Wednesday, October 22, 2014

The Departure

The e-mail from the principal was an unpleasant surprise.  It informed us that "Mrs. Nurse You Have Now" will soon move on to a new opportunity and that "Mrs. Nurse You Don't Know" will be taking her place.

We've done this before.  In third grade, the "Best School Nurse Ever" retired. We spent 4th grade with a professional and well-meaning person who could never have filled her shoes no matter how hard she tried. At the end of that year, we met the middle school nurse and decided we really liked her, only to receive a letter in July saying that she'd been replaced.

It turned out that this new nurse, currently referred to as "Mrs. Nurse You Have Now" has been wonderful. We have specific expectations of a school nurse, and she's met them all:

First and foremost, of course, is to know what to do in a real emergency.  Know how to use glucagon. Be willing to shove a glob of glucose gel into my child's cheek if needed.  Know when she's low enough that she needs to sit in the office for a little while longer.

Train the staff.  Provide enough information to my child's teachers so that they know what to do when she is experiencing a high or low blood sugar. Make sure the lunchroom staff isn't going to interrogate her about taking her last 2 pretzels out to recess.

Trust us.  We will provide the physician's school forms every year.  Once they're in the folder, please listen to my child, and to me.  If we're having a week of low blood sugars, please let her shave a few tenths of a unit off of her lunch bolus.  If something bizarre happens with the pump, call me.  If she's 105 but still claims she feels low before gym, let her eat something.

Last, but of utmost importance, be cool.  My child has to spend an extraordinary amount of time in the nurse's office.  She's there every day at lunch.  She has to hang out there whenever she's low.  She needs good company.  She needs someone who will a tell her a funny story, who will ask what she did over the weekend, who might even offer a hug if she's having a tough day.

So we'll spend the next week on 2 projects.  We'll try to accelerate our progress on eliminating this fall's round of low blood sugars, so that my daughter doesn't get roped into providing a full-scale orientation to this new employee while spending hours on end in her office.  And we'll think up a lovely parting gift for "Mrs. Nurse You Have Now," to thank her for 2+ years of helping diabetes interfere as little as possible in my daughter's day but for being there-and being cool-when it did.

Thursday, October 16, 2014

A Minor Miracle

AFTER Calibration!!!

Maybe once a month we get a perfect match between the glucometer reading and the dexcom.  It's always very exciting and everyone in the house is summoned to see it with their own eyes.

On occasion these matchy moments occur at the same time the dexcom needs to be calibrated.  In the past, every single time we've entered a meter number that matches the dexcom's number we've been left shaking our heads.  Without fail, Dexi will decide my daughter's blood sugar is not exactly the matchy number at all, but one just one or seventeen points in one direction or the other.  

For this and other reasons, Dexi's strong-mindedness has become a running joke in our family.  

This morning, I was summoned to view the breakfast numbers- which were a little higher than I'd like but did indeed match.  I then stayed to watch as the dexcom calibration took place, waiting to see what whimsical number Dexi would decide was the real one.  

"Mom...look...she actually agreed!"

"Wow...maybe she's mellowing out."

Probably she's just thinking up some other way to torture us later on.

Monday, October 13, 2014

A Near Miss With Auto-Correct

*She'd been low ALL DAY, hence the advice not to bolus when she was 80.  As per usual: not medical advice.  It worked, though.

Tuesday, October 7, 2014

Not a Full Moon

As we pulled out of the parking lot and headed towards home, I turned to my daughter and asked, "Is it a full moon?"

"I don't think it's even close, but wow."

This week's endo day was full of chaos.

The traffic on the way in was full of terrible drivers making bizarre decisions.

As we turned into the parking lot, I let out a sigh of relief.  "Finally someone will take this car away from me for a little while." That was before the valet attendant nearly ran over my daughter as she tried to enter the building.

The bustle was evident as soon as we entered the clinic doors. Phones were ringing.  There were several patients waiting at the front desk.  Staff were scurrying around.  We took the last available waiting room seats and waited to be called for the traditional first step of height, weight, A1C and meter downloading. We were half an hour early for our 4:00 appointment, so expected to sit a little while.  A big dent had been made in homework when at 4:10, our endocrinologist himself came around the corner.  "Do they know you're here?" he asked.

"Yeah...I mean we checked in..."

He disappeared into the height, weight, etc. room and seconds later my daughter's name was called.

He took us into his office before her pump had finished downloading and started with the preliminary conversation. Soon the pump and its information had been delivered.  "So we were talking about lows, but I'm seeing a lot of high numbers here in the evenings."

Indeed, the week we were viewing had some awful looking 270's and 300-somethings.  Which didn't sound familiar at all.  Knowing that sometimes they print out a week or two back, I glanced over at the date.  "This says it's from August."  (Vacation week to be exact.)

On we went like that, with the doctor needing to take my daughter's pump in hand to accurately see and discuss the current basals, total daily dose, correction factors, and insulin to carb ratios.  We used the downloaded Dexcom graph to discuss some potential treatment changes. We came away with a few suggestions for dealing with the recent school lows, and a minor tweak for afternoon.  But it was hard to see the direct impact of insulin doses on blood sugars without the pump download. We never received the A1C results.  They'll let us know.  Maybe, I guess.

This is a top-notch clinic, with which we've always been happy.  I'm sure there's a good explanation for whatever trouble the medical assistants were having. There was at least one unfamiliar face in the back room, either new or subbing.  I overheard at least one other conversation about difficulty downloading data.  I'm pretty sure the whole thing was a fluke.  It would just make more sense if I could blame a full moon.

Thursday, October 2, 2014


"The granola is 10, the blueberries are about 5.  That was the new brand of soy yogurt.  How many carbs were in the container?"

As I turned around from giving the smoothie one last whirl, I found my daughter elbow deep in the kitchen trash.  Holding the yogurt cup delicately with 2 fingers, she said, "27" before dropping it back in and turning to wash her hands.

It wasn't the first time this scene has played out here.  Generally, though, I'm the dedicated trash picker. What particularly struck me about yesterday's episode was my child's nonchalance about diving in herself.

Add it to the long list of peculiarly unpleasant things we do for diabetes' sake.

We pick the trash.

Monday, September 29, 2014

Missing Class

Low blood sugars have been frequent around here lately.  My daughter seems to go through a streak of them every fall, but the implications are getting harder to manage.  Missing class time in 7th grade is much different than it is in 3rd.

Our current in-school low blood sugar protocol is this:  She checks in the classroom to confirm she's low and is escorted to the nurse by a classmate.  She has a juice box and waits 10 minutes.  She rechecks and if she's back in range she heads back to class. Usually, one juice box perks her back up, but she's had a few 2 box lows lately.

Nobody's comfortable with her wandering back up to class at 53, hoping that second juice will kick in. So there she sits with the nurse.  The nurse, as we all know, is lovely.  But she's not accredited to teach geometry, or geography, or grammar.

So when 4:00 homework time rolls around, I'm called upon for help.  I'm able to help with English. Geography is easy enough with the textbook at hand, and it's interesting.  Geometry?  Forget it.  Helping with math homework consists of me sitting near her, muttering encouraging words while she reads the textbook out loud until she figures it out.

Fortunately she's a smart kid, and can catch up pretty quickly.  But it's frustrating for both of us.  The question is, can we make it so she doesn't have to?

Obviously we're tackling the low blood sugar issue.  No matter when they happen, sticky low blood sugars shouldn't happen on a regular basis.  Adjustments are underway.

But I'm also wondering about our low-at-school game plan.  What could we do so that she misses less class time when this does happen?

As usual, sitting here writing has brought ideas to mind, some of them pretty obvious.  Like when she tests in class and she's 58, she should drink the juice she has with her on her way to the nurse, not wait until she gets there.  And maybe we need to talk with the nurse about whether any lows could be treated by my daughter in the classroom.  For her, some lows are very functional lows at which she can drink juice and keep doing what she's doing.  During others, she feels much safer taking a time-out in the company of a caregiver.  How to quantify or describe this on a 504 plan, I'm not sure.

Any other ideas or suggestions which will keep me from (re?)learning more geometry or algebra are most welcome.

Monday, September 15, 2014

Cereal Lows???

Here's a sentence you won't read often:

Twice in a the span of a week, my daughter has ended up in the nurse's office with a low blood sugar and I think it's because of her breakfast cereal.

You see, breakfast cereals are notorious for causing high blood sugars, not low.  Also, blood sugar tends to spike in the morning, making any breakfast carbs harder to cover with enough insulin.  So I'd say these may be the first 2 times in 7+ years of school my daughter has ended up in the nurse's office low before 10 a.m.

Our tactic for combating  post-breakfast highs has worked well of late.  A few years ago, a registered dietitian at our clinic suggested trying cereals with 5 or more grams of fiber per serving, which would slow the digestion of the cereal and thereby even out the spike.  Occasional experiments with old favorites like Cheerios and Kix prove that the extra fiber in the new choices really does help.

In her quest to reduce breakfast boredom, my daughter spotted a new cereal in what might be referred to as the 'healthy' aisle of our grocery store.  We enjoy other cereals of the same brand, so we picked up a box.

This cereal has 6 grams of fiber per serving, the same as several others my daughter eats.  The serving size, and the number of carbs per serving are comparable. The same almond milk is added.  The first time she ate it she needed 2 juices to get her back to class.

Several days of her usual breakfast foods and standard post-breakfast blood sugar results went by, and then she tried again.

Despite mediocre reviews the first time around of both flavor and chew-a-bility with braces, she had a bowl of the new many-grained flakes this morning.  Already suspicious of last week's low, we subtracted a handful of carbs from the total per serving, and she ate 3 slices of my peach which we never covered.  Again she ended up with the nurse and a blood sugar of 58.

I guess if she really loved this cereal, I'd put on my scientist cap and try to figure out what was going on here. Instead, I'll finish the box (which will require lots of peach slices for flavor) and we'll move on.