Halloween Lows

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

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



 

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

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

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

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

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

A Cautionary Tale

It was Saturday evening at 5:30. My daughter had, as is her custom, waited until the last minute to do a site change.  In less than half an hour she would be leaving to go out to dinner with friends: a gathering to commemorate the end of summer.  Just a quick site change and she would be off.

Supplies were gathered.  The cartridge was filled.  Wipes were applied.  The pump was picked up and buttons were pressed to 'rewind' the area that holds the insulin in order to accommodate the new, full, cartridge.  The motor started to buzz and then...

'BEEP boop BEEP boop.'  It sounded like a very tiny ambulance.  The message on the pump screen read: 'ALARM  CALL SERVICE  No delivery.' There was a code number.

It was then that our lives passed before our eyes.  Diabetes-wise anyway.

Where were the syringes? When was the last time I'd given her an injection?  She had never had to give herself an injection. Would she be able to figure it out in time to go out to dinner? When was the last time I'd written down all of the basal rates, insulin to carb ratios and correction factors?  Probably a year ago.  And where exactly were they anyway?

Without that information we would be challenged to figure out how much lantus to give her if the pump was actually dead.  Then, how would we figure out how much novalog to give for dinner and for meals and corrections to come?  I'd have to call our diabetes clinic and get help.  On Saturday night of a holiday weekend.  And what if a replacement pump couldn't come until Tuesday- after Labor Day?  What if she had to go through her first day of high school on Lantus and Novalog shots? 

My hands were shaking as I dialed the number on the back of the pump.  'For 24 hour technical assistance with your insulin pump system, press 1.'  I pressed 1 and was connected to a new menu including: 'For 24 hour technical assistance with your insulin pump system, press 1.'  I pressed 1 again and was connected to yet another new menu including: 'For 24 hour technical assistance with your insulin pump system, press 1.'  Really? Maybe if I press harder?  The third time was the charm.

The representative I spoke with did not seem panicked or pessimistic.  This was encouraging.  "Have you tried rebooting the pump by removing the battery?"  I had not.  "Let's try that."  My daughter fetched a quarter.  It took longer than usual, with my shaky hands, to use the quarter to unscrew the battery cap, but I did it.  We removed the battery, waited a few seconds, put it back in.  The alarm screen was gone.  I was told to attempt to rewind again, and if that was successful to continue with the whole insulin replacement process while still on the phone with the representative. 

As it began to become clear that things weren't as bad as I had imagined they might be, I said to the representative, "It sounds like this isn't as big a deal as I thought it might be...is this a common call you get?"  She explained that when the pump rewinds it does a series of self-checks and that if it detects a possible abnormality this alarm screen comes up.  Rebooting the pump and rewinding it again causes it to recheck itself and most of the time it does not alarm a second time, meaning (apparently) that the first one was a false alarm.  She did say to call if it happens again, so that they can document it, and that if becomes a regular occurrence they would need to replace the pump. 

In the end, we loaded up the new cartridge and primed the pump with no further problem.  While my daughter finished getting herself ready to go out, I jotted down total daily doses from the pump's history, her basal rates and ratios, and every other number I could think of.  And I set a reminder in my phone to do it again after the next endocrinologist appointment. 

 

So please, pump users, take this as a cautionary tale.  Please (today) make sure you have all your info jotted down or electronically stored somewhere other than your pump, and that you have the equipment and knowledge you need to activate your back-up plan.  Hopefully, like us, you won't need it.  With any luck you won't even be late for dinner.

We Wouldn't Do This Again

At 8th Grade Graduation practice my daughter's class was told in no uncertain terms that they could not carry anything as they marched down the aisle. A two minute conversation would have led to her being allowed to carry her meter, but she didn't want to.  She wanted to walk in empty-handed like the rest of her classmates. Having a 'what's the worst that could happen- it'll all be fine,' moment, I acquiesced.  Here's what we did and why I wouldn't do it again:

Because the middle school's auditorium is small and infamously hot, the program was held in a large gymnasium at different school.  The kids were to arrive at 9 a.m. and meet in the building next door to the one where the ceremony was held.  At 9:30 they would process in and sit together in the front of the room.  The program was expected to last until about 11 a.m.

Creating a safe diabetes plan would have been easier with pockets as part of the equation, but she had a great dress to wear.  We knew a pump pack fit well underneath, but when we tried to add the Dexcom, there was an obvious bulge.  At least when we added a roll of glucose tabs tucked into the waist band of the pump pack, there was not. Those glucose tabs were our insurance policy.

We decided that she would check her blood sugar and make any needed adjustments in the car on the way to the ceremony. There had been no mid-morning blood sugar issues of late, which made us feel more comfortable with this plan. If at any point when we were not together she felt she was low, she would err on the side of caution and would (with a discreet move practiced before leaving the house) obtain glucose tabs from beneath her dress and eat a couple.  Then, once she was in the room with us, I would have the Dexcom and be able to signal her to eat glucose tabs as needed.  No problem.  Except these two unforeseen problems:

At about 9:25, just before the kids were to make their way into the ceremony, an audience member experienced a medical emergency.  There was a nearly half hour delay while the person was treated and eventually taken away by ambulance.  The kids were kept in their holding room in the next building over, too far away for the Dexcom to reach.  The half hour we'd expected to be apart turned into an hour.

Also, as we arrived at the venue, we learned that the kids would be seated in the empty chairs facing the podium, not facing us as we'd originally assumed. So there was no eye contact to be made and no hand signals to be used should my daughter need to be aware of a need for her hidden glucose tabs.

The story has a happy ending.  She left the ceremony with a blood sugar of 132, and a lovely award from the music department.  But in retrospect this was not a smart decision.  We should have had her carry her bag. Or asked a teacher who was supervising the kids in the other room to bring it over and slip it to my daughter once she was seated.  Or found a roomier dress with pockets.  As a rule, we don't even go around the corner without carrying a meter and a juice box.  Because as we were reminded on 8th grade graduation day, you never really know what's going to happen.

Prepared?

With the news from Belgium on in the background this week, I'm reminded of a question I've considered and dismissed several times over the past few years:

Is my daughter, at any given time, prepared to 'shelter in place,' or to be displaced?

In this increasingly dangerous world where bombings, mass shootings, terror threats and other such events are becoming commonplace, it's question worth considering.

In her school classrooms, she has a meter and its assorted equipment, one juice box and a roll of glucose tabs.  She carries these items with her throughout the day. Would that be enough for a six hour lockdown?

When we travel to the city for the day to see a show or visit a museum, we have double those supplies and usually a small snack.  What if we were told to shelter in place due to an event near our location?

When we go away for a weekend, we take twice the number of supplies we think will need for the days we're away, and a vial of lantus and a pack of 10 syringes in case the pump fails.  What if something happened which stranded us from home for much longer than expected?

Then there are the days when we run to Staples and forget to bring even the meter kit.  Or go for a half mile round-trip walk to the library with only a tiny box of nerds stashed in a pocket, just in case.  What if we were unexpectedly detained?

I don't like to consider these questions.  Dwelling on the scariness of the world in which my child is growing up isn't on my to-do list.  Carrying a bigger bag of stuff in case of an event I desperately hope will never happen seems like a burden which might outweigh the risk.

But maybe there should be extra snacks and spare test strips in her pencil case.  And maybe we should have spare insulin and a few granola bars with us when we're away from home for the day.   And maybe we should always have at least the meter with us even when we're walking a neighbor home who lives only a block away.  And maybe every road trip should involve a really big box of supplies.

But maybe I don't want to think about it.