I’m just here for the gloves.

It is 2015 and just so there is no confusion later this really is the year Marty came to in the future.

maxresdefaultAlthough that has absolutely nothing to do with this post. Honestly it has nothing to do with anything but somehow that picture has shown up on my Facebook feed a half-dozen times since Jan 1st. Granted similar photos showed up in the past only claiming that 2012, 2013, and 2014 were all the years Marty went to. Why is this so important to people? Anyway – be sure to post on your Facebook feed how everything you post is covered under copyright law – I hear that is important. Do it while sipping okra infused cinnamon water and your personal photos will be protected while you cure diabetes.

Moving on –

My kids all have had Endo appointments in the last 1.5 weeks.

I took the boys separately but together, meaning I took them together but separate from my daughter.

I took all three kids to the appointment before this one and honestly I am surprised we all made it out alive and free of any criminal charges. Seriously – my advice (free of charge) to any parent with multiple kids with diabetes or just multiple kids in general. Schedule separate appointments if you can. Doctors visits are stressful with just one kid. The stress for all parties increases exponentially with each additional patient.

Ok so the boys had their appointments back on December 29th.

It was time for blood work too.

IMG_5282 IMG_5283Those finger puppets were in the sticker basket. I was about to try to distract the boys from the poke of the blood draw needle but honest to goodness the blood whisperer (the man whose head you see) had poked each boy and drawn their blood in less than 2 minutes flat each. Neither boy felt the needle or knew what the heck happened before the blood whisperer dismissed them. *I did not name this saint of a man the blood whisperer. I was informed who he was after posting the picture of Sugarboy on my FB page wherein another Dmom saw it and told me about the blood whisperer. He is well-known in our community as being the best phlebotomist within 100 miles of Seattle.

As far as the actual appointments went – the boys A1Cs both came down a fraction. I don’t typically share A1Cs for two reasons: 1) Diabetes is not a competition 2) It is an average. I could say my boy had an A1C of 5.5 and all that might mean is he spikes extremely high and then plummets to the lowest of lows – and voila a very pretty A1C. *my boy is not 5.5 – I was simply using that as an example.

Sadly the appointment did come a good week into the holiday break which meant the weeks numbers prior to the visit were useless. Eating at random times, continuous snacking, lots of high carb treats, missed boluses, sleeping in, staying up till the witching hours and hours and hours of sitting in front of a game system. (yup – my kids spent quite a few hours playing video games and I’m not ashamed to admit it. Ok I am a bit ashamed – we could have, should have spent more time out doing something together, but they don’t get a ton of screen time during the week and this was their break and by golly it was mine too. I’m fairly certain a weeks – fine two weeks – of video games will not have ruined them for life.)

Anyway I asked the endo to ignore the pump/meter downloads from Dec 20th on. Instead we focused on the first weeks of December. In general the boys are doing well. Each is checking blood sugars 7-10 times a day and bolusing at least 4-5 times a day thus covering meals and snacks. Middles had quite a few boluses without blood sugars and spent many afternoons/every evenings above target. The doctor discussed how grazing or frequent snacking and bolusing without blood sugars is often the reason for the later afternoon/early evening highs. Post hoc ergo propter hoc. Middles agreed to cut down on random milk consumption and snacking and improve his bolusing with blood sugars.

Sugarboy didn’t have much to discuss. The doctor noted his post lunch lows and it was determined that he boluses before eating but often runs out of time before finishing his lunch. It was decided he would bolus for half his lunch prior to eating and then the remainder of his carbs after he is done. This is how he had been bolusing for lunch since kindergarten. This was the 1st year he had switched to a straight up pre-bolus.

It was a painless visit for all of us despite blood draws – seriously every endo office needs a blood whisperer.

You still with me? – How boring is this post right? I feel like some comic relief or intermission is in order. I read this  in a comment on tumbler and I am dying to try it.

Next time you are in a public rest room and you are washing your hands and a stranger comes up to wash their hands, cup your hands under the water to allow it to pool. Allow it to run over your hands. Then with a stone serious face say to the stranger “this water is getting out of hand.”

Did you get a good laugh? Maybe stretch your leg? Good.

Sweetstuff’s visit was tonight. (which was now last night because it is ow Tuesday morning)

She hates hates hates the endo. Not any particular endo – all endocrinologists. They tell her what she is doing wrong. They nit-pick, they tell her what she has to do or should be doing. There is nothing my daughter hates more than someone telling her what she should be doing or needs to be doing. Well, she hates the sound of someone chewing. She also hates the sound of the dogs lapping up water, and her cat cleaning herself, and she isn’t particularly fond of loud breathers. But her real hatred falls on endos.

Her appointment was at 5pm. I made dinner early and fed all the kids. She and I left at 4pm to get into the city. When we arrived I asked her if she wanted Starbucks and in the same breath told her she would be getting blood work done. While she was saying something like “yes, wait, what the heck?!$&?#!” I asked her again’ so how about Starbucks?’. We checked in and then went to the blood draw window. I told the receptionist I needed the blood whisperer (only I used his actual name). My daughter gave me the most annoyed yet somewhat intrigued look. We found a comfy spot to sit and soon she was called back for her blood draw. I told her she wouldn’t feel a thing and it wouldn’t take but 2 minutes. She gave me an exasperated look and declared to the blood whisperer that she was a hard stick due to spider veins. Where does she get this stuff? Three minutes later she came out looking both in shock and in awe. She admitted it was crazy how quickly and painlessly the whisperer did his job.

Moments later we were called back for measurements and vitals. She got on the scale and then checked her height. At this point I declared “You’ve been weighed. You’ve been measured and you’ve been found wanting.” She rolled her eyes. I was cracking up. It isn’t often I can quote a favorite movie in the literal sense. She was not impressed. Well she didn’t let on that she was impressed but I saw the corner of her mouth curl up just a smidgen while she shook her head with disapproval for my shenanigans.

When the nurse came in to ask for Sweetstuff’s pump I inquired if they had yet received the software to download a TSlim. They had not. They (the hospital group) have not endorsed the Tandem pump just yet. No doctor in the group has prescribed one (although I think our doctor would like to). I had anticipated that and I had printed out a months worth of pump data and meter data.

When the doctor came in with A1C results and to discuss the pump data with me I motioned her (the endo) towards my daughter. I said “she needs to discuss it with you, I’m just here for the gloves” waving a couple of rubber gloves in the air. Seriously the kids and I totally play with the gloves while we are there and I always leave with a few in my pockets – you never know when you might need a non-latex glove.

Sweetstuff’s A1C also went down. Not exactly where we want it but not anywhere that would suggest she isn’t doing most of what she needs to do. Her data shows 5-8 checks a day and 4-6 boluses a day. While she has had a number of extreme highs they could be explained by missed boluses, bad infusion sites or the occasional dead pump battery or pump out of insulin. She is a teen and while I don’t like to admit it to her often – she is doing a very good job most of the time and her occasional blunders are nothing out of the ordinary for a teen her age with diabetes.

The endo pointed out a half-dozen ways she (my daughter) was doing wonderful and made only a few suggestions of things that might improve some of the not great numbers. The endo complimented her on the number of blood sugars taken and her lower A1C. The endo never criticized, told her she was screwing up, or even told her she could do better. It was the perfect visit.

My daughter left feeling empowered and successful. IMHO – there is no better way to help a teen with diabetes do better than to allow them to feel pride and independence.

Woohoo! 3 Endocrinologist visits done and no school was missed. All the kids doing well. Plus I scored a few gloves.

My bit of advice – again free of charge:

  • Don’t fret over numbers the few days before endo visits – those numbers right before will not have an effect or large effect on your kiddos A1C overall. That goes for my adult friends with diabetes too – so many of you fret over bad numbers right before the endo. Stop that.
  • As much as possible have the endo talk to your child, even the littles ones. Empowering the kids makes a humongous difference in how they view their diabetes – do they view it as theirs or yours? Let them own their success or their short comings.
  • An A1C is not a report card. It is a progress report and can help you/your kiddos see what needs to be done to change things. Still it is an average – the numbers could be 400, 36, 390, 54, 512, 59, 464, 61, 63, 42, 119, 84, 72, 123, 111 averaged = 172 which would be roughly an A1C of 7.5 which is what the ADA recommends for kids. In no way are the imaginary numbers I listed above healthy. Again an A1C is an average of the amount of sugar in a person’s blood over a 2-3 month period. I was once told by an endo that just 2 missed boluses (resulting in a substantial highs) can increase an A1C by as much as 0.5. Imagine how many missed boluses a teen has in a 2-3 month period. Those 2+ missed boluses are not the only indication of how well the teen is managing his/her diabetes. 
  • Download pumps and meters at home between endo visits. I don’t do this and I should. Those pie charts, bar graphs and line graphs provide a wealth of information. I have no problem changing my kids basal rates, carb ratios, and correction factors. Why do I avoid pump downloads? Imagine how much more informed I would be if I looked at the data each month and taught the kids how to review the data. The data from Middles pump showed clearly that he was bolusing without blood sugars. I had no idea and it had been a chronic issue with him since school began. Knowledge is most certainly power.
  • Don’t forget your gloves. They are basically party favors from the endo.

I know this was long, but seeing as I haven’t posted in a couple of months I was making up for it.

Happy New Year all.

May 2015 find you happy and healthy, surrounded by love and laughter and full of moments that turn to memories.


I Hate Cliches

I Hate Cliches

Watching a slow motion train wreck….
That is what everything with my Middles feels like.
Today I took Middles to our endocrinologist. They drew 6 vials of blood to run a full diabetes panel. They also had him do a glucose tolerance test and checked his  A1C. It will be a week before I know all the blood work results.
According to Middles A1C of 4.3 and his glucose tolerance test (109 fasting start, 170 at 1 hour mark, 130 at 2 hour mark) he does not have diabetes.
However – with the half dozen blood sugar results that were 200+ postprandial (that’s 2 hours after a meal) in the 72 hours prior to visit; combined with frequent urination, increased thirst, stomach aches, chest pain, headaches, leg soreness (not associated with physical activity), positive results for all the antibodies associated with Type 1 and the fact that his 2 siblings already have Type 1 – the Endo believes diabetes is coming. It may be a month, a year, ten years – etc. but it is coming.
My hope – to get Middles into a study (there is one in the San Francisco area) that focuses on slowing if not stopping diabetes in people that are at high risk. Maybe I can divert the train.
As for right now – his numbers today and most of yesterday were all within normal range. Even after eating a personal pan pizza from Pizza Hut (they are addictive and should come with a surgeon generals warning) his blood sugar never went above 142 (we were running late for soccer and they all begged me – don’t judge).
The Endo instructed me to continue to check his blood sugar 2 hours after meals and get a fasting blood sugar each morning. It made me sad to see him “excited” to have his own meter complete with a new style of lancing device Delica – which I tried and am pleased to say it is way less painful than the older model.
I will continue to discourage High Glycemic Index foods high glycemic index foods (sorry no cupcake for you). Again – I want to say that I am normally a “let them eat cake” kinda Dmom but I want to reduce the chances of blood sugar spikes allowing his pancreas to keep plugging along – no need to add stress to an organ that is clearly having a hard time keeping up. The improved diet will likely improve the D control my other two have as well. I have always believed and advocated that people with type 1 diabetes can eat everything people without diabetes can eat BUT that doesn’t mean any of us should be eating some of the crud we put in our bodies (stay the heck away form my Reese’s – they have protein in them).
Thank you everyone for your support during this crazy time for our family. I truly appreciate all the emails, tweets and comments. Thank you God for allowing me to be wrong this time – even if it’s temporarily wrong – if it is coming please let it wait till after the move, after puberty, after college – is there ever an OK time – doubtful.
For now we keep plugging along – I think we can, I think we can, I think we can…..

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.

A1C day is coming

One Week to A1C Day

I know it isn’t a true indication of diabetes “Control” – scratch that – Management. What the heck is control anyway? A very cool, very smart, very funny man known as Diabetes Dad posted a funny on FB last week. I will copy it below but know I don’t claim any credit for it and further I can’t find where I copied it from other than it was a link on the FB page of  Tom Karlya .

If I can find said link I will share it because aside from the above picture there were others. See I am a huge LOTR fan (not to mention the small fact that Viggo Mortensen who played Aragorn is not the least bit hard on the eyes). Anyway for those that have not memorized the LOTR movies, there is a scene in which it is told that to destroy the ring it must be thrown into the fires of Mordor. “One does not simply walk into Mordor. Its black gates are guarded by more than just orcs. There is evil there that does not sleep, and the Great Eye is ever watchful. It is a barren wasteland, riddled with fire and ash and dust, the very air you breathe is a poisonous fume. Not with ten thousand men could you do this. It is folly.” The most difficult thing imaginable right? Thus one does not simply “Control Diabetes”. Not that managing diabetes without letting IT manage your life is the most difficult thing imaginable. I have met and know many whom manage IT very well but “control” –  I don’t know that word will ever fit. Here is where I admit that I have not merely digressed but have actually jumped trains from the point of my original post and will return you now to the regularly scheduled programming.

Both of my kids have their quarterly Endo appointments a week from tomorrow. (Albeit not with their regular Doctor – I was notified that she is leaving the practice and this saddens me deeply and I dearly hope she will stay local with a new practice so we can follow her – (insert sigh affirming hope and recognition that I have strayed from topic). This last week has been a diabetes roller coaster riddled with failed sites and forgotten boluses. Multiple huge highs for both kiddos and a number of over corrections resulting in some ugly lows thus causing rebound highs. I’d like to get off this ride please.

I know I am not alone when I feel as though all things go kablooey (medical term) the week or two prior to an endo visit. Knowing (or rather having been told by various diabetes educators and doctors) that just 2 missed boluses a week can result in an increased A1C by as much as .5%. We don’t usually miss 2 boluses a week – normally – but the week or two before the endo visits we sure seem to. Again – the A1C (Glycated Hemoglobin average over a 2-3 month period) – is not a perfect report card regarding diabetes management – however it always feels like one. The A1C is considered a fair indicator of future complications though from my understanding. Ideally I should try to keep my kids A1Cs in the low 7 range (normal non-diabetic range is 4-6). I’ve never been pushed to try to get them to the normal range because it is believed that having a “normal” number would likely mean a great deal of low blood sugars or higher risk of low blood sugars since the A1C is an average of blood sugars over the 3 month period.

I know that most that would care to read this know all this and likely know a great deal more than me. This post serves two purposes – well turns out three but the last was by accident. First – I get to vent and talk through things in my head. Second – it opens the door to those who are smarter than me or have valuable information or thoughts to share to leave comments that I (and others) can learn from. The third and accidental purpose was to allow me to share a picture of Viggo.

Still learning this blog thing – thanks for checking in.