sleepover version 2.0

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.