New and Sparkly



We fired up my daughter's new insulin pump over the weekend.

Our four year warranty was up and, while the pump still worked, its appearance led us to believe it might be living on borrowed time:





The screen protector was peeling off.

And so was the paint.

It was still effectively giving insulin, but the idea of having no warranty was making us nervous.










We've had very few issues with Animas pumps over the past 12 years, but when we have, having one under warranty has unfailingly led to an overnight replacement.

That's hugely reassuring, especially considering how long it took to order a new one from scratch.






Granted this wasn't an emergency since my daughter's pump was still perfectly operational, but it took about six weeks between my first call to inquire about a replacement and its arrival on our doorstep. The process began with two different phone calls with questions for me, then doctor's orders, insurance authorization (which was the longest process), another phone call to discuss our copayment and the shipping details, and then actually getting it shipped out.

The possibility of reverting to multiple daily injections for even a fraction of that time is not appealing to us.

The new pump is silver, and sparkly all over, with no chipped paint. The screen protector is intact and clean.


And we expect to have a reliable source of insulin delivery for four more years.

 


 

Reading is Fundamental


My daughter had a few late afternoon and evening lows last week.

When she's out and about, she carries juice boxes, glucose tabs and smarties. When she's home she prefers something different. There are occasional seasonal choices in the fridge like fresh apple cider or high-test lemonade leftover from a cookout. Usually, though, the home juice of choice is orange juice. She pours four ounces into her pink sippy cup and waits for the low to turn around. Nine times out of ten, unless she's under 50 or been exercising heavily, those 4 ounces bring the low up within 15 minutes and life goes on.



Last week, not so much. The lows seemed slower to respond. If it was dinner time and she hit 70 after 15 minutes, we'd eat and subtract some bolus insulin. Otherwise, she found herself adding more juice, or a little snack of fruit or crackers to make sure she came all the way up.

A couple of seemingly sticky lows in one week was weird. And a nuisance, especially at dinner time. What was going on? Maybe it had to do with impending full moon or some other such mysterious and passing variable. Or maybe something had changed and my daughter's new normal involved closer to 20 carbs per low.

Then I walked into the kitchen as she poured the last of the orange juice into her cup:


I accidentally bought low-carb orange juice. I don't drink it and my husband hadn't noticed when he slugged it down still half asleep in the mornings.

I read a lot of labels: cereals, snacks, bread, starches and countless other packages are fully assessed before they're consumed. I missed this one. Which explains why those lows wouldn't come up.





No Diabetes In There


Yesterday was the dreaded eye doctor day. Dreaded for several reasons:

   -Making time for any appointment is a challenge with the busy high school schedule.

   -Most of the homework had to be finished prior to the appointment since she expected to be blurry afterwards.

   -While we truly appreciate the thorough exam and attention to detail we receive at this office, we've learned that an appointment there is an hour and a half commitment.

   -And, of course, the diabetes what-ifs.

The plus, in addition to liking this doctor, is that the office is less than a mile from home. So a few minutes before five we hopped in the car with the last of the homework in hand. We arrived, signed in, and took our seats in the waiting room. After half an hour of reading for history class and watching a series of increasingly unsettling segments on the 5:00 news (Car crash! Bomb scare! Everything could kill you!) we were ushered into the exam room.

The doctor started with the basic vision tests, which came out about the same as last time. My daughter has 20/20 vision in one eye, which she apparently uses to compensate for astigmatism in the other. No glasses yet but probably some day. Then there were the eye drops- which she hates but which she took like a champ.

Next up was the visual field test. Our doc usually gives this once, as a baseline in kids. But because having diabetes isn't enough of an eyeball challenge, my kid also has an 'it's probably nothing but we're going to keep an eye on it' issue going on with her optic nerves. So into the dark room she went to squeeze a clicker every time she saw a light flash in a machine. She did great, just like last time, so we put this concern off for another year.

Round three involved the actual looking into the eye part. The part when the fingers get crossed and the breath gets held. The doctor used a couple of different instruments to look into the eye herself and, after that, took the retinal photograph. She then pronounced,

"They look great- perfect. There's no diabetes in there."

Which is kind of a peculiar way to put it, but the exact words don't matter. My kid, despite still being a kid, has had diabetes for 14 years. That starts to get into the potential collateral damage timeframe.

So far so good. All the ophthalmologist had left to say was, "See you next year."





A New Low





There have been two evening concert band rehearsals this winter, from 6:30-9 p.m. These are intense monthly rehearsals during which the kids are playing challenging music non-stop.

The nights after both of these rehearsals have been multiple juice box affairs.

After 14 years of T1D, we have learned when to expect most lows.

Running, dancing, swimming, and miscalculating the number of carbs in a meal are the causes everyone knowledgeable about diabetes would expect. 

Slow but steady walking, staying up late even if it involves no physical activity, and being sick with a cold all also trigger lows for my kid.

Could playing a wind instrument for an extended period also lead to dropping blood sugar?

The first post- concert band rehearsal low seemed to come completely out of the blue. She hadn't been having any overnight lows at the time, and the rest of the day hadn't involved any unusual food or activity. The only variable I could come up with was the rehearsal. Could the physical exertion of playing her clarinet for that long combined with the mental energy to concentrate on and learn new and difficult music be what led to a 50-something blood sugar so slow to budge? Maybe, I guessed, but since one instance doesn't make a pattern, we chalked up to a mystery low and set the episode aside.

Until it happened again this week. Both times she was at a nice 90-ish number when she came home and had a snack. Then around 1 a.m., she tanked.

Despite using a variety of search terms, my research turned up only one mention of this phenomenon. It's master's thesis from 2006 by Derrick Alan Crow called 'The Effect of Instrumental Rehearsal on Blood Glucose Levels of Five Low Brass Players.'  The link will take you to a several-page preview of the study, which was all I was able to access. His participants, as far as I can tell, did not have diabetes. The blood sugar checks were before, during and immediately after rehearsals, not hours later. But his preliminary background research was interesting and, based on it, he posed some logical hypotheses. His results, while inconclusive mostly due to the small sample, did note some trends of lowering blood sugars during long rehearsals. His theory was that between the mental, aerobic (from breathing), and muscular energy expended by a wind instrument player during a lengthy rehearsal, blood sugar levels drop.

I'd love to see this study repeated in instrumentalists with diabetes. I'd love to see the research include investigating a delayed drop of the sort people with diabetes see with some other kinds of exercise. Clearly, I need to befriend a musical scholar. Or convince my kid to become one.

Meanwhile, we'll plan on covering fewer carbs on concert band nights, and/or setting a temporary basal rate. Or maybe next time this won't happen at all.

Fancy Berry Muffins



What should one do on Valentine's Eve when there is a bag of 'Fancy Grade A Berry Medley' ossifying in the freezer because nobody's been in the mood for a smoothie? 
 
Make some fancy muffins, of course!








You could, of course, chop large unfrozen berries by hand.
This was my quick alternative- just a few pulses did the trick.
I got them a little smaller than I'd intended,
but it worked well for the mini muffins.


Fancy Berry Muffins

3 Tbsp. butter, melted
3 1/2 Tbsp. sugar
1 egg
1 c. white flour
1 c. whole wheat flour
1 Tbsp. baking powder
1/2 tsp. salt
1 c. milk
1 c. berries (fresh or frozen, any variety, chop anything larger than an average blueberry)





1. Combine the butter, sugar and egg in a large bowl. This is the bowl all of the batter will end up in.
2. Sift the flour, baking powder and salt together.
3. Add flour mixture alternately with milk to the butter/sugar/egg bowl, mixing after each addition.
4. Beat well, then stir in berries.






Your batter will be colorful!



5. Fill muffin tins 3/4 full. Use paper liners or grease pan well.
6. Bake at 350 for 15 minutes (mini muffins) or 30 minutes (lg. muffins).

I ended up with 32 mini muffins with approximately 8 total carbs each.


Next time? Some cinnamon sugar on top for color and crunch.

Maybe these would make a nice treat for your Valentine in addition to that rose I'm hoping you've already spared?



The Nervous Nurse


I glanced at the caller ID on my phone, which read  'SCHOOL.' It was my daughter on the line from the nurse's office.

"I was told to call you.  My blood sugar is 77.  I was 60 when I got here 15 minutes ago. I had a juice then and couple of glucose tabs just now. Lunch is in 20 minutes. It's Mrs. X.  She's not sure if I should go back to class. I'm worried about missing the final review and study-guide handout for tomorrow's math quiz."

"Mrs. X is the nervous substitute nurse, right?"

"Yup."

"Put her on. I'll tell her to let you go back to class."

Encounters with nervous nurses are, at best, like the one above. But they have also been known to go like this:

OMG YOU"RE 47!  SIT IN THIS CHAIR AND DON'T MOVE UNTIL YOU'VE CONSUMED ALL OF THE JUICE IN THIS OFFICE. I'M CALLING YOUR MOTHER RIGHT NOW.

Or, WHAT DO YOU MEAN YOU DON'T CHECK KETONES EVERY TIME YOU'RE OVER 200? THAT'S A VERY HIGH BLOOD SUGAR. DO YOU KNOW HOW DANGEROUS THAT IS?

Or, I CAN'T LET YOU {PLAY GYM/TAKE THE TEST/WALK HOME FROM SCHOOL} THIS AFTERNOON. YOU WERE 62 AT 9 A.M. YOU'LL GO LOW AGAIN!

Our full-time nurse for the duration of fourth grade was a nervous nurse.

We spent hours over the course of that school year talking her down from the ledge. With each phone call we explained again that every blip on the blood sugar graph was not a full-blown medical emergency.

We indoctrinated her, slowly but surely, into the idea of addressing diabetes concerns in the moment and then letting that moment pass and continuing on with the regularly-scheduled programming.

It was a delicate dance of acknowledging her concerns while inserting a dose of reality. We were unable to completely reprogram her but she became less panicky as the year progressed.

Substitute nurses are trickier- they definitely don't know my daughter as well, and they often have less experience with children with diabetes in general. I do hear we're making progress with one we've known since early elementary school. Generally, though, we resort to phone calls like the one above, on a case-by-case basis.

I absolutely understand the concerns. A nurse's job is to focus on the medical concern of the moment, with a 'safety-first' mentality. Which begets worry. Which I understand.  I know worry. I worry a lot about diabetes. So does my kid. But after 14 years, we've learned when to worry and when not to. We have learned when the time to worry has passed. We have learned how to incorporate life with a chronic illness into life lived fully. So sometimes we need to talk a nervous nurse down from the ledge.



Why Not A Dozen?


 
I live in Suburbia, USA and I'm worried about diabetes.

I'm worried about the future of access to quality, comprehensive, affordable healthcare.

I'm worried about whether current diabetes treatments are enough to lead to long-term health.

I'm worried about whether there will ever be a diabetes cure for anybody but mice.

I'm worried about the financial cost of diabetes care.

I'm worried about the emotional cost of diabetes care.

I'm worried about the daily to-do list of living with diabetes.


 You Can Spare A Rose By Clicking Here

Then I imagine being a mother of a child with diabetes in Syria. Or Sudan. Or Rwanda.

Their children are dying from having diabetes.


My daily worries pale in comparison.

Fortunately it's February and I'm reminded regularly of the work of Life for a Child. 

One rose for one month of life. A dozen roses for a year of life.

Eliminate one rose from your traditional Valentine's bouquet and donate $5.

Or follow my husband's lead and eliminate the whole dozen.

Roses die and children shouldn't.

One of the best ways I've found to reduce worry is to do something.

Saving the life of a child seems like a pretty good thing to do.