Friday, May 27, 2011

The Excuse

A second in an occasional series reflecting on the occasional positives which come with diabetes:

Today was a the 80th anniversary of my daughter's elementary school.  Students, alumni, staff alumni and parents were invited to a celebration.  It kicked off on the lawn with the high school band marching a block down the hill from their building to play a patriotic song after the students saluted the flag.  The high school jazz choir sang next. Everyone was then escorted inside with the band processing in last down the aisles and playing two more pieces on the stage.

Retired faculty were introduced.  Students were invited up to share 80 ways the school is special.  The jazz choir performed again.  Alumni staff shared their favorite memories of the school.  Students shared facts about the school's namesake.  The third and fourth grade chorus performed.  Current staff read letters from former staff who could not be at the event.

Bored yet?  I, for one, figured it was time to get going when down the aisle bops my daughter.  "I have to go get my snack," she happily said.  I walked her to the nurse and gave her a hug.

"I think I'll take my time coming back," she said. 

I'm sure there were some fun moments to come, like my daughter's best friend's interview with her mom who went to the school in the "olden days," and singing the school "sound off" and the school cheer.  But if you ask me, she was lucky to have an excuse to get out of there for a while!

Tuesday, May 24, 2011

Spring Cleaning

It's been a busy month, spent traveling from one activty to another in the car, often with little time to spare. 

Therefore, our vehicle's back seat has become "diabetes central."  My daughter uses the well in the door, intended as a handle for pulling the door shut, as her wastebasket.

When test strips and candy wrappers started flying around the mall parking lot this morning, I realized it was time for a clean-up.  But first, a picture:


The bottom of my purse, which looks almost exactly like this, is next.

Thursday, May 19, 2011

The NPH Days or Why We Got A Pump

After her diagnosis with diabetes, my daughter was on injections of NPH and Humalog insulins.  NPH, combined with a small child who didn’t want to eat, was disastrous.  For those of you who’ve never had the pleasure, NPH is a long-lasting insulin which peaks.   I can still remember the endocrinologist and educator drawing the curves for us, showing the action of NPH and reinforcing for us the importance of sticking to our “meal plan.”  Humalog was given with the NPH at breakfast and dinner to cover those meals, but the NPH covered a morning snack, lunch, and afternoon snack.  Whether my daughter wanted them or not.

I could probably count on one hand the days between the ages of 14 months and 18 months when my child (who’s subsequently been known to sneak lobster off of my plate) actually wanted lunch.  That was when her independent spirit surfaced, and she decided to she’d manifest it at lunchtime.  Every day.

I spent the first two months of 2003 trying, religiously, to stick to the “meal plan” sent home with us by our medical team.  Starch, protein, fruit, milk.  Every day at 1 p.m.  There was screaming and crying.  Yelling and throwing of stuff.   Sometimes she would throw stuff and I would cry.  Sometimes we’d trade. 

It was reminiscent of Green Eggs and Ham, without the happy ending.  Would she eat it in her chair?  Would she eat it over there?  Would she eat it if I sing?  No…she won’t eat ANYthing.  We’d inevitably end up sitting on the kitchen floor, covered in yogurt or peanut butter, in an exhausted stalemate. And then there was a low blood sugar at 2 p.m., for which I’d have to squirt cake decorating gel into her mouth because she’d refuse to drink juice.

By the time month 3 of this circus rolled around, I was coming to my senses (or desperate in my insanity) and began to ask questions of the medical team.  “I understand what I’m supposed to be feeding her at 1 p.m, but is there a plan B?”  The answer was, of course, yes.  We should try for the ideal balanced meal, the carbs combined with protein for steady bg, the healthy fruit and milk.  But the carbs, of course, were the most crucial.

And so it was that our kitchen cabinets began to resemble those of Jerry Seinfeld.  Because the one meal my daughter would always eat was dry cereal and a little fruit.  With a wide variety of healthy cereals all to her liking, we stocked up and relaxed a bit.  I’d still offer her a pb&j, or a piece of string cheese, but learned that she survived without them.

The moral of this story is that there’s a learning curve to diabetes.  When I think back, I wonder how I went so long assuming that I HAD to feed her these things and accept the psychological damage to both of us.   But upon further reflection, I realize it was really the first of many “aha” moments we’ve had since then…getting her an insulin pump, writing up a 504 plan for school, tucking a roll of glucose tabs in the pocket of every coat I could possibly leave the house in.  Why didn’t we think of it earlier?  At least we firgured it out eventually.

Tuesday, May 17, 2011

Motivation

Last Monday, we had our regular visit to the endocrinologist.  It was part of the busiest day of our chaotic week.  My daughter began her standardized tests, left school early for the doctor’s appointment in the city, and changed her clothes there so we could go directly to a 5:30 softball game. 

The idea of regular endocrinologist visits is to take one’s current state of diabetes affairs to the doctor’s office to receive professional suggestions for better control.  We always gratefully come away with excellent suggestions and a new perspective on things.

However, it’s the looming appointment that usually begins the process of bringing us back into better control.  I hate to show up at the diabetes center with a couple of weeks of truly crappy numbers for them to download.  I feel like a loss of control reflects poorly on my concern for my child’s health and on my diabetes skills.

Therefore, a couple of weeks before each appointment, I invariably become more aggressive with diabetes management.  I’ll scour the logbook, noticing that my daughter's blood sugar has been 200 at 10:00 every night that week.  Maybe the 7:00 dinner insulin bolus isn’t quite enough.  I become hyper vigilant about bolusing before the meal instead of during (or after). We'll do a basal test for the first time in recent memory. Things are placed in the food scale which haven’t made it there in months.  It’s not that I never do these things, but some combination of diabetes monotony and the many distractions of real life make me inconsistent at times.  An impending appointment is one of my primary motivations to re-group.

This pre-appointment focus also frees up time with the doctor for conversations about those things I haven’t been able to fix.   A new set of eyes is best focused on things which I either didn’t see, or couldn’t figure out.  Last week, my daughter's A1C was good.  The downloaded numbers were decent too, despite a few outliers.  Thanks to my obsessiveness in the preceding week, I was able to intelligently discuss the post-bagel 308, and the string of 200’s possibly caused by adrenalin from pitching in her first softball game.  We received good advice, got to the game in time, and had ice cream for dessert to celebrate.  Thankfully, nobody will ever download those post-ice cream numbers.

Thursday, May 12, 2011

The Test: Part 357

After Monday's successful first day of standardized testing, I relaxed a bit about the whole thing.  My child was happy, the day went smoothly.  Tuesday was great too.  Everything was going to be just fine. 

Then there was Wednesday.  At 9:40, I got the phone call.  "Hi Mrs. Osborne."  I could tell from the tone of the nurse's voice this wasn't going to be good.  "She's 357."  "Crap," I eloquently responded.

"OK," I said, "we'll obviously correct it.  Then she needs to wait to take the rest of today's test until she's under 300, I think.  She must be a little fuzzy-headed."

The correction was given and I was put on hold while the nurse went to talk to the principal to confirm how this would be handled.  Based on my several conversations with him in the preceeding weeks, I was certain she could wait to finish the test when her blood sugar came down. 

"She can make up the rest of today's test next week," was the response. Puzzled,  I was put on the phone with the principal, who had somehow made the assumption that her blood sugar wouldn't come back down for hours.  "I hope it will come down within the hour," I explained.  Finally we agreed that my daughter would hang out in the nurse's office until she was under 300.  I spoke with my daughter, who was upset by the whole incident, but agreed in the end that the plan was ok.

Twenty minutes later, I got the next call.  She was down to 310.  She'd was working on her second large water bottle and was jogging in place.  "Check again in 10 minutes," I said.  "I bet she'll be good."

"She's 257, " was the next call.

"Great!  Send her up quick before she drops to 50," I replied. The nurse, who blessedly gets both diabetes and my sense of humor, laughed. 

In the end she balanced out to a nice 108 by lunchtime and stayed in range the rest of the day. 

Why was she 357 in the first place?  Why did it have to happen on test day?  What did other visitors to the nurse's office think when they saw her in there jogging and chugging water?  I don't have answers to any of these questions.  Did we handle this the best way we could think of?  Did it work out in the end?  Did we manage to maintain a sense of humor about the whole thing?  Absolutely.

Tuesday, May 10, 2011

The Test

This week, my daughter’s grade is taking their statewide standardized test.  The bulk of each morning will be spent assessing  their skills in reading, writing and arithmetic.  They’ve completed many weeks of sample tests, and have been working on their writing skills throughout the year.  They are as ready as they will ever be to prove what they know.

I received a call from the principal a couple of weeks ago informing me that, because of her 504 plan, my child would be taking her test in a “small group setting” in a separate room.  As he went on to explain the reasons for this and to detail his discussions with the school nurse, teachers, and social worker, my mind was racing.  When it was my turn to speak, I’m afraid I wasn’t initially as grateful as he expected me to be for the school’s concern.

I understand why she’s taking the test elsewhere.  According to the statewide regulations for the test, if she left her regular classroom for any reason during the testing, she would not be allowed back in.  She’d have to make up the whole day.  So if she felt low or high, she’d have to decide whether to leave the room to see the nurse or tough it out, potentially skewing her score if her blood sugar is really out of range.  More significantly in the long run, there is the potential effect on her health from not checking and treating when she should.  I was also told the breaks would not be long enough for her mid-morning snack. 

I really am grateful that the school’s staff is attuned to my daughter’s diabetes and has made sure she’s accommodated.  But the whole time I was speaking with the principal, all I could think of was my daughter having to get up at test time and leave the classroom.  We have a consistent message at our house, usually unspoken, but always present: you can do anything the other kids can do.  I knew there may be exceptions to this rule, like being a contestant on Survivor, or flying to the moon, but I assumed we had some time before we ran across them.  Apparently, though, she can do anything other kids can do except take the 3rd grade standardized test at her own desk with her teacher and her friends.   I spent the hours until she came home from school fretting about how I would explain this to her.

In the end, I used a bit of spin. ”You get unlimited time to take the test.  You can leave the room anytime you don’t feel right.  So take advantage of it.  Take your time.  Get up and stretch.  Enjoy your snack…I’ll send you something fun.”  Her initial expression of bewilderment about these rules quickly turned into an “O.K., Mommy.”  And she was off to do her homework. 

There were a thousand questions later, like where exactly she’d take the test, what teacher would be with her, what other kids would be there, and what happened if the other kids took much longer than she did.  All those questions were answered yesterday, the first day of the test.  It was “great,” she said.  The aide from her classroom, who she likes very much, was their proctor.  She got her snack on time.  She got to go to the bathroom when she needed to, “and there was nobody in there, Mommy, since they weren’t allowed!”  As it turned out, her little group finished testing half an hour before the rest of the kids, so she got to chat about Harry Potter and draw pictures. 

In the end, it’s always about making lemons into lemonade.  Sometimes it takes me a while to get the sour taste out of my mouth when diabetes throws me for a loop, but if I’m able to make lemonade for my daughter,  it’s well worth the effort. 








Thursday, May 5, 2011

Tornado Relief: Diabetes Style

This morning, I learned through one of my favorite blogs, Six Until Me, that the JDRF chapter in Huntsville, Alabama is collecting supplies for people with diabetes who lost everything in the past week's storms.

The biggest needs are meters, strips, insulin and syringes.  Pump supplies, lancets, alcohol swabs, batteries for pumps and meters, glucose tabs, glucagon and ketone strips are also being collected.
All supplies must be unopened and not expired.  Don't forget to remove your personal information from the packaging.

Remember insulin must be shipped in an insulated container.

All supplies can be mailed to the Huntsville JDRF office at 2225 Drake Ave., Office 17, Suite K, Huntsville, Alabama 35805. Mark the box as D-Supplies for Tornado Relief. Address them to Victoria Cumbow and Karen Morris.

Sharing a few extra supplies this week is a unique and concrete way to ease a bit of the burden on people with diabetes who are living through this horrible disaster.

Tuesday, May 3, 2011

The Roller Skating Party

This post serves as a most public thank-you to all parents who have thrown birthday parties which involve physical activity.  Ice skating, dancing, active back yard games, gymnastics, bouncy houses, and mini golf are our kind of party activities.  When you combine these activities with the requisite pizza, cake, and assorted other high carb and high fat foods, things turn out better for my child than when party food is combined with the beading party she chose to have to celebrate her own birthday last year.

This Friday’s party was at a roller rink.  If you’re recalling the pie-in-the-face party of a couple of weeks ago and thinking, ‘Gee…it sounds like this woman’s social life revolves around attending Friday night birthday parties for 9 year olds,’ you’re quite right.  Welcome to my world.

Despite never having been roller skating before, my daughter impressively got the hang of it after hugging the wall next to the skate-rental for 20 minutes or so.  Desperate not to be left behind by her free-wheeling friends, she managed to get around the rink faster and faster on each attempt.  She entered the rink with a blood sugar of 170, just about perfect for a pre-roller skating number, I thought.  Of course, I didn’t know exactly what roller skating would do to her, but I do know that steady walking and also ice skating send her in a moderate, steady downward path. 

I was certain she’d gotten the hang of it when 45 minutes into the party she appeared out of nowhere saying, “I feel low.  Do you have my meter?”  She was 70.  She munched some smarties and nursed her bruises for a few minutes, and was off again.  “This is really fun, mom!”

Another half an hour later, at pizza and cake time, she was still about 70.  It was time to guess the carbs in one rectangular piece of pizza and a rectangle of “cookie cake,” a giant sheet-cookie with a border, decorations, and writing in thick icing.  I imagine I was squinting and furrowing my brow as I tried, in my mind’s eye, to make the pizza into a triangle and the cookie cake into a circle to properly judge their size and therefore their carbohydrate content. Then I had to add a bit for the cookie’s frosting, and subtract a bit from each to compensate for the 70 blood sugar, and for the exercise which would still catch up with her as the hours progressed.

My counting and variable considering resulted in a not-so-terrible 200-ish by 10 p.m.  I can’t say the rest of the night was perfect either, blood sugar wise.  But the post-party aftermath was better than it often is. 

Roller skating is in our birthday party plus column, both because it’s “really fun,”  and because it’s a really decent antidote to pizza and cake!