A Little Fear Can Be A Good Thing


I usually drop my daughter at her summer music program after helping make her lunch and gather her belongings for the day.

Last Friday I had to leave the house early and so she chose to walk the few blocks to the program rather than arriving half an hour before her first class and having to wait around.   No big deal, I thought, and a great opportunity to be independent.  When I left, she was eating breakfast, and her lunch was made.  She had half an hour until she had to leave, plenty of time to get her stuff together and get out of the house. 

She texted me before 9 to let me know she'd arrived at her destination and we continued on with our busy days.

Then at 11, my phone buzzed.  Surreptitiously taking it out of my pocket for a glance, I saw this:

'I'm such an idiot I don't have the meter.'

Meanwhile the Dexcom sensor had breathed its last at 9 the night before and we'd decided a free day would be okay before replacing it.

The next text read:  'I felt low so I drank my one juice and now I'm eating and I'm gonna do like half my lunch and then I'm going to the store to buy a coke or something in case I'm low again.'

Fifteen minutes away and responsible for a group of 7 children until 12:15, and then expected to stay where I was until at least 1:30, I texted back,

'Sounds good.'

As it tuned out, she did absolutely the right thing with the lack of tools at hand.  The low or low-ish she treated was likely real.  When she bolused for lunch she factored in the amount of dancing she expected to do during the show rehearsal.  As the afternoon wore on she thought often about how she was feeling. She realized, should she need it, that in addition to the soda she had purchased she had access to candy usually awarded as prizes for the daily trivia contest. When she got home her blood sugar was 79. 

With some significant inconvenience to myself and others I could have left what I was doing to get a meter to her.  Instead I let her wing it until her program was over for the day.  Was it the safest plan?  No.  If I had it to do over again would I bail her out?  I don't know. But when she got home, she said this:

'That was scary being without the meter.  I don't think I'll forget it again.' 

Sometimes a little fear can teach a very important lesson.



Meter Bag Clean-Out


 

This is what a pile of 237 used test strips looks like.
At least I know she checks her blood sugar when she's out!

 

Next...


My daughter is going to high school next year (eek).  So among many anxiety-inducing steps we met the new nurse.  We also met the old nurse, who is retiring but orienting the new nurse.

It was a familiar routine.  By my count, these were the 8th and 9th school nurses we've met in as many years. Not including, of course, countless substitutes. I'm incredibly grateful that while we've definitely clicked more with some nurses than others I've always left these meetings feeling comfortable that my daughter would be in good hands.  These people have done everything we've needed them to do to support my daughter's care in the nurse's office. They have also been proactive in communicating and planning for my daughter's diabetes needs with staff  throughout the school and at school-based activities. Taking a step backwards, I'm very grateful that we've always had a full-time school nurse at all, since so many schools do not.

The conversation about the school year gets shorter every time, as my daughter takes on more and more of her own care.  We were reassured that teachers would be informed of my daughter's diabetes, alerted to symptoms of low blood sugar, and even given a roll of glucose tabs per classroom which, as far as I know, is a step beyond what took place in the middle school.  She'll continue to go to the nurse when she is low, because it's important for her to be somewhere safe and because it's also important for her teachers to know she's not absorbing the material being presented or that she's unable to adequately complete the classwork, quiz or test of the day.  She'll also visit if she's high enough that she feels unwell or needs to troubleshoot the cause of the high blood sugar.  Which goes hand in hand with visits for pump alarms, and emergency site change needs.  In August we'll deliver our bag of strips, glucose tabs, juice boxes, a back-up meter and more so that the nurse's office can also serve as a source of back-up supplies.

The biggest topic of conversation about the school day involved lunch.  My daughter decided that she'd rather handle lunch on her own and only come to the nurse's at lunchtime if there's an issue (she's low, runs out of strips, can't figure out the carbs). She has handled lunch by herself at her summer music program for years, and does her own mealtime routine at home without help.  The other motive for this request was a desire to maximize her time. Our high school's schedule is designed to accommodate club meetings and extra teacher help during lunch periods, to allow a little study or library time, or to provide a solid break in the day for kids who participate in both before and afterschool activities.  With a hefty fall extracurricular schedule, every spare moment during the school day will be valuable. Taking care of lunch independently was, apparently, how other kids have handled diabetes at our high school in the past, so this plan was not only allowed but encouraged. The philosophy (which is refreshingly in tune with the day-to-day realities of living with T1D) is that gaining self-sufficiency is an overall high school goal and that diabetes self-sufficiency is at least as important as bringing the right materials to class. Support and help are available if she needs it but she does not have to come to the nurse daily.

Woven into these conversations were threads of humor, helpfulness, and welcome.  My daughter was reassured that she is welcome in the health office at any time. It was clear that if she changes her mind on any of the plans we made that nothing is written in stone.  While a nurse with enough knowledge to use glucagon if needed and to educate the staff about diabetes is important, what's more important to us is that the nurse is someone my daughter feels comfortable asking for help when she needs it and someone who is good company to sit with while she comes up from a low. 

We're grateful to have one less thing to worry about in the fall.



Pump Wearing


The biggest hurdle in making the decision to switch from injections to a pump when my daughter was 2 was figuring out how she would wear a pump on her tiny frame.  For several years she wore an Animas brand double zippered pump pack with a luggage lock on it to prevent her curious little fingers (and those of other children on the playground) from pushing a disastrous pattern of buttons.  Once she was 4 or 5 and we felt comfortable with a Velcro closure, she was fortunate enough to have a great-grandmother who made a few packs for her out of fun fabrics.  These days she either uses the clip provided with her pump to attach it to her waistband or she tucks it into her pocket.

Except at night with pajamas, or under a dress. We've continued to try different packs for these scenarios but we're still seeking the best solution. So while I've never before accepted anything to write about here, when Julie from Pumpwear contacted me about trying out a couple of their products I said 'yes!'  She sent us two things to try. 

The first is a familiar-looking double zippered pump pack with an elastic adjustable waist band and a plastic buckle. 



There are countless fabric choices, of which we were sent a cute, subtle pastel polka-dotted one. The feature we like more than we thought we would is the button hole on the side closest to my daughter's body through which to feed the tubing.
 

It allows the tubing to be contained; a real plus for an active sleeper, and generally safer for anyone who comes into close quarters with doorknobs and drawer handles. Another feature of this pack is the expandable pouch.  We were dubious about this at first because her current bedtime pack is so roomy that the pump slides around inside it, making it less comfortable to wear and harder to access when needed. This pocket, though,  appears small and remains small if just the pump is in it, keeping any sliding to an extreme minimum. It could expand to hold a Dexcom receiver instead, or any brand of pump.  The waist band is both elastic and adjustable on two sides, which makes it able to fit a wide range of sizes and yet also fit very precisely in the end because of the elastic.  That's a feature which was sorely missing from packs we tried in the baby and toddler years.  This particular pack lacks a clear window, a feature we look for to allow quick access to the pump's buttons in the middle of the night, but the company does make several versions with windows.  My daughter isn't a fan of the double zippers because they're noisy when she walks (I kind of like a teenager you can hear coming myself) but she really likes the soft fabric and finds this pack comfortable to wear.

The second product we tried is a waist band.
 

This one is made of a silky material (think slips and other feminine undergarments) but which is also stretchy so that it fits close to the body.  It's got an elastic waist, sized to fit based on waist measurement. The pump slips into a large pocket which has a Velcro closure and then rests slightly below the waist.
 

We're particularly thankful that this arrived in time for 8th grade graduation. The dress/pump combo is getting trickier.  We have a tiny pump pack, a relic from my daughter's preschool years, which fits very snugly at the small of her back.  It's worked with dancewear and countless dresses over many years. But as she's gotten older, dresses have become more fitted, and with the 8th-grade graduation dress there was a noticeable bulge where the pack sat. Also, the felt-like material of the old pack did not allow the dress to slide over it, creating weird creases with movement.  The pumpwear band, however, worked perfectly with this dress, with the pump sitting below the waistline under the fuller skirt, and the silky fabric allowing the dress to move naturally.  She finds the waist band very comfortable.  It's the first pack she's tried with no Velcro or buckle.  At first, because it was so unconstricting, she felt like it might just slip off, but once it didn't, she found it very enjoyable to have a freer feeling midsection under her dress. And the lack of a front closure made it even more inconspicuous under clothing.  This one is also available with more than one pocket, to accommodate, for example, both pump and cgm.  It's more of a 'special occasion' item, since she doesn't find it comfortable under pajama pants, and the pump hangs low enough that it wouldn't work under regular pants or shorts, but we love the alternative under-dress/under-skirt option.

We have fashion challenges coming at us thick and fast in the next few years:  marching band uniforms, more semi-formal dresses, dress-pants and possibly suits for academic events and interviews, and of course the prom dress.  Among pumpwear's many products geared to older teens and adults are pump garters, underwear with pockets and, of course, a multitude of waist and clip options.  I'm very thankful to have been given the opportunity to check out these two choices and we'll definitely be back for solutions to future fashion challenges!

Disclosure:  These two products were sent to me free of charge in exchange for my writing about them here on my blog.  The opinions expressed here, both mine and my daughter's, are our own. 

 

We Wouldn't Do This Again


At 8th Grade Graduation practice my daughter's class was told in no uncertain terms that they could not carry anything as they marched down the aisle. A two minute conversation would have led to her being allowed to carry her meter, but she didn't want to.  She wanted to walk in empty-handed like the rest of her classmates. Having a 'what's the worst that could happen- it'll all be fine,' moment, I acquiesced.  Here's what we did and why I wouldn't do it again:

Because the middle school's auditorium is small and infamously hot, the program was held in a large gymnasium at different school.  The kids were to arrive at 9 a.m. and meet in the building next door to the one where the ceremony was held.  At 9:30 they would process in and sit together in the front of the room.  The program was expected to last until about 11 a.m.

Creating a safe diabetes plan would have been easier with pockets as part of the equation, but she had a great dress to wear.  We knew a pump pack fit well underneath, but when we tried to add the Dexcom, there was an obvious bulge.  At least when we added a roll of glucose tabs tucked into the waist band of the pump pack, there was not. Those glucose tabs were our insurance policy.

We decided that she would check her blood sugar and make any needed adjustments in the car on the way to the ceremony. There had been no mid-morning blood sugar issues of late, which made us feel more comfortable with this plan. If at any point when we were not together she felt she was low, she would err on the side of caution and would (with a discreet move practiced before leaving the house) obtain glucose tabs from beneath her dress and eat a couple.  Then, once she was in the room with us, I would have the Dexcom and be able to signal her to eat glucose tabs as needed.  No problem.  Except these two unforeseen problems:

At about 9:25, just before the kids were to make their way into the ceremony, an audience member experienced a medical emergency.  There was a nearly half hour delay while the person was treated and eventually taken away by ambulance.  The kids were kept in their holding room in the next building over, too far away for the Dexcom to reach.  The half hour we'd expected to be apart turned into an hour.

Also, as we arrived at the venue, we learned that the kids would be seated in the empty chairs facing the podium, not facing us as we'd originally assumed. So there was no eye contact to be made and no hand signals to be used should my daughter need to be aware of a need for her hidden glucose tabs.

The story has a happy ending.  She left the ceremony with a blood sugar of 132, and a lovely award from the music department.  But in retrospect this was not a smart decision.  We should have had her carry her bag. Or asked a teacher who was supervising the kids in the other room to bring it over and slip it to my daughter once she was seated.  Or found a roomier dress with pockets.  As a rule, we don't even go around the corner without carrying a meter and a juice box.  Because as we were reminded on 8th grade graduation day, you never really know what's going to happen.

Party Trick



We've been busy taking pictures of 8th grade graduation events here, but those aren't the only interesting moments we've been able to capture.  I present to you The Amazing Finger:

Only one hole was pricked.
We've seen 2 for the price of 1 before, but never 3.




 

The Boy on the Field Trip


My daughter's 8th grade wasn't the only group visiting the family resort/camp on the day of their field trip.  After telling me that she hadn't talked to her school nurse all day, my daughter shared this contrasting story about a boy from another school:

There was another kid there with diabetes.  I felt so bad for him. I saw him out of the corner of my eye when I sat down for lunch.  He was a table over from us.  I could see him checking his blood sugar.  His nurse was hovering over him with her giant bag of stuff.  It took him a long time to check.  Then they got out a Calorie King book.  You know- not the app but one of those old books like we have on top of the refrigerator? 



Please rest assured we no longer use this alarmingly outdated 2003
COLOR edition to look up restaurant foods or packaged foods.
It's for fruit, grains, baking ingredients and other natural and recipe basics.

I could hear their conversation.  It was painful. They were looking up hamburger buns and macaroni and cheese.  It took them forever.  They came up with 65 first but the nurse decided that was too high (I think she was right) so they rounded down to 55 but weren't sure about that either. I thought about going over there and saying, 'a hamburger bun is usually 21 and half a cup of macaroni is 20-ish.  Enjoy your lunch.'  But I didn't.

I'm not even sure he'd started eating by the time we left.  I felt really bad for him.

We talked about what might have slowed this boy down.  The most likely scenario was that he was newly diagnosed and that this adventure was all new territory for him, diabetes-wise.  Or maybe he didn't eat out much and/or burgers and mac and cheese weren't on his usual menu.  Maybe his was a nervous nurse who needed to be sure they were taking care of his diabetes 'by the book.' 

Whatever the scenario, I understand my daughter's decision not to jump into the conversation. They probably would not have taken advice from another kid, and so her appearance would likely have just further delayed the poor boy's lunch.  She did wish she'd run into him later at one of the activities.

I do wish I'd seen him somewhere else. I would've told him that it'll get easier but I never saw him again.  I hope he didn't spend the rest of the day in the dining hall trying to figure out his lunch carbs.