Halloween Lows

Dear Parents of Trick-Or-Treaters-With-Diabetes,

Please make sure your child has plenty of fast-acting carbohydrates available when trick-or-treating on Halloween.



 

'Wait...what?' you may ask, 'but it's trick-or-treating! There are fast acting carbohydrates at every door!'

Trust me. There are not. We've been there not once but twice. Once we were unprepared and the second time just underprepared.

The year she was 6, my daughter's blood sugar was over 150 when she left the house, perfect for a little walking followed by a sample or two from houses of people we knew.  We went around the corner to meet the neighbors. There was a little running around in the yard until the youngest neighbor was ready to go.  By house #3 my kid was low.  In her bucket were fritos, a spider ring and a 3 carb dumdum pop.  Houses #4 and #5 offered Hershey's kisses and tattoos.  We had to drag our party back to our house for juice before proceeding.

 A few years later we were trick-or-treating  in a friend's neighborhood.  We'd covered a couple of blocks when suddenly my kid was not just low but in the 40's.  I had one juice box with me, having assumed that would be enough, since we'd gain a stash of candy as we went.  Despite having visited a couple dozen houses, my little witch had received almost exclusively peanut-butter cups, snickers and chips, all members of the 'slow-acting don't eat this if you're low' carbohydrate category. It was dark and difficult to see into her friends' plastic pumpkins to ferret out all of the available smarties and nerds, which she downed in rapid succession as we continued on our route.

So take it from a mother who has seriously considered asking for orange juice in lieu of the spider ring, assume nothing; except that you're taking a long walk, at night, probably at an hour when exercise is unusual.  Bring the juice.

The Muffin Chronicles Part 3: Apple (& Pear?) Muffins

We started out making these with no fruit at all, as a fall spice muffin.  Then my daughter had her baking-loving friend sleep over one night.  She's is my favorite sleepover guest since the evening always involves making something great either for dessert or for breakfast the next morning.  This friend suggested the addition of diced apples, and we've never gone back.

Start by preheating the oven to 350°.

Then mince up some apple, and maybe pear if it happens to be around. I had parts of two apples left from chopping the rest into salads during the week, and a sad pear.  I was only able to salvage a small chunk of the pear, but I wouldn't want to use too much anyway since they're so much moister and mushier than apples.  In total I used somewhere between 1/2 and 2/3 cup of finely chopped fruit. 

Next, combine in a large bowl (to which you'll eventually add the dry ingredients):
1/2 c. sugar
1/2 c. milk
1/3 c. vegetable oil and
1 egg

 

 

Then add:
1 c. whole wheat flour
1/2 c. white flour
1 1/2 tsp. baking powder
1/2 tsp. salt
1/4 tsp. nutmeg and
1/4 tsp. cinnamon
.

Stir just enough to combine. 

Then fold in the fruit.

The first few times we made these, we went back and double checked that we'd measured correctly.  The batter is extremely dense- more like bread, or even cookie dough.  The thickness does make it easier to get it into the muffin cups, which should be about 2/3 full.  Sprinkle lightly with cinnamon sugar. 

 

Bake for 15 minutes.

 

 

 

The whole recipe has approximately 285 g. carbs if you use the equivalent of one average apple and depending on how heavy-handed you are with the cinnamon sugar.   I ended up with 35 mini muffins which mathed out to approximately 8 carbs each. 

 

They're even more fun if you're fortunate, as I was, to find holiday themed baking wrappers in your pantry!

 



Dear Diabetes

Dear Diabetes,

Please stop.

You have had your fun.  Now please leave us alone. 

The blood sugar of 400 after dinner was sarcastic, no?  Yes, we forgot to bolus for the little baked potato until after it had been eaten, but a bg that high for maybe 15 missed carbs?  Get a grip.

Then you showed up at gym the next morning.  You and gym had finally started to get along I thought.  But you threw in a random 40 to start the day. Why? 

Oh- yes.  I remember.  So that my kid could have a moment to ask the nurse about the next day's standardized testing plans.  Where would she be taking it?  What were the accommodations for you, diabetes? This question ended in a lunchtime meeting with the guidance counselor, a series of emails and still no firm answer.  We'll have to go with the flow for this one it seems, partly my fault for not taking note this test was coming and asking earlier. But we would've gone with the flow anyway, without having the opportunity to ask the question and waste an hour of the day with stressful communication about the answer.

As if the testing question fiasco weren't enough, the low also resulted in missing most of Spanish class, where the assignment to do a project on a famous Hispanic person was handed out.  By the time she got back to the classroom Big Papi and Freda Kahlo, her first choices, had been taken.  She chose Pedro Martinez, but while the choices on the original list included links to articles in Spanish to work from, that wasn't the case for off-the-list options.  So while the class had the opportunity to complete most of the initial portion of the project in class, my daughter spent an hour at home finding an article in Spanish about Pedro and answering questions.  On a night she was supposed to have no homework due to the aforementioned tests.

Diabetes, we've had enough.  We see you.  We hear you.  We feel you.  We get it.  You've got power to derail any day you want to.  And you did.  You won the day.  Please go somewhere else to celebrate.

Respectfully,

Us

Like a G6?

We upgraded our Dexcom system a few weeks ago to the G4 Share.  Why, you may wonder, didn't we go straight to the newest Dexcom system, the G5?  And what's the difference, anyway? 

Here's what we learned about the distinctions between the two:

-The G4 Share sends data from the transmitter (worn on my daughter's body) to a receiver (within several feet of the transmitter). The receiver has a screen on which the data is viewable, and it alarms for high and low blood sugars.  The receiver then sends data to a paired smartphone (in this case my daughter's). That phone, in turn, can be set to send data to other smartphones (in this case, mine and my husband's).

-The G5 Share sends the data straight from the transmitter to a smartphone, bypassing the need for a receiver.  There is an option to have the data go to a receiver instead, but it cannot go to both places.  From what I've read,the distance over which the G5's transmitter will send its data is shorter than that of the G4's transmitter.  The share part works the same way, with the option to send data on from the primary smartphone to designated recipients.

Here's how we thought through our decision:

-My first consideration was that I didn't want my daughter's phone in her room at night.  The temptation to text, stream Netflix and/or scroll through Instagram would be entirely too great. Because of it's reportedly shorter transmission range, I wasn't confident that the G5 transmitter's signal would reach through the wall to the adjoining bathroom or hallway. And even if it did, I had another issue:

-I didn't want my phone in my bedroom at night. Much to the chagrin of a few of my friends, I'm known for putting my phone 'to bed' by 9:30 p.m.  If I were using it for Dexcom alerts I would not only need to leave it next to the bed, but also leave the sound on.  This wasn't appealing if we could continue our current practice of using a receiver with a longer signal instead.

-We then began to consider where else my daughter wouldn't or shouldn't have her phone, even if it were part of a medical device. It would be hard to carry a phone during gym class.  What about marching band practices and competitions?  Theater costumes don't often have roomy pockets.  The size and simplicity of slipping a much smaller-than-an-iPhone Dexcom receiver in a pocket or clipping its case on a waistband seemed much more convenient in these situations than finding somewhere on her person to stash the phone.

-The receiver emits a unique series of vibrations and/or beeps to alert its user of low or high blood sugars.  This would make it possible to be alerted of, and to address, a problem even if the receiver were silenced and tucked deep and irretrievably in a uniform or costume.  Two vibrations for high, three for low, four for very low.

-The receiver's information seemed more quickly accessible.  The receiver is usually clipped to her waist band or in her front pants pocket. At the push of one button to wake up the screen, she can see her current number, a trend arrow, and a three hour graph.   With the phone, there would be the process of locating it in her bag, unlocking it, opening the app and then being able to see the data before putting the phone away again.  More steps would make it harder to be surreptitious and more likely to get questioned or looked down upon for using her phone inappropriately.  Was it worth the extra conversations and dirty looks?

It was a tough decision, mostly since my inclination is usually to go with the very newest technology, but I'm convinced we've made the right choice for our family at this moment.  Now we can stop thinking about it until we have to decide whether we'd like a G6 or a G6.

Share Scare

Marching band practice started at 6:30.  Soon thereafter my phone started emitting a sound alarmingly similar to a fire alarm in a large building.  I grabbed it and discovered this:

 

I don't text my daughter for moderate lows in the 60's range. Those I trust she can handle just fine on her own, just like she did 3 weeks ago before we had this technology.  The same is true, so far at least, for any issues at school.  She's got teachers, friends, and a school nurse there to help her. 

 

But this was unsettling.  The band was outside.  It was getting dark.  What if she'd stepped aside to check and nobody noticed her?  I texted:

 

My phone is alarming about this low...assume you're treating it?

 

Five minutes passed with no response. It felt like 15. The next time the number updated it was 46, still straight across. I could hear the band from the high school, just up the hill from our house. I texted again:

 

???

 

A few more minutes passed and another glance at my phone showed me this disconcerting screen:

 

As the minutes continued to creep by with no return text, I considered all kinds of possibilities. Was she:

 

Keeled over in the dark on the sidelines somewhere far away from her phone and supplies?

 

Being taken care of by a responsible adult somewhere not near her bag?

 

Still marching, unaware she was this low?

 

Perfectly fine and wearing a 12 day old Dexcom sensor that was giving flaky information?

 

I started to gather my shoes and my jacket.  How long was it okay to wait before going?  How horrified would she be if I showed up there and it was a false alarm?  What if I didn't go and it wasn't a false alarm?  A few more minutes passed as my thoughts swirled. I decided to wait it out until 7:30 when I was planning to leave the house for a meeting anyway.  I'd just casually drive by on the way...even though it wasn't on the way at all. 

 

But then, finally ... a text!

 

I was actually 79.  Drank a juice and kept marching.

 

We're finding lots of reasons to love the 'share' technology.  This evening of scary misinformation wasn't one of them.

 

 

The Muffin Chonicles Part 2: Blueberry!

I mentioned a couple of weeks ago that we're on a muffin kick here.  They're the new go-to lunchbox addition.  Summer (and blueberry season) have sadly come to an end, but frozen blueberries work just as well as fresh in this recipe:

 

Whole Wheat Blueberry Muffins

 

This recipe is adapted from Betty Crocker's New Cookbook ©1996

 

Preheat oven to 400°

 

Combine the following in a large bowl (large because you will eventually have all the batter in it):

 

1 c. milk

1/4 c. vegetable oil

1/2 tsp. vanilla (or a little more)

1 large egg

 

Combine the following in a separate bowl:

 

1 c. white flour

1 c. whole wheat flour

1/3 c. sugar*

3 tsp. baking powder

1/2 tsp. salt

 

Add dry ingredients to wet and stir until just combined.

 

Fold in:

 

1 c. fresh or frozen blueberries**

 

Spoon batter into a greased or paper-lined muffin tin.

 

Lightly sprinkle with cinnamon sugar if desired***

 

Bake 20 -25 minutes for large muffins, 14-18 minutes for mini muffins, until an inserted toothpick comes out clean.

 

Yield: 12 large muffins, 30-36 mini muffins (I ended up with 32).

 

With 32 made, they mathed out to between 9 & 10 carbs each. 

 

*Yes- real sugar. I have made these with Splenda and they come out fine that way too but a little denser, and they're dense to begin with.  Especially since it's such a small amount of sugar, I don't think it's worth the substitution.

 

** Especially for mini muffins, the smaller the berries the better.

 

*** We like a sprinkle of cinnamon sugar to give the muffin top a little texture. We usually have a container of cinnamon sugar mixed up in the pantry to sprinkle on toast or muffins. Our formula is not an exact science. The general recipe is: a couple of spoonfuls of white sugar combined with several generous shakes of cinnamon until it's approximately this color:

 

 

 

Blueberry muffins are great for a little taste of summer year-round. 

 

But fall has arrived, so be on the lookout for something apple-centric in the next edition of The Muffin Chronicles! 



Apparition

I woke slowly, confused.  It was definitely the middle of the night.

I thought I'd heard footsteps, which would ordinarily mean my husband had gotten up, but he was still in bed.  I opened my eyes as my husband sleepily said, 'Hi?'

There she was, in front of me: my kid. I said her name groggily, with a question mark at the end, like I wasn't sure who she was.  But the real question was what she was doing there, a foot from my face.

"What's going on?"  The more awake I got the more worried I got about the possibilities. She was sick, or something had gone awry in the house (flood? electrical?), or something had scared her terribly.  I could not remember the last time she'd showed up in our room in the middle of the night.  There was definitely a problem.

"My pump is alarming.  The battery is dead."

"Okay...  Let's go."

She and I stumbled back into her room.  She found a quarter and I found a battery.  We switched out the battery and rewound and re-primed the pump as per procedure. 

"I don't know how I missed that the battery was low," she said by way of apology, "I guess I use the meter remote more now so I don't notice it as much."  The pump screen does give fair notice- usually at least a week for us- that the battery should be changed and we ordinarily change it with a regular site change after we've been warned.  It's preferable to 2:38 a.m. on a Wednesday. 

"I'll try to check more often and notice."

What could I say?  "I'm guessing you will...this isn't much fun."

She checked her blood sugar, not knowing quite how long the pump had been alarming and how much insulin she'd missed, but it apparently hadn't been long enough to cause any real spike. 

So I shut her light back off and tucked her back in with a kiss, grateful that it didn't turn out to be a true emergency.  It was just another night with diabetes. 

Information

 

 One bit of wisdom shared often by both professionals and veterans of the diabetes community is about how we react to blood sugar numbers.  The numbers are, the wise people tell us, neither good or bad.  They are simply information.

 

A blood sugar check should be a 'no judgement zone,' the theory goes.  The sole purpose of the number is to tell us what needs to happen next:  a juice box, a correction bolus, a regular meal bolus, and nothing at all are all possibilities.

 

It's pointless, we're told, either to express elation at a perfect 100 or to throw the meter across the room over a 357.  Tying feelings to the numbers has the potential to lead to unnecessary frustration.  It can lead to checking less often for fear of getting a "bad" result.  It can lead to spiraling emotions when things inevitably derail; emotions which could get in the way of being clear headed enough to make necessary adjustments. 

 

So it is with this philosophy in mind that I look at the now-constant stream of blood sugar numbers available on my phone thanks to our new 'share' technology.  Take this day for example:

 

The information tells me that my daughter's blood sugar was more often higher than her target number and lower than her target number than it was anywhere near her target number.  I'm informed that if we averaged all of the numbers together, we would come up with a number close to the target  number.  The graph informs me that steps were taken throughout the 24 hour period to return blood sugar levels closer to the median but that those attempts had more than the desired effect almost every time.

 

But it's incredibly difficult not to look at this graph and utter a few choice words, non-informational in nature.  It's hard not to see how crappy a day this was, and to wonder what we're doing wrong to make this happen; how things have spiraled out of control like this. 

 

While I don't discount the wise people's theory, I think there's a balance. I do not want to get so frustrated that I stop looking at the numbers.  I do not want to say things about the numbers which imply a sense of guilt.  But sometimes, at least for me, it takes a little anger and frustration to get me moving or, in the case of this fall, keep me working until we figure this whole high school schedule out.  Because, really, I'd prefer the information steaming onto my phone screen always looked a little more like this: