Thursday, March 28, 2013

Adrenaline 2

My previous post described our experience with adrenaline when my daughter performed in the school musical last weekend.  The excitement and anxiety of performing resulted in a large spike in blood sugar.  The spelling bee, amusement park rides, and other big moments have resulted in similar spikes.  Yet there are circumstances in which we'd expect to see an adrenaline spike and do not, such as this weekend's other stressful event.

In the midst of her busy play weekend, I dropped my daughter and my husband at softball practice at 11 a.m. on Saturday morning.  I returned an hour later to find my daughter with an ice pack and a growing bruise near her eye.  She didn't catch the fly ball.

This scenario involved physical trauma, fear and embarrassment.  It seems to me that this would be a perfect trifecta of adrenaline production.  For her? Nothing. Her blood sugar was 81 after practice and didn't spike until her performance later that afternoon. 

There is a long list of areas in which people's experience with diabetes varies.  Foods which are disastrous for some pose no difficulty for others.  Exercise may cause a slow and steady drop, or it might cause a spike followed by a later crash.  Low and high blood sugar symptoms differ greatly from person to person.

It becomes a matter of tracking individual experiences and learning the patterns. We learn the basic science and execution of it all from our health care team.  We read and listen to the experiences of others with diabetes.  Yet diabetes management also involves a great deal of 'learning by doing.'

We hope not to have a repeat of the softball to the face incident, with its resulting black eye; particularly not hours before the school play.  Perhaps, though, we've learned something about the difference between physical and emotional trauma in their ramifications on my daughter's blood sugar.


Tuesday, March 26, 2013

Performing

My daughter's middle school musical was this past weekend.  She had a few lines and one phrase of song around the middle of the first act.  Throughout the show, she sang and danced as part of the 'chorus.'

It seems theater will require the honing of some new diabetes management skills. The first night, her pre-show blood sugar was in the high 100's: just fine for shortly after dinner.  At intermission, after her big part, she texted me from backstage.  Her blood sugar was 301: very high.  While in the back of my mind I was factoring in adrenaline while helping her tweak the pump's recommended correction, I had her dose a substantial amount of insulin.

I do know that adrenaline affects her blood sugar, and that depending on the circumstances, some or most of the resulting high will resolve itself on its own.   Revisiting my spelling bee post might have refreshed my memory, or reading this Diabetes Forecast interview with Crystal Bowersox.  Particularly the following:

Q. Does performing affect your blood glucose? It does affect it, actually. Right now my routine is: I’ll check my sugar one to two hours before hitting the stage. And then if it’s too high or too low, I can adjust accordingly. If it’s too high, I’ll take half the amount of insulin I’m supposed to take because adrenaline makes your blood sugar go up. But it also comes down on its own. You don’t have to correct for an adrenaline high, and if you do, you end up bottoming out after the show. It’s been a struggle to find that fine balance, but I feel like I’ve got it now.

It's hard to let a number like 301 ride, but I definitely overreacted.  I therefore found myself up all night chasing low blood sugars. The physiology is beyond me, but somehow that spike disappeared on its own, leaving a boatload of insulin to keep working well into the night.

Saturday saw a similar pattern, with a 308 at intermission.  This time, having learned something Friday, I had her give about a third of the suggested insulin.  Despite pizza, chips and a cookie an hour later at the cast party, then more pizza and a dessert buffet at a friend's after-party, she stayed in the 100's all night. 

She thoroughly enjoyed rehearsing for and performing the play, so I expect we'll have some more theater experiences ahead of us.  As with many other diabetes tricks of the trade we've picked up over the years, we'll figure this one out too.


 

Wednesday, March 20, 2013

Wordless Wednesday: In Lieu of Candy





The Easter Bunny always brings a good chocolate rabbit, but we're up to 2 bins of Easter creatures, games and toys. 
 
 

Friday, March 15, 2013

Bits and Pieces 2

A few things caught my eye this week:

Check out this video about a model explaining the Hemoglobin A1C test.  It's a 3-D educational tool which shows how glucose molecules stick to hemoglobin.  Being very much a visual learner, I'd love to see one of these on the endocrinologist's desk, so that he could use it to explain the somewhat mysterious number we discuss at each visit.  If you like it, vote and you may see it at your doctor's office soon!

It was great to see Charlie Kimball appear on the Today show talking about indy car racing but also about howType 1 Diabetes shouldn't stop anyone from pursuing their dreams. 

I have found kindred spirits in parents of children with food allergies. We've huddled together at many a birthday party or school event obsessively reading labels or unwrapping the substitute treats we've provided for the occasion. This New York Times Magazine Article describes the results of an ongoing study treating children with multiple food allergies.  One of the intriguing aspects of the article comes towards the end, and involves a ten year old girl who began the study with such severe allergies to so many familiar food items including dairy, wheat, peanuts, nuts and eggs that she had a full-time aide at school.  By the end of her time in the study she was able to eat almost everything she was once allergic to.  Yet she often chose not to.  Partly, there was still a lingering fear.  She also wonders if the people around her would think she had been dishonest about how severe her condition origionally was.  It brings up questions about how diabetes defines those who have it. How would a potential cure or less hands-on treatment affect how people with diabetes are viewed? How would it affect the way they view themselves?

It's always encouraging to be reminded there are people out there researching, advocating and serving as role models for kids (and maybe adults too) with diabetes.

Wednesday, March 13, 2013

Many Miles

One of the annual steps we take as part of our tax preparation is to calculate the number of miles traveled for medical care.

This year's family total was 495.  All but about 20 of those miles were for my daughter's appointments.

Granted, that's not all diabetes-related.  There's the orthodontist, and the eye doctor, and the regular pediatrician and the dentist, and another specialist thrown in here or there for good measure. 

Regardless of the destination, that number translates into significant time spent in our car.  Many homework assignments have been completed there.  Many snacks have been consumed.  Many magazines have been read.  Many games of Angry Birds have been played.

Some of the car time, and we'll add waiting room time, is not quality.  Video games or mindless radio listening are sometimes the order of the day.

Yet every so often it becomes an opportunity.  Conversations take place about school, friends, or the world around us which we might not ordinarily get into.  Medical conversations take place too, particularly on the way home, reviewing what happened at the office. 

The travel to these appointments often takes time away from the school day, or pre-empts an after school activity.  The driving there and back can be tedious or occasionally challenging.   It sometimes feels like time we will never reclaim.  Every so often, though, it becomes time we never otherwise would have had. 

Monday, March 11, 2013

Alone

My daughter was home sick from school at the beginning of last week.  She spent most of two days on the sofa watching t.v. and blowing her nose. 

By the morning of day two we faced an emergency.  We were down to five tissues.  I had to go out.

At eleven years old many of her friends get left home alone.  Some are alone for an hour or two daily before their parents get home from work.  Others are left while siblings are taken to practices, games or appointments.  We are fortunate to live in a relatively safe community.  The word 'responsible' has been used to describe my daughter at every parent teacher conference since she was four.  Despite all of this, my daughter had never been left home alone for more than about 10 minutes.

It's not my daughter I'm afraid to leave home alone.  It's her diabetes.  Would she remember to bolus for a snack? What if she were low?  Would she notice?  If she did notice, would she have the wherewithal to treat it?  What if the low caused her to be too confused to react?  What would she do if the pump alarmed? 

Yet the idea of resorting to blowing our noses on napkins or paper towels seemed unappealing.  So did scrounging around the freezer for ossified leftovers for dinner.  We had finished the box of peppermint tea.  A snowstorm was predicted to begin the next day.  I had to go, and I couldn't drag a child with snot pouring down her face around the grocery store.  Had it been necessary, I probably could have found somebody to come stay with her, but I really didn't want to expose anyone to this illness.

So around 10 a.m. when she wanted a snack, she tested her blood sugar. It was 200-ish (not bad for sitting on the sofa all morning) and she bolused for the number and some dry cereal.  I put the meter, a juice box, and the phone on the table in front of her. 

"Please check if you feel at all funny.  Call me if you need me." And then, in an attempt to elicit a smile, "Don't do anything crazy."

It was a combination smile and eye roll. "I'm just going to sit her and watch 'Good Luck Charlie.'  Don't forget to get me a diet ginger ale."

So I left. 

You know how the story ends. When I got home she was sitting on the sofa watching 'Good Luck Charlie' and blowing her nose in the next to last tissue.

At this age, I can still avoid leaving her alone in most circumstances.  She prefers a visit from grandpa or going to a friend's house to being home alone anyway.  Yet the day will come when she can legitimately be home alone for a few hours.  I'm sure she'll be responsible and careful.  I'm also sure I will be nervous.  While I can't arrange playdates when she's sixteen, I'll always be happier when she has a buddy around in case she needs a little help.

Saturday, March 9, 2013

Daylight Savings!

Tonight brings daylight savings time.  Below I've revisited a post recapping a previous year's experience:

Along with most of the clocks in the house, my daughter’s pump clock got set ahead one hour this weekend. Others with diabetes tell me this hour time change poses no problem for them. Somehow, it throws us for a loop every time.
At 2 a.m., under the watchful eyes of many webkinz, I rolled my daughter around until I could find the pump, wondered how this didn’t wake her up, and changed the time. Her blood sugar was perfect.
We saw perfect again once or twice on Sunday, but also saw 315 and 47. From experience, I know consistency will return in a couple of days. We may need to do some minor tweaking of basal rates, but essentially things will work themselves out once her body clock catches up with the pump clock.
Meanwhile, calls will come in from school, many extra test strips will be used, and juice boxes will be at the ready. We’ll consider this a secret inside peek at how our bodies adjust to this semi-annual time change, and be glad that the next time it happens, we’ll get an extra hour of sleep to help us cope with the consequences!

Falling back doesn't seem to be an issue, but somehow springing ahead gets her every time.   Another diabetes mystery.

Wednesday, March 6, 2013

DRI BioHub -- Bub


Perhaps there are a few readers who are not regular followers of the diabetes online community. Or who spent yesterday in a cave. So first, a bit of background:

The Diabetes Research Institute released a video around midnight describing a new therapy they are working on called the 'biohub.'  Take a look if you haven't done so yet:




The official announcement was preceded by DRI announcing it would soon have a big announcement.  This buzz was picked up by an evening news broadcast in Boca Raton and a few medical interest websites.  A familiar figure in the diabetes online community, who also works for DRI, pre-announced the announcement with great enthusiasm.

There are those who, upon viewing the video, felt disappointed.  It did not, for them, live up to the hype.  For others, it felt more like a fundraising gimmick than an announcement of scientific advancement.  Most cringed at the overused 'five to seven years' time frame.  If eye rolls were audible, the sound from the diabetes community would have been deafening.

Maybe it's because I'm not terribly excitable.  Or because I'm a 'hope for the best but expect the worst' kind of person.  But I was not disappointed.  I think this is good and interesting news.  Maybe in 5-7 years, I'll be able to schedule a procedure for my daughter's biohub implant.   More likely, this research will spur more research by DRI and other competing researchers which will ultimately bring us to a cure.  Either way, in my eyes, it's a step forward which can only beget another step, keeping the research momentum going.

We live in a world of constant information.  Five to seven years ago, we would have discovered this research development as a small press release in the newspaper or perhaps in our weekly perusal of the Children With Diabetes e-mail blast.  Now my local pub, my favorite t.v. show, my family and friends, and every diabetes organization that exists are vying for my attention 24/7.  They're posting on facebook, tweeting, e-mailing, calling and texting me ALL THE TIME.  If one of them wants attention, they need to be dramatic.  Sometimes it will work, and sometimes it'll lead to disappointment.  The 'rare and extra dark porter' being offered only this weekend could be fabulous or could turn out to be awful.  The friend who posts, 'very excited!!!!' may later announce a pregnancy, or disappointingly, a new sofa.  Yet, 'come for beer tonight, ' or 'got a new couch' won't get my attention at all.

I can see how people would be disappointed by this if the buzz led them to believe a cure was around the corner.  Buzz or no buzz, though, it's pretty interesting and a step in the right direction. 

Friday, March 1, 2013

Word Problems

Word problems are coming home thick and fast as a part of my daughter's math homework these days.  Maybe she does well with them because we solve them at home too.  Here are some we've recently worked on:

1. A child with type 1 diabetes wants to eat 1 cup of chex for breakfast.  If 3/4 cup of multigrain chex contains 39 grams of carbs, how many carbs does one cup have?  Bonus: If 14 pieces of chex are left in the box and the child consumes these as well, how many carbs should be added to the total?

2. One roll of smarties has 4 grams of carbohydrate.  Each roll contains 15 candies.  If 10 grams of carbohydrate are required to raise a low blood sugar, how many smarties should be consumed? How many rolls will be needed?

3. One batch of cookie dough contains 620 grams of carbohydrate.  If 48 cookies are made, how many grams of carbohydrate are in each cookie?  If 1/8 of a cup of sugar is ommitted from the cookie topping, does the final answer change?

4. Mom makes homemade chicken soup with rice.  The entire pot of soup, approximately 2 quarts, contains 1 cup of cooked rice.  How many grams of carbohydrate does 1 cup of soup contain?

5. The grilled cheese sandwich comes with a side of homemade french fries varying in length from 1 to 3 inches.  How many carbs are in 15 of these fries plus 5 of your mother's sweet potato fries?

Diabetes math problems aren't always as solveable as 5th grade textbook ones.  Some of these we solved correctly with math.  Others required a bit of luck.  Others we got wrong, but gathered information to help us obtain a more accurate answer next time. 

Now, for extra credit:

If 89 baby goldfish crackers contain 20 carbs, how many minutes will it take to count said goldfish into a bowl?  What is the number of goldfish the count can be off by before the change in carbohydrate grams would cause a significant flux in blood sugar?