The Junior Mints
"So," she admitted, "we stopped at the store on the way home. I had 50 cents, and I was tired of glucose tabs."
She'd been hovering between definitively low and low-ish all day. A couple of juice boxes, a half-bolused lunch and half a roll of glucose tabs later she texted me before walking home. "78!"
Knowing she had no snack with her, I suggested a couple more glucose tabs to keep her upright until she got home. She had other ideas.
"They had those little boxes of Junior Mints for 25 cents. There were 5 in a box. It seemed perfect. I hope you're not mad."
"It seems to have turned out well...your blood sugar is perfect now. Did you enjoy them?"
"Yeah. But then I was looking at something and I spilled 3 of them. I still had 25 cents so I went back in the store and got another box. I ended up eating 7 of them altogether."
Seinfeld got it just right. Junior mints are easy to spill, very refreshing, and might even contain curative properties.
We Had To Say No
"You can do anything other kids can. Diabetes can't stop you." For the past 11 years, there have been very few exceptions to that rule. This time, though, we had to say no.
My daughter was invited to a birthday celebration, overnight, at a friend's vacation home two hours from here. This (very brave) family invited eight or nine girls to come celebrate.
Let me begin by saying how happy I am that she was invited. I'm always incredibly grateful when no assumptions are made by other people about when and where diabetes becomes an obstacle. No matter how difficult the ensuing conversation was, I love that my daughter was included.
I thought carefully about this invitation before telling my daughter about it, weighing how to approach the conversation. In the end, I let her read the invite, and respond however she chose to.
"That sounds so fun. I don't think I can do it, though. I wish you could come too. But that might be weird."
"I wish I could too, but even if it wasn't weird, Daddy and I set aside that Saturday for {insert awful activity daughter would love to have an excuse to get out of here}. I'm really sorry."
As I said, I considered the possibility carefully. Maybe she could do it. She could text me pictures of the food. She'd be wearing the Dexcom. She's responsible. She's 12! Then came the what-ifs, and they were plentiful. What if the pump site failed? What if the Dexcom conked out? What if she forgot to check often or missed the Dexcom alarms since she was having so much fun? What if she needed glucagon? What if she ate more or less or differently than what we agreed on? What if she forgot to plan ahead for activities involving exercise? What if her low blood sugar symptoms got lost in the chaos of a crowd of partying tween girls? I would be 2 hours away, a 4 hour round trip. For over 24 hours. She's only 12!
The birthday girl and her family are great people. But while our families have spent time together, my daughter hasn't spent time alone with them. There would be a big learning curve, diabetes-wise. A party at their house a few blocks away? Absolutely. Two hours away? As much as she wanted to go, even my daughter knew this was impossible.
We talked at length about all of this. It precipitated a conversation about when something like this might be possible. We came up with a list of things to work on. They include being able to do her own site change, knowing how to give a shot if she needs to, becoming more proficient at and confident in counting her own carbs, actively planning for periods of exercise, and consistently responding to alerts on her Dexcom.
My daughter finds this list overwhelming. Understandably. But then we looked back.
"Three years ago, did you ever think you could go to a sleepover party?"
"No."
"And now you've been to a few. Did you think you'd be able to go to things like the school social or a movie and pizza birthday party without me there to help you with your diabetes stuff?"
"No."
"Six years ago, I came and stayed with you at almost every playdate. Look at all you've learned to do. You'll figure it out, when you're ready. Soon enough, something like this will be no problem. And until then we're here to help you as much as you need."
The conversation continued with a tirade about the awfulness of diabetes, a few tears, and the promise of finding a few minutes of fun amidst the aforementioned boringness of the weekend in question.
In the end, I think we made the only decision we could. We had to say no. I wish it were otherwise.
Let me begin by saying how happy I am that she was invited. I'm always incredibly grateful when no assumptions are made by other people about when and where diabetes becomes an obstacle. No matter how difficult the ensuing conversation was, I love that my daughter was included.
I thought carefully about this invitation before telling my daughter about it, weighing how to approach the conversation. In the end, I let her read the invite, and respond however she chose to.
"That sounds so fun. I don't think I can do it, though. I wish you could come too. But that might be weird."
"I wish I could too, but even if it wasn't weird, Daddy and I set aside that Saturday for {insert awful activity daughter would love to have an excuse to get out of here}. I'm really sorry."
As I said, I considered the possibility carefully. Maybe she could do it. She could text me pictures of the food. She'd be wearing the Dexcom. She's responsible. She's 12! Then came the what-ifs, and they were plentiful. What if the pump site failed? What if the Dexcom conked out? What if she forgot to check often or missed the Dexcom alarms since she was having so much fun? What if she needed glucagon? What if she ate more or less or differently than what we agreed on? What if she forgot to plan ahead for activities involving exercise? What if her low blood sugar symptoms got lost in the chaos of a crowd of partying tween girls? I would be 2 hours away, a 4 hour round trip. For over 24 hours. She's only 12!
The birthday girl and her family are great people. But while our families have spent time together, my daughter hasn't spent time alone with them. There would be a big learning curve, diabetes-wise. A party at their house a few blocks away? Absolutely. Two hours away? As much as she wanted to go, even my daughter knew this was impossible.
We talked at length about all of this. It precipitated a conversation about when something like this might be possible. We came up with a list of things to work on. They include being able to do her own site change, knowing how to give a shot if she needs to, becoming more proficient at and confident in counting her own carbs, actively planning for periods of exercise, and consistently responding to alerts on her Dexcom.
My daughter finds this list overwhelming. Understandably. But then we looked back.
"Three years ago, did you ever think you could go to a sleepover party?"
"No."
"And now you've been to a few. Did you think you'd be able to go to things like the school social or a movie and pizza birthday party without me there to help you with your diabetes stuff?"
"No."
"Six years ago, I came and stayed with you at almost every playdate. Look at all you've learned to do. You'll figure it out, when you're ready. Soon enough, something like this will be no problem. And until then we're here to help you as much as you need."
The conversation continued with a tirade about the awfulness of diabetes, a few tears, and the promise of finding a few minutes of fun amidst the aforementioned boringness of the weekend in question.
In the end, I think we made the only decision we could. We had to say no. I wish it were otherwise.
Antibiotics
The sniffles and cough started last weekend. "I feel fine, just stuffy," was the report. We started the allergy medicine, assuming the start of spring was to blame. On Wednesday she woke with a disconcerting fever of 102.5. The pediatrician did an exam and a strep test, and diagnosed a virus. "Keep giving her Motrin and plenty of fluids." I wasn't convinced, but we took that route for a couple of days. When she still had a cough and a fever of 102 on Saturday morning, I took her back to the doctor's office. To add insult to injury, her blood sugar had been hovering around the 250 mark for 3 days despite aggressive corrections and temp basals.
The practice's other doctor had pulled the Saturday shift. I elaborated on the recorded chain of events, and emphasized my concern that nothing about her condition had changed in the past three days. My stubborn skepticism about the virus idea led to a more careful look. "Looks like she has a little ear infection. I'll put her on an antibiotic." She thought for a while. "I'm going to give her one that works on ear infections but which we also give for upper respiratory infections and mild pneumonia. Her throat is very red and her lungs don't sound great either. This medicine should take care of anything that's going on."
Observing Saturday's Dexcom graph below, you'll see an ugly pattern in the first 18 hours. This is indicative of the previous 3 days' patterns as well. No tactic we attempted proved to be a match for the havoc this illness was wreaking on her blood sugar. Her first dose of antibiotic was at noon. We did nothing different that afternoon, diabetes-wise.
 |
| Exhibit A |
She spent Sunday primarily below the (admittedly inflated because we couldn't stand the constant alarming) line. Everything was not awesome all day long, but comparing the two is like looking at two different people's dexcom receivers.
 |
| Exhibit B |
The fever was gone by mid-day Sunday and so was the lethargy of illness.
I know the medical community is increasingly wary of prescribing antibiotics, recognizing that their overuse can cause problems on both individual and global levels. These are important concerns. But sometimes there's an actual infection and an antibiotic is needed. Had an antibiotic been started on Wednesday, we wouldn't have spent 3 days beating our heads against the wall fighting unfightable high blood sugars. And she wouldn't have spent so much time on the couch instead of at school, or out in the spring air.
But I suppose she wouldn't have been introduced to Gilligan's Island.
The Adrenaline Was A No-Show
Last year's school musical provided us a glimpse into how blood sugar can be influenced by adrenaline. Last year's performance excitement led to numbers in the 300's both nights of the show. These highs, it turned out, needed very little insulin to correct them. Having learned from our mistakes, we put together a game plan for this show. I was particularly concerned since this year's role involved first lines in the middle of the first act but a more significant part including solo singing during the second half. If my daughter's blood sugar spiked in Act I, we needed to be very careful not to over-correct.
I was excited, in a nerdy science-y sort of way, to watch the Dexcom graph. Would her blood sugar start to go up before the show as she started to think about being on stage, or not until she was the one in the spotlight? Would it start to go down again as she relaxed during intermission, or would it stay up through the show? How would our game plan to keep her from having a performance impacting high without causing a performance impacting low work out? How cool would it be to be able to use the Dexcom information from opening night to tweak our game plan for the next day?
We'll never know. We talk often about how everybody's experience with diabetes is different. Activities and foods which may spike or tank one person's blood sugar may have no affect on another's. What makes even less sense to me is that one person's own experience with diabetes can vary over time.
Whether you're a boy scout or not, today's diabetes lesson is this: be prepared. We did everything in our power to ensure a quality blood sugar number for the start of the show. She had her pump's meter remote backstage so she could gently correct the anticipated high blood sugar through her costume. We arranged to text during intermission to decide a dose. Fortunately, we'd planned for any eventuality. Her bag was also stocked with plenty of glucose tabs and juice boxes. We were quickly able to switch gears to prevent an onstage low blood sugar. Otherwise she'd have had to rely on Willy Wonka's pink candy boat, and Willy would have had to admonish her once again:
"Violet, please do NOT lick the boat. You'll only make the ship sticky."
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