Tuesday, April 24, 2012

Enough Already

Here's a collection nobody wants to have:




It had gotten to the point where they'd taken over most of a dresser drawer.

Though they're all size 10-12, my daughter decided she couldn't wear all of them. She kept her favorites and donated several to the Red Cross clothing bin. 

 I just hope I kick myself someday when 'cure diabetes'  
t-shirts are selling for buckets of money on e-bay.

Wednesday, April 18, 2012

Good Control

The question stumps me every time.  "Are her blood sugars in good control?"

It's asked by medical professionals in every office we visit: the dentist, orthodontist, eye doctor, pediatrician, specialist, lab.  No matter how it's asked, my mouth seems to open and close but I'm unable to form an adequate sentence."Is her diabetes under control?"  "Have her blood sugars been stable?" 

The first problem is how vague the question is.  What do you mean by 'good control'?  Are you asking about today?  This month?  Since you saw her a year ago?  Today, her blood sugar may be terrific, but it could be the first day in two weeks she's stayed below 200.  Is it her A1C you're looking for?  That may not reflect the past 2 months' work to bring it down by next time. 

It also strikes me as curious that a medical professional who should have some rudimentary knowledge of the disease phrases the question this way. By definition, her blood sugar is out of control.  We use many tools to control it as best we can, but she will get smacked by random highs and lows no matter what we do.  These are caused by factors like growth, illness, unanticipated exercise, stress and possibly a full moon.  These factors are out of our control, part and parcel of life with diabetes. 

Which leads to the ultimate problem with the question. No matter how it's asked, it's phrased so that 'yes' and 'no' are the only possible answers.  Yet neither is accurate.

Usually, I cobble together a response such as, 'pretty good...we do the best we can," or "most days."  I imagine neither of those is terribly helpful. 

The reason for the question is generally clear.  Doctors, nurses, and technicians need to find out if she's at risk for any complications they should be on the look-out for. 

Perhaps those of us who encounter this question could begin to use it as a conversation starter.  Instead of mumbling through a useless answer, we could formulate responses which could make doctors rethink the question.

"Are you looking for her A1C?  That was x.x last time, down from x.y the time before."  Or, "Do you mean the last couple of weeks?  She's been having random lows we can't account for...that's part of what brought us here." Or, with a tired smile, "Could you be more specific?  It's a big disease and it's hard to quantify how we're managing it with a yes or no question."

Thursday, April 12, 2012

The Field Trip

The fourth grade of my daughter's school visited our state capitol on Monday.  The trip involved an hour and a half bus ride each way, walking around the plazas surrounding the important buildings, and a guided tour of the capitol building.  As a class parent, I came along.  There was also a school nurse on the trip.

On the way there, my daughter bolused for her snack and a 200-ish blood sugar with the nurse.  Once off the bus, we began walking around the plaza, posing for pictures, and awaiting our appointed time to tour the state house. 

At about 11:00, the 4th grade was broken into two groups. One embarked on their official tour, while our group explored a visitor's center for about half an hour.  Just as our visitor's center time was ending, my daughter approached me. "Mommy, I think I should check before we start our tour."  Proud of this wise decision, I grabbed a meter out of my purse, and pulled her aside.  She was 54.

I dug around and realized I hadn't replaced the juice box in my purse.  I had plenty of glucose tabs and a ziploc full of smarties and starburst, but knew juice would act faster and be more efficient to consume.  So I started looking around for the nurse.  I looked and looked and eventually concluded that she had been sent with the other group because I was with my child and there were kids in the other group with asthma and allergies.

Our class was lining up and someone was explaining the ground rules for the tour: quiet, respectful behavior and no eating, drinking or chewing gum.  At the same time, I was methodically slipping my child one glucose tab after another.  She took 3, which is 12 carbs compared to the small juice box count of 15 which is usually more than enough for her to treat a low in the 50's.  We tried for one more, but I struggled to dislodge it from the bottom of the vial and when I did it flew onto the floor. 

By the time I'd found the second container of glucose tabs in the bottom of my purse, the class was quietly assembled, single file, around the beautiful rotunda of the state house.  A lovely elderly volunteer was telling the children all about the room, and about the building they were about to tour.  Initially, my daughter appeared to be paying attention.  I became hopeful that her blood sugar was rising. 

I glanced over at her again a couple of minutes later.  She was looking at me, pale, teary, and frightened. Unless I wanted to find out what her teacher had retained of his glucagon training, I needed to act.  Trying to be as surreptitious as I could, I quietly walked up to her and handed her 2 more glucose tabs.  "Chew them quickly," I whispered.  I grabbed her camera, since she was clearly in no shape to take pictures of this beautiful room and her memories of it  might be a bit fuzzy, and  returned to my spot. 

We  proceeded to the governor's office less than 5 minutes later, at which point she said she was starting to feel better.  By the time we left that area, color had returned to her cheeks, and she seemed to be engaged in the tour.  Lunch was an hour or so after the initial low blood sugar.  By then she was only around 140 despite my fears that in the end we may have over-treated. 

"Mommy, that was scary," she said later in the day.  Indeed.

Wednesday, April 4, 2012

Growing

"Around this age," the endocrinologist said at our last visit, "you can expect a growth spurt.  She'll likely grow up to a few inches in a year.  And you can imagine," he went on, "what that will do to her blood sugars."

I imagine no more.

She's been growing quickly for the past couple of months.  The official 'pencil mark on the door jamb' measurement shows a gain of a solid half an inch in March alone.  Last spring, she wore a size 7 Easter dress.  This year's is a 10. 

The growing part is a great.  The blood sugar part is not.  The predawn hours until late morning are the worst, not unlike when she grew quickly as a toddler.

"You'll find you're needing to increase basal rates and bolus ratios much more often," the (here paraphrased) doctor continued.  "Sometimes it will only be a couple of weeks before everything is off again."  The wry smile softened the news a bit. 

My recollection is that my daughter's 9 a.m.blood sugar was over 200 for her entire toddlerhood, though that may be a bit exaggerated.   With better tools including an insulin pump and years of experience at our disposal for her tween years, it's my hope we can do a bit better for this growth spurt.  No matter the tools, though, what really matters is the persistence of the person using them.

Therefore, there's one tool we'll need to borrow from those years: the theme song from Bob The Builder: "Can We Fix It? Yes We Can!" 

Monday, April 2, 2012

Time Capsule


The premise:  Two (perhaps not so bright) young men discover a time capsule in 2112.

"Yikes! What IS this stuff?"

"Wow...I have no idea.  Horrible."

"Yeah.  You know, there were all those terrorist plots back then, remember?"

"Maybe that's it.  Looks terrifying to me."

"Suppose they planned to implant these in people with the needle-things?"

"That's what it looks like, and then give them some kind of poison with the machine, maybe."

"But what are these other pointy things?  And this container rattles.  Wait...it opens.  Let's look."

"Little strips of some kind.  Do they go in that other machine?"

"Yeah, look.  They fit."

"Wait a minute.  I think we've got it wrong.  I remember my grandmother telling me about some sickness she had until she was in her twenties.  She called it diabetes. She used to talk about having to poke her finger to get blood like 10 times every day.  And she wore a machine around all the time.  Before they cured it, that's all that kept her alive."

"Wow.  That's rough.  I'm glad they figured out how to cure it."

"Yeah.  Me too.  My grandma was a great lady.  I'm glad she didn't have to live her whole life dealing with all of this scary stuff."

"What should we do with it?"

"I say we bury it again.  Who would want to be reminded of a time when people had to use all of this dangerous-looking junk just to stay alive?"


This idea came from WEGO Health which sponsors a health blog marathon, encouraging a daily post for the month of April.  While a daily post is beyond my stamina at this point, the website does encourage me to use the prompts anyway, and this one struck my fancy!