Bolus-worthy Bunny



 
 
 
 
As my daughter looked through her Easter basket yesterday she remarked,
 
"My friends all get chocolate bunnies from CVS. I'm glad mine is always homemade dark chocolate. It makes it so much more worth eating it."
 
The Easter Bunny's reasoning (as far as I understand it, though we've never met) is that if your basket is not going to be filled to the brim with candy, the candy that's in there should be worth eating... 'bolus-worthy' as it were.
 
So nestled among a few silly Easter toys, a package of baseball cards, a couple of  EOS products, an i-tunes gift card and some marigold seeds there's always a really good chocolate rabbit the Easter Bunny has picked up at a local candy store.
 



What We Know


My daughter got a new pump a couple of weeks ago. It's her fourth Animas pump.

We know there are other options out there. The new Medtronic pump with it's built-in glucose-responsive CGM technology is by far the closest to the ultimate goal of a closed-loop system. The slim and durable Tandem has some nice user-friendly touchscreen and Bluetooth features. The tubeless Omnipod would be convenient with exercise clothes and on the beach.

We briefly considered all of the options.

In the end we decided not to undertake the challenge of learning to use a whole new insulin delivery system. We decided to stick with what we know.

 
My daughter has been attached to an Animas pump since fall 2004, 24 hours a day, seven days a week. It's as close to a part of her body as an electronic device can be. Replacing it with a new brand of pump would, we think, require an extraordinary amount of learning, thinking and adjustment. Which seems unnecessary since we're perfectly happy with the results we've had.
 
We use several of Animas' unique features to our advantage. My kid has very low basal rates during certain parts of the day, so the tiny basal adjustment increments the pump offers are great for really fine-tuning her doses. The meter remote is a huge quality-of-life feature because it allows my daughter to program a bolus without extracting her pump from underneath a dress or a marching band uniform.  We have a good feel for the current insulin-on-board set-up, and for how the bolus calculator takes her blood sugar into account so that we can easily factor that knowledge into dosing decisions. We've rarely had problems with our pumps but when we have, we've consistently had good experiences with Animas' customer service department. After 12 years of the same pump I'm able to do site changes, battery swaps, and cartridge changes under almost any circumstances. My kid can program a bolus and have a conversation or keep an eye on the baseball game at the same time. Using this pump has become second nature.
 
In four years, or maybe sooner, our decision making process may be different. There could be some amazing new technology on the market by then, like an honest-to-goodness artificial pancreas or at least something much, much closer than the current options. For that we would certainly switch brands and learn something completely new. Until then we'll stick with what we know.

Endo Day


As I started to write about yesterday's endocrinologist visit the words felt familiar. I looked back and found a post (which you can read below) from 2013. The only difference between the old story and yesterday's visit was the added visual aid of a Dexcom graph which showed that the average range of blood sugars was about 40 points higher than we'd like it to be. "This whole graph just needs to move down an inch or two," was our doctor's assessment of the issue. The rest of the conversation was about the same as this one four years ago:

We visited the endocrinologist this week. 

In the weeks leading up to a visit, I am usually motivated to keep a more detailed log and to scan through the meter's averages and graphs.  I try to identify any major issues we need to discuss.   Sometimes I am able to fix a few things or at least narrow down the issues to a few really tricky ones.  I do this so that we can spend our endocrinologist time on issues I really need help with.

This time I tried to think about it.  I really tried to weed through all of those numbers and find the places we needed to change things.  I didn't know where to begin.  I gave up.  It turns out my confusion was warranted. The doctor's initial impression?

"She needs more insulin...like most of the day."

Her A1C was up, only by .3, but after going down a couple of times in a row it wasn't great news.  It wasn't surprising either.

Many things had changed since our last visit.  She'd added height.  She'd added weight. Yet she was missing a sufficient quantity of a key ingredient.

So we added insulin to almost every basal rate.  We added insulin to almost every carb ratio.  We added insulin to the correction factor.

We've been doing diabetes for ten and a half years.  I'm able to tweak a basal rate here and there, or recognize when the correction factor is no longer correcting.   I'm a person who, given sufficient knowledge, tries to solve problems on my own before asking for help.

Yet once in a while, particularly with a growing child with diabetes, the time comes for a major overhaul. In many ways, it was freeing to hand that whole pile of 'undesirable' numbers over to the endo and say, 'please fix this.'   Now we'll watch and see if he did, and hope he at least got close enough that I can trouble-shoot the rest from there.

I don't imagine all of yesterday's adjustments will work perfectly. We'll be following up with more tweaking in the weeks to come. But I'm grateful for yesterday's major overhaul so that we can get back on track, an inch or two lower on that Dexcom graph.



Different Every Time


Airport security experiences are like snowflakes- they're different every time. Fortunately this week's travel was different in a good way.

Our journey began at a huge, busy international airport.

My daughter's boarding pass was marked pre-check. The procedure was shoes on, metal detector only. She approached metal detector and said to the TSA agent, "I'm wearing an insulin pump which could set this off."

"Try it," the agent replied.

My kid walked through metal detector, and did not set it off. She looked at the agent who gave a friendly wave. "Have a good trip!"

On the way home, at a smaller airport, the procedure was different:

Our boarding passes were, once again,  marked pre-check. Upon arrival at the first security checkpoint we were informed that because the boarding passes were printed at the hotel and not on site at the airport, the authorization was not valid and would not scan in their system. We were ushered to the full security, shoes-off, body scanner line.

My kid approached the body scanner with her disconnected insulin pump in hand. "This is my insulin pump. It can't go through the luggage x-ray or the body scanner. It needs to be visually inspected."

She was instructed to hand it to the agent behind the luggage scanner. As she did so, she reiterated that it could not go through the luggage scanner. He smiled and nodded, and seemed familiar with the issue. "Yup- I'll meet you on the other side."


The agent walked away with the pump (a little unsettling) and my daughter went through the scanner. The pump was handed back on the other side, as promised, and we continued on our way.

A couple of notes on our experience:

-On past trips I've been the person to speak to the TSA people, but I asked my daughter before we left if she'd be willing to be her own spokesperson through security. Eventually an opportunity may come for her to fly without me and I want her to be comfortable with the process. We talked quite a bit ahead of time about what could happen and how she would respond. She handled both experiences well.

-We're often tempted not to mention the insulin pump and just go through the metal detector hoping for the best. We certainly do that at museums and other more minor security checkpoints. But for some reason the pump occasionally does set off the metal detector. Also, because my daughter is on the smaller side, the pump is always visible in her pocket or on her waist band so it's immediately obvious that she hasn't followed the instructions to empty her pockets. For those reasons, when we're at TSA security or touring a highly secure location like a government building, we've always mentioned the pump first with the goal of heading off suspicion before it can begin.

-People make a variety of choices about going through the full body scanners and about putting their pumps through the luggage scanners. Some leave the pump on and opt for a pat-down, after telling the TSA agent that they want to avoid the body scanner altogether. Some send the pump through the luggage scanner and hope for the best despite many pump manufacturers' recommendations to the contrary. Some wear pumps through the body scanner, which is also not recommended for my daughter's brand of pump. To us the option of asking for it to be visually inspected seemed like the safest, easiest, least intrusive, and most efficient solution.

We don't fly often, but thus far we've had no two TSA experiences which were alike diabetes-wise. Sometimes the carry-on's contents have been called into question. Sometimes she's patted down despite the insulin pump being the obvious reason for the metal detector alarm. This week's TSA experiences were our smoothest ever. Maybe we've finally hit the sweet spot on the security learning curve. Maybe the voices, including my own, of people who've been reaching out to the TSA requesting common-sense security measures for people with diabetes are finally being heard. Or maybe the TSA is finally realizing there are more important things to worry about than a 15 year old girl with an insulin pump.



New and Sparkly



We fired up my daughter's new insulin pump over the weekend.

Our four year warranty was up and, while the pump still worked, its appearance led us to believe it might be living on borrowed time:





The screen protector was peeling off.

And so was the paint.

It was still effectively giving insulin, but the idea of having no warranty was making us nervous.










We've had very few issues with Animas pumps over the past 12 years, but when we have, having one under warranty has unfailingly led to an overnight replacement.

That's hugely reassuring, especially considering how long it took to order a new one from scratch.






Granted this wasn't an emergency since my daughter's pump was still perfectly operational, but it took about six weeks between my first call to inquire about a replacement and its arrival on our doorstep. The process began with two different phone calls with questions for me, then doctor's orders, insurance authorization (which was the longest process), another phone call to discuss our copayment and the shipping details, and then actually getting it shipped out.

The possibility of reverting to multiple daily injections for even a fraction of that time is not appealing to us.

The new pump is silver, and sparkly all over, with no chipped paint. The screen protector is intact and clean.


And we expect to have a reliable source of insulin delivery for four more years.

 


 

Reading is Fundamental


My daughter had a few late afternoon and evening lows last week.

When she's out and about, she carries juice boxes, glucose tabs and smarties. When she's home she prefers something different. There are occasional seasonal choices in the fridge like fresh apple cider or high-test lemonade leftover from a cookout. Usually, though, the home juice of choice is orange juice. She pours four ounces into her pink sippy cup and waits for the low to turn around. Nine times out of ten, unless she's under 50 or been exercising heavily, those 4 ounces bring the low up within 15 minutes and life goes on.



Last week, not so much. The lows seemed slower to respond. If it was dinner time and she hit 70 after 15 minutes, we'd eat and subtract some bolus insulin. Otherwise, she found herself adding more juice, or a little snack of fruit or crackers to make sure she came all the way up.

A couple of seemingly sticky lows in one week was weird. And a nuisance, especially at dinner time. What was going on? Maybe it had to do with impending full moon or some other such mysterious and passing variable. Or maybe something had changed and my daughter's new normal involved closer to 20 carbs per low.

Then I walked into the kitchen as she poured the last of the orange juice into her cup:


I accidentally bought low-carb orange juice. I don't drink it and my husband hadn't noticed when he slugged it down still half asleep in the mornings.

I read a lot of labels: cereals, snacks, bread, starches and countless other packages are fully assessed before they're consumed. I missed this one. Which explains why those lows wouldn't come up.





No Diabetes In There


Yesterday was the dreaded eye doctor day. Dreaded for several reasons:

   -Making time for any appointment is a challenge with the busy high school schedule.

   -Most of the homework had to be finished prior to the appointment since she expected to be blurry afterwards.

   -While we truly appreciate the thorough exam and attention to detail we receive at this office, we've learned that an appointment there is an hour and a half commitment.

   -And, of course, the diabetes what-ifs.

The plus, in addition to liking this doctor, is that the office is less than a mile from home. So a few minutes before five we hopped in the car with the last of the homework in hand. We arrived, signed in, and took our seats in the waiting room. After half an hour of reading for history class and watching a series of increasingly unsettling segments on the 5:00 news (Car crash! Bomb scare! Everything could kill you!) we were ushered into the exam room.

The doctor started with the basic vision tests, which came out about the same as last time. My daughter has 20/20 vision in one eye, which she apparently uses to compensate for astigmatism in the other. No glasses yet but probably some day. Then there were the eye drops- which she hates but which she took like a champ.

Next up was the visual field test. Our doc usually gives this once, as a baseline in kids. But because having diabetes isn't enough of an eyeball challenge, my kid also has an 'it's probably nothing but we're going to keep an eye on it' issue going on with her optic nerves. So into the dark room she went to squeeze a clicker every time she saw a light flash in a machine. She did great, just like last time, so we put this concern off for another year.

Round three involved the actual looking into the eye part. The part when the fingers get crossed and the breath gets held. The doctor used a couple of different instruments to look into the eye herself and, after that, took the retinal photograph. She then pronounced,

"They look great- perfect. There's no diabetes in there."

Which is kind of a peculiar way to put it, but the exact words don't matter. My kid, despite still being a kid, has had diabetes for 14 years. That starts to get into the potential collateral damage timeframe.

So far so good. All the ophthalmologist had left to say was, "See you next year."





A New Low





There have been two evening concert band rehearsals this winter, from 6:30-9 p.m. These are intense monthly rehearsals during which the kids are playing challenging music non-stop.

The nights after both of these rehearsals have been multiple juice box affairs.

After 14 years of T1D, we have learned when to expect most lows.

Running, dancing, swimming, and miscalculating the number of carbs in a meal are the causes everyone knowledgeable about diabetes would expect. 

Slow but steady walking, staying up late even if it involves no physical activity, and being sick with a cold all also trigger lows for my kid.

Could playing a wind instrument for an extended period also lead to dropping blood sugar?

The first post- concert band rehearsal low seemed to come completely out of the blue. She hadn't been having any overnight lows at the time, and the rest of the day hadn't involved any unusual food or activity. The only variable I could come up with was the rehearsal. Could the physical exertion of playing her clarinet for that long combined with the mental energy to concentrate on and learn new and difficult music be what led to a 50-something blood sugar so slow to budge? Maybe, I guessed, but since one instance doesn't make a pattern, we chalked up to a mystery low and set the episode aside.

Until it happened again this week. Both times she was at a nice 90-ish number when she came home and had a snack. Then around 1 a.m., she tanked.

Despite using a variety of search terms, my research turned up only one mention of this phenomenon. It's master's thesis from 2006 by Derrick Alan Crow called 'The Effect of Instrumental Rehearsal on Blood Glucose Levels of Five Low Brass Players.'  The link will take you to a several-page preview of the study, which was all I was able to access. His participants, as far as I can tell, did not have diabetes. The blood sugar checks were before, during and immediately after rehearsals, not hours later. But his preliminary background research was interesting and, based on it, he posed some logical hypotheses. His results, while inconclusive mostly due to the small sample, did note some trends of lowering blood sugars during long rehearsals. His theory was that between the mental, aerobic (from breathing), and muscular energy expended by a wind instrument player during a lengthy rehearsal, blood sugar levels drop.

I'd love to see this study repeated in instrumentalists with diabetes. I'd love to see the research include investigating a delayed drop of the sort people with diabetes see with some other kinds of exercise. Clearly, I need to befriend a musical scholar. Or convince my kid to become one.

Meanwhile, we'll plan on covering fewer carbs on concert band nights, and/or setting a temporary basal rate. Or maybe next time this won't happen at all.

Fancy Berry Muffins



What should one do on Valentine's Eve when there is a bag of 'Fancy Grade A Berry Medley' ossifying in the freezer because nobody's been in the mood for a smoothie? 
 
Make some fancy muffins, of course!








You could, of course, chop large unfrozen berries by hand.
This was my quick alternative- just a few pulses did the trick.
I got them a little smaller than I'd intended,
but it worked well for the mini muffins.


Fancy Berry Muffins

3 Tbsp. butter, melted
3 1/2 Tbsp. sugar
1 egg
1 c. white flour
1 c. whole wheat flour
1 Tbsp. baking powder
1/2 tsp. salt
1 c. milk
1 c. berries (fresh or frozen, any variety, chop anything larger than an average blueberry)





1. Combine the butter, sugar and egg in a large bowl. This is the bowl all of the batter will end up in.
2. Sift the flour, baking powder and salt together.
3. Add flour mixture alternately with milk to the butter/sugar/egg bowl, mixing after each addition.
4. Beat well, then stir in berries.






Your batter will be colorful!



5. Fill muffin tins 3/4 full. Use paper liners or grease pan well.
6. Bake at 350 for 15 minutes (mini muffins) or 30 minutes (lg. muffins).

I ended up with 32 mini muffins with approximately 8 total carbs each.


Next time? Some cinnamon sugar on top for color and crunch.

Maybe these would make a nice treat for your Valentine in addition to that rose I'm hoping you've already spared?



The Nervous Nurse


I glanced at the caller ID on my phone, which read  'SCHOOL.' It was my daughter on the line from the nurse's office.

"I was told to call you.  My blood sugar is 77.  I was 60 when I got here 15 minutes ago. I had a juice then and couple of glucose tabs just now. Lunch is in 20 minutes. It's Mrs. X.  She's not sure if I should go back to class. I'm worried about missing the final review and study-guide handout for tomorrow's math quiz."

"Mrs. X is the nervous substitute nurse, right?"

"Yup."

"Put her on. I'll tell her to let you go back to class."

Encounters with nervous nurses are, at best, like the one above. But they have also been known to go like this:

OMG YOU"RE 47!  SIT IN THIS CHAIR AND DON'T MOVE UNTIL YOU'VE CONSUMED ALL OF THE JUICE IN THIS OFFICE. I'M CALLING YOUR MOTHER RIGHT NOW.

Or, WHAT DO YOU MEAN YOU DON'T CHECK KETONES EVERY TIME YOU'RE OVER 200? THAT'S A VERY HIGH BLOOD SUGAR. DO YOU KNOW HOW DANGEROUS THAT IS?

Or, I CAN'T LET YOU {PLAY GYM/TAKE THE TEST/WALK HOME FROM SCHOOL} THIS AFTERNOON. YOU WERE 62 AT 9 A.M. YOU'LL GO LOW AGAIN!

Our full-time nurse for the duration of fourth grade was a nervous nurse.

We spent hours over the course of that school year talking her down from the ledge. With each phone call we explained again that every blip on the blood sugar graph was not a full-blown medical emergency.

We indoctrinated her, slowly but surely, into the idea of addressing diabetes concerns in the moment and then letting that moment pass and continuing on with the regularly-scheduled programming.

It was a delicate dance of acknowledging her concerns while inserting a dose of reality. We were unable to completely reprogram her but she became less panicky as the year progressed.

Substitute nurses are trickier- they definitely don't know my daughter as well, and they often have less experience with children with diabetes in general. I do hear we're making progress with one we've known since early elementary school. Generally, though, we resort to phone calls like the one above, on a case-by-case basis.

I absolutely understand the concerns. A nurse's job is to focus on the medical concern of the moment, with a 'safety-first' mentality. Which begets worry. Which I understand.  I know worry. I worry a lot about diabetes. So does my kid. But after 14 years, we've learned when to worry and when not to. We have learned when the time to worry has passed. We have learned how to incorporate life with a chronic illness into life lived fully. So sometimes we need to talk a nervous nurse down from the ledge.



Why Not A Dozen?


 
I live in Suburbia, USA and I'm worried about diabetes.

I'm worried about the future of access to quality, comprehensive, affordable healthcare.

I'm worried about whether current diabetes treatments are enough to lead to long-term health.

I'm worried about whether there will ever be a diabetes cure for anybody but mice.

I'm worried about the financial cost of diabetes care.

I'm worried about the emotional cost of diabetes care.

I'm worried about the daily to-do list of living with diabetes.


 You Can Spare A Rose By Clicking Here

Then I imagine being a mother of a child with diabetes in Syria. Or Sudan. Or Rwanda.

Their children are dying from having diabetes.


My daily worries pale in comparison.

Fortunately it's February and I'm reminded regularly of the work of Life for a Child. 

One rose for one month of life. A dozen roses for a year of life.

Eliminate one rose from your traditional Valentine's bouquet and donate $5.

Or follow my husband's lead and eliminate the whole dozen.

Roses die and children shouldn't.

One of the best ways I've found to reduce worry is to do something.

Saving the life of a child seems like a pretty good thing to do.




Murky


My twitter feed has been weird for the past couple of weeks.

I use Twitter to follow diabetes-related accounts and current events.

The tweets from the news accounts and politicians are usually easily distinguishable from those from diabetes organizations and bloggers. 'Earthquake rocks Italy' and 'Mayor jailed' fall into an obviously different bucket from 'Drowsy from a 3 juicebox night' and 'Just passed the 30 minute mark on hold with insurance co.'

I now have to take a closer look. Was the tweet about the cost of insulin a Bernie Sanders quote or was it from the American Diabetes Association? Will the link to the article on repealing the affordable care act take me to the New York Times or to a Blogger site? Is the anxious political tweet from a political commentator or from a person with diabetes afraid of losing her health insurance ?

It's getting very murky.

Just Another Morning


6:15     Teen crawls out of bed later than is ideal. Finds nondairy yogurt, granola, berries.

6:18      Checks blood sugar. Programs breakfast bolus.

6:19      Discovers pump's insulin cartridge is almost empty after bolus. Implores mother to fill
             a new one.

6:20      Mother inhales cheerios, chugs coffee, gets dressed, packs lunch.

6:40      Mother listens to stream of consciousness commentary on teen's outfit, hair, and tonight's
             potential homework while filling an insulin cartridge and priming the pump.

6:59      Teen is delivered to school.

7:26      Text: 'I forgot Dexi.'

7:27      Text: 'Unless you put it in my bag?'

7:45      Mother (belatedly) texts back:  'Nope. It's here on the kitchen counter.'

7:47      Text: 'Oh well.'

7:55      Text: 'You wouldn't drop it off for me would you?'

7:56      Mother takes deep breath and decides that, yes, she would (and should) drop it off.

7:57      Text: 'I'll drop it off by 8:15.'

8:13      Mother arrives at school. Mother who is usually happy that school is secured as tightly as
             Fort Knox is not happy today. Mother is buzzed into vestibule with table on which to leave
             forgotten items for kids to pick up. Mother is uncomfortably holding Dexcom thinking, 'I'm
             not so sure about leaving this here' a when kind secretary appears behind large (bulletproof?)
             window in vestibule.

8:15      Mother says, 'Hi. This is a medical device- I'm not sure I want to just leave it here. My
             daughter knows it's coming and will pick it up between periods.'

8:16      Kind secretary says, 'Here- let me take it. I'll give it to the nurse.' Secretary jimmies open
             a pass-through slot like one might find at a shady check-cashing joint, and takes Dexi.

8:17      Mother thanks secretary and leaves.

8:18      Text: 'Gave Dexi to secretary who will give to the nurse.'

8:50      Text: 'Ok I will go grab it now.'

9:29      Proof arrives, in form of blaring cell phone alarm, that teen is in possession of Dexcom: 

 
9:42     Text: 'I'm low so I'm not playing gym.'
 
And so on and so forth...
 



Muffin Chronicles Part 4: Applesauce Theme Week Edition




 




Applesauce Mini Muffins

Since too much applesauce is never enough, here's the latest batch of muffins for the lunchbox:

1 c. whole wheat flour
3/4 c. white flour
1 tsp. baking soda
1/2 tsp. salt
1 tsp. cinnamon
1/4 tsp. nutmeg
(you could also add 1/4 tsp. clove if you like it but we don't)

1/2 c. shortening or softened butter
1/2 c. sugar
1 egg

1 c. applesauce

Mix flour, soda, salt and spices in a small bowl or in a glass measuring cup with spout. If you use a spouted measuring cup (which makes a later step easier) it's still best to measure your flour first with a standard measure for dry ingredients (you know- a metal or plastic one that'll let you level the flour off across the top). Set this mixture aside.

In a large bowl, cream the shortening and then add the sugar gradually until the mixture is light and fluffy. Then add the egg.


The shortening/sugar/egg mixture will look like this.
Also of note, these single-serve applesauce packs are
1/2 cup each which is convenient.





















Add the dry ingredients, alternating with the applesauce, to the bowl containing the shortening mixture. Stir between each addition. I usually add about a quarter of each at a time. This is the part my daughter has always loved to help with!



 


How much dough? I just used a teaspoon from my silverware drawer-
one heaping spoonful per muffin cup.



Spoon into mini-muffin tins and bake at 350° for about 18 minutes until a toothpick inserted in the center comes out clean. I made 33 mini muffins for about 8.5 g. each.


The recipe is adapted from my husband's Nana's applesauce cake recipe. To adapt it back for a great dessert, use all white flour and a full cup of sugar. Bake it in a standard sized loaf pan for an hour (which sounds like it would be too long but trust me, it isn't).

We love this recipe because - yum - but also because we almost always have the ingredients we need for them in the pantry.
 
Hope you'll enjoy it too.



Gym Win


Out of all the anticipated diabetes challenges of high school, gym has been the biggest thus far.

Marching band's 14 hour days, including an outdoor week in the August heat? We handled it.

New nurse? She's great.

An intense and stressful academic schedule? Intense and stressful, but managed.

Gym? A disaster since day one.

I wrote about it in the fall. Gym is always in the morning but that's where the predictability ends.

Gym class happens three out of every four days. At 8 or 9 or 10 a.m. Some days are 'fitness days' with sprinting or other heavy cardio. Some days they play volleyball which my kid enjoys playing at a moderate pace. Some days feature floor hockey, during which the senior boys apparently dominate the puck and give nobody else a chance to play. Some days gym is preempted by 'peer leadership,' which can involve either active or sedentary group bonding activities. All we can be certain of is that the whole thing is totally unpredictable. Therefore, adjusting basal rates didn't help. And changing the breakfast bolus was useless. Our next best hope was this:


Squeezy Applesauce!
Toddler applesauce has greatly reduced trips to the high school nurse's office. It's fifteen carbs provide slightly more nutritional value than a straight juice box. It's easier to consume while changing into one's gym clothes than a clementine or a handful of grapes. It's even sort-of fun? And, most importantly, it's working.

She makes the decision whether to consume a pouch before gym based on three factors: what her blood sugar currently is (usually based on the Dexcom, inclusive of arrows), what the day's anticipated activity is, and what time it is (she's more likely to drop fast if there's still a bunch of breakfast insulin on board). There are occasional problems, like when an anticipated floor hockey day becomes an unannounced outdoor running day due to good weather, or when she's had an unusual breakfast and the 'insulin on board' factor is harder to predict. But overall, this tactic is (thus far...knock on wood...fingers crossed) a winner.

Also a plus? We won't be running out of squeezy-sauce anytime soon due to today's 5/$9 sale at the grocery store. She's not sure about the new 'applegrape' flavor, but if you're sucking it down in three gulps, how much does flavor really matter?






Advocacy


I've shared with you my first New Years plan: spending more time with my fellow 'diabetes people.'  The second plan is much less fun, but in my opinion, unavoidable. I plan to spend more time advocating for people with diabetes. Phone calls, emails, tweets and more appear to be a necessary evil for the coming year.

I started today, thanking my representatives who support the parts of the Affordable Care Act which are important to me, and contacting some who do not. The ACA is not a perfect law, but eliminating it without a reasoned replacement would be a setback not just for people with diabetes but for those with all kinds of chronic and expensive diagnoses. Repeal of the ACA will not only impact people who've been able to buy insurance because of it, but also the greater majority of us with employer-sponsored insurance who've seen new benefits and protections through the law. This article explains those parts of the law in greater detail, including coverage regardless of preexisting conditions, coverage for preventative care and the elimination of annual and lifetime maximums.

My daughter is at the age where she's considering career choices. The existence of protections for her as someone with a pre-existing condition and who has high annual healthcare costs is important to us. We'd rather she not have to choose a career, and a job within that career, based primarily on whether she can obtain quality health insurance and be assured that her coverage will never lapse.

Are you concerned too? Here's an easy way to get in touch with your representatives:

http://diabetespac.org/

I'm certain this is only the beginning of my advocacy this year. At the rate insurance companies and prescription benefit managers are picking and choosing what's covered, it's likely I'll be in touch with them. We're fortunate to be in a great school district, but small conversations still need to be had from time to time.  Other political issues may arise locally or nationally which I feel require my voice- not just for my own child's benefit but for that of the whole diabetes community and beyond.

Diabetes People

We were very fortunate to find a parent support group shortly after my daughter's diabetes diagnosis. People in that group were also involved with the local JDRF chapter and I got involved there too. Once we got our heads above water with the help and support of both of those organizations I found myself able to turn around and help others. I encouraged the next round of newly-diagnosed families at the support group meetings. I got involved in planning and running a local JDRF walk. In the three years after diagnosis, personal contact with other 'diabetes people' was a big part of my life.

Then, because of a lay-off and a subsequent job opportunity, we moved back to the area where I grew up. We continued to participate in JDRF walks, and I did help with walks at the elementary school, but my contact with our local chapter was minimal. There was not a parent support group in the area. We were fortunate to know a couple of nearby families with T1D and so had, and continue to have, an informal network of information and support. I found the diabetes online community, and there found both personal support and a way to be supportive of others by starting this blog. For a while that was enough.

Now, though, I'm feeling a pull.

I'm still incredibly grateful for those moms and dads I met during the first months after diagnosis. Having those conversations provided a framework for how we still live with diabetes today. There's nothing like sharing stories, laughs, information or tears with people who have faced the same challenges.

In lieu of New Years Resolutions, I tend to think of something I'd like give some extra energy to over the course of the year.  Some years it's practical, like learning new recipes or starting a vegetable garden. Some years it's more social, like sending thank-you notes for even the littlest of gestures. This year?

I'll be looking for ways to spend more time with other 'diabetes people.'