Sweet Sixteen

Sixteen sweet things about the past sixteen years with T1D:

1. My daughter was diagnosed in time.

2. Christmas in a children's hospital is not an experience I'd wish on anyone and yet was magical in ways no other Christmas could be.

3. She and I both survived the toddler diabetes years.

4. We found other families with diabetes quickly.

5. We continue to have diabetes people in our lives: friendships we treasure both despite and because of their diabetes glue.

6. Ruby, the teddy bear with diabetes, lives with us and continues to be a fuzzy source of support.

7. A perfect and welcoming preschool was, essentially, in our backyard.

8. I found the diabetes online community; and then I got to start a blog and revisit my second grade goal of being a writer when I grew up.

9. The elementary school nurse was a treasure; and her diabetes care was great too.

10. Friends' parents invited my daughter over for playdates, however uncomfortable they may have been.

11.Lots of friends and family have gone out of their way (especially in those early pre-pump years) to loop us in on menu plans and eating schedules, making our visits easy.

12. Teachers have kept an extra eye out, no matter the other chaos in their classrooms.

13. Schools have found a way to make trips, special events and after-school activities work.

14. We've had amazing medical professionals on our team.

15. Math has always come easily for my daughter (and my math skills have greatly improved).

16. My daughter has grown into a responsible, self-confident and compassionate young woman.

Sixteen years ago today we had a tough day. There have been quite a few tough diabetes days every year since then. But, from time to time, it's worth counting our blessings.

Insurance of the Year Club

We're switching insurance again.

Of all the employer-sponsored insurance plans offered for 2019, our current plan will now be three thousand dollars more expensive for the year than the least expensive one. The cheapest of the three, of course, is the one we've never had. We will sign up for what the company calls a 'gold plan,' and the system is tiered so that all insurers in the gold plan cover similar medical services, charge the same copays and have the same deductibles. The gold plan's coverage fits our high medical use and costs, and so is our best choice. But the per-paycheck cost is staggeringly different for each plan.

We did our homework, which was easier this year after lots of practice last year. The new insurer will cover all of our current doctors and drugs (though still not Novolog which stinks). It's possible we'll be able to escape Edgepark's grip since other DME providers are listed, but I'm not holding my breath since they are still one of the options. And while I generally subscribe to the adage, 'the devil you know is better than the devil you don't know,' $3000 is a lot of money.

The big risk, the one we can't get a clear answer on, is whether there will be hoops we have to jump through to get coverage for diabetes-related equipment. We delved pretty deep into the new insurer's website and made phone calls to learn about diabetes coverage and could not come away with a clear answer on whether we'd have to prove my daughter's need for an insulin pump and CGM before coverage is granted. Between reading and conversations, the possible answers range from 'you might need a letter of medical necessity from your doctor' (which is pretty standard), to needing to submit tons of documentation, to maybe they don't cover CGM unless it's some sort of dire situation.

I'm well aware that we're incredibly fortunate that we have access to insurance at all. That we've consistently had access to really good insurance, which for the most part covered what we needed with little to no hassle, is unusual. Maybe that's about to change, but after 16 years at this, I'm prepared to use every tool I now have up my sleeve to fight for what my daughter needs. Hopefully we'll repurpose that $3000 wisely. If need be we'll spend it on things that aren't covered. Or on a little getaway to help me recover from a year of insurance fights.

Slowly but Surely

Our household diabetes policy (yours may vary) has been for my daughter to take on diabetes responsibilities as she feels ready. The understanding has been that while we do not expect to live in her college dorm with her, she should not feel rushed. Every diabetes task will ultimately be hers, for the foreseeable future.  For now, we're here to help.

Slowly but surely over the past sixteen years, one or two things at a time, my daughter has taken over her own care: blood sugar checks, carb counting, then insulin pump site changes, and so many more in between.

The Dexcom was at the center of the two lingering exceptions.

Because of the awkwardness of the G4's insertion device, I continued to assist with putting in a new sensor every 7 or so days. She did it once, to prove to herself that she could in case it failed while she was traveling without me, but it was super-awkward and I was happy to keep helping. The insertion device for the G6 is a much easier to handle one-handed push-button device. My daughter inserted the first and second ones with no problem. It's easy and nearly painless, she reports, though the spring-loaded insertion contraption is alarmingly loud.

The second area of responsibility we've recently relinquished (to some extent) is overnight diabetes care. Until the G6 arrived, the Dexcom receiver remained on a parent's bedside table each night. We got up to deal with its alarms while my daughter slept, or roused herself briefly for juice. That routine, of course, followed years of setting 2 a.m. alarms for fingerstick checks.

The new plan is that my daughter keeps her phone, and the Dexcom receiver, on her bedside so that she can awaken to deal with the alarms. She started with just the phone, but the Dexcom app alarms were not loud enough to consistently wake her (though they woke both of her parents in the next room). She's added the receiver, which she keeps on the bed with her to feel its vibrations, and so that two alarms are blaring at once. She still does not consistently wake to the alarms, while I, of course, still do. But things are improving. She did wake up and treat a low this week without my hearing anything, which was good news. And the alarms are diminishing after the Thanksgiving leftovers are gone, and as we use the Dexcom data to work on keeping numbers more consistently in range...which is the ultimate goal.

It's bittersweet to watch my kid take on these responsibilities. Yes- by all rights they're hers to deal with and it's important for her to practice with the safety net of mom and dad around to help. But how I wish she didn't have to.

G6

The Dexcom G6 is up and running, and it's keeping us running.

Technologically we're totally impressed. It's accurate. The readings flow seamlessly from the transmitter to my daughter's iPhone and the Dexcom receiver, and then on to my phone and the Dexcom Clarity page online. And no fingersticks? Amazing.

We used our previous CGM, the G4, only as a general guide. Heading up or down? Always alarms between 2-3 a.m.? Should she do anything before changing for gym? It was less accurate and had crapped out months ago on sharing numbers to anybody's phone, so unless it was alarming with an urgent low, it was mostly background noise to be addressed eventually.

The G6 feels less like a lowly assistant making suggestions from the corner of the conference room and more like the boss. What it says goes. Low predicted in 15 minutes? Eat something. Now! Suddenly skyrocketing? Drop your pants and check that site! Clarity shows you've gone over 220 after lunch five of the past seven days? Fix something!

Some of that is good for us. Most of us get lazy with diabetes at one time or another, and of late, we have. Having the G6 looking over our shoulders and nudging us at every turn is causing more action than had been happening here, at least in terms of more minor excursions from a target blood sugar range.

Some of it, though, is wearing. Already. After 12 days. (But who's counting?)

The alarms are driving us nuts. Starting it up over a busy school play weekend followed by a Thanksgiving week full of family and food certainly didn't help. Diner pancakes at 10 p.m., daily servings of stuffing, and pecan pie two nights in a row are rare treats, and as the schedule goes back to normal, alarms are settling down. We learned quickly not to have both the Dexcom receiver, and all of our phones set to alarm when all of them are in the same house. The cacophony and the subsequent process of silencing them all would jar anybody's nerves.

We're also struggling with information overload. The numbers are in our faces all the time. Because the previous system's data went only to its own receiver, my daughter would look at it at mealtime, before bed, and when it alarmed. Now can see numbers whenever she opens her phone. And with share operational again, I too can see numbers anytime I want instead of looking at the receiver once a day- or less. A diabetes-life balance is, in my opinion, a very important aspect of living sanely. It will take some time to figure out how to compartmentalize the extra information so that it does not overwhelm.

Was it worth waiting for? Absolutely. The steady stream of accurate data is incredibly useful. It helps with hour to hour decision-making. Once the bulk of the data isn't skewed by Thanksgiving food, the long-term graphs will be incredibly valuable in adjusting basal rates and bolus ratios. And maybe when the data settles down into a more predictable range we won't mind seeing it so often.

Humbled

Have you signed Dr. Frederick Banting's birthday card yet?

I did, first thing this morning. On the card (you'll see it when you click the link above to sign it) there's an area to write a personal message. I wrote, "Thanks to your work, I have an amazing teenager." 

Before Dr. Banting and Dr. Best made their discovery of insulin in 1921, people with Type 1 Diabetes died. Their bodies wasted away. It's humbling to consider.

In 2002, on a crisp December morning, we rushed my daughter to the hospital, and by mid-morning she was receiving insulin. She's now a thriving high school student who is looking forward to this weekend's school play, college in a couple of years, and a career in education.

Had she been born less than 100 years earlier, she simply would have died. Probably by Christmas, only a few days after we'd called the local doctor to stop by on his rounds to examine her.

I'm thankful to Dr. Banting, and his colleague, Dr. Best, for making insulin available so that my daughter can be alive. And I'm thankful for all of the discoveries and inventions that ensued, including modern synthetic insulins, increasingly accurate technology for glucose monitoring, and insulin-delivery tools that have come a long way from regularly boiling and sharpening the one syringe in the household.

Dr. Banting's birthday, now World Diabetes Day, helps put life with diabetes in perspective. There was no life with T1D before Dr. Banting. It's still a daily challenge, and the dangers aren't completely gone, but my daughter is here, and thriving. I couldn't be more grateful.

Happy Birthday, Dr. Banting.

Trick-or-Treat

It was 8:45 on Halloween. The doorbell hadn't rung for almost an hour. And then it did. We paused Survivor, and my daughter got up to greet the trick-or-treaters. She had enjoyed her door-answering responsibility all night, and I was glad to let her get up one more time.

Peeking through the living room window, she recognized a life-long friend at the door, dressed as Kim Kardashian.

She opened the door, and I could hear another voice, in addition to my daughter's and Kim's. There was a little chatting about the nice weather and what the girls had acquired in their travels. "There was a house handing out apples. Honeycrisp ones though, which are amazing, so I guess if I wash it I can eat it?"

My daughter then offered as much of our loot as the girls wanted to take. We didn't have as many kids as usual, and so generosity was in order.

"Are you sure? Thanks so much," Kim Kardashian exclaimed.

"Ugh, my mom won't let me eat most of it anyway," replied the other voice, which I was still trying to place.

"Take the airheads" was my daughter's quick response. "They're great for low blood sugars!"

Now, of course, I was able to narrow down which friend was accompanying Kim Kardashian on her rounds.

"Ha! Yes- I will! My mom buys terrible glucose tabs at Costco. I can't stand them."

Now Kim Kardashian's friend has a nice stash of airheads for her low blood sugar needs.

Who says Halloween and diabetes can't go well together?

Another Wait

The Dexcom G6 finally arrived last week, after a wait which was entirely too long.

And yet, we've decided to put off using it.

There are still 3 Dexcom G4 sensors here, and we've decided to use them up.

The wait is, in most respects, really hard. It's like getting a new toy on Christmas morning and not getting to play with it until February. Why would we torture ourselves like this?

We have our reasons:

We are grateful for what we have, and don't want to waste the G4 sensors. We're certain that once the switch is made, there's no way my daughter will want to go back to the G4 for a few weeks to use up the old supplies.

We feel much more comfortable with supplies in reserve. By waiting a couple of weeks, we build up a few extra G6 sensors in the supply closet for a rainy day.

We want to take the time to start it and to set it up right. Because of our family's marching band commitments, time is at a premium in October.  We're waiting for a quiet evening, or weekend morning, to sit and learn the minimal but important basics of insertion and sensor start-up, download the apps and software, and learn how to use them. That might not be until November.

And the most trivial reason? The Dexcom receiver fits perfectly in the tiny pocket of the marching band uniform jacket, and my daughter's phone (which will be her new receiver) does not. Waiting until next year to solve that problem, which will likely involve some stealthy sewing, feels easier.

So we wait, the box of G6 stuff taunting us from the corner of the dining room.

Back to Insulin One

A change in insurance has led to a change in insulin.

We've used up our stash of Novolog, and the first cartridge of Humalog in several years went in the pump 3 days before back to school.

Some people say they experience no difference at all between the two insulins. Some think Novolog withstands heat better. Maybe Humalog sticks around in the system longer. Humalog could be more likely to clog infusion sets. We switched to Novolog a few years ago because it was reported to kick in just a little bit faster. Some of the differences are detailed here, on T1D Living.

The key difference to us is that insurance will pay for Humalog now, and it won't pay for Novolog anymore.

There are too many variables here for this switch to serve as a scientific experiment. The change coincided with an already established need to make some pump setting adjustments. It also coincided with back-to-school, and with the hamster wheel which is marching band season. A couple of things do seem obviously different, despite the chaos.

What we've noticed for sure is a greater need to pre-bolus breakfast. That aspect feels familiar to me from our switch from Humalog to Novolog a few years ago. Breakfast, after which my daughter's bg had spiked significantly almost every day since diagnosis, became more manageable with Novolog. The Humalog is a little more sluggish.

I'd also agree that Humalog sticks around a little longer. It's hard to see during the day, but I'm noticing that the Dexcom graph's downward slope continues longer on the last-before-bed bolus, or for any overnight corrections.

Because we're changing basal rates anyway, based both on feedback from our last endo appointment, and on the schedule changes from the start of school, it's hard to tell what other differences there are. It won't be until we finish tweaking that we can see, for example, if the total daily dose went up.

Given my druthers, I'd say Novolog is probably a snappier variety of insulin, and that it would be nice to go back. But in accounting for Humalog's more sluggish nature we're making adjustments that are working.

Humalog and NPH were the first insulins prescribed when my daughter was diagnosed. The glass-half-full part of me will note that Humalog's challenges are minor and manageable compared to the nightmare that was NPH.

The Edgpark Order that Won't Die

We placed our initial Edgepark order in March. The details of that ordeal are here, if you'd like to read the beginning of this story.

I returned two of the three items in that shipment on April 11th, using the return label sent to me by Edgepark, because they were not items my daughter uses, nor were they the items prescribed.

I subsequently received a bill for the Verio Test strips I'd returned. When I called, the representative said to disregard the bill. Edgepark was in the process of 'billing the return' with our insurance.

Ignore it I did, along with a couple of subsequent, identical bills I received in quick succession.

Mid-summer, after another bill, I called and was told again to disregard it.

Fast forward to the beginning of this month. I placed an order for a new Dexcom G6 system.

I then received an email telling me I had an outstanding bill. I called and was told once again to disregard it.

Two weeks later, I followed up, since there'd been no word on the G6. They'd just processed the order with the doctor's prescription, I was told, and it would be shipping from the Ohio warehouse within 24 hours. It would be at my house by Friday via FedEx. It was very specific information.

I then received another bill, for a higher amount than the previous ones, and a subsequent email warning me that no further orders would ship until I had resolved my delinquent account with the Edgepark billing department.

So I called. Yes, I was told, they had 'billed the return' and refunded my account $63.60 for the test strips. I acknowledged that as a good start, but then noted that I had paid them $288, and that they were now sending me bills for over $400. It was an unproductive conversation which ended in the representative telling me she was sending March's whole order and subsequent billing back for a 'full review.'

So, did that mean my upcoming order would be cleared to ship? "Oh- yes - that wouldn't have been on hold anyway."

Today, still no word on the Dexcom, so I went onto the patient portal to check the status. There were 'urgent alerts' posted warning me that no further orders could be processed until I paid my outstanding bill of what was now two hundred-something dollars.

An hour phone call, piles of explanation-of-benefits and bills reviewed, and lots of math later I agreed with the billing representative that the current number was correct. In (very) short, the original billing on the one item I did keep (Dexcom G4 sensors) was also incorrect, not in my favor, and that error was reflected on a subsequent explanation of benefits in July. After the whole day's bills were sent back for review, my account was credited with the rest of the Verio money Edgepark owed me, in order to pay for part of the cost of the Dexcom sensors. I still owed the balance for those supplies.

I paid the bill then and there on the phone.

My daughter's Dexcom G6, the third person in so many weeks told me, is on its way. She's, once again, really looking forward to getting it. It seems highly unlikely to me that there isn't at least one more phone call involved in this. And then, of course, the next set of bills...

Stay tuned.

And if you have a choice to get supplies from someone other than Edgepark, do.

You Know What To Do

We visited the endocrinologist a couple of weeks ago.

My daughter's A1C was up a smidge, which isn't unusual at her end of summer visit. We do better keeping her blood sugar stable when her schedule is more predictable, as it is during the school year.

The numbers downloaded at the beginning of the visit from the pump and Dexcom covered the prior two weeks of blood sugars. One week was from vacation and the other was from the youth group mission trip. Both involved strange meals at strange times, late nights, periods of heavy activity at all different times of day and night, and at least during the second week, a few moments of stress.

There seemed to be a couple of patterns, but they could just have easily been a pattern of what happens when you follow a heavy, late lunch with a busy afternoon, an unusual dinner, a walk, and no 9 p.m. snack.

After talking things over, the endo said something like this:

Look- it looks like you need a little more insulin in a couple of different places here. You could tweak a couple of things now, like maybe this after-dinner spike, but maybe you don't want to do too much yet. Why don't you wait a week- get through band camp where you don't want a bunch of lows, and then once school starts look at these patterns again and make the adjustments. You know what to do. And hopefully by then you'll have the G6 which'll make it so much easier.

Band camp was, predictably, another week of unusual eating, busy schedule and extreme heat. It felt safer to run a little higher than what we'd ordinarily consider ideal.

School started last week with a weird schedule for the first day and an unexpected half day on day 2 due to a heat advisory, which was followed by a takeout lunch with friends. Friday night was the first marching band performance at the football game, preceded by a 4:30 p.m. dinner. This week will be slightly more predictable, so we'll see if some basal tweaks we made over the weekend make a difference. And we'll add more insulin for dinner. That was the one change we did make after the endo visit but it isn't doing the trick yet. No G6 yet either- more on that another day- but we've been managing T1D in a growing, changing child since long before any CGM at all.

We'll keep watching and adjusting. We know what to do.

Piecemeal

We talked technology at last week's endocrinologist appointment. My daughter is using an Animas Ping pump and a Dexcom G4 CGM. The Animas can be serviced or replaced for another year before we'll have to switch to Medtronic for the last two years of its warranty. The Dexcom version we're using is almost obsolete, so we have to change something, but the question is, how much?

We could close our eyes and jump headfirst into a full switch to all things Medtronic. We would likely be transitioned to their 630G model which works with their Guardian brand CGM system and a Contour meter as a meter remote. This pump would suspend insulin delivery when low blood sugar is detected by the CGM sensor.

The low glucose suspend feature would be reassuring, especially for those few nights per year that my daughter spends away from us. On the other hand we've heard mixed reviews of the Medtronic sensors, in terms of accuracy and calibration neediness. We hear they're improving with each version, which is incentive to wait a while. There is already a more current Medtronic pump, which adjusts the basal rate every few minutes based on feedback from the CGM.. We wonder if we wait a year if we'll have the option of switching directly to their most recent version, whatever that is at the time, which would surely have more bells and whistles than the current offer.

Our other option is to keep the Animas pump for another year and upgrade to Dexcom's G6 CGM. The G6 requires no fingersticks for calibration, and can be worn for 10 days before changing the sensor. The CGM data can go straight to my daughter's phone, and be shared with us from there, or we can choose to use a receiver. The reviews of its accuracy are stellar.

My daughter is comfortable with the Animas pump, and super-excited about the Dexcom G6. So the plan is to move forward with those for the next year.

It feels like a piecemeal solution. But it's not a perfect world. Insurance and corporate deals dictate the diabetes choices we can make. We are destined to be Medtronic people.

Just not yet.

After Midnight

"Mom?"

"Mom?"  My eyes must have opened slightly, or I mumbled something.

"Something's wrong with my pump."

And then I was awake.

"It was beeping when it woke me up … booEEp, booEEp … but now it's dead. Nothing happens when I push the buttons. And it's hot."

It was the wee hours of the morning. We were on vacation in a cottage near the beach.

"Ok- let's see."

I got up and followed her back to her little room where we turned on a light and set to work.

Hoping the simplest explanation was the right one, I took out the battery, using a coin from the pile on her bedside table set aside for an expedition to the penny candy store. The battery was hot.

I inserted a new battery and screwed the cap back on. I prayed, thought good thoughts, and implored the diabetes gods for mercy. The pump would spring back to life. We would not, in the middle of the night, on vacation, have to go back to injecting insulin for the first time in 13 years.

Time stood still for an infinite moment and then, there it was, the familiar alien-like startup beep of the Animas pump. I confirmed, when prompted, the battery type, and the date and time, which were reassuringly still correct. Then, as the pump requires with every battery replacement, I set in motion a full rewind of the cartridge area. Knowing that the full rewind also signals the pump to perform a full system check I once again sent out pleas to the universe that a pump failure would not, please, be among our vacation memories.

The motor whirred. And whirred. And whirred. And then...

"beep!" Just the usual, friendly little 'I'm ready,' beep. I finished the process and my daughter reconnected.

Still more than a little freaked out, and now wide awake, I photographed every pump setting, not sure if my most recent records were recent enough. I tucked my daughter in and returned to bed where I lay; not at all optimistic that the crisis had actually been averted. I considered all of the options for obtaining a replacement pump if need be. I sorted out what I could remember about multiple daily injections. I tried to figure out what had happened in the first place. I got up twice to make sure her blood sugar was staying steady- that the pump was still working correctly.

In the light of day, with the pump working properly again, the explanation seemed fairly logical. The hot battery was familiar from times we've changed it after the 'I'm going to die in half an hour or less' warning. The initial low battery warning, indicating a couple of days' power remaining, had been visible on the pump for at least most of that day, my daughter said, and she'd planned to change it during the next day's site change.  But it's possible it had been there longer, since we were in vacation mode and, as is our custom, paying less attention to diabetes than usual while enjoying vacation things. Or maybe the battery died a little faster than usual with all the extra use for vacation food. Maybe the pump alarmed for the full half an hour foretelling its imminent demise, and simply didn't wake my daughter from her vacation-induced deep slumber - we'd been out late and came home tired.

All that really matters is that the new battery continues to work just fine, a couple of weeks later, and we were able to enjoy the rest of our vacation.

Still Lending a Hand

Our family has experienced several turning points over the years when it comes to my daughter taking on increased responsibility for her care.  To us, each of these has been a big deal.  She can check her own blood sugar!  She can troubleshoot enough to be left alone at a birthday party!  She can count her own carbs at a restaurant with friends!  She can change her own site!  She can go away overnight! The list of these moments is long.  For some families, this list doesn't exist at all because their kids were diagnosed at an age when they naturally took on all or at least most of these tasks independently from the start.  For others of us, it's been and continues to be a long incremental journey.

Sometimes I feel weird, or even guilty, that I still help my daughter with her Dexcom sensor insertions or that until a couple of years ago I did almost all of her site changes. The little voice in my head nags,  'She's a teenager for goodness' sake- she should be doing all of this by herself.  Other kids are doing it by 8.'

But if I step back and reflect on how we got here, it feels okay. 

When she was diagnosed at 13 months old, we did EVERYTHING.  Obviously.

Then around 3 she wanted to help...as many 3-year-olds want to do.  It's the 'I can do it by myself 'age and we took full advantage.  She learned to use the lancet and apply blood to the test strip.  She learned to read the number on the glucometer out loud.  She learned to gather all of the supplies for her site changes.  She was in charge of separating the various wipe packets which come in perforated pairs of two. She also spent quite a bit of time taking care of the diabetes needs of her dolls and stuffed animals who, occasionally, also had to count carbs at tea parties, check their blood sugar or drink juice boxes.

By the age of 5 she knew how to use her insulin pump, with supervision and an adult counting the carbs. She knew to drink a juice box if her meter said she was low and to wait 15 minutes and check again before she could go back to what she was doing - again, with an adult around to support her.

In early elementary school she learned how to count and bolus for a simple snack like goldfish crackers or pretzels so that she could go to a friend's house after school.

If she WANTED to do it, we figured out how to make that happen.  If she didn't want to, we didn't push. 

She now, of necessity, knows how to do it all. And yet, still, I help if asked. Diabetes is a huge undertaking. For now, the least I can do is give her a hand filling the insulin cartridge if she has to do a site change in a hurry, or be an extra set of hands for the awkward Dexcom insertion.  She's going to have to do it all by herself soon enough.

The Gatorade Trick

I have no official connection to Gatorade, and this is not medical advice, but marching band practice is well underway here, and I have stocked up...

Gatorade's low-carb G2 is my daughter's go-to drink for evening marching band practice.

We first tried G2 for middle school volleyball which was a slow-paced, instructional, noncompetitive evening rec. league activity. We tried it mostly as a compromise because middle school is the era of 'all my friends are...,' and all her friends brought Gatorade to volleyball. As it turned out, it also helped her end up with better blood sugars than on the nights she didn't take it to practice.

There are eight grams of carbohydrate in twelve ounces of G2.  About that amount, poured over an abundance of ice and sometimes diluted with water to fill a large container, sipped slowly over the course of a 3 hour marching band practice, is just about right. Infusing just a few carbs per hour to burn off immediately seems, for her, to keep the lows at bay.

We've tried, as an alternative to this plan (generally when I've neglected to stock up at the grocery store), bolusing less insulin for pre-practice dinner, which just leads to an immediate spike. We've set temp basals, which lead to overnight highs. The Gatorade is what works for her.

Two years in, there have been 2 occasions when she's had to sit on the sidelines for a few minutes for a significant low to come up. That's with hundreds of hours of practice and performance.

It's obviously not just the Gatorade. A solid, healthy meal before practice, assessing the Dexcom or glucometer at breaks and reacting accordingly, and having a well-stocked bag of diabetes tricks including healthy snacks and fast-acting carbs are among countless factors crucial to staying in range enough to participate and enjoy the activity.  But on occasions when I've neglected to replenish the Gatorade supply things have not worked out as well.

A Long Night

It's 10 p.m. The teenager has been home for an hour from band practice. She has showered and is thinking about going to bed. She checks her blood sugar in order to calibrate the Dexcom.

"WHAT?!?!"

The parents watch warily from the couch while the teenager gets another test strip and rechecks her bg.

"WHAT IS GOING ON??? HOW IS THAT POSSIBLE??? HOW DID THAT HAPPEN???"

The teenager is distraught.

"Mom...can you help me do a site change so it goes faster? APPARENTLY I'M 485."

The mother rises wearily from the sofa, her plans for quiet time with her book followed by a good night's sleep dashed. She fetches a large glass of water for the daughter, in hopes of keeping ketones at bay.

"Yup. Drink this first. What happened do you think?"

"I DON'T KNOW!!!"

The teenager is grumpy, irrational and teary. Probably because of the blood sugar of 485. She gathers herself for a moment.

"I don't know... I was fine at dinner - 130 something. I don't remember Dexi alarming at band but it must have. It alarmed again a little while ago. But not that high. It's been iffy all day- it's like 10 days old - but I didn't know it was that far off and now I'm really high and I don't know WHY!"

The mother and teenager go off to the teenager's room to change the site. The chain of events leading up to the current situation is reviewed.

"I bolused dinner - I'm sure..." opens the pump's memory and double-checks "yup- and it wasn't a lot of carbs and you used the measuring cup. And then I just went UP! And I didn't eat anything at band- I just drank my water and I never had anything when I got home and now I'm SO HIGH FOR NO REASON."

When the site is removed the cannula is gunky, clearly clogged up. The mother thinks out loud.

"I don't think, in 13 years of pumping, you've had a pump site conk out that quickly. Usually they take a gradual turn for the worse, but this one seems to have suddenly and completely stopped working. That's the only logical explanation to go from 130 to almost 500 in 4 hours."

The teenager curls up on her bed, nursing her second pint of water. She is clearly miserable. She complains of a headache.

"... not just in one spot but like...my whole head...it just hurts...it's awful."

The mother initiates calming conversation … a friend's new puppy, a funny story someone posted on Facebook. Eventually, it's been 30 minutes since a correction dose of insulin was given. The teenager rechecks and is now just barely over 400. She gets up to brush her teeth and finish preparing for bed. The Dexcom alarms... FALLING! … and hope increases that the correction dose will work.

The teenager goes to bed. The mother gets to read her book, but for much longer than she'd intended, staying up until 12:30 a.m., when the blood sugar has dropped to 230-something.

The mother is awakened at 2 a.m. by the Dexcom alarm (which is now, incidentally, spot-on again) and gives the teenager some juice for a bg of 76.

The father gets up at 3:45 to give more juice for a bg of 68.

The family gets up in the morning. The teenager has a bg of 77. They are all tired. They are all grateful for the discovery of insulin. But moreso now for the discovery of caffeine. .

False Advertising

I love this sale.

We will stock up.

They will fit perfectly into my daughter's diabetes bag.

I am grateful for portion-controlled 15 carb. servings of juice.

But I will not. Ever. Refer to them as "Fun Size."

I Almost Asked

My daughter's Dexcom G4 sometimes chooses to stop 'sharing' these days, making its receiver the only source of information. When this happens, as it did this week, I try to take a quick peek at the receiver once in a while, just in case we need to talk about tweaks in the basals, carb ratios, correction factors and such.

I looked at the receiver this morning - it was on the table after breakfast - and yesterday morning showed a spike, reaching the top of the graph, and hanging there for an hour or so before coming back down to a reasonable range by noonish.

My initial instinct was to ask something along the lines of, 'What the heck happened yesterday???"

Then I realized three things:

1. I already knew what happened  yesterday. Her grade had a delayed opening because of standardized testing at the high school. She had been out to breakfast with friends and she ate eggs and toast and potatoes- which was a better choice than pancakes - but she clearly either under-guessed on the potatoes or forgot to bolus until too late.

2. The evidence showed that she'd picked up on her mistake, corrected her blood sugar, and gotten herself back in range by lunch. She had solved the problem by herself.

3. Nit-picking is counterproductive. She'd just get defensive if I brought it up, no matter how much I tried to turn the conversation towards 'all's well that ends well.'

So I didn't ask. 

What to Say?

We currently have more than one family in our lives with a recently diagnosed blood-sugar-challenged person. While we're hoping this isn't becoming a trend, I'm working on my own initial reaction conversation, and reflecting on some I had 15 or so years ago.

We were fortunate to be hooked up with a local group of diabetes parents shortly after my daughter's diagnosis. When I called for details about their meetings, the group's facilitator - both a CDE and a diabetes mom herself - stayed on the phone for almost an hour, offering support and encouragement, with lots of, "slowly but surely it'll get easier," and "it sounds like you're doing well, considering how little she is and all you've been through," and "I'll bring you some resources when you come to support group." She then asked if she could have a member of the group call me since this member's daughter had been diagnosed at about the same age as mine. The phone rang a few days later.

"Oh... I'm so sorry this is happening to you," the well-meaning mom began, "Having diabetes is terrible. It's the hardest thing we've ever done."

We had other conversations with fellow diabetes families over those first few months, some from that support group and some from other parts of our lives, but I think those two interactions mark the extreme opposite answers to the question, "What should I say to the newly diagnosed?" Should I assume they're in a place of despair, or should I begin with hope?

Talking with the "diabetes is terrible" mom wasn't all bad. Simply chatting with someone with similar experiences was helpful. But I was left wondering why, 3 weeks in, I seemed to have a better level of acceptance of my new normal than she did after a few years.

So in my interactions, even on days when I'm feeling like diabetes is particularly terrible, I've decided to aim for encouragement: offering and answering questions, listening, and providing information or resources if I can.  If the conversation flows towards the terrible parts, I'm not opposed to supportive commiserating, but want the end message to be, "but we survived those first months, we're surviving now, and you will to."

I don't think there's anything much more helpful than a real live person saying, "I've been in your shoes. I'm still standing, and even thriving. It's going to be okay, and I'm here to help."

A Mother's Day Gift

A poem written especially for moms of young kids with diabetes:

Not flowers, nor chocolate - not even fine tea!
What I want is a break from the numbers, you see.

For three sixty four they've been swirling around
'Til I fear on some days that my brains will be drowned.

So this Sunday for Mothers, I ask for a rest
From basal and bolus, from 'What are you- test!'

From site change and carb counts, from dexcoms that blare,
Insurance and phone calls and 'the juice boxes are there.'

So Sunday at lunch and the walk by the lake,
I ask that from d-stuff I get a quick break.

I'll be back on Monday, raring to go,
To support my sweet hero in her diabetes show.

Nurse Perks

Happy National Nurse's Week!

My daughter has, for over 10 years, almost always enjoyed going to the nurse's office.

The minutes she was late for lunch in elementary and middle school were hard, and she never enjoys being low or needing a site change. But there are upsides to those nurse visits:

There's often something interesting going on in the office. An overheard phone call to a parent who doesn't want to pick up a sick kid. Or a bizarre gym injury. Or an update on the current plague, be it flu or lice or a lingering cold.

There's a kind, interested adult there. When the office is quiet, there's conversation. Our school nurses have known more about my daughter than most of her teachers and even some of her friends. And vice-versa. While killing the time it takes for a low blood sugar to come up they talk about family, vacations, restaurants, afterschool activities and more.

Teachers and other staff stop by. My daughter has overheard, and often been included in, conversations amongst school staff. It's pretty interesting to hear the 'grown-ups' talk. Some nurse's offices are adjacent to the main office, providing yet another interesting source of conversation and information.

There's air conditioning. This is no small plus in September or June around here. On elementary school field day, or as an escape from the south-facing third floor middle school classroom, a low-ish blood sugar was a free ticket to relief.

I'm incredibly grateful for the nurses who've sat in those offices over the years. Being concerned about and dealing with my child's medical needs are line items in their job descriptions. The relationships they've built with her, and the extra kindnesses along the way have been above and beyond.

Thank you, this Nurse's Week, to all the school nurses who make their offices a safe, pleasant and even desirable place for their kids with diabetes.

Ye Olde Pharmacy Days

Fifteen years ago, when my daughter was first diagnosed with diabetes, we were given a handful of paper prescriptions. I drove to the local pharmacy near our house which, conveniently, doubled as a Hallmark store. I handed over the prescriptions and went home with two kinds of insulin, including one which had been diluted to make her baby-sized doses possible. I also went home with test strips, lancets, syringes and glucagon. At regular intervals I returned to the pharmacy, paid a reasonable copay, and received more supplies. Sometimes I was also able to pick up a birthday card or a baby gift while I was there.

It sounds like a fairy tale now. The only thing I still obtain at a brick-and-mortar pharmacy is insulin, and I fear those days are numbered.

I fail to understand how the current system could possibly be more cost-effective...or better in any other way for that matter.

The layers of bureaucracy which have been added in the interests of keeping costs down can't really be doing so, can they?

Our endocrinology office now has staff members who answer the office's 'prescription hotline,' speaking, emailing and faxing all day with patients, pharmacies and insurers.

Our health insurer now pays a third party case management company to manage our prescription and durable medical equipment (pump, dexcom, etc.) supply needs. That company then contacts the people at supply distribution companies who then process our order. Both the prescription case management company and the supply shipping company call, email and snail mail us, our insurer, and the aforementioned 'prescription hotline' people regularly with questions, updates and statements.

Then FedEx, UPS or the USPS is paid to deliver our supplies. They're also paid to return wrong orders, or malfunctioning equipment.

How does any bulk purchasing discount not get balanced out by all of these additional expenses?

It's also definitely less efficient, taking days if not weeks to fill prescriptions when it used to be possible to pick it all up on the way home. Or, at worst, kill the 20 minute wait picking out a birthday card or browsing the toy department.

And the room for error has increased exponentially. When I pick up a prescription from CVS, I peek in the bag before I walk away from the counter. If there's a problem it's fixed immediately. Meanwhile, our initial order from Edgepark, containing 2 wrong items, required 3 phone calls, a 48 hour wait for a replacement items, a 2 week wait for a return label, and a trip to the post office. And I'm not sure the billing is straightened out yet.

There's so much wrong with the current healthcare marketplace that this is just the tip of the iceberg. At the same time it serves as a lens through which to view the layers of bureaucracy which are adding expense and frustration for all of the players in the healthcare system.

While it wasn't always convenient to go to the pharmacy, especially with a toddler in tow, it was most certainly better than the rigmarole we go through now.

The Owl Bag is in the Orange Toolbox

"The owl bag is in the orange toolbox," the text read.

Nope. This isn't where I reveal that we're part of an intriguing spy ring.

The owl bag is, in fact, a small insulated cosmetic bag which currently holds a glucagon kit, one-touch mini meter, strips, a lancet and a pouch of glucose gel.

The orange tool box is a standard-sized portable toolbox which holds a vast array of items useful for repairing band instruments. Screwdrivers of all sizes with screws to fit everything from a piccolo to a marimba, pliers and wires, glue and assorted tape, reeds, mouthpieces and so much more are all housed in this very heavy toolbox which travels to the field for every rehearsal and with the band for every game, competition and concert.

We turned over the owl bag before summer band rehearsals began for freshman year. Over the course of that first year, it could be found in the director's desk drawer, in his messenger bag and on the sidelines of the football field. Last summer, at the start of summer rehearsals, I received the above cryptic text from my daughter. The band director, wisely we think, decided that if the owl bag was always in the orange toolbox, then it would always be in close proximity to the band.

We removed the owl bag from the toolbox and handed it over to the nurse who went on the recent overnight music department trip. It held just the right collection of things the nurse needed to carry. The day the kids returned to school post-trip, I was reassured by a mid-day text from my daughter:

"The owl bag is back in the orange toolbox."

Mission accomplished.

It Shouldn't Be This Hard

I'm a good 4 weeks into my effort to secure my daughter's Dexcom sensors, test strips and lancets through our new insurance provider. I'm only a little closer than when I began.

I called the insurance company. Who said I had to use their home care case management company, Carecentrix. I talked with Carecentrix a few times more than should have been necessary. I did the job they assigned me: to ask my daughter's doctor's office send them prescriptions with very specific specifications. I was told that Carecentrix would then send my daughter's order to a company through which the supplies would be covered by my insurance. That assigned company would call me to make arrangements.

I received a call the next day from a supply company. The conversation ended with the very nice representative saying this:

"Well, ma'am, I understand you'd rather not switch to a new brand of meter. If you want to continue using the one touch strips...and it sounds like you do...I'm going to suggest you call Carecentrix back and ask for them to assign you a new supply company. I'm sorry I couldn't be of more help to you today."

A couple more phone conversations with Carecentrix, and I was told our supplies would be coming from Edgepark. "They'll call you in the next couple of days." Which they didn't.

When I called Edgepark they had my daughter's name in the system and the list of items requested which was more than I had hoped for. They did not have the correct insurance company, and they had my 16 year old daughter as the primary policy holder. Once that was settled, my phone call was transferred to someone else to 'confirm that the order was underway.'

"Next," I was told, "we have to verify your benefits, and then we will reach out to your provider for the prescriptions." Apparently neither the referral from Carecentrix nor the prescriptions that came along with it were good enough. "We have to fax your doctor paperwork and they have to fax it back with very specific information. It all has to be done on Edgepark letterhead, ma'am."

I asked, in as many ways as I could think of, if there was anything else they needed from me. No, I was told. New orders take up to 10 days to ship, and ours should be on the way within that timeframe.

A recorded telephone call the next day told me that Edgepark needed additional information to process my order. They needed me to call them as soon as possible. After 20 minutes on hold I was told they needed a 'valid method of payment,' which I provided. I was told, once again, that there was nothing else they needed from me.

I received two recorded updates, one that the order had been processed, and then an exciting one that the order would arrive "within one business day."

The next afternoon there was a box on my doorstep!

It contained Dexcom sensors, test strips and lancets:

On the plus side, the Dexcom sensors are exactly what we needed. And, if there's a silver lining, the item we needed most urgently. The test strips and lancets, on the other hand, are being returned. Edgepark, I was told when I called to complain, doesn't carry the variety of lancets my daughter uses. The correct test strips are, allegedly, in the mail.

Thankful

Unlike last year's expedition, which could have been subtitled, 'airplane flight to 5 days of walking in chaotic environments,' this year's music department trip seemed like a manageable adventure. It was a four hour bus trip to spend 3 days and 2 nights in and around an interesting city. Because of the presence of a great school nurse, concerned chaperones and staff, and friends who have my daughter's back, we decided, with my daughter, that she'd travel without a parent. Here's the note [with awkward edits for privacy] I sent to the band director on the Monday after this year's trip:

Just a note to say thanks for a great music trip.

 

What a nice opportunity it was for the kids to attend Thursday's concert.  [My daughter] was especially excited to see such an incredible piano concerto performed. 

 

Between the concert, the chance for feedback and work on the concert band's competition pieces, and a fun and interesting collection of places to explore with friends, [my daughter] had a terrific time.

 

We're always happy to be involved in the life of the band, including chaperoning. But we're also grateful for the steps you and [the high school] as a whole have taken to allow [my daughter] to participate fully and safely without us present, encouraging her growing independence both diabetes-wise and beyond.

 

Looking forward to hearing tomorrow night's performance!

I mailed a similarly thankful note to the nurse who accompanied the kids on the trip. My daughter was in touch with her regularly via text, and they always knew where the other was. The nurse carried a little bag (within her giant 'nurse bag') with glucagon, glucose gel, and a spare meter set. Her assistance was never needed.

These notes reflected my acute awareness that my child was fortunate to have such a fun and positive trip.  There are other kids who are allowed to have these kinds of experiences but with much less quality support. And there are kids who are told (illegally but indisputably) that they can't participate at all. For three days Dexcom Share was my most-used app. The texts about the frosted flakes for breakfast and the bus full of rice crispy treats were cringe-worthy. But mostly, I'm thankful.

Another Opening, Another Low

It's been a couple of years, and we forgot. Performing in musicals makes my kid low.

Except for an occasional adrenaline-induced high, especially on opening night. For which insulin should be dosed sparingly, not aggressively.

Exercise is the most obvious cause. This year's show was particularly dance intensive. At two and a half hours long and involving at least five quick costume changes, every performance resembled a marathon. Saturday's double-header was made possible by a giant between-shows order of Thai pineapple fried rice.

Being in a show also puts her off schedule. Diabetes likes to eat, move, sit still and sleep within the confines of a predictable routine. Dinner at 4:30 on show nights, 8:30 on dress rehearsal nights? Both unusual. Dancing and performing in the evening instead of sedentary homework? Unusual. Diner pancakes or cast party food post-show? Her insulin to carb ratios are set pretty accurately for regular mealtimes, not so well for midnight. There was lots of overnight juice.

Exhaustion is another probable contributor to the show lows. The weeks leading up to opening night involved long rehearsal days followed by late homework nights. Schoolwork didn't stop. Regularly scheduled music rehearsals didn't stop. She burned more energy than usual just to keep up with the long hours.

It's absolutely true that kids with diabetes can do the same things others do. They can even make it look effortless. Waking a couple of times per night for juice, calculated intermission snacks to improve the odds of stable second act blood sugar, checking and double-checking the backstage bag of supplies, and maintaining an overall high level of diabetes vigilance are invisible tasks, even to most of her cast-mates.  To her all those tasks are totally worth it to be able to participate in her high school's musical.

Wouldn't it be nice, though, if she could just do the same things other kids did without all of the extra effort?

Flu

Neither of us felt great on Tuesday a week and a half ago. By mid-day Wednesday we were camped out on the couch coughing, feverish and watching the Olympics.

We visited our respective primary care providers on Thursday. Both were out of diagnostic swabs but our symptoms of fever, aches, cough and utter exhaustion led both to diagnose us the old-school way.

Despite getting flu shots and obsessive hand washing and hand sanitizing, we ended up with the flu.

Because of the afore-mentioned flu shots, the experience was allegedly less awful than it could have been. Nevertheless we spent Wednesday through Monday pretty much immobilized in front of the television.

Diabetes, needless to say, did not like the flu. The night before it hit was a multi-juice box night, which is consistent with my daughter's pattern when she's coming down with a virus. Despite no medical information to back me up, I've always assumed these pre-symptom lows were caused by her body waging a last-minute battle against whatever germs have invaded.

Then the blood sugars headed up. And stayed there. Days would usually start out okay- higher than usual but nothing crazy. Then, despite temp basals, corrections, and a diet consisting mostly of chicken soup, she'd crest 300 by mid-afternoon.

By bedtime (which was before 9 several nights- when sitting on the couch became too exhausting) she was sliding back into an acceptable-for-being-sick range. My saintly husband took overnight duty a few nights in a row, each of which required at least one correction bolus.

By Sunday afternoon and Monday the highs weren't SO high and the correction boluses began to actually work a little.  She was on the mend.

We've done diabetes + colds, stomach viruses, strep, pneumonia, chicken pox, dental surgery, ear infections and more, but never flu. There was quite a bit of transferrable information from our experiences with other ailments. We knew about the necessity of frequent glances at the CGM, setting increased temporary basal rates on the pump, and aggressive correction boluses for highs. We knew that with patience and perseverance blood sugar would return to normal as the illness passed.

The primary novelty of the flu compared to our countless other illness + diabetes experiences was the duration of being really sick. With the illness lingering, in a serious way, for nearly a week it was a long wait for blood sugars to look more like they usually do. The silver lining was that both of us were too sick to expend any energy worrying about it. It took everything we had just to keep our tea mugs full.

Spare a Rose

I reorganized my daughter's insulin this morning. I discarded a vial of Lantus which expired two years ago- a vial we had on hand only in case her insulin pump failed and we needed to give her an injection. We had never opened it. We have a new container of long-acting insulin on hand, which we also hope never to use. 

I took the oldest vial of her usual fast-acting insulin out of the refrigerator so that we can start using it to fill pump cartridges, and then I reorganized the butter compartment with several more vials, enough for a couple of months.

I also restocked the diabetes supplies in her room: test strips, lancets, insulin pump paraphernalia, and the stash of juice boxes we keep on hand for overnight lows.

What a hassle all this acquiring, organizing and using diabetes supplies is. And how fortunate we are to be able to do it.

The International Diabetes Foundation's Life For a Child Program helps families who live in places where having a butter compartment full of insulin and a drawer full of lancets and test strips is unheard of. There are children in underdeveloped countries around the world whose lives have been saved by this program. Children who would otherwise have no access to insulin or any other diabetes care supplies. Per the organization's website,

The program currently supports over 18,500 young people in 42 countries. There is so much work still to be done, we estimate that over 100,000 young people still need our help. Together we can achieve our vision that no child should die of diabetes.

This will be the 5th year that 'Spare a Rose' will be part of our Valentines' celebration.

Sparing one rose from a bouquet of a dozen and donating that $5 cost to Life for a Child provides a month of insulin, syringes, and diabetes education to a child in need. Donating $60 and foregoing roses altogether provides a year of life.

Want to learn more, or participate? This is the link!

Happy Valentine's Day!


Driving!

"GOOD MORNING! Go ahead and get in the driver's seat. You'll tell me if you're feeling high or low, right?"

And that's why we waited for this driving instructor.

My daughter turned 16 in November and passed the written part of the state driving test at the end of that month. The next step, per our state's motor vehicle department, was to begin six hours of behind-the-wheel instruction through a certified driving school.

The high school's gym teacher of few- but loud -words I've written about here is an instructor with the driving school most kids in town use. Other instructors were available in December, but we waited.

That little interaction at the beginning of the first lesson made me glad we did.

We wanted her first few hours on the road, since it would not be with us, to be with someone with whom she was comfortable sharing any diabetes-related needs she had during the lesson. This guy checked all the boxes. My daughter knew and liked him. He was, professionally as a gym teacher, aware of low and high blood sugars and the seriousness there-of. We also know that he has a niece with T1D, so would be attuned in a more personal way to the issue.

As it turned out, diabetes was a non-issue during any of the three lessons.

As with so many things diabetes, though, we were comforted knowing that while we hoped for the best case scenario we had a safety net in case things went awry.

Crisis! (Averted)

'AAAAH CRISIS'

That text arrived around 11:30 the other morning.

Having a 16 year old girl, lots of possibilities came to mind. Forgotten clarinet on a band day, wardrobe malfunction, unexpected test? Turns out it was a diabetes crisis.

'I bolused 10.8 for lunch then 2 more for muffins so then I looked at Dexi and I was skyrocketing and then I looked at history to see if I had bolused and I only saw the 2 units so then I bolused 8.8 more ahhhhh'

So, I confirmed with her via text, she had bolused 8.8 units of insulin with no matching food? She had forgotten that she had bolused for the main part of her lunch, panicked at the rapidly rising blood sugar, and therefore given insulin for it twice?

'YES I RLY SCREWED UP'

While she freaked out, knowing that an overdose of insulin had the potential to be catastrophic, I trusted that her friends would take care of her mental health while I focused on how to fix the problem.

'What's the current insulin to carb ratio?'

'1:8.'

If 1 unit of insulin covers 8 carbs, I reasoned, then 8 units covers 64 carbs, 9 units covers 72 carbs- essentially reverse-engineering of the math to figure out a game plan. She would need to consume some serious carbs to balance out the equation.

'I'm currently eating a tootsie roll pop which is 15 carbs.' (There's a teacher who sells these, essentially at cost, in his classroom...a little mysterious but very helpful at that particular moment.)
'And then I need how many more? Math for me.'

I'll spare you some details, but because to it turned out she was, indeed, skyrocketing we decided that the tootsie pop, one juice box and the pretzels which were to be her snack after school before play rehearsal would be a sufficient start as long as she kept a close eye on the Dexcom. It was a total of about 50 carbs.

It worked out pretty well. At the two hour mark from the error, she was about 150 and continued a slow downward trajectory during play rehearsal but was over 100 when she got home- hungry because she'd eaten her afternoon snack at 11:30 a.m.

And to Drink?

The waiter at the BYOB restaurant arrived, opened the wine, and started pouring it into glasses that were preset on the table.

One glass, two, three...

"Uh...only two glasses," my husband said, with a pointed glance towards my 16 year old daughter who was our only dining companion.

"Oh- yeah- sorry- I wasn't paying attention... Can I put in any appetizers for your table?"

We ordered something that had caught our eye and then my daughter asked for unsweetened iced tea.

The waiter returned a minute or two later with a glass of clear bubbling liquid. "You said Sprite, right?"

"No...iced tea please."

"Sweet or unsweetened?"

"Unsweetened."

He returned again with a glass of tea. "All we have today is sweet- I hope that's okay."

All three of us shook our heads.

"No? No sugar then?"

"Right."

"I think all I can offer you then is water or seltzer."

Eventually she received a very small glass of plain seltzer.

"I should've asked for a lime or something," she said regretfully.

But in the end she was just happy to have gotten something to drink.

The Sensor Order

I ordered Dexcom sensors at the beginning of December.

Two weeks later I got an email from Byram telling me that an order was shipping. Good news, I thought- the sensors would be here soon.

Early on a late December morning a box from Byram arrived on my doorstep. It seemed big for a three month supply of sensors.

That's because it wasn't. It was our quarterly, automatically refilled, shipment of pump supplies. I hadn't clicked on the email details, mistakenly thinking that we weren't due for any more pump supplies until January so assuming it could only be about the sensors.

I looked up my sensor order on Byram's online patient portal. 'Order in progress,' it said. But it seemed unusual to me that an order placed over 2 weeks ago would still be 'in progress.'

I called Byram and explained the situation to a representative who really seemed like he cared.

Side note: all of Byram's representatives really seem like they care and I'll be deeply disappointed if next year's new insurance company does not allow us to continue to do business with them.

'I see here it needed insurance authorization, but that should have happened quickly. Can you hold a moment while I look into this a little further?'

So I held.

'So it looks like, as I said, it needed insurance authorization, but it seems nobody followed up on the order. I've expedited the claim and it should be taken care of within an hour or two. And I've set the order up for free express overnight shipping because it was our mistake. Would it be alright if I call you back when it's taken care of?'

'Thank you so much, and yes- a call would be great.'

An hour or so later, the phone rang.

'It's been processed and headed out for shipping. You should have it tomorrow.'

I thanked him again, profusely.

So many things about diabetes are hard, and the grind of procuring supplies and insulin is often punishing. This interaction was anything but.