Wednesday, February 29, 2012

Flying

My daughter took her second airplane vacation last week.  I thought perhaps, having been through it before, I'd be less anxious this time, but by the time we were safely on the other side of the security gate at our home airport, I realized my heart was pounding and my hands were shaking.  Our return was somewhat less stressful, partly because of the people and partly due to sheer exhaustion.

Like last time, nobody questioned our carry-on bags at all despite the syringes, juice boxes and infusion sets.  On our overseas trip two years ago, I developed a routine for passing through security points, which I followed on this trip as well. I passed through before my daughter.  I then turned to the official and, pointing at my daughter, said "She has Type 1 Diabetes and is wearing an insulin pump."  She then passed through the metal detector and set it off.  At that point, the official called for a "female assist," who we waited for in a little plexiglass enclosure so we couldn't make a run for it.

My daughter was then asked to stand on the designated mat which showed how far apart to put her feet for the pat-down.  She was given a little leniency here as these mats are not designed for 4 foot tall potential terrorists.   Unlike last time when her pump was swabbed for explosives, this time it was only her hands.  I thought that odd on the way out, but on the way home, the agent said to her, "now I want you to touch your pump with both hands and then I need to wipe them with this swab, ok?"   I then remembered that on the way out, the agent had asked her to take her pump out of her pocket to show her before swabbing her hands.

I must give credit to the agents on our trip home. Usually when I inform the agent of the impending situation, I get a stern nod and my daughter is motioned through.  This agent was genuinely concerned.  "Oh...I hope it's not an issue.  Let's see what happens."  Ordinarily when she sets it off, we generally hear"female assist" barked across the security area.  "I'm sorry, ma'am, but I'm going to need to get a female colleague to check her out, " this guy said sadly, before motioning to an agent to help us.  She was equally kind and gentle with my daughter, taking her time to explain everything she was doing.  Maybe these people would like to relocate to our local airport?

This whole process leaves me torn every time.  I realize that the world is a dangerous place, and that a terrorist could easily use a device masked as an insulin pump to blow up my airplane.  Some might even be nutty enough to get a child to wear it.  On the other hand, I've read that some other models of pumps don't set off metal detectors.  Just because ours does, how does that make it any more likely to be a weapon?  Ordinarily, I disagree with profiling for terrorists, believing that crazy people come in all varieties. I would venture a guess, though, that a 10 year old curly haired girl has never been, and never will be, on the terrorist watch list.

Maybe this will get easier with more experience.  Meanwhile, know that my daughter sacrifices herself each time she flies under the auspices of making the world a safer place.  We take some solace in the kindness of many of the security agents, and in the astonished looks of passers-by as they watch a small child being patted down to secure their safety.

Tuesday, February 21, 2012

BYO Snack

Our school instituted a nutrition policy last year which was quite controversial.  Neither class parents, nor the school are allowed to provide treats to the children.  For any party, such as last week's Valentine's Day celebration, children may bring their own treat to eat.  The parent-teacher organization even provides holiday themed bags for parents to send said treat to school in, complete with a large sticker on which to write a note.  Treats for individual birthdays have been discontinued completely.

This policy makes my life much, much easier.  I do not need to know ahead of time what is being served for a party in order to send in a carbohydrate count for the nurse.  I do not worry that what I was told was coming in will turn out to be something completely different.  I do not spend time questioning whether my definition of a "medium cookie" is wildly different from Mrs. Smith's.  I no longer field desperate cell phone calls from the school nurse announcing last minute birthday treats. 

Having attended the recent Valentine's Party to help with a craft, though, I'm not certain this policy's goal as a nutritional improvement has been met.  A few children had pretzels.  Most children had cookies or cupcakes or brownies.  Some even had candy, an item which was never allowed for  parties even before the new policy.  My child had a cookie, albeit a home-made and well carbohydrate counted one.

Having argued for this policy change more from the medical perspective than the nutritional one, though, I'm happy.  My child can participate in parties the same as the others, without worry on her part or mine about what she's eating.  Her friends with food allergies can do the same  With a laundry list of things for our family to worry about each day, this was a nice one to cross off the list.



Friday, February 17, 2012

Better

Last night's dinner number was 218, and I was unhappy. 

Three weeks ago,  I would have been relieved.  "Hey...at least it doesn't start with a three," I might have muttered to myself as I corrected it.  Or, "At least that's better than most of the numbers we saw today."

Apparently, things are looking up.  There's certainly been a lot of hard work involved.  There have been sleepless nights.  I've spent long intervals staring at log book numbers and meter averages. Tweaking and re-tweaking have occurred. Yet somehow the end result of it all snuck up on me.

It happened slowly, but there's evidence things have improved. Looking back on the week, I realize I haven't talked to a school nurse once.  We used juice boxes which had been collecting dust in the pantry.  The log book is filled with numbers which begin with one. 

Unfortunately, I know things are better just for now.  For all I know, tomorrow will throw random 300's at us again.  The upcoming school vacation days will certainly send us off course a bit.  I'll know, though, that I was recently unpleasantly surprised by a 218, and that it's possible to get to that point again.

Monday, February 13, 2012

So...what happened?

Friday evening was site change night.  The low battery symbol was appearing on the pump, so I decided that instead of waiting for it to alarm at midnight, I'd go ahead and take care of that too. 

My daughter had an unusual and not easily explained low blood sugar Friday evening.  She was low again around 10.  By morning she was in the higher range.  Mid-morning, she went to bolus for a snack and the pump alarmed.  "Exceeds total daily dose," was the message.  Her pump allows us to set up maximums for total daily dose, and for each bolus.  It's a safeguard against, for example, giving 2.5 units instead of .25, or wildly miscalculating a dosage.  We run into the single bolus maximum occasionally for an enormous meal, but we'd never hit the total daily dose maximum before. 

Her insulin needs have been slowly increasing over the past couple of months, and my initial assumption was that we'd crested over the somewhat arbitrary maximum we'd set up when we first programmed the pump a couple of years ago.  Looking back, however, the total it was showing was a good eight units over the twenty-four hour totals for any days in the previous week.  She hadn't eaten anything unusually high in carbs. I began to flip through the recent history to see if there had been some sort of accidental bolus.  As I scrolled backwards, it clicked.  The most recent bolus was recorded as 7 p.m. 

You may recall the Seinfeld episode in which Jean Paul comes to stay with Elaine for the New York City Marathon.  He has recently overslept and missed the marathon at the Barcelona summer Olympics.  How could this happen, Jerry wants to know.  Was it the snooze alarm?  No snooze. Perhaps a.m./p.m.?  No. Not a.m./p.m.  For Jean Paul,  the alarm volume was his downfall.

In my case, it was a.m./p.m.  When I reset the clock after changing the battery, I made it 5 a.m., not p.m.  We were fortunate to escape with just the confusion of  the total daily dose alarm and some somewhat strange blood sugar patterns.  Her bolus ratios and basal rates are really quite different throughout the day, and yet thankfully we had no really scary situations.  We reprogrammed the total daily dose to a higher number, set the clock back again and moved on.  Saturday evening, we realized the need to reprogram the date.  We set the clock back so many times that somehow it lost a day in time travel.  But all's well that ends well. We really didn't miss out on much because of this, unlike poor Jean Paul.

Tuesday, February 7, 2012

Sledding

In our neck of the woods, there are currently snowdrops blooming.  I took a long walk today without wearing mittens.  My stash of sugar-free hot chocolate has not been replenished since Thanksgiving.  Yet, technically, it's winter, which ordinarily provides its own special set of diabetes obstacles.

There's been no sledding yet, but in winters past, it's been our nemesis.  The initial experience of being very cold, combined with the thrill of the hill causes an adrenaline rush for my child.  Her body is fighting off the chill and the fear.  Her blood sugar skyrockets.  Then, usually suddenly, her body realizes that she's just spent an hour repeatedly climbing a hill.  Were there a life-sized graph of this decline, it would be the best sledding hill ever.

I periodically dig the meter out of my inside coat pocket, where I've (hopefully) stashed it to prevent the "I'm frozen" error message.  We test and correct, or treat with something unfreezable like glucose tabs or smarties, and she's off again.

I can't really figure out a better way to manage this situation. Upping the insulin prior to sledding would, I think, just exacerbate the low later on.  Testing more often is always a great diabetes management tool.  But testing while sledding is near impossible.  The mittens, the snow, the wind, the lack of anywhere to put anything down, the numb fingers and their related bloodlessness all combine for an unpleasant five minute ordeal.

So, if we get any significant snow here, we'll need to pack up the meter and the smarties (along with the sled), and head for the nearest hill.  We'll manage the diabetes the best we can. I'll stand at the top of the hill, and each time she appears, I'll say, "feeling ok?" or "need to check?" Eventually, I'll force her to stop.  She'll be high and correct about half of it.  Twenty minutes later, she'll be low and have smarties.  We'll bring enough to share with her friends.

Sledding is a rare treat, and in my opinion, we do the best we can while being practical.  If she decides to join the Olympic luge team, we'll need to come up with something better.

Thursday, February 2, 2012

H-I-G-H

High.  H-I-G-H.  High.

Yes, contestant number seventeen, that's correct!

Well, that wasn't one of her words, just the end result of last weekend's spelling bee.

We've seen adrenaline highs before, but this one was a doozy.  There was the 20 minute wait to start spelling, which was difficult.   The pressure of standing up in front of the microphone was new. The intense disappointment of messing up an easy word was, I'm sure, the final straw.

By the time it was all over, she was 318.  As she sat to watch the grand finale, I bolused about a third of that number and handed her some water. Experience told me that with my child, much of that number would disappear on its own once she calmed down.  A couple of hours later, thankfully both her blood sugar and her self confidence were back in range. 

Adrenaline is a funny thing.  She certainly didn't need that surge of blood flow and glucose to spell correctly.  In fact, the related jitteriness and, in her case, high blood sugar, was nothing but detrimental.  Yet after so many years of evolving from cave people who required that fight or flight response to escape charging bears, it's still a physiological reflex in any anxiety producing situation. 

Maybe next year she'll have to spell adrenaline.  She'll take a deep breath, and ask the pronouncer to use the word in a sentence.  "A surge of adrenaline makes me want to run screaming around this room instead of spell."  By then she'll have taken that deep breath, calmed her nerves, and she'll spell it perfectly...unlike her mother who is fortunate to have access to spellcheck.