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.

Great?

Thanksgiving weekend was great. We had family travel to spend the weekend with us. We hosted the meal. We enjoyed leftovers, played board games and took some long walks.

Diabetes-wise? It wasn't great. The Dexcom beeped all weekend, mostly for high blood sugars. There was a 'FALLING' alarm each time we set out for a walk, as though all of the insulin delivered over the previous hours had pooled, waiting for the slightest movement to activate all at once. And there was a mysterious low after the Thanksgiving Day pie:



 

 



The leftovers are mostly gone now and the routine has returned to the usual school day schedule. Blood sugars are coming back into range.

We decided long ago, the first time we vacationed with diabetes, that special occasions warranted a loosening of diabetes perfectionism. This doesn't mean we don't correct highs and treat lows. It doesn't mean that we stop trying to count carbs altogether. It doesn't mean that we don't use the tools and tricks in our arsenal to attempt to keep things on as even a keel as possible. It simply means that we accept the inevitability of wider swings in blood sugars because of the change in routine and eating patterns. It means we take a deep breath and don't freak out over every out of range number. It means that we focus on the diabetes to the extent we need to in order to keep my daughter feeling good. Beyond that, we focus on the fun. Not medical advice, I'm sure, but it's a philosophy that keeps us sane so that we can enjoy the special occasions in life.

Which is why I can say that, despite the incessant beeping, Thanksgiving weekend was great.





Birthday Day and Other Heavy Eating Occasions

My daughter's friend had a birthday last week.  It was on the same day as mine.  The kids have found a way to skirt the school nutrition policy of 'no outside food for celebrations' by bringing in treats to share at lunch. So lunch that day included oreos, hershey kisses, doritos and munchkins.  To her credit, she ate the sandwich and grapes I packed first, but she sampled the rest as well.

For dinner we went to a Thai restaurant and she had an uncountable portion of pineapple fried rice. We came home and had mini cupcakes and cannolis for dessert.

Our household diabetes philosophy (yours may vary) allows sweets, and even junk food.  Birthdays include cake.  S'mores over the fire pit or a trip for italian ice are part of summer fun.  A little bag of chips for the walk home is o.k.  Most days include cookies or a non-dairy frozen treat before bed. Taken one at a time, or even two in one day, we're o.k. with both the questionable nutrition of it and with the diabetes challenges.

'Everything in moderation' is the general idea. But on days when moderation goes out the window, I'm left feeling torn.  Should we ever let her eat this way?

"Yes!  You can eat anything except poison...or cookies made with poison..." is one side of the coin. But she really can't eat anything and maintain the same kind of blood sugar numbers she does when she eats healthy, countable things.  Twenty carbs of oreos and doritos is not the same as twenty grapes. Half a restaurant portion of pineapple fried rice and a bakery cupcake simply can't be counted and dosed for as accurately as portions prepared, weighed and measured at home. Add the 'one more dorito because everyone else is still eating,' or the picking all the pineapple out of the fried rice despite bringing home 'half,' and the challenge increases.

Still, I lean towards letting her learn from her mistakes over outright forbidding her from eating like this. She'll encounter days with heavy eating potential for the rest of her life, so perhaps helping her develop a healthy sense of how to handle them is the answer.  Last week's birthday day was an example of how not to handle it.  And she knew it.  She was upset that her blood sugar was high for hours.  Between that lengthy high and the general junk food overload, she had some lingering indigestion into the next day.

Sometimes she makes better choices.  Last weekend, she said no to lunch out with a friend before an evening birthday party because it would consist of too much uncountable food in one day.  She's come home from parties and told us she was the only one who ate the proffered grapes or salad to balance out the junk. She will report with alarm how many cookies or cupcakes some kids consume in one sitting.

I guess it's like all things diabetes, really.  We do our best.  We try to fit the diabetes stuff into what we consider a normal, healthy lifestyle.  We try not to let it ruin our fun.  We learn from our mistakes.  And we're never quite sure we're doing it right.

Enough Already

Here's an abbreviated list of things I wish I never had to do again:

-Hear my alarm clock at 2 a.m.

-Receive a text that has only a blood sugar number in it.

-Answer a call from the nurse's office.

-Hear "I feel low."

-Do math before my first cup of coffee or in the midst of a party.

-Lug pounds of diabetes supplies through a museum or up a mountain.

-Worry whether my child is passed out somewhere.

-Explain type 1 diabetes.

-Argue with a pharmacist, insurance company representative or medical provider.

-Support my child through a disappointment or frustration diabetes has caused her. 

This parenting a child with diabetes job is intense and unrelenting. Being responsible for keeping another person alive,safe and healthy is a stressful job. It involves countless physical, mental and emotional tasks every day. I must also help with the math homework, do some laundry, make dinner and provide sufficient regular-people parenting support to a 13 year old.  In my spare time I should surely contribute to society in some productive way.  Then I need to get out to see the latest movies, read the big novels, exercise, and make time for the rest of my loved ones.

I've heard diabetes described as a juggling act among carbs, insulin, activity and multiple other factors, and it's a good  metaphor.  There are occasional days when this juggling act seems possible.

But then diabetes throws in a knife or a flaming torch and all those other balls must instantly lose my attention.

Seasonal Chaos

'Tis the season.  The busy one.  With the endless stream of places to be and people to see.  The one with the cookies and cider.  The one with distractions around every corner.

With the aforementioned cookies, cider and chaotic schedule, diabetes should really be getting more attention this time of year.  In a sense it does, with increased blood sugar checks and carb count research.

What we lose track of is the big picture stuff.  Does the basal rate or carb ratio need to be changed at dinner or has she been high after dinner every night because we spent the weekend eating leftover Thanksgiving pie for dessert?  How could we possibly do any kind of basal testing to see which we should change when there's leftover pie to eat for dessert?  If it seems something should be changed, can I manage to remember to do so when she and her pump are in the house with me or will I only think of it when she's at school or when we're together at a gathering at dinner time?  That's the current dilemma here.

Last week brought a night when it was tough to squeeze in just 10 minutes to do a site change.

Next week I need to remember to order the test strips.  It remains to be seen whether I can retain that in my memory bank (or even notice it among the items on the seasonally long to-do list) by then.

To a certain extent, I think letting the diabetes stuff sink a bit among the priorities is o.k. once in a while as long as it doesn't drop too far.  A little change of focus can do wonders for the mental health.

The trick in this season, which lasts over a month, is to bring it to the forefront again on a regular basis to address the troublesome spots.

So tonight, no pie.