I had things to do anyway. I told him I would nap later. I told him its not a big deal. I even lied and whispered to him that I was exaggerating because I didn’t want to hear more about a scooter. I told him anything I could think of to take the sadness and guilt off him.

So the moral – some unsolicited advice for other Dmoms and Ddads out there – be careful what you say in front of your little ones in regards to the hard times WE have helping manage diabetes. As much as we hurt for them they hurt for us. They see all we do, all we give up, how tired WE are and it makes them sad and makes them feel guilty. They have enough to worry about. We do this for them but they shouldn’t have to hear about it. They already know and if they don’t recognize it now they will when they grow and leave and have to spend a lifetime doing it for themselves. Just my two cents.

I love this kid.

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Snorks and Demons Be Damned

It’s been awhile.

I’ve not posted.

That could mean a lot of things.

It could mean that nothing has gone wrong.

It could mean no one has required me to put on big girl panties.

It could mean that life is too busy being awesome for me to take the time to share.

It is all of these above and for that, I am thankful.

Of course we have experienced some bad pump sites (infusion sites where insulin pump infuses insulin into the body). It happens. We change sites, correct highs and move on.

We have also had some yucky low blood sugars – in all three kids. They drink juice, eat a fruit roll up and tell me they are STARVING for 15 minutes but again we move on.

Just another month with our unwanted house guest that refuses to leave, occasionally puts its feet on our coffee table (we don’t actually have a coffee table – technically its an ottoman but saying ‘puts its feet on our ottoman’ really doesn’t cause the visual cringe like a coffee table image does), it makes a ruckus at night, it messes with the kids homework like a poorly trained dog, and in general gets annoying.

That is until last night. My littlest, my Sugarboy was 268 at bedtime which meant no cookie. For those not overly familiar with type 1 diabetes – normally he can have a cookie and take insulin but when he is already high I turn into the soup nazi and its “no cookie for you” only I say it with a hug and an apology. We dosed insulin, read stories and kissed good night. He was tired and his head hurt from the high blood sugar and I was sad for my son.

I plugged into my phone, hit play and listened to Percy Jackson battle a number of monsters in a labyrinth while I tidied up the kitchen, folded laundry and moped a floor. An hour later I was relaxing on the couch with my new John Irving book. An hour after that I checked blood sugars.

Kid #1 – all good.

Kid #2 – right as rain.

Kid #3 – Sugarboy – not so much, lower than he was before bed but not by much. I figured it was a stubborn high, dosed more insulin and returned to my comfy couch. Too sleepy to read I caught up on Big Bang Theory (oh that silly Sheldon), Modern Family (glad I’m not the Cam of the family), and Two and a Half Men (mmm Ashton).

At this point it is after 1am and I am fighting exhaustion myself. I check the boy. He is now higher than he was before bed. Insert a number of expletives here also insert a new infusion site. Luckily my boy did not wake up when I put a new infusion site on his backside, despite the needle that shoots through the skin to leave the flexible canula behind. When he has high blood sugars he sleeps more soundly than normal. His body is just exhausted from the additional glucose coursing through him and very likely some ketones (ketones are toxins produced when the body burns fat and fatty acids for fuel because it doesn’t have enough glucose available – the irony is the glucose is there for people with diabetes but the body is lacking the magic key (insulin) needed to use the glucose). Dose insulin. Kiss his forehead. Kiss his little hand that hugs his pillow and say a little wish that all will be well.

I set my alarm for 3am. I don’t always do a 3am check but with a new infusion site, high blood sugars and a large dose of insulin to correct a high blood sugar I do need to recheck him.

Fast forward to 6:05am when my normal alarm goes off. Great song playing ‘Demons’ by Imagine Dragons. It’s kind of a dark song but has a catchy tune and I take the lyrics as a warning not to let my demons rule my days. Sorry – digressed.

Demons – In case you don’t know the song.

As the song played on I realized I didn’t hear my 3am alarm. This is the scene where I leap from bed and down the hall in less than a blink of an eye. Crash into the boys room and pause for a half second to watch his chest rise and fall. He is alive. I didn’t overdose him with insulin. (Just FYI – I am not the only parent who watches for the rise and fall of a child’s chest when the child has Type 1 diabetes – trust me on that.)

I check his blood sugar. Insert more expletives. His blood sugar 468. He wakes up, tells me his head hurts, tells me his chest hurts, tells me his stomach hurts. Then he goes potty – you know that scene in Austin Powers  – the Wiz – yea it was like that.

Don’t know the scene – click here >>> The Wiz

I tell him about the late night highs and the new infusion site. I tell him it likely failed.

He took the one I put in at 1am off – thankfully without much complaint. Sometimes those suckers stick on pretty good and removing them can be as uncomfortable as getting a new one.

The reason the new site and correction dose of insulin at 1am didn’t work.

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Friggen snorks. Shakes fist in air.

The infusion set I put in at 1am didn’t take. The canula (flexible tube that stays under his skin) bent and therefore was not infusing insulin into his body. We here in the diabetes world call that a snork. (remember the cartoon with odd sea creatures with the bent snork on their heads – google it if you don’t and don’t be fooled by their cuteness – they are pesky little a**holes).

Put on a new infusion set and dosed insulin. Checked ketones – LARGE. He ate toast and a yogurt (yes he was high but the only way to clear ketones is to eat carbs, dose insulin and drink lots and lots of water).

His blood sugar at 9am – 270. He was going down which meant the new infusion site was working. Still had a long way to go plus he still had moderate ketones.

He stayed home from school. It wouldn’t have been safe to send him to school with a severe high blood sugar, large ketones and a wallop of an insulin dose. Not to mention he felt miserable.

It’s eleven now. His sugars are down to 180. Ketones are small. He is still home playing xbox and relaxing. I’ll let him veg the rest of the day – he’s earned it.

Meanwhile I was writing this in an attempt to clear my head and keep the demons (anger, frustration, fear) at bay. I like it better when I don’t have much to say. Take time to hug a diabetic today.

PS. was not my intention to rhyme so much – clearly I’m feeling lyrical.

High With A Chance of Ketones

I went to bed at 10pm last night.

All three kids safely within range with no active insulin.

I didn’t set any alarms for night checks, no reason to worry.

This morning I got up made coffee and packed lunches.

Middles got up and took a shower, checked BS (117) and ate breakfast. All was well.

Sugarboy got up, took a shower, checked BS (149) and ate breakfast. All was well.

No sign of Sweetstuff. I went up to get her moving guessing teenage girl ‘sleeping in’ issue. She was curled up still asleep. I nudged her and then poked her finger. As the meter counted down she mumbled “my site fell off”.

Huh? When?

She shrugged. She didn’t know when she just found it dangling.

(The infusion site that normally is stuck to her body that allows her to get a constant insulin drip was not attached.)

BS 418. Crud.

I ask her to get up and check for ketones. To check for ketones (something caused by lack of insulin – not a good thing) one must either pee on a stick or use a ketone meter to test the blood for ketones. We don’t have a ketone meter. She peed on a stick.

ketone1photo

Massive ketones. Not good. Chest hurts, feels nauseated, head hurts, pale.

To clear ketones she needs insulin, STAT. Plus time to start pushing fluids.

New infusion site, new insulin, yogurt consumed.

Moments later Sweetstuff is in the bathroom vomiting.

Call left on attendance line at school – Sweetsuff will be out today.

An hour later still large ketones. Sleepy child. Head hurts. Chest feels better. BS 271

Like me, when her head hurts she desires a hot shower, always makes head feel better.

2 hours later still large ketones. Still sleepy child. Head feels better. BS 201

3 hours later moderate ketones. Child is asleep on the couch. BS171

ketonephoto

Diabetes is stupid.

PS. Dear FDA – please hurry the heck up and approve Dexcom G4 for use with those under 17. Had she been wearing a CGM (continuous glucose monitor) this would be less likely to happen.

WTFedness

Yesterday a FWD (Friend with diabetes) posted on a social media site about a low blood sugar before dinner. She included the phrase “WTFedness”. I didn’t find her low humorous but the phrase “WTFedness” cracked me up and I told her as much.

Diabetes has been frustrating the crud outta me lately. Unexplained stubborn highs for both kids. Multiple bad insfusion sites (place where insulin pump is connected to their bodies). Pharmacy mishaps when ordering test strips and insulin. Late night lows/highs that require me to burn midnight oil.

At some point in the last week I had thought – this build up of frustrations needs a word. Truly I did think that. Then comes my friend’s post with the phrase ‘WTFedness’ (is it a phrase when it is only one word but that word is short for a number of words?)

WTFedness – yup pretty much says it all when it comes to my frustrations.

My friend wrote a blogpost about WTFedness yesterday – you should read Kelly’s post HERE.

Last night was a whole night of WTFedness.

Sugarboy

Before dinner was 241 – correction given with dinner bolus.

After dinner 7pm 262 – correction given (miscalculated dinner?)

Bedtime check 9pm – 278 – huh? correction given

11pm check (hoping all would be well and I could go to bed) 262 – WTF Diabetes – disconnected tubbing from infusion set (which was less than 24 hours old and worked properly earlier in the day) – primed tubbing (sent insulin though tubbing to clear any bubbles) – reconnected and gave a correction bolus. (how many parentheses are allowed in one sentence?)

1:00 am (really expecting all to be well and the boy would be going down) 262 – Yes this is where the WTFedness comes into play. Put in new infusion site and new insulin in pump. Moved the boy to my bed to keep an eye on him and set my alarm for 3am.

Slept through my alarm at 3am. Checked him at 6:30 – blood sugar 90.

All this of course happened just a day after his blood sugars were ridiculously high including a “High Glucose” the day before due to a bad site. Which was also the day before his endocrinologist appointment – screw you murphy and your damn laws.

So my question is do I have a box of bad infusion sites (same box working fine on daughter) or has the switch to Humalog from Novalog created a new level of havoc? Or is just typical diabetes WTFedness?

Backseat Driver

A twitter friend @Nitacure4t1d has joined the blogosphere at NitaCure. She wrote her first post yesterday Canada Day in regards to taking a road trip with her son who has Type 1 Diabetes. Comments on my blog give me all sorts of warm fuzzies so I do try to comment on other blogs frequently (do to others as you would have them do to you). As I began the second paragraph of my comment I realized I was hijacking her post with a post of my own. That is not good blogosphere etiquette (well I assume it is not good blogosphere etiquette – I don’t think there is a book on the subject but there should be – I also like saying blogosphere btw – it is a fun word). Thus I deleted my long windy comment and instead offered her the kudos she deserves for her first post. Yet I still had so much to say about road trips and diabetes – thus here we are.

Diabetes does not like road trips. I can attest to that. I am a road trip woman, partially because flying or even the idea of flying causes me huge panic attacks even with a double dose of Xanax, but also because I love to drive. I love the freedom of detours, Starbucks on demand and bathrooms that are larger than a coffin.

We have taken many road trips since D moved in. Our first road trip after Sugarboy was diagnosed was to the annual Children with Diabetes International Friends for Life conference in Orlando FLorida. This was 5 months after Sugarboy was diagnosed. It is an 18 hour drive from Austin Texas to Orlando Florida. We have made this drive 3 times. We never went directly to Orlando – we would stop by my most favorite place on this wonderful planet – Destin Florida (white powder soft sand and turquoise water – my happy place). Sorry digressed….

During that first road trip Sugarboy was still using multiple daily injections (one shot of long lasting Lantus and 4-6 shots of fast acting Novalog for meals, snacks, corrections). We were very new to diabetes and didn’t realize the toll long road trips would take on Sugarboy’s sugars. Sitting for extended periods of time raise blood sugars – it is that simple. (Did I just use the word simple in relation to Diabetes? I should be fined) Sugarboys sugars were high despite intense carb counting and free foods (no carb foods). With injections it is not possible to adjust basal insulin – you can increase the dose of long acting insulin but it is increased for an entire 24 hour period. That is not was we needed – once we arrived at the beach the boy was running around like mad playing in the surf – no additional basal needed for that. Basically Sugarboys sugars were a mess the days we were on the road but then also while on our vacation and at the conference (conference blood sugar craziness was likely caused by a such huge changes in our routines).

All our future road trips have been with insulin pumps which makes reducing the road trip highs a bazillion times easier since we can adjust basal rates to provide additional insulin for the time leading up to and during long drives which result in long periods of inactivity. Insulin pumps also allow us to decrease basals while enjoying beach time and theme parks since less insulin is required to increased activity. It’s been 5 years now and we are not experts by any means but we are getting better.

After reading my friends post and thinking about the travel that is in our near future I decided to search cyber space for more advice regarding road trips and traveling with diabetes. I found these sites to be very helpful.

How Stuff Works

Fit4D

While searching cyber space for tips for road trips with diabetes I stumbled on this little gem: controlling Diabetes Is Like Taking A Road Trip. It is a wonderful post written by Karen Marschel for KM Nutrition @KMNutrition on twitter. Oh the things we will find when we google. (I am not endorsing any products shared on Karen’s website – I just really liked her post. I have not fully explored her website otherwise – although I will likely add it to my list of things to do.)

 

Pumping Air

Last week was Diabetes Camp Week! It was AWESOME.

My kids blood sugars were the best they have been in months. Why is that?  I didn’t change basals (amount of insulin that is continuously given via the insulin pump) or I:C ratios (Insulin to Carb ratios ex. 1 unit insulin for 14 grams carbs) or ISFs (Insulin Sensitivity Factors – amount of insulin given to correct a high blood sugar)? Yet their BSs stayed between 78 and 176 while at camp. That mystery is for another post. This post I want to share a problem I hadn’t run into before – well I had but I didn’t know why until now.

At camp on Thursday Sugarboy’s tubbing became detached from the cartridge of insulin in his pump. He didn’t know how long it had been detached before he realized it. Someone (he can’t remember if it was his group leader or a medic) told him to just plug it back in. Don’t get to upset with the person – I have done the same thing.

After camp we went to a water park. We ate dinner before and Sugarboys BS was 227 so he dosed for his dinner and corrected. An hour or so later he wanted nachos for a snack. He had just eaten and dosed so I let him dose for his nachos without checking his BS. At home he was 358. I thought we had not dosed enough for the nachos so I corrected him. At bedtime he was HIGH GLUCOSE. Huh?

 

I thought perhaps his infusion site had gone bad so we put a new one on. His pump said he still had 46 Units of insulin available and it was late so I decided against a new cartridge of insulin and to use the old tubbing until I replaced the insulin in the morning.

Thus, I ran a prime (push insulin through tubbing to remove any air). While priming I noticed a bit of blood come out of the tubbing. Huh?

Seeing the blood I decided to remove the cartridge to investigate. Huh?

There was no insulin in the cartridge – just 46 units of air. Thus after the insulin that was in the tubbing was used for dinner, nachos and attempted corrections my boy wasn’t getting any insulin. Turns out while the tubbing was disconnected insulin drained from the cartridge (makes perfect sense). Thus plugging back in without priming and checking the cartridge is dangerous. I did share the occurrence with the medical director of the camp and she assured me that she does instruct the medics to send the camper to the infirmary so proper procedures are followed. It was an honest mistake that even I have made. Which explained why in Feb of this year I found a cartridge filled with air when I thought Sugarboy’s site failed. At that time I didn’t make the connection that the disconnected tubbing caused the air filled cartridge – thus I called Animas and explained the air filled cartridge and they believed the cartridge was faulty and sent me a new box of cartridges.

New cartridge of insulin was installed with new tubbing and site and Sugarboy was within normal ranges in three hours. He was negative for ketones. All was right in the world of diabetes (at least in our home).

Limitations

I Don’t do Well with Limitations

Day 29 Health Activist Writer’s Month Challenge

Sunday’s prompt: Six Sentence Story. In this day of micro-blogging – brevity is a skill worth honing. Can you tell a story and make it short and sweet? What can you say in six sentences.

First let me ask do parenthesis count?
So those of you who have read any number of my posts you are already laughing at this prompt when it comes to me. Brevity is not my forte. I will give it a go though.

There are times in the last 5+ years that one or more of my littles has said something regarding diabetes that stops me in my tracks, makes me force a smile, and then leaves me hiding in my laundry room silently weeping.

One of those times was when Sugarboy was only 3 and getting ready to check his blood sugar, he took out his canister of strips and noticed it was the last strip in the canister, thus he said to me, “wouldn’t it be great if when you ran out of strips diabetes would be done.”

Later that same year we took part in the JDRF Walk to Cure Diabetes – just before we began the walk Sugarboy asked if we got the cure at the end of the walk or would they mail it to us.

Another time just before his fifth birthday Sugarboy said he would be happy when diabetes went away after his birthday; seems he thought that D was something kids had until they turned 5 since his brother didn’t have D when he was 5.

Wait there’s more…

Sweetstuff viewed the sex-ed video at school when she was in forth grade, when she returned home I asked her if she understood everything, she said yes it was fine but then asked, “will my kids have diabetes?”

This last one isn’t a tear jerker – it is actually funny and I wanted to end on a happy note – btw this sentence doesn’t count. 😛

We were at a friends house and Sugarboy was playing with their big fluffy dog, I told him that Buttons has diabetes too, he looked under Buttons belly and moved his hands through her fur then asked, “Where is her infusion set?”

10 Things THEY couldn’t live without

10 Things THEY couldn’t live without

Day 13 Health Activist Writer’s Month Challenge

Todays prompt is to write a list of the 10 things you need (or love) most. Since this blog is intended to be mostly about being the parent of children with diabetes my list will not be what I need, it will be what they need.

Starting with the obvious:

  1. Insulin – well duh – sorry that was snarky but it is obvious. Without insulin my kids wouldn’t last long even if I put them on the starvation diets used prior to 1922 and the discovery of insulin.
  2. Method of injecting insulin – yes obvious but you would be surprised as to how often my kids or I get asked “isn’t their a pill”. Perhaps the folks asking that have heard that some people with diabetes take a pill to help their body utilize insulin. That is a true statement, I know of a number of people with diabetes or pre-diabetes that are not insulin dependent but my kids are have Type 1 diabetes so a pill will not provide all that their bodies require. Insulin is a protein so it can not be ingested, it would be digested by the stomach and intestines rather than absorbed into the blood to help unlock cells to allow glucose to be burned as energy. To inject insulin one needs an insulin pump or insulin syringes.
  3. Pump paraphernalia – Both my kids are pumping insulin so in addition to needing the actual pump they require insulin cartridges (small reservoirs that are filled with the insulin and housed in the pump). They also need infusion sets – a thin tube that connects to the insulin cartridge inside the pump as well as to a cannula that is inserted into the subcutaneous tissue with a funky UFO looking device (thanks to Kerri S @sixuntilme for the validation of my thoughts). I often imagine beating ignorant individuals (that refuse to be educated) with said tubing.
  4. Glucose Meter – The best way for me to help my kids to avoid future complications is to check (I try not to say ‘test’ as it implies pass or fail) their blood sugars at least 10 times a day (which is what the insurance companies deem appropriate – although my kids generally test about 12 times a day). Thus 4a would be the tiny test strips used to collect the blood sample. I think I read somewhere that the test strips cost about $.10 each to produce but cost $1.00 each (without insurance). Pisses me off.
  5. Fast Acting Carbs – My kids need instant access to fast acting carbohydrates in case of low blood sugars. At any given time my kids will have packages of smarties, fruit roll-ups, juice boxes, glucose tabs, or small tubes of frosting on their person or in their diabetes pack (currently using a case produced by REI intended to hold a handheld game system).

Moving to less obvious but not less important

  1. Hugs – my kids need hugs. They need hugs when their blood sugars are over the rainbow and they are cranky, frustrated and hating diabetes. They need hugs when their blood sugars are plummeted downward taking their ability to function normally with them. They need hugs to celebrate a success. They need hugs when the new infusion site stings like a bitch. They need hugs when an unDeducated (un diabetes educated) person tells them they shouldn’t or can’t do something or eat something – or worse when a narcissistic (although sometimes well meaning) unDeducated person shares the story of how their grandma had to have both legs amputated because of diabetes. They need and deserve hugs for all the times they try.
  2. Laughter – many say (and I agree) it is the best medicine. Finding humor in all that it diabetes makes it sting less. My sweetness has only recently begun to understand the humor in me saying in public “you better be high with your attitude” (not sure if that is a good thing). We make note of the times the kids are bstwins (both check to find the same exact number – happens more than you might guess). We draw eyes and scales on the little twisty paper that protects the adhesive on the infusion sets, meet George George . We giggle that Sugarboy never fails to have to go pee just as I am about to squeeze the sides of the quick set to place an infusion set. There is opportunity for laughter everywhere and we take advantage of it.
  3. Food – ok so this one is obvious too, however I don’t mean it in its most basic sense. I mean that my kids can eat everything their peers can. I know just because they can doesn’t mean they should and so I do try to limit the foods that will cause an ugly number. I let my kids go trick-or-treating and bring home pillow cases full of wonderful. (I actually encourage it – how else am I going to get a two months supply of Reese’s peanut butter cups?) The thing about all the holidays that involve candy candy and more candy is they forget about it after about a week. We put all the candy in a large container and the kids can choose a piece or two each day. This lasts about a week – I move the container slowly from a clearly visible spot to a less and less visible spot as the week goes on. By the end of the week the container is relegated to the top shelf of the pantry. It will stay there until the next holiday usually. We eat cake at birthdays and stop at Baskin Robbins a couple Tuesdays a month (kids cones only $1). I still make potatoes, rice and pasta but try to limit it to only a quarter of their dinner plate. We don’t use food as a reward or a punishment. Food is food and I don’t see the point in giving it any additional role.
  4. Diabetes Camp – This one truly should be part of the obvious as well. My kids (all three of them because diabetes effects siblings too) attend a day camp each summer called Camp Bluebonnet – Children’s Diabetes Camp of Central Texas. It is a week of fun in the sun (gets to be above 100 degrees here), laughing and learning with other children with diabetes, finding the courage to scale tall rock walls and fly down zip lines in the blink of an eye, playing in mountains of foam, competing in silly games that more times than not include dawning over sized clothing soaked in ice water. It is a week of feeling normal and meeting new besties. My daughter also attend Texas Lions Camp – a week long sleep away camp about 3 hours from our home. She will tell anyone and everyone that the weeks she has spent at TLC are the very best weeks of her life. I am a nervous wreck those weeks – playing a game of ‘wheres waldo’ while searching the 300+ photos that the camp posts on FB each day just for a glimpse of my Sweetness. This year my Sugarboy is old enough to also attend – I may start drinking that week.
  5. Friends – we all need friends and my kids are fortunate enough to have a few that aren’t just friends. They are other children with diabetes that ‘get them’. They also each have a few non-D friends that also get them and can identify a low or high blood sugar sometimes before my kids can feel it themselves. We love those friends.

So there it is the list of 10 things my kids need most – the second set of 5 meet my needs too.

    Pump Hiatus

    Woo hoo! (Feeling excited but maybe guilty too)
    In early February my dd “sweetstuff” decided she wanted a break from her insulin pump. Trying to convince me she used the idea that she would have better control with shots because she wouldn’t have the freedom to eat whatever/whenever. As a mom (who knows everything) I knew it was more about her feeling different at school and the fact that an insulin pump does not go well with skinny jeans and tight ts. I didn’t call her out on it though. I supported her choice to encourage diabetes ownership.
    For the last 5 weeks she managed her diabetes with MDI (multiple daily injections). She has done fairly well overall. Although, she treated the shots like she did her pump – she had no qualms about dosing for snacks in between meals. (So much for better control due to decreased snacking) She purchased an application called “RapidCalc” from the app store. http://www.gilport.com/rapidcalc/index.html
    Honestly it was a great application. We programmed it based on her carb ratios, insulin sensitivity factors, and target blood sugars. It basically did everything her pump did except deliver the insulin of course.
    The problem was of course the Lantus (long acting basal insulin). She started off with 10 units and hovered in the upper 200s each night. We increased to 11 units and still she was in the mid 200s. We increased to 12 units and that put her in the 60s. We were using the Lantus pen which only dosed in whole units. No problem, we switched to syringes and dosed 11.5 units and she was in the upper 100s low 200s. (We used each dose for 4-5 days prior to making a change)
    Using the Lantus worried me – flashbacks to the months post diagnosis for both my kids left me in a constant state of worry. Both of them would be in the 40s for 4-6 weeks after diagnosis at the wee morning checks despite constant reductions in Lantus. (Honeymoon??)
    The pump was such a blessing for both of my dear children. Being able to reduce/increase basal as needed made a huge difference in control and allowed for much needed sleep for me. While using Lantus I checked blood glucose multiple times during the night – never allowing myself more than 3 hours of sleep in between checks.
    So a few nights ago after reading a post by Kerri S. www.sixuntilme.comregarding a stranger in the airport in which Kerri discussed her pump, my dear Sweetstuff decided she wanted her pump back. It likely also had something to do with me suggesting she might actually have better control using her pump and thus decrease the chances she would develop complications much later in life. (Disclaimer – I know a number of pwd that successfully use MDI and have excellent A1Cs – without the extreme highs or extreme lows but those that I know are also very disciplined in that they eat low carb meals, don’t snack, and exercise daily.) That does not describe my daughter. Like most 12 year olds she loves carbs, hates exercise and loves to snack too.
    So that evening she said she wanted her pump back. We had already dosed her Lantus that night so I suggested she sleep on it and think more about it in the morning. I didn’t want to feel as though I coerced her.
    The next afternoon she asked if I had figured out her basal programs so she could start the pump again. I actually had not. I had written them down when she gave the pump up – knowing that after 24 hours of being off the pump would reset itself and I would lose the programs. In my lack of organization I had misplaced my note (is that irony? – I have the hardest time understanding what is actually ironic – Alanis Morissette got me all confused with her song)
    Late yesterday I found my note. She had asked me a number of times in the interim if I had found it. I replaced the pump battery, programmed it (wishing I had loaded insulin first so the dang thing would quite alerting me to lack of priming and causing me to scroll through the menu options a half dozen times). I loaded insulin and waited until her normal Lantus dose time to invite her to put an infusion set on. She seemed excited – like she had cleaned her room and found an old toy that she had misplaced and forgotten about.
    We put on the infusion set and connected the pump. Then we both realized that the last low profile clip we had was broke (those dang things last just over the 3 month warranty mark). We did have a rotating pump clip. (I actually have 4 – we were asked by Animas to try them and report back – I really should do a blog post regarding them.) She was not excited about the rotating clip (reasons to be explained in future blog post). Thus, she chose to wear her spibelt instead. (Love our spibelts. http://spibelt.com/?gclid=CMqIyLb08K4CFQK9tgodVgT3Kgfor those that are not familiar with spibelt – they do have diabetic specific belts that have a pass-through hole for insulin tubing.
    Sweetstuff’s bedtime check was 168 but she had eaten a fudge bar an hour or so earlier and still had insulin working. Her 3am check was 104 (woot woot) and her morning check was 122. I could likely increase her 3am basal dose by a bit but I’ll wait a few days to be sure.
    I feel so much calmer with Sweetstuff back on the pump. I hope she doesn’t regret her decision tomorrow when she returns to school after the last week off (spring break). I also hope she doesn’t resent me and feel coerced back on the pump.

    Mommmy gets an F on her report card

    Worst A1Cs since diagnosis.


    Yup – it’s true. I suspected due a few recent infusion site failures, missed corrections, and missed meal boluses for both kiddos that we would indeed have higher A1C’s than we did in November. Once you factor in Thanksgiving and Christmas food consumption – time off school resulting in a nearly laissez faire attitude by everyone except the Diabetes Nazi (that’s me) – we were bound to have gone up despite my efforts to pre-bolus, increase basals, reduce between meal snacks, etc. both kids were higher – nut just higher but the highest either had been in years.


    I try not to take it personally – but how else should I take it? I promise I have and never will judge another parent or patient regarding their kids or their own A1Cs – God knows I wouldn’t want to be judged by others but that doesn’t mean I will sit by and shrug it off. I will make promises to myself to download meters and pumps weekly – double check that corrections and meal boluses are done promptly and correctly (what was I thinking not following up with my 12 and 7 year old to be sure that they heard me say – “do a correction” “dose for that” over iCarly and Spongebob. Who can compete with Spongbob?) and discourage the spoonfuls of Nutella (I admit it is goo but I don’t buy it – my dh does). It isn’t that they don’t dose for their nutella – it is having them understand that 2 TBSP does not mean a heaping serving size spoon.


    On top of the A1C smack to the face my dd has been insisting that she wants to go back to shots and take a break from the pump. Thus we left the endo’s office with insulin pens. Lord help me – I feel I am a smart person. I am educated – the state of Texas even says I can teach children. But going back to doing all the math that goes with shots – I can’t get my brain to function before 4 cups of Joe in the morning – AND worse – my daughter – who is a math superstar (advanced courses in school) has a difficult time remembering to empty her lunch box everyday after school among other things. I know she can do the math but her remembering to do it is another thing. I know there are lots of adults and kids that do MDI and have fantastic results. Some may do it because using the pump is more costly and not all insurance plans cover it well if at all. Some may not like the idea of being tethered to a pump. I know there are lots of reasons. My daughter tried to sell me on the idea of returning to shots as follows:


    Me: “You don’t need a snack, you just ate. If you must have a snack can you make it a free snack? All this snacking in between meals can be hard on your body.”


    DD (yelling – thus caps) “THAT’S WHY I WANT TO GO ON SHOTS!”


    Me: “you don’t need to yell. We can have a conversation about it without yelling. How will going back to shots stop you from snacking?”


    DD “I wouldn’t snack if I knew Id have to take a shot.”


    Me “Why not just choose not to snack now?”


    DD “I can snack now because I use the pump. If I didn’t have the pump I wouldn’t snack and I would get better control.”


    Me “Your logic is flawed. You can’t rely on your insulin therapy method to teach you impulse control and better food choices. Why don’t you just make better choices.”


    DD stomps off and says that I hate her.
    The biggest problem here is she has inherited her fathers logic and his lack of will power. ie. If the snacks aren’t in the house he won’t eat them. Thus – both admit that they have zero impulse control. That will not serve her well as she grows and has to take care of her own D.

    At 8:30 pm she received her first Lantus shot in nearly 3 years. It was 10 units and I won’t be sleeping tonight at all. It didn’t help that we ate Olive Garden tonight and we clearly under counted carbs – she was 410 at 10:30 (3 hours after dinner dose). Thank goodness we used the pump to dose for dinner so at least tonight I could put her BG in the pump to determine her correction dose that I would be giving with the Novalog Pen. I can easily do the math but the who IOB thing is beyond my math skills – at least until I figure out at what rates the RAI breaks down.

    Worst Part of today – We got the Trial Net results back regarding my non-diabetic son that agreed to be tested at our local JDRF Walk to Cure Diabetes in October. The results – all positive (and I don’t mean positive news). I knew they would be based on random BG tests I have taken from him. Also, on how really fast acting carbs like candy effect his mood. Most of the time his BG numbers were within range. A handful of times he was above normal but not far enough above to check him into the ER. Also his A1C (yes my dear endo has been kind enough to test him for me) has not been above 5.1. Yet here sitting on my desk next to my late night cup of Joe I have a page that clearly indicates that he is at a much higher risk of developing Type 1 than others.

    Sometimes I really do wish I was a person that could relax with a glass of wine – I’m not. I’m more of a venti non-fat cinnamon dolce latte with only 3 pumps of syrup and no whip kinda gal.