In the middle of Diabetes Blog Week, I got really sick and dropped off the face of the internet. At some point I plan to go back and post about the remaining topics, but first I wanted to share what happened last weekend. L had her first sleepover since her diabetes diagnosis. The next morning, when I picked her up, she said, "that was pretty much my worst nightmare come true". I couldn't blame her.
Now that she's using an insulin pump, we need to check her blood glucose (BG) levels more frequently, for a couple of different reasons. 1) She no longer has the nighttime long-acting insulin shots, which means that she no longer has background (basal) insulin that lasts 24 hours. Instead, she gets a basal dose every hour. Which brings us to 2) if there is a malfunction with her insulin pump (kink in the cannula, air bubble in the tubing, bad insulin, mechanical malfunction), the only way we will know if she is not receiving the proper dosage due to the above-mentioned possibilities, is if we check her BG and she's way high. So we need to keep a very steady eye on her BG to make sure she doesn't go crazy high, which, aside from making her feel crummy also raises the long-term risks of kidney failure, blindness, amputation, and heart disease.
Additionally, if she has a low BG overnight, it is possible that she wouldn't feel the effects and wouldn't be able to treat herself or let us know she needed help. In some cases, this can lead to a coma or worse.
So! I set my phone alarm to wake me up overnight and check her. On the three hour schedule, this usually means I check her at midnight-ish, 3-ish, and then when she wakes up for school. (Since she sleeps in on the weekends, I get up again at 6-ish. I reckon it will be the same for our summer schedule.) ANYWAY. All of this backstory is to illustrate that at a sleepover, she would be responsible for checking herself a couple of times in the middle of the night. We had a test run at home, where she set her phone alarm to try to wake her up, but she slept right through it. So the plan was for her to call me with her numbers when they were finally going to sleep (probably around midnight anyway) and then I would call her cell phone at 3am and stay on the line while she checked herself. Except that her friend's house was in a dead zone, so her cell phone wouldn't work. Luckily we knew this ahead of time, so I told her I would call her on the home phone at 3am. Phew.
Okay, so there were a couple of different possible scenarios.
1) Her BG is running in the target range when she goes to bed. (between 80-120), which would require no intervention.
2) Her BG is running on the high side when she goes to bed (anything above 120), which would require no intervention, aside from possibly a small insulin correction, if it were really high.
3) Her BG is running low when she goes to bed. (anything under 80), which would require her to take some fast-acting crabs and then test again in 15 minutes.
Or, the I-don't-even-want-to-think-about-it-because-it-would-be-the-worst:
4) Her BG is running low when she goes to bed and then when we check her at 3am she is STILL low and has to take more crabs and stay up and check herself in 15 minutes.
Can you guess how things went down? Yeah.
She was 145 at dinner, at 6:30 pm and she had pizza, which is historically a difficult thing to treat for, but we did our best to guesstimate. She was supposed to call me when they were getting ready for bed and by the time 11:30 rolled around, I still hadn't heard from her, so I called her. She hadn't checked herself at 9:30 like she was supposed to, and now she was 296. I wouldn't have minded her being a little on the high side overnight, but that was higher than I was comfortable with (especially since it had been well over 3 hours since she'd had her dinner insulin, so I just figured we had under corrected for the pizza). I told her to take 1 unit of insulin (a normal correction at that time of night would have been 1.5, but since she was away from home, I wanted to minimize the chance of her going low. HA!).
Cut to 12:50 am, and everyone is getting ready to go to sleep. She calls me and her BG is 74. Not a bad number, if it's the middle of the day, but we don't like her to go to bed under 100. So I tell her to have 5 fast-acting crabs and call me back in 15 minutes.
1:18 am - 64. WTF? I ask her to test again.
1:19 am - 76. That’s better, but not awesome. I tell her to take 5 more crabs.
1:42 am - 142. Perfect. I tell her I’ll call her in 3 hours.
4:50 am - 93. Not so great for overnight. I ask her to take 5 crabs and call me back in 15.
5:03 am - 82. WTF?? She’s getting upset. I don't blame her. Her friends are sleeping around her and she's trying to be quiet and test in the dark and not wake them up while she opens her candy wrappers. I tell her to take 5 more and call me in 15.
5:16 am - 73. Are you freaking kidding me? She starts to cry. She wants to come home. I do not blame her, but I try to convince her she'd feel worse if she had to leave. I tell her to take 5 more crabs. Pass the phone to John. He talks her down a bit.
5:35 am - 68. GIVE ME A FREAKING BREAK. I tell her to take 5 more crabs. She is nearly hysterical. She really wants to come home. She has a stomachache and feels terrible. I nearly tell her we'll be right there (even though she's half an hour away), but John says he thinks he can get her to calm down. He tells her that she's just feeling bad because she's so tired and because of the low BG. He speaks in soothing tones and gets her to breathe normally. He reminds her of how bummed she'll be if she misses out on all the playing she and her friends are planning in the morning when they wake up. He tells her how proud he is of her for making it so far and says it's just a bit longer until morning. He asks her to call us back in 15 minutes.
5:51 am - 104. THANK FREAKING GOD. She is relieved but still wants to come home. John continues to calm her down over the phone and she finally agrees to try to go to sleep. It’s already starting to get light outside. He is father of the year. She is the bravest girl I’ve ever known.
By the time she wakes up and has breakfast at 9:30 am, she's 171. She calls me to let me know what she's having for breakfast and she sounds great. By the time we pick her up at 11 am, she's running around outside with her friends and doesn't want to leave. As we walk to the car, I tell her how incredibly proud I am of her for sticking it out and “See? Now you know you can do it! The worst possible scenario actually happened, but you stuck it out and dealt with it and anything that happens next time will be no biggie, right?”
Right.
Thursday, May 27, 2010
Friday, May 14, 2010
moronic moment (day 5)
Today's topic was meant to be the role exercise plays in your diabetes management, but my kid is 10 and she plays soccer and swims and goes to recess and PE and there's not much more to it than that. So instead I have chosen to play one of the blogging week wild card options: Moronic Moments.
Picture this: your kid has just transitioned to using an insulin pump and you're doing your best to remember all the different things that need to be taken into consideration with this treatment versus multiple daily injections. One thing to keep in mind is that if she needs to take a shower, but it's not time to change her infusion set, you'll need to protect her site so that the warm water doesn't cause the adhesive to peel off.
*lightbulb* Why don't we use some tegaderm to cover that bad boy up?
Oh wait, pick me, I know this one!
(now)
BECAUSE TEGADERM IS THE STICKIEST SUBSTANCE THIS SIDE OF WHATEVER THEY USE TO AFFIX PRICE TAGS ONTO THE GLASS PART OF PICTURE FRAMES (I MEAN SERIOUSLY WHAT IS THAT ABOUT), SO WHEN THE TIME COMES TO REMOVE THE TEGADERM FROM YOUR CHILD, PREPARE YOURSELF FOR THE HORROR THAT IS THE INFUSION SET BEING PULLED FROM HER TENDER BELLY, AS IT IS HAS SOMEHOW FUSED WITH THE TEGADERM, AND AS YOU BEGIN TO UNWITTINGLY YANK THE CANNULA FROM BENEATH HER SKIN, THAT THING WILL BEND AND POKE HER AND CAUSE PERMANENT EMOTIONAL DAMAGE TO ANYONE UNLUCKY ENOUGH TO HAVE BEEN INVOLVED, NOT THE LEAST OF WHICH, OBVIOUSLY, IS YOUR TEN-YEAR-OLD DAUGHTER.
Rookie mistake. Won't be making it again.
Picture this: your kid has just transitioned to using an insulin pump and you're doing your best to remember all the different things that need to be taken into consideration with this treatment versus multiple daily injections. One thing to keep in mind is that if she needs to take a shower, but it's not time to change her infusion set, you'll need to protect her site so that the warm water doesn't cause the adhesive to peel off.
*lightbulb* Why don't we use some tegaderm to cover that bad boy up?
Oh wait, pick me, I know this one!
(now)
BECAUSE TEGADERM IS THE STICKIEST SUBSTANCE THIS SIDE OF WHATEVER THEY USE TO AFFIX PRICE TAGS ONTO THE GLASS PART OF PICTURE FRAMES (I MEAN SERIOUSLY WHAT IS THAT ABOUT), SO WHEN THE TIME COMES TO REMOVE THE TEGADERM FROM YOUR CHILD, PREPARE YOURSELF FOR THE HORROR THAT IS THE INFUSION SET BEING PULLED FROM HER TENDER BELLY, AS IT IS HAS SOMEHOW FUSED WITH THE TEGADERM, AND AS YOU BEGIN TO UNWITTINGLY YANK THE CANNULA FROM BENEATH HER SKIN, THAT THING WILL BEND AND POKE HER AND CAUSE PERMANENT EMOTIONAL DAMAGE TO ANYONE UNLUCKY ENOUGH TO HAVE BEEN INVOLVED, NOT THE LEAST OF WHICH, OBVIOUSLY, IS YOUR TEN-YEAR-OLD DAUGHTER.
Thursday, May 13, 2010
to carb or not to carb? (day 4)
Today's prompt: Today let’s blog about what we eat. And perhaps what we don’t eat. Some believe a low carb diet is important in diabetes management, while others believe carbs are fine as long as they are counted and bolused for. Which side of the fence do you fall on? What kind of things do you eat for meals and snacks? What foods do you deem bolus-worthy? What other foodie wisdom would you like to share?
First of all, reading the Shakespearean title of today's topic has inexplicably put 80'schart-topping dance hit "Girlfriend" by Pebbles in my head. Why did she pronounce question "quest-eee-own"? And why can't I get it out of my head?
As for whether our family eats carbs or not, the short answer is: yes. The long answer is, well, longer. L was diagnosed with Type 1 Diabetes last fall after a very difficult spring and summer. We had been operating for several months under the assumption that she had multiple food allergies, and starting in April of last year, we implemented some very severe dietary restrictions. We called it The Reboot, and the foods we removed from her diet included, but were not limited to: gluten, milk, corn, eggs, peanuts, soybean, wheat, yeast, and much much more. We managed to stick to the reboot for a few months, and it was an absolute nightmare. Initially, we saw an improvement in some of her symptoms (stomach/headaches, mood swings), but eventually those all creeped back in, and in some cases, got even worse. Gee, I wonder why? OH YEAH, IT'S BECAUSE SHE HAS DIABETES.
Needless to say, by the time L was diagnosed with T1D, it was a bit of a relief, because then we knew for sure what we were dealing with, and there was a very specific way to treat it. On her first day in the hospital, she actually uttered the phrase, "If I can have a brownie, I don't care how many shots I have to get!" So, as difficult as it was to go through the whole Reboot thing, I believe it actually made the T1D diagnosis easier to deal with. Go figure!
So, yes, we do not restrict her carb intake. Especially since by the time she was finally diagnosed, she had lost 10% of her body weight. We were happy to do anything we could do get those pounds back on. I reckon that in the future, as she continues to grow, we may have reason to adjust her "diet plan". But as it stands now, that is what works for us.
First of all, reading the Shakespearean title of today's topic has inexplicably put 80's
As for whether our family eats carbs or not, the short answer is: yes. The long answer is, well, longer. L was diagnosed with Type 1 Diabetes last fall after a very difficult spring and summer. We had been operating for several months under the assumption that she had multiple food allergies, and starting in April of last year, we implemented some very severe dietary restrictions. We called it The Reboot, and the foods we removed from her diet included, but were not limited to: gluten, milk, corn, eggs, peanuts, soybean, wheat, yeast, and much much more. We managed to stick to the reboot for a few months, and it was an absolute nightmare. Initially, we saw an improvement in some of her symptoms (stomach/headaches, mood swings), but eventually those all creeped back in, and in some cases, got even worse. Gee, I wonder why? OH YEAH, IT'S BECAUSE SHE HAS DIABETES.
Needless to say, by the time L was diagnosed with T1D, it was a bit of a relief, because then we knew for sure what we were dealing with, and there was a very specific way to treat it. On her first day in the hospital, she actually uttered the phrase, "If I can have a brownie, I don't care how many shots I have to get!" So, as difficult as it was to go through the whole Reboot thing, I believe it actually made the T1D diagnosis easier to deal with. Go figure!
So, yes, we do not restrict her carb intake. Especially since by the time she was finally diagnosed, she had lost 10% of her body weight. We were happy to do anything we could do get those pounds back on. I reckon that in the future, as she continues to grow, we may have reason to adjust her "diet plan". But as it stands now, that is what works for us.
Wednesday, May 12, 2010
my biggest supporters (day 3)
Today's topic: Sure, our diabetes care is ultimately up to us and us alone. But it’s important to have someone around to encourage you, cheer you, and even help you when you need it. Today it’s time to gush and brag about your biggest supporter. Is it your spouse or significant other? Your best friend, sibling, parent or child? Maybe it’s your endo or a great CDE? Or perhaps it’s another member of the D-OC who is always there for you? Go ahead, tell them just how much they mean to you!
Two people popped into my head when I read the prompt, and I decided they were equally important, so I'm gonna write about them both.
My husband, John. We are totally 50/50 partners in L's care. He cooks for her, measures her food, remembers complicated math calculations, calls in prescriptions, works hard at a job so that we have excellent insurance that makes the financial difficulties related to a chronic illness less of a burden, checks her in the middle of the night when I'm too tired, takes over her care 100% when I run off on rock 'n' roll roadtrips, inserts her infusion sets with the gentlest of touches, taps out air bubbles in her insulin reservoir like a pro, treats her like the rest of the girls on her soccer team when he coaches, knows how to make her laugh during the most dire of situations, juggles his schedule to make sure he's at every doctor's appointment, and gives me great kitchen hugs, when nothing else seems to help.
The other person I couldn't do this without is L herself. That probably sounds totally bizarre, but bear with me. This kid. Man. From the very beginning she has amazed me with her ability to adapt. Whether it was her insane zen breathing technique during Lantus shots, or the fact that on the first day back to school after her diagnosis, she rocked her medical alert necklace on the *outside* of her school uniform, or the way she mocked retinal neuropathy in our JDRF video by making the creative choice to rhyme "site" with "sight", I am constantly amazed by her humor and resilience.
Don't get me wrong, we spend plenty of moments lamenting how completely messed up it is that she has to deal with all this shiz, but they are far outnumbered by the times that we do our best to laugh it off and just get on with it. So thanks you guys, for being on my team.
Two people popped into my head when I read the prompt, and I decided they were equally important, so I'm gonna write about them both.
My husband, John. We are totally 50/50 partners in L's care. He cooks for her, measures her food, remembers complicated math calculations, calls in prescriptions, works hard at a job so that we have excellent insurance that makes the financial difficulties related to a chronic illness less of a burden, checks her in the middle of the night when I'm too tired, takes over her care 100% when I run off on rock 'n' roll roadtrips, inserts her infusion sets with the gentlest of touches, taps out air bubbles in her insulin reservoir like a pro, treats her like the rest of the girls on her soccer team when he coaches, knows how to make her laugh during the most dire of situations, juggles his schedule to make sure he's at every doctor's appointment, and gives me great kitchen hugs, when nothing else seems to help.
The other person I couldn't do this without is L herself. That probably sounds totally bizarre, but bear with me. This kid. Man. From the very beginning she has amazed me with her ability to adapt. Whether it was her insane zen breathing technique during Lantus shots, or the fact that on the first day back to school after her diagnosis, she rocked her medical alert necklace on the *outside* of her school uniform, or the way she mocked retinal neuropathy in our JDRF video by making the creative choice to rhyme "site" with "sight", I am constantly amazed by her humor and resilience.
Don't get me wrong, we spend plenty of moments lamenting how completely messed up it is that she has to deal with all this shiz, but they are far outnumbered by the times that we do our best to laugh it off and just get on with it. So thanks you guys, for being on my team.
Tuesday, May 11, 2010
making the low go (day 2)
The description for today's blogging subject is: Tell us about your favorite way to treat a low. Juice? Glucose tabs? Secret candy stash? What’s your favorite thing to indulge in when you are low? What do you find brings your blood sugar up fast without spiking it too high?
Since I'm not the one who has to shove fast-acting crabs* down my pie hole, I think I'll let L answer this one on her own. She's participating in World Diabetes Blog Week (as she called it), though her first post was cut short due to bedtime last night.
*Late one evening I composed an email to friends explaining the treatment for low blood sugar, which is administering 5-15 grams of fast-acting carbs. However, in my haste, I neglected to notice that I had misspelled "carbs". We have called them fast-acting crabs ever since. COMEDY!
I will take this moment to relate a frustration that L runs into occasionally, when she is at school or a soccer game, and she gets a low blood sugar and has to treat it (usually with Skittles or jelly beans). Invariably, one of her peers will say, "Oh my gosh, you get to have candy? YOU ARE SO LUCKY!!!" This is even after she has previously explained to them that it's not a treat but a medical intervention. She came up with a comeback, which goes a little something like this: "Oh yeah! I sure am lucky! Maybe one day, due to diabetes, I'll have my feet amputated, and then I can be in a wheelchair and jump to the front of the line for rollercoasters! LUCKY!"
As you can see by the length of her retort, it's kind of clunky and doesn't roll off the tongue. Also, slightly mean-spirited. So, I was wondering, have any of ya'll encountered similar situations? And if so, what do you/your kids say?
Monday, May 10, 2010
a day in the life . . with diabetes (day 1 of dbw)
Today is the first day of Diabetes Blog Week, launched by Karen at Bitter-Sweet, so here's what yesterday looked like for our family. (For those of you just joining us, my daughter L is 10, was diagnosed 8 months ago, and has been on a MiniMed insulin pump for about 6 weeks.)
(Apologies for the length and inexplicable tense changes.)
11:06 pm (Saturday night) - 218 BG. Slightly higher than the 183 she was just an hour before, so I bolus .8 units. I was a little sleep-deprived from a recent rock 'n roll roadtrip, which is why I made the mistake of correcting her. Why was that a mistake, you wonder? Because when I checked her three hours later...
2:12 am - 76. Not so good, Al. I suspend her basal (thanks to Meri's suggestion, but have the feeling it won't be enough, so I hang out in L's room for 15 minutes and test her again. But I fall asleep on her floor and wake up a half hour later and she's...
2:40 am - 58. Well that wakes me up. Run downstairs, grab an orange juice from the fridge and race back to L's room to try to get her to wake up and drink some OJ. She slurps on the straw, half-asleep, until I determine she's had about half of the mini-bottle (approximately 15 grams of carbs). She rolls over and goes back to sleep. But I am too amped up from the excitement. I check her in 15 minutes and she's...
3:01 am - 112. Now that's a number I can go to sleep on. Phew. But just in case, I set my alarm for two hours, instead of the recommended three. Everything is still so new with the pump, and we just changed her basal rate a few days earlier, so since she's already had one instance of an overnight low, I feel more comfortable checking her sooner rather than later.
5:01 am - 97. This is well within the target range, but she's not supposed to go to sleep if she's under 100, so the number makes me a bit anxious. I decide to check her again in 15 minutes.
5:16 am - 95. Taking the meter's margin of error into account, she is holding steady. But I am still feeling nervous, so I decide to test her again in a little bit. I get into bed with her and doze off.
6:01 am - 98. I am encouraged that she continues to hold steady. I feel comfortable enough to get back into my own bed. Luckily she has slept through all of the testing, and only had to wake up once to chug some OJ. She wakes up at about 9 am, but since it's Mother's Day, I get to sleep in. Yay!
9:14 am - 149. She's not hungry right away, so she waits to correct her BG until she has some breakfast, about an hour later. She has 52 carbs (two bowls of Lucky Charms) and the pump says that she needs 3.6 units of insulin to cover her breakfast and her high BG. She spends the morning hanging out with her dad, watching Mythbusters. She learns that redheads have a higher tolerance for pain than their blonde and brunette counterparts, and women can deal with pain better than men. As a red-headed girl, she concludes that she can handle more pain than a substantial percentage of the rest of the world. I cannot disagree.
1:27 pm - 249. Her CHECK BG alarm goes off, as it had been three hours since her last bolus. I am surprised that her number is so high, but I don't think much of it, and she follows the pump's calculation of a 1.8 correction. We head out to see a movie, and plan on having snacks there and an early dinner afterward. We settle into our seats in the theater and she grabs for her tester. She's feeling low.
3:08 pm - 42. WHAT. Did we overcorrect for her high BG an hour and a half ago? Maybe it was an inaccurate reading? WHO KNOWS. She pops 15 jelly beans and then digs into her hot dogs. Low blood sugars always make her super hungry. She has no problem polishing off two hot dogs and a small bag of popcorn all by herself. John boluses her for the hot dogs at 3:17 pm (1.2 units for 20 carbs) and at 3:39 he programs a square bolus for the 44 grams of carbs in her popcorn. We have only recently begun experimenting with the extended bolus features of the pump, and we still don't quite have the hang of it. (For those of you who do not eat and breathe diabetes every day, a square bolus simply means that instead of injecting the 2.7 units of insulin all at once, the pump will deliver it over a longer period of time based on a percentage/time equation that you program into it. This is especially helpful when L is eating things that take longer to process, such as popcorn, pasta, or ice cream. Phew. Are you still reading? Only 9 more hours to cover in this post!) After the movie, we go to the bookstore and make good use of some gift cards. Then we go to dinner. L is still full from her movie food, so she doesn't have anything to eat. It's probably for the best since the restaurant we chose does not have nutritional info, so we would have been guessing the carb count of her dinner anyway.
6:57 pm - 294. She still has a small amount of active insulin on board (.5) because of the square bolus earlier, so the pump corrects her BG with 1.9 units. We get some ice cream for dessert and we are fully stoked because they DO have nutritional info. Her small order of chocolate fudge ice cream with rainbow sprinkles is 49 carbs. John decides to program her pump with a dual wave bolus due to the dairy content. Like the square bolus mentioned above, a dual wave bolus is designed to extend the delivery of insulin over time, rather than delivering it all at once, since the body takes longer to process certain foods. In the past, when she was on multiple daily injections, which does not allow for delayed insulin delivery, she would experience a low BG right after some meals, followed by a wicked high BG a few hours later, depending on how much fat or protein was in the meal vs. carbs. Are you still with me?? I'm still learning all this myself, so I don't feel that I'm doing the best job explaining it, but basically, in this instance, John told the pump to give L 10% of the insulin right now (.4) and spread the other 90% (2.8) out over the next hour. Okay. So. We head home after ice cream and settle in to watch the season finale of The Amazing Race (Go Cowboys!). We wouldn't normally let L stay up late on a school night, but it happens to be time to change her infusion set (we have to do so every 2-3 days), and we have to give the numbing cream an hour to work, so as soon as we walk in the door, John puts the EMLA cream on her belly so it can start working its magic. As we watch the show, John loads a new insulin reservoir into her pump. After an hour has passed, during a commercial break, he inserts the new set into her belly and hooks up the freshly refilled pump. She rubs some baby oil on the old site and pulls it out. It's time for her to go to bed.
11:32 pm - 289. I test her for the last time of the day on my way to bed. A little high, possibly from the infusion set change. I worry that there's an air bubble or a kink in the tubing that is interfering with the insulin delivery. I bolus 1.4 units and hope for the best. I set my alarm for 2:30 am and get in bed, so we can do it all again tomorrow.
(In case you're on the edge of your seat wondering, she was 263 at 2:38 this morning, so I corrected her with 1.1 units. When I checked her again at 5:41, she was down to 116. Much better. So, on we go...)
Tune in tomorrow for Day 2 of Diabetes Blog Week. I promise it won't be this long and boring! ;)
(Apologies for the length and inexplicable tense changes.)
11:06 pm (Saturday night) - 218 BG. Slightly higher than the 183 she was just an hour before, so I bolus .8 units. I was a little sleep-deprived from a recent rock 'n roll roadtrip, which is why I made the mistake of correcting her. Why was that a mistake, you wonder? Because when I checked her three hours later...
2:12 am - 76. Not so good, Al. I suspend her basal (thanks to Meri's suggestion, but have the feeling it won't be enough, so I hang out in L's room for 15 minutes and test her again. But I fall asleep on her floor and wake up a half hour later and she's...
2:40 am - 58. Well that wakes me up. Run downstairs, grab an orange juice from the fridge and race back to L's room to try to get her to wake up and drink some OJ. She slurps on the straw, half-asleep, until I determine she's had about half of the mini-bottle (approximately 15 grams of carbs). She rolls over and goes back to sleep. But I am too amped up from the excitement. I check her in 15 minutes and she's...
3:01 am - 112. Now that's a number I can go to sleep on. Phew. But just in case, I set my alarm for two hours, instead of the recommended three. Everything is still so new with the pump, and we just changed her basal rate a few days earlier, so since she's already had one instance of an overnight low, I feel more comfortable checking her sooner rather than later.
5:01 am - 97. This is well within the target range, but she's not supposed to go to sleep if she's under 100, so the number makes me a bit anxious. I decide to check her again in 15 minutes.
5:16 am - 95. Taking the meter's margin of error into account, she is holding steady. But I am still feeling nervous, so I decide to test her again in a little bit. I get into bed with her and doze off.
6:01 am - 98. I am encouraged that she continues to hold steady. I feel comfortable enough to get back into my own bed. Luckily she has slept through all of the testing, and only had to wake up once to chug some OJ. She wakes up at about 9 am, but since it's Mother's Day, I get to sleep in. Yay!
9:14 am - 149. She's not hungry right away, so she waits to correct her BG until she has some breakfast, about an hour later. She has 52 carbs (two bowls of Lucky Charms) and the pump says that she needs 3.6 units of insulin to cover her breakfast and her high BG. She spends the morning hanging out with her dad, watching Mythbusters. She learns that redheads have a higher tolerance for pain than their blonde and brunette counterparts, and women can deal with pain better than men. As a red-headed girl, she concludes that she can handle more pain than a substantial percentage of the rest of the world. I cannot disagree.
1:27 pm - 249. Her CHECK BG alarm goes off, as it had been three hours since her last bolus. I am surprised that her number is so high, but I don't think much of it, and she follows the pump's calculation of a 1.8 correction. We head out to see a movie, and plan on having snacks there and an early dinner afterward. We settle into our seats in the theater and she grabs for her tester. She's feeling low.
3:08 pm - 42. WHAT. Did we overcorrect for her high BG an hour and a half ago? Maybe it was an inaccurate reading? WHO KNOWS. She pops 15 jelly beans and then digs into her hot dogs. Low blood sugars always make her super hungry. She has no problem polishing off two hot dogs and a small bag of popcorn all by herself. John boluses her for the hot dogs at 3:17 pm (1.2 units for 20 carbs) and at 3:39 he programs a square bolus for the 44 grams of carbs in her popcorn. We have only recently begun experimenting with the extended bolus features of the pump, and we still don't quite have the hang of it. (For those of you who do not eat and breathe diabetes every day, a square bolus simply means that instead of injecting the 2.7 units of insulin all at once, the pump will deliver it over a longer period of time based on a percentage/time equation that you program into it. This is especially helpful when L is eating things that take longer to process, such as popcorn, pasta, or ice cream. Phew. Are you still reading? Only 9 more hours to cover in this post!) After the movie, we go to the bookstore and make good use of some gift cards. Then we go to dinner. L is still full from her movie food, so she doesn't have anything to eat. It's probably for the best since the restaurant we chose does not have nutritional info, so we would have been guessing the carb count of her dinner anyway.
6:57 pm - 294. She still has a small amount of active insulin on board (.5) because of the square bolus earlier, so the pump corrects her BG with 1.9 units. We get some ice cream for dessert and we are fully stoked because they DO have nutritional info. Her small order of chocolate fudge ice cream with rainbow sprinkles is 49 carbs. John decides to program her pump with a dual wave bolus due to the dairy content. Like the square bolus mentioned above, a dual wave bolus is designed to extend the delivery of insulin over time, rather than delivering it all at once, since the body takes longer to process certain foods. In the past, when she was on multiple daily injections, which does not allow for delayed insulin delivery, she would experience a low BG right after some meals, followed by a wicked high BG a few hours later, depending on how much fat or protein was in the meal vs. carbs. Are you still with me?? I'm still learning all this myself, so I don't feel that I'm doing the best job explaining it, but basically, in this instance, John told the pump to give L 10% of the insulin right now (.4) and spread the other 90% (2.8) out over the next hour. Okay. So. We head home after ice cream and settle in to watch the season finale of The Amazing Race (Go Cowboys!). We wouldn't normally let L stay up late on a school night, but it happens to be time to change her infusion set (we have to do so every 2-3 days), and we have to give the numbing cream an hour to work, so as soon as we walk in the door, John puts the EMLA cream on her belly so it can start working its magic. As we watch the show, John loads a new insulin reservoir into her pump. After an hour has passed, during a commercial break, he inserts the new set into her belly and hooks up the freshly refilled pump. She rubs some baby oil on the old site and pulls it out. It's time for her to go to bed.
11:32 pm - 289. I test her for the last time of the day on my way to bed. A little high, possibly from the infusion set change. I worry that there's an air bubble or a kink in the tubing that is interfering with the insulin delivery. I bolus 1.4 units and hope for the best. I set my alarm for 2:30 am and get in bed, so we can do it all again tomorrow.
(In case you're on the edge of your seat wondering, she was 263 at 2:38 this morning, so I corrected her with 1.1 units. When I checked her again at 5:41, she was down to 116. Much better. So, on we go...)
Tune in tomorrow for Day 2 of Diabetes Blog Week. I promise it won't be this long and boring! ;)
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