Tuesday, July 22, 2014

None. Nada. Nil.


Half of a basement closet  is dedicated to diabetes supplies. The usual suspects are there, unpacked from the three month supply boxes which arrive on our doorstep: pump supplies, dexcom sets, lancets, and strips. There's a large collection of manuals to diabetes devices and booklets given to us by various diabetes care providers. This is where we keep our collection of spare lancets, meters, tapes, and samples of stuff we are reluctant to throw out.

Until recently I have been the primary user of the closet. Supplies were put in and taken out only by me. Times are changing for the better, with a kid who is happily taking on a little more independence with a few things diabetes.  One task she's taken on has been replenishing the supplies in her room, including lancets and test strips.

Here's where the cautionary part of the tale begins:

Happy that she was regularly ferrying the test strips from the basement, I neglected to keep up with the inventory. So yesterday as I started to pack the diabetes box for vacation I made an alarming discovery. There were no boxes of test strips in the closet. None. Nada. Nil. 

We weren't OUT out. There were two vials in her room and some other partial vials in spare meters. I immediately ordered more and am extremely hopeful the box will arrive on our doorstep before we travel. If it does not, it's possible to purchase them over the counter.  Just incredibly expensive.

A two part solution has been put into place to address this issue.  I've put a note on my calendar and a reminder in my phone to reorder at the next possible interval. I can no longer rely on noticing the supply is running low before I make that call.  Secondly, while attempting to support the responsibility and helpfulness of my daughter's new role as the designated strip fetcher, I've emphasized the importance of also being the designated strip inventory-er.

I'm ordinarily a bit of a supply hoarder.  I feel much more comfortable with stuff stashed away, 'just in case.' In my mind, this 'just in case' has meant an insurance mix-up, a financial glitch, or a job transition. Now I know - it could come in handy for something as simple as packing for vacation.


Wednesday, July 16, 2014

Dexi's Wordless Wednesday






Helpful Hint:

The Dexcom ceases to be useful if you pack it in your mother's purse instead of your own before leaving for the day.




Thursday, July 10, 2014

Time Suck


A sampling of annoying events from the past few summer days:

I received a lunchtime phone call from the beloved nurse-free music program.  "I'm 72.  How should I bolus?"  The question took several minutes to sort out.

While at the pool, she had to stop to disconnect or reconnect her pump while her friends were already running for the diving boards/ping-pong table/snack bar.  This scene repeats several times daily.

She had to leave her friends in the pool to treat a low blood sugar.

We delayed leaving for the pool to replace the tape on the Dexcom.

We delayed leaving for music to add tape to the Dexcom.

I spent half an hour online searching for tips to keep the Dexcom stuck when frequently submerged in a swimming pool, lake or ocean.  (Suggestions are still welcome...).

We expected to do a quick site change, only to find that the pump battery needed to be replaced and the supply of wipes needed to be replenished from the downstairs closet.

A desire for a summer peach turned into an ordeal involving the food scale and the calorie king app since it was the first peach of the season and we couldn't remember the carbs.

A group of friends descended on the kitchen for a snack break.  She was the last to eat, as usual, since she had to stop to check her blood sugar, read the nutrition label, and bolus for her food.

A cure and/or a bionic pancreas will some day dramatically improve my daughter's health.  That, in the big picture, is the reason we want these things.

The other benefits are indisputable though.  When the day comes, we'll go through every day without any of these kinds of stops and detours.  She'll stop being the one lagging behind at the pool.  She'll dive into her friend's pantry right along with everyone else.  Diabetes won't delay the fun.  We can't wait.


Wednesday, June 25, 2014

Geocaching

My husband and daughter have taken up a new hobby.  Geocaching is described in detail in this link, but essentially, it's a treasure hunt using GPS coordinates.  People hide 'caches' in public places.  Then they post GPS coordinates and additional clues on the website linked above.

So far our family has found about 40 caches in 4 different states.  I'm not so much a fan of the scrounging around in bushes and under park benches part of the whole thing, but it's been a great excuse for visiting nearby parks, hiking trails, historical sites, and even extra rest stops when we're on the road.

After having found a good amount of caches and getting the hang of the GPS app and how the website works, my husband decided it was time to create our own cache.  We needed a small, waterproof container in which to place a scroll for people to sign when they found the cache.  We had just the thing. A little camouflage duct tape to make it a little harder to find and it was ready to go:


People who hide caches often offer a prize or a special shout-out to the first person to find their cache.  My husband went a different direction.  Included in the clue is this line:

The first person to identify this container will earn a special place in our hearts.


Monday, June 16, 2014

Best Advice


In the past 11 + years of diabetes, we've been given all sorts of advice about my daughter's health and care. Advice has come at all stages, from all sorts of people. At this week's endocrinology appointment, I was reminded of a piece of advice which falls at the top of my list of favorites.

Looking like perhaps he'd just been through a challenging appointment or two, the endocrinologist sat down at his desk, glanced at the dexcom printout and the A1C slip and said, "Ahhh...this should be easy."

"It should?"

"This A1C is very nice.  And these graphs look pretty good too."  He shared the A1C and discussed it with my daughter.  Then he asked us, "Do you know how you did this?"

"Um...not really.  If I did, I think I could make a fortune," I replied as my daughter merely shook her head.

"Well I do.  Look at this printout here.  This part of the graph is the overnights."

Ah, yes.  The advice we received years ago from our first (and favorite) diabetes educator:

If you can stay in range overnight and wake up near your target number, everything else will fall in place.

Being in range overnight takes care of 10 hours of the day right off the bat. Then, if she wakes up at 100-ish instead of 180-ish, the breakfast spike is less significant and the lunch number is better too.  All those other spikes from the miscalculation of carbs or the crummy site become blips on the screen rather than compounding factors for an already high average.

If, the uninitiated or the overachiever might ask, this overnight thing is the key to success, why don't we just keep her numbers in range overnight all the time?  I wish we could, but as the old pro and the realist know, stuff happens.  In this case, growing happens and hormones happen.  Every so often things slowly get out of whack, particularly in a growing kid.  The 5 a.m.creep up begins.  Or the 2 a.m. correction comes into play.  The evening carb ratio no longer quite does the trick.  Sometimes, all of these things seem to happen at once.

At our winter endo appointment, my daughter's A1C was 3/4 of a point higher than it was last week.  We spent a good part of that appointment addressing high numbers at 10, 2, and 6 a.m. It felt like the whole night had gone haywire all at once and like untangling those numbers would be like untangling the Christmas lights: a task best left to somebody else. We gladly accepted the help.

As winter turned to spring, we continued to tweak basal rates and the evening carb ratio. Problems crept up one at a time and we apparently managed to keep things under control. Can we keep it up all summer?  I don't know.  I do know that I should pay close attention and call in professional reinforcements if I need to, because:

If she can stay in range overnight and wake up near her target number, everything else does, indeed, fall into place.


Friday, June 13, 2014

A Teaching Moment




We visited the endocrinologist this week.  As he glanced at my daughter's A1C slip, he was pleased with what he saw.  "This is what I'd call a good A1C."  Then, turning to my daughter, "Do you know what kind of number a good A1C would be?"

"Ummmm..."

The omnipresent chart was on the shelf to her left.  She looked it over.  "6?"

"Six would be very impressive.  Five would be amazing.  But in people with diabetes, particularly kids, five would be almost impossible without some really nasty lows.  What we aim for in kids your age is an A1C around seven, and you've done that very well."

There was much to appreciate about this little exchange.  The teaching. The relationship building.  The gentle passing of the torch of responsibility for understanding the disease to my daughter.  The affirmation of our hard work which, I know from experience, would have happened no matter what number showed up on that A1C slip.

We don't go to the closest pediatric endocrinologist.  Our visits require a sometimes hairy, sometimes traffic-ridden journey.  When we arrive, we look like we're planning to camp out for the duration, with snacks, homework and books in addition to the usual diabetes baggage and the materials we need for the appointment.  Despite these hassles, we never think twice about repeating this expedition.

I hear horror stories all the time about people's relationships with their doctors.  I realize we're fortunate to live in a part of the country with lots of choices, and that we're fortunate to have insurance which allows us to make them.  Some people have neither.  But if you do, and you're not happy, find a great doctor.  It's so very worth it.