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……

A Lesson In Parenting

Parenting lessons come at us in many ways.

Some lessons are from friends or colleagues who have ‘been there, done that’.

Some lessons are overt as with our own mothers or mother-in-laws that come to help with a new baby, especially the first baby.

Some parenting lessons are learned by observing or experiencing ‘bad parenting’ and consciously choosing NOT to be that parent.

There is an endless supply of books on parenting – most of those I was given or purchased have never been opened.

Then there are the social media posts, often inspirational quotes with adorable pictures of toddlers with muddy hands or faces full of food, or the posts that talk about how a piece of paper crumpled and then unfolded will never be the same thus be careful with words. I think there were also a few commercials some time ago that depicted young kids picking up the same “bad” habits (cell phone use, smoking, drinking, etc) by watching their parents.

whisper-meme

My favorite (read ‘most humbling’) way to receive parenting advice is from my own child.

My middle child – who I often refer to as Middles, is 13 now. He is in the 8th grade. He is taller than me now, his voice is getting deeper and he has just a bit of peach fuzz on his upper lip. He is clever and funny and kind and I love him for exactly who he is, even on the days I want to throttle him.

Middles has had diabetes the least amount of time between my kids. He just past his two-year diaversary on August 1st.

Being diagnosed with diabetes is never easy and every person (kid or adult) handles the diagnosis differently and also manages their diabetes differently. Some with more zest than others. Even then, ones diabetes management often has an ebb and flow due to diabetes burnout, life circumstances and for those diagnosed before the age 12 – puberty.

In my experience my Middles has had the hardest time with diabetes. My youngest (Sugarboy) was diagnosed at age 2 so he really doesn’t know a life without diabetes. My oldest (Sweetstuff) was diagnosed at age 9, and while she remembers life before diabetes she was young enough to develop a routine and habits before puberty hit. Middles diagnosed at age 11 clearly remembers life before diabetes and didn’t have enough time before puberty caused his front lobe to take a sabbatical. (IMHO)

All my kids have off days when they forget to check blood sugars or bolus for lunch or a random snack but Middles forgets most often. There were school days toward the end of the school year last year in which he went a couple of weeks without a single blood sugar check during the school hours. Now before you are tempted to judge my D parenting skills and wonder how I could let a couple of weeks go by without verifying or downloading (giggle) meters let me say I put a lot of trust in my kids and the majority of the time I am not disappointed so I don’t act like the diabetes police 24/7. Instead I do random checks on their meters – the randomness of the checks typically keeps them on their toes while allowing us to put diabetes in the corner and focus on the really important stuff like how my boys can’t seem to get their aim just right in their bathroom.

So going back to the couple of weeks of no checks…

Once I discovered the discrepancies, discussed the discrepancies with Middles and provided time for my son to get his act together I did another check. Imagine my surprise when there were few to no checks. That earned Middles the privilege of checking his blood sugar in the health office 3x a day for the last few weeks of school. He was not pleased but knew in advance what the consequences would be if he didn’t pull it together. School ended and we moved on.

Before the start of this school year we discussed how he would return to independence but chronic forgetfulness would land him in the health office 3x a day again.

Alas, I checked his meter last night. No checks for the last 7 school days. Bugger.

Now I should have likely waited a bit before discussing the issue with my dear teenage front lobe deficient son. I was a bit worked up, not just for the lack of blood sugar checks but for a few non-D related issues with him. I didn’t wait. I called him downstairs and with very little planning laid into him in a manner reminiscent of Tom Cruise (Lt. Kaffee) cross-examining Jack Nickolson (Col. Jessep) in the final court scene of A Few Good Men. (Shared below for those under the age 40 who may not have seen it. Pretty sure my face looked just like Tom’s in the still shot below).

Middles reacted just as one would expect – (re-watch if needed with Col. Jessep playing the role of Middles)

It wasn’t pretty.

Me: yell, yell, accuse, yell, threaten, etc.

Middles: yell, yell, deny, accuse meter of being faulty, yell, yell

Me: more yelling, more accusations, more threats.

Middles: Crying

long pause

Me: (ignoring what I saw as deflecting behavior) “Empty the dishwasher please.”

Middles: (slamming cabinets as he puts away dishes) “You know mom, you could have just been nice.”

Me: “What? What do you mean?”

Middles: (In a voice that was supposed to be mine) “Honey. I noticed you haven’t been checking your blood sugars. Is everything ok at school? I worry about you. Is there someway I could help you remember to check”

Me: (I had nothing. I just stood there with my jaw on the floor. I knew he was right and I knew I was just schooled by my 13 year old) finally I said “You’re right. I could have handled this better. I shouldn’t have yelled. What can I do? How can I help you?”

Middles: (because I wasn’t humbled enough) “Well, you could hug me more”

And that, ladies and gentlemen, is how your own children give you parenting advice.

 

Whack A Mole

When my kids were younger I would take them to Chuck E Cheese often. We lived in Texas and the summers were hot so the days we didn’t hang by the pool we would hang out with the mouse. Yes it was a petri dish of germs. No I didn’t take hand sanitizer, might not have even required the kids to wash hands before eating. A favorite game was always Whack A Mole. All three of my kids loved whacking the mechanical moles and often we would race since there were two games right next to each other. There was something therapeutic about whacking those plastic heads repeatedly always trying to beat the game.

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It is no longer therapeutic. The moles are no longer cute plastic rodents with hard hats and a grin.

The moles are highs and lows, the game never ends and I don’t get any tickets to trade in for trinkets.

Also I am now playing three games at once. Are you imagining me dashing between three arcade machines with a mallet whacking heads? Oh and the mallet – it is always attached to a single machine with a short cord so often I forget which mallet I’m holding and find myself flat on my ass because I tried whacking a mole with the wrong mallet. (giggling yet? It’s ok – I find humor in it too because if I didn’t I’d need to be drunk off the cheap beer)

My kids are 15, 13, and 11. Hormones, puberty, outside play, missed boluses, sports participation, lazy day electronics, lack of any meal schedule, late nights, endless snacking, and more make the whack a blood sugar game all that more difficult.

Yesterday on a FB page for parents of kids with diabetes another mom was waging war on a stubborn high with her 14-year-old son. Multiple highs and multiple corrections with different insulin (MDI) and she and her son likely felt they were using a 19th century flintlock pistol to lay siege on an enemy using 21st century armor. At least that is how I felt between 10pm and now at 6:30am. In the FB feed when she first posted her concerns of repeated highs despite corrections I, like others, had said if it’s a pump it may be a bad site. If it is MDI it may be bad insulin. Any chance the child was sneaking food? This exchange took place long before my 13-year-old returned home from a babysitting gig and learned of his 432.

Of course he isn’t currently wearing his Dexcom so he didn’t realize. He had checked his blood sugar at 7pm and was in the upper 200s. He and the boys he was watching ate pizza (yes part of the issue I’m sure) and he bolused and corrected. I called him a bit before 9 and asked him how he was. He checked BS and was in the 400s. He corrected.  He returned home a bit after 10 and checked, still in the 400s. He corrected again with his pump thinking it was pizza related and went off to bed, well he is a 13-year-old boy and it was a Saturday during the summer so he corrected and went off to veg in front of his Xbox. A bit after 11 I was going to bed and asked him to check again, 512. What? New pump site, new insulin, correction, kisses good night, alarm set for 1am for me. 1am – 355 not a big drop for 2 hours. Another correction. 3am 279. 6:30am 224. Stubborn ass high for sure. A losing battle of Whack A Mole or laying siege to a heavily armored enemy with a flintlock. Either way I am left feeling defeated.

Every person and child with diabetes reacts differently to insulin – oh and there are different brands of insulin that work better in some than others. Teens have raging hormones that seem to taunt the best offensive line of diabetes management.

I think I may have strayed from my original intention of this post which was to describe what it is like trying to help 3 kids of different ages and genders manage diabetes. Different games of Whack A mole – trying to use the same mallet on all three games, etc. It is true – corrections like the ones my middle son completed would have likely corrected my youngest son with little difficulty – less hormones. The corrections would have also corrected my daughter easily on most days. Why is correcting highs in my 13-year-old son more difficult? Perhaps his pump settings such as his correction factor (how much insulin he gets to correct out of range blood sugars) needs adjusting – although we had increased the ratios just a few weeks ago.

I’m not sure this post has any redeeming qualities. I think I was mostly venting. But if you ever feel like you are playing an endless game of Whack A Mole perhaps you will find solace in knowing it is a game we all play at times and if you are a parent of a teen and the game is getting harder, it is normal. I hope you won’t make the same mistakes I have made and accuse your teen of sneaking snacks (although mine really does often sneak snacks but nearly always boluses for them). I have found the less I trust my teen to be doing the right things (how do we define the right things in a teen that wants to be normal?) the more difficult it becomes to help him manage his diabetes. When he is high and I try to help discover why he immediately goes on the defensive. That isn’t helpful to either of us. I have never punished my kids for high blood sugars and I’ve never rewarded them for in-range numbers. I commend them for checking and bolusing but that is about it. Still the temptation, especially towards my middle child, for me to say “what did you eat?” is a strong one. I have said it many times and accusing him (whether I was correct in my assumption or not) has built a wall of defense. I don’t need an additional wall of defense to negotiate while trying to battle the actual blood sugar.

Sigh. 3 kids with diabetes, two teens and one right on their heels.

Thank goodness for coffee, cookie dough ice-cream and the diabetes online community.

Random Encounters

It wasn’t the first time I met someone with a diabetes connection while in line to get a latte, probably won’t be the last.

Last weekend the daughter and I were in target. After checking out we stopped by the Starbucks located inside Target. (How ingenious is it to have Starbucks inside Target? If only movie theaters would follow suit.) While in line I placed a call to husband to ask him to have Sugarboy check his blood sugar because he had been in the 400s twice that day. The second time because he didn’t correct the first 400. I did not use the word diabetes.

I ended the call (funny how the phrase ‘hung up’ isn’t really in our vocab any more – curious if there are teens across the country saying ‘no you end. No you end. I’m not ending first, ok lets end together’)  <<(blame my ADD) and asked daughter if she wanted a beverage. Just then I made eye contact with another mom ahead of me. She smiled and simply said “type 1?”

We chatted for a few minutes while the sweet barista waited patiently to take my order. Sneaking a peak at the two children with her I asked if she also had a child with Type 1. She answered in the affirmative but her cwd wasn’t with her. Her cwd is a 14-year-old daughter and she shared that her daughter is currently having a ‘hard time of it’.

My daughter isn’t always excited to share with the general public that she has type 1 so before I made any mention of my daughters diabetes I stole a glance at her and she nodded her permission.

I told the other mom I had 3 with T1D. I waited the few seconds for that to process with the other mom. Often when I share ‘that’ with parents a couple of things happen – they sneak a peek at their non-T1D kids and their faces show a brief look of concern and I imagine they are thinking ‘what, how, why – really? could my other?’ I think it can be a scary thing to meet a family with multiples so I usually toss in a comment like ‘we are not the norm’ and watch as they relax a bit. I can’t recall if I added that tidbit during our brief encounter.

After sharing that I have 3 cwd I told the mom my daughter was also 14. Since my brain is mush lately – it being the last week of school – I can’t recall all we chatted about in our brief coffee line meeting. I do recall mentioning CGMs (Dexcome G4) and inviting my daughter to show off her TSlim pump which was greeted with the typical ‘oohh and ahhh’ (I mean lets face it Medtronic and Animas have nothing on TSlim when it comes to the initial WOW factor – it is sleek and sexy (I don’t use the word ‘sexy’ with my kids but if ever an insulin pump could be sexy the TSlim is) it is also very easy to use and IMHO a fabulous choice for teens and adults – my boys are still rock’n their Animas Pings and I do love them (the pumps and my boys of course) too) – how many parenthesis are in that run on sentence?

I also asked if the her child would be attending a sleep away diabetes camp this summer. She will be, the same week as my daughter. I saw the corner of my daughter’s mouth curl with a smile. My daughter isn’t nearly as excited about meeting other T1Ds or T1D families in the wild. She is happy to spot them, like some diabetes game of eye-spy but rarely wants to approach them. She tolerates my enthusiasm to a point. She was a good sport this day.

I gave my contact information to the other mom and wished her well.

Meanwhile a meet-up of families with kids attending various weeks of diabetes camp was coming together via a private Facebook group for the area. Thinking of the sweet family Sweetstuff and I had met I sent an email to the sleep away camp. I had nothing but the child’s name and HS she would be attending. The mom had introduced herself but alas my brain….

My contact at the camp was able to locate the family and shared the meet-up info with the family. I wasn’t trying to be weird or come off as stalking the other family, I just wanted to invite them to the meet-up. Thankfully when the mom emailed me she assured me she didn’t think it weird. Unfortunately they are out of town the day of the meet-up but we hope to get the girls together before camp.

My point to this post – I don’t really have one. I just thought it was fun to share.

well I guess I have a couple of points:

First – always be sure your kiddo is ok with you sharing diabetes stuffs – even if when they were younger they didn’t mind and actually participated in sharing – the silly thing about kids is they grow and they become these separate little people with their own thoughts and preferences. I am very cautious about what I share regarding my daughter now and almost always get her permission first – whether it be here on the blog, in a line at target or on other social media. There are many things I wish I could share because maybe something I share would help someone but the thing is this isn’t all my story it’s hers and she needs to own it. I guess that’s a bit off topic from a random diabetes encounter but since I had mentioned that she doesn’t always want to share I thought Id explain further.

Second – well there isn’t really a second but since I started with ‘first’ I think proper grammar/writing rules says there has to be a ‘second’ something like in an outline you need a ‘B’ if you have an ‘A’. I’m not always great with grammar which is why its unlikely I’ll ever write a book.

I do love random diabetes encounters.

The membership to our club is costly but I must say the members are priceless.

Leg Transplant??

You’re Gonna Give Me Your Leg?

Sweetstuff has had some really cruddy numbers the last few days. Pump is working fine – it’s her brain that is malfunctioning. In the last 72 hours Sweetstuff has forgotten to bolus for a meal 3 times resulting in numbers in the “Hi” range. She forgot twice to put her pump back on after a shower resulting in numbers in the 400’s.

Tonight at bedtime she was 403 – which resulted in a WTH (heck – she was kind enough to use the G rating) comment. (This was one of the times she had forgotten to put her pump back on after a shower 2 hours earlier).

At this point she said “I’m just so overwhelmed lately”

I told her that it is a stressful time for our family with the impending move to a new state. I reminded her that it is the end of the school year and she has had some fairly large projects to work on and also that her big solo at the choir concert is tomorrow. It’s a lot to handle for a 12 year old.

She replied  “If I am making this many mistakes now how will I manage when I move out, go to college, get a job, and have kids?”

I told her about so many of my DOC (diabetes online community) friends that are living well with Diabetes – most have full-time jobs, are parents, successfully navigated college and have no complications.

She replied again “But what if I keep making mistakes – and my leg falls off”

I told her first that everyone forgets things, mistakes can be fixed, that the fact that she cares enough to correct her mistakes means she is doing things right. I also told her that her leg wouldn’t fall off – it would have to be removed. (I said the last part with a sarcastic smile of course) Then I added “and I will always be around.”

To which she replied “You would give me your leg?” (also with a sarcastic smile)

I love my sweetstuff – she will be just fine.
Tomorrow she will sing “A World of My Own” from Alice In Wonderland
She has also decided that from henceforth her pump shall be called Alice