The Juice-Related Benefits of the Discontinuation of Head Gear

My daughter has been wearing head gear to bed for almost a year.  Head gear works with braces to pull the teeth back with additional pressure.  For the uninitiated, Kit Kittredge has agreed to demonstrate the look with her own equipment:

Kit wants you to know that wearing head gear while playing volleyball is not recommended.

At yesterday's appointment my daughter was told she no longer needs to wear the head gear.  She'll switch instead to an unpleasant configuration of rubber bands, but overall this was good news.  The head gear was uncomfortable and significantly limited her side and stomach sleeping.  It was also unfashionable. So for those reasons alone, she's thrilled.

At 4:30 this morning, the Dexcom buzzed.  "LOW."  A finger stick confirmed 60-something, so I got the juice.  "Sweetie, you need some juice.  Sit up," I nudged.  It was gone in 4 sips.

"Wow.  That was easier!" she happily remarked as she snuggled back under the covers with a smile.

You see the head gear, with its attachments both inside and outside the mouth, made drinking a true challenge.  First she had to figure out how to slip the straw in her mouth around the metal. Then, four ounces of juice would take a good minute of noisy slurping to consume.  The process was interspersed with verbal encouragement from the parent and attempts to roll over and go back to sleep from the kid.

Whether she was awake longer after the previous juice drinking marathons, or last night from the excitement of being able to drink easily I can't say.

What If?

 This is a story about something that happened last weekend.  It is not advice, medical or otherwise.  Except maybe to be extra-careful when walking on frozen lakes.

'Does your daughter have any medical conditions?'

I mumbled a little.  "Nothing that's relevant here."

'Too young to have much of a medical history, huh?'

'Mmm,' I said with a tight smile.

The EMT continued to treat the facial injury.

We were at a family resort for a girl scout troop overnight.  Our last outdoor stop of the day was to explore the frozen lake.  I saw it happen in super slow-mo from about 30 feet away.  My daughter was walking towards her friends when her feet went out from under her and her face hit the ice. We're unable to reconstruct where her arms went, but they were of no help to her mouth.

She bit deeply into her left outer lower lip. The left side of her mouth was swollen and riddled with abrasions and braces marks inside and out. There was a lot of blood. We took her inside, got ice, washed up her face and rinsed out her mouth.  The bleeding wouldn't subside.  We were told there was an EMT on site.  I decided, particularly being far from home, that it would be smart to have it looked at carefully so I wouldn't wonder later if more should have been done.

My daughter later described our time with the EMT eloquently.  "He had trouble finishing his sentences.  And he kept repeating himself."  He was perfectly kind, and gentle, and competent.  But 20 minutes into his work, he was still cleaning the cut.  He had reassured us that she didn't need stitches and that her teeth seemed fine. He was finally getting out antibiotic ointment and bandages.  Then he asked the question.  "Does your daughter have any medical conditions?"

I looked over at the rest of my daughter's girl scout troop, so patiently and lovingly gathered with the other parents, waiting for her.  I thought about bumper cars, and dinner, and the evening fun to come.

I ran through the diabetes-related possibilities in my head.  I knew I should be honest. But could anything either he or I would gain from the potential conversation be worth the 20 minutes it would take to have it?  I mumbled my answer.

It felt really weird.  As I denied the diabetes, her life flashed before my eyes: the traumatic events of diagnosis, the countless endocrinology visits, the pump and CGM stashed under her winter layers.  What if none of that had happened?  What if this lip injury was one of the most significant medical events of her young life?

Eventually we were walking towards the bumper cars with an adorable stuffed lion her friends chose for her from the gift shop (conveniently located adjacent to where we met up with the EMT) when my coat pocket vibrated and beeped. A glance confirmed the inevitable:  240, double arrows up.  The adrenaline was at work.  Diabetes was, indeed, relevant to this situation just as it is to just about every other one.

But I refuse to let it slow us down.

Orthodontist As A Second Language

I don't speak 'orthodontist' very well.

My daughter and I have been visiting one for a few years now.  A year and a half ago the first orthodontic appliance was installed: a 'space maintainer' in her lower palette.  Three weeks ago, she had braces put on her upper teeth, complete with head gear.

We've had many consultations with the orthodontist.  X-rays and brochures have been viewed together and discussed. Options have been explained.  I'm embarrassed to admit that I understood about half of it.  If I'm lucky.

In contrast, when we go to the endocrinologist, I follow along completely.  I understand all the words.  I ask questions if something's unclear and keep asking until I understand the answers.

Why the disparity?  Our orthodontist is not the problem.  She's a smart and articulate professional. She takes her time explaining things and is always willing to take more.

I think it's me.  To be exact (this may sound bad), it's the degree to which I care about what she's saying.

When we leave the endocrinologist's office, I become the resident expert on diabetes for the next 3-4 months.  I need to understand every detail about the diabetes treatment plan in order to make it happen 24 hours a day, 7 days a week.  I need to be able to explain it to my husband, the school nurse and sometimes even the pediatrician. During every office visit, I'm absorbing information about how to keep my child alive and healthy every day, and for as long as possible.  It's information which is crucial for me, and increasingly so for my daughter, to fully understand.

In our initial meetings with the orthodontist, we discussed a 2-3 year plan to straighten teeth.  I understood in a general way that the space maintainer would hold her bottom teeth where they were. The braces would push (pull?) teeth to the back of her mouth to make room for a couple yet to come in near the front. Details of exactly how it all works remain blurry to this day.  But in this case any missing information will not be life-threatening.  I'm able to leave those details for the orthodontist to worry about every 8 weeks when we visit. I need to know a limited amount of information, like not to feed her hard, chewy foods and how to help her get the head gear on.  I need to nag her to wear it and to keep her teeth really clean. Beyond that, my basic understanding of the process was enough for me to feel comfortable signing off on it.

Of necessity, endocrinology needs to remain my primary language and focus.  I'll just have to muddle through in orthodontist.  It's kind of a relief not to have to master another whole language.

Meal Plan

When my daughter was first diagnosed with diabetes she had a very strict meal plan.  It specified exact portion sizes of starch, fruit, milk, protein and vegetables for all 6 meals and snacks every day.  Getting particular servings of particular foods into a toddler was, as I've explained before, awful.  But this was during the dark ages of NPH insulin. To avoid dangerous low blood sugars it had to be done.

Fast forward 11 years.   My daughter has an insulin pump and the flexibility to vary her carbohydrate intake from day to day.  Yet, as we were reminded this week, sticking to a general food routine has its benefits.

The installation of braces has altered the meal plan at our house.  Smoothies, soups, applesauce and hot cereals have replaced many more standard meals in the past week or so. We've learned that, for my daughter at least (everybody's diabetes is different!), protein is important.

The vegetable soup with just a few chick peas was soft and delicious.  The resulting low blood sugar necessitated 10 p.m. juice.  To make things worse, the juice had to be sucked down through the orthodontic head gear, challenging at any time but particularly when half asleep.

The lunch of coconut milk yogurt and applesauce went down easily.  But so did her blood sugar.

You physiology experts out there will already be aware that when we consume protein and carbohydrates together, the body digests the carbohydrates more slowly.  This slower rate of absorption stabilizes the blood sugar over a longer term.

For years now, with very few exceptions, my daughter's main meals have contained some combination of protein and carbohydrates.  Therefore her carbohydrate ratios and even likely her basal rates are contingent on both being in the digestion mix. Without protein, we saw quick drops in blood sugars after meals.  It was an interesting, if annoying, science experiment.

This week has been better.  She's chewing more easily.  The crock pot is in action, making things tender. The protein-free coconut yogurts have been replaced with protein-rich soy ones.  The scary post-meal drops have subsided.

The moral of the story is this:  Though we're told (and often loudly proclaim) that people with diabetes can eat anything they want as long as they bolus for it, we find that sticking with a general meal routine leads to more stable and safer blood sugars.

Of Braces and Smoothies and Math

What do you feed a growing 12 year old who's just gotten braces?

How about one with type 1 diabetes who can't have dairy?

Enter the single-serve blender, cartons of 'alternative milks,' coconut and soy yogurts, and a freezer full of frozen fruit.   And math.  Always math. The combinations are nearly infinite.  If your 12 year old gets hungry enough, she'll try them all. My daughter's favorite smoothie so far was today's.  It contained gently thawed mixed berries whirred together with half a blueberry soy yogurt, some granola and a little almond milk:

With 11 years of diabetes management under our belts, we've memorized the carbohydrate content of favorite breakfast cereals, breads, fruits and dinner items. Crackers, chips, desserts?  Filed away as well. It's become rare that we need to stop before bolusing to math out a plate (or glass) of food.  Sure, there's an occasional new recipe or brand.  Restaurants, and meals at which we're guests require some thought. Most days, though, armed with a measuring cup, a food scale, or the simple ability to count, we can move from serving to eating fairly quickly.

So this week's math intensive has been challenging.

The above smoothie required measuring frozen fruit, granola, soy yogurt and the accidentally purchased slightly sweetened almond milk. (The 'original unsweetened' kind blessedly has negligible carbs, making it unnecessary to measure.)Then there was the '1 cup contains x carbs, so half a cup would contain y carbs process for the fruit, granola and milk; add the half container of yogurt for a grand total of ???' word problem.

My daughter is enjoying experimenting with different smoothie combinations, which on one hand is fun.  On the other hand, I'm kind of hoping she decides this one's a keeper so I can take a math break tomorrow.