Roll Over Beethoven

I heard it from across the crowded room. The unmistakable melody. A terrible electronic version of 'Fur Elise' was coming from my daughter's insulin pump. What, I often wonder, would Beethoven think?

Eye contact confirmed that this wasn't a simple 'Bolus cancelled by user button push' or 'Unable to communicate with pump' Animas Ping alarm. My kid looked both concerned and irritated. I made my way through a few conversation groups.

'I forgot to do a site change before we came. I'm out of insulin. It gave all it was supposed to give to cover what's on my plate but now I'm out.'

We were really enjoying this party. I was reveling in the opportunity to hold an adorable baby whose mom needed a civilized plate of food and adult conversation. My daughter was enjoying helping the little ones at the cookie decorating table. We were having great conversations with friends both new and old. To add atmosphere, it had just begun to snow. This particular festive gathering was exactly what we needed after a whirlwind weekend of holiday shopping and preparations.

We were not, I decided, going to let diabetes win the afternoon. My daughter ate a little less than she'd bolused for, to provide a cushion. We kept an eye on her numbers. She held steady for almost an hour, then her blood sugar started to creep up very slowly. We considered leaving then, but I had to return the baby, and then on the way to get our coats we found other people we wanted to talk to. The rise became more significant about twenty minutes later, and we started our round of goodbyes. But considering the homework that still needed to be done and the football that needed to be watched we wouldn't have stayed much longer no matter the diabetes circumstances.

We got home, replaced the insulin and the site, and bolused for an hour and a half worth of missed basal insulin in addition to the suggested correction for her blood sugar at the time (about 220...not bad at all). The rest of the night was uneventful blood sugar wise.

There were few minor downsides: I needed to heat up some leftovers since she had stopped eating anything but raw vegetables once she ran out of insulin. She missed out on a great spice cake. And the electronic Beethoven theme repeated itself every few minutes- but I'm guessing it probably wasn't audible to anyone but us over the music and conversation.

Looking back, I'm glad we didn't panic. There was no need to. She disconnects her pump at the pool for an hour at a time all summer. At the beach it's often longer. We do the same thing we did last night: make up the insulin once she's hooked back up to the pump. Ideal? No. Medical advice? Absolutely not. But sometimes it's more important not to let diabetes ruin a good time.

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.





Impressive

“You should probably check before you go to bed.”  It was late and every second before climbing under the covers felt like an eternity but it seemed smart to head off any problems before we slept.

“191.”

“Not bad- do what it takes.”

“It says to give .5.”

“Go for it.”

We relied on the Dexcom for updates, in lieu of setting an alarm, and Dexi slept through the night.  Morning blood sugar was around 140.

I realized days later that I had said nothing else to my daughter about any of this.  On a normal day, these were okay numbers, nothing to celebrate, nothing to panic about.  On this day they were impressive, and I forgot to be impressed.

These numbers came after our annual Christmas open house. The buffet table included chicken fingers, egg rolls, mini hot dogs, teriyaki meatballs, three or four kinds of chips and crackers with assorted dips and salsas, raw veggies and fruit, and at least five desserts.  My daughter visited this spread several times, and I think she sampled all but one of the desserts.

We’ve been hosting the same party every year since Kindergarten, inviting families back to our home after Santa lights our town's tree.  For the first couple of years, I made my daughter a plate and bolused her for it before sending her off to eat with her friends.  We'd do round two of this routine when the cookies were served.  By third grade or so, she graduated to making her own plate but she still needed to have me calculate the carbs.  Last year was a mixture of her bolusing for the foods she knew (ritz crackers, my homemade cookies, grapes, the egg rolls from Costco) and needing to ask for help with the more complicated items.  This year, for the first time, she was completely in charge of her own carb counting.  This was amazing for two reasons:  first, I got to focus on being hostess and spend more time socializing with our guests, and second, the end results were much better than usual blood-sugar-wise.


It makes sense, really.  Who better to keep track of the carb intake than the person putting the food in her mouth?  Who better to dose the insulin than the person watching the Dexcom graph while she dances around the basement to Christmas music?  Reaching the point where we're both comfortable with her managing her diabetes in these types of situations is a huge plus for both of us.  Especially if she does so as successfully as she did the other night.  It was impressive.

I'll have to remember to tell her so.
 

Support

I'm going to take a little liberty along the time-space continuum and continue Thanksgiving weekend one more day. While we traveled this weekend, I was reminded how thankful I am for support along our diabetes journey from our family and friends. We were very fortunate to spend the weekend with people who are concerned and interested in a helpful way when it comes to my daughter's diabetes. I'd like to share one example of the kind of friendship I feel very blessed to have enjoyed.

We visited a couple this weekend with whom we've been friends since long before we had children. They and their 2 kids are great people and there are many reasons we enjoy their company and friendship.  As I think of so many people with diabetes who spent this past weekend surrounded by family and friends who simply don't get the whole diabetes thing, I'm ever more thankful to have these and other people in our lives who do.

These friends were at our hospital bedside after diagnosis, with funny gifts for my tiny daughter and treats and hugs for us.  They were kind enough to feed and shelter my husband for a night during our hospital stay since we'd been helicoptered to a city over an hour from home.  This hospitality allowed him to get some rest, to have a civilized shower and to bring some calm and perspective back to a challenging situation.

When we returned for appointments at the diabetes center where my daughter was diagnosed, we were invariably invited to this home afterwards.  I'd arrive at 4 or so, exhausted from the appointment's conversations and from the travel. I'd have an over-done toddler in my arms who'd just screamed through a blood draw.  We'd be escorted to their great playroom and I'd be handed a glass of wine and asked how things went this time while my daughter was handed an amazingly distracting toy or craft.  My friend would work with me ahead of time to plan a dinner my daughter could enjoy despite the NPH and humalog shots of that era and their related dietary limitations. There were always string beans, my daughter's favorite vegetable- at least when cooked al-dente the way our friend always makes them. Husbands would arrive from work in time for dinner and I'd leave the house relaxed as my daughter dozed on the drive home.

Several years ago, we moved a few hours away and don't see these friends as often.  Yet when we do, they remain concerned and interested in all things diabetes.  They still go out of their way to make their home and meals hospitable to my daughter when we arrive, saving carb counts, stocking seltzer, and asking questions.  We spent a great evening with them last Friday, catching up on all sorts of things.

And, of course, enjoying the string beans.

Raising Awareness Delicately

"I thought she couldn't have pie."

"I just read an article about cinnamon and diabetes.  It sounds like a supplement could really make things easier for you."

"Did you see the story about the guy in (insert neighboring state here) who just crashed his car and died and they think it was because he was experiencing low blood sugar?"

'Tis the season to spend time with the loved ones we don't see every day: relatives at the holiday table, friends who come into town once a year, neighbors we talk at length with only at the annual open house.  Conversation starters like the ones above are likely.  

When posed by someone with whom we have no biological or emotional attachment, the following responses might be deemed acceptable:

"You thought wrong." A little half-smile is optional, to soften the impact.

"I think you might want to read a little more about that one," delivered with a subtle shake of the head.

"Well that's terrifying...thanks so much." Walking away could be the next step.

When posed by a misinformed close friend or by a relative we spend a good amount of time with, it's probably worth it to spend some time really explaining the ins and outs of why what they've said is inaccurate and/or upsetting to us.  We can assume this person cares about us and doesn't want us to be upset, and that it will benefit all of us to have a substantial conversation in order to avoid a repeat in the future.

But what to do with dear Aunt Susie who you see, at best, twice a year?  These kinds of answers work for me:

"Ah...but what's Thanksgiving without pie?  She can take extra insulin for it."

"Hmmm...I've read about that too.  Unfortunately it's not for the kind of diabetes she has."

"Oh dear!  I find those kinds of stories so scary- I avoid them if I can.  But even though she's only 14 I've started impressing upon her the importance of checking her blood sugar before driving."

My goal is to remember that people like our fictional Aunt Susie are asking out of love and concern.  Aunt Susie certainly means no harm, and I certainly don't want to spend Thanksgiving dinner or the duration of the cookie exchange party arguing with her.  So a brief, accurate and kind reply works best, raising a little awareness and then moving on quickly...hoping that politics isn't the next topic she decides to bring up.

The Buffet Table

Personally, I love a good appetizer and snack focused buffet table.  Interesting dips, meatballs, crackers with good cheese and foods encased in puff pastry are a few of my favorite things.  Top it off with a good cookie table and it's perfect.  If I'm there alone.

With my daughter around, a couple of hours of happy grazing turns into a couple of hours of math and negotiating.

When there is a buffet table, one is expected to graze.  You have a mini hot dog, meet the relative in from out of town, try a couple of dips, chat about the school play, make your way to the meatballs where you spend time with the party host; and on it goes.

The first problem with this scenario is that each snack requires a math problem and a bolus.  When every conversation is interrupted with 'I took 4 meatballs, mom,' or 'I just ate 7 corn chips,' it's hard to carry on a conversation. When I'm interrupted to nix the plea for a 4th cookie, my already limited cocktail party-related social skills take a big hit.

The second, but related problem is an extension of the standard regular-people buffet party challenge.  If I have a drink in one hand and a little plate in another, I already must find a third hand to eat.  Add the meter remote to that third hand and I'm out.  Even with the understanding that every mother develops a third hand (a.k.a. the ability to juggle well), this scenario becomes impossible and I remain hungry or thirsty so that my kid doesn't end up high.

So a buffet party turns into me with a drink OR food in one hand, following my kid with the meter remote while trying to make small talk and perform carbohydrate equations in my head at the same time.

Ironically, I suppose, we throw one of these parties every year.  The difference is that I painstakingly create a list of every food with its carbohydrate content and post it on the fridge.  My daughter takes the meter remote and is able to do her own juggling act while I play hostess and eat my fair share of mini quiches.

In a perfect world, we'd be handed a cheat sheet at the start of every party, and one of these cool plates .

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.

Important Santa Information Revisited

Santa Knows. We Proved It. (A post from the past, but it bears repeating!)

One Christmas when my daughter was about 4, she asked me what would happen if Santa came down the chimney while she was awake with a middle-of-the-night low blood sugar.

After I'd blinked the tears out of my eyes, I reminded her of a favorite Christmas song.  It's probably the one from which she got the idea Santa would skip over her if she was awake, but I managed to turn it around. "Santa will know if we're awake.  But he also knows everything about you, including that you have diabetes. He'll just visit other houses in our neighborhood first, and come back when you're asleep."

The same conversation has taken place regarding the Tooth Fairy and the Easter Bunny, with significant anxiety around the issue.

Should your household have similar concerns, I hope the following tale will provide some reassurance:

On Christmas eve, around 9 p.m., my child was dozing off with a blood sugar of 110.  A check at 10 had her up for juice to treat a 77.  By 10:45, she'd balanced out to a nice 118, and around 11 we were all dreaming of sugar plums.  Yet at 2 a.m., I was rummaging around Grandma's refrigerator for more juice to treat a 79.

We must have been asleep by 3 when my nephew claims to have been awakened by reindeer hooves on the roof.  But at 4:30, I was awakened by my daughter fumbling with her meter in the little guest room we were sharing.  She was 73.  More juice.

We all (magically) fell back to sleep, and when we emerged to the living room around 7 a.m., the stockings were filled!  Santa had come.  Not close to 10, or 2, or 4:30.   Despite so much wakefulness, he knew when we were sleeping, and that's when he came.

Maybe next year, if I'm really good, he'll put on a pot of coffee for me before he gets back in his sleigh.

Wordless Wednesday: In Lieu of Candy

The Easter Bunny always brings a good chocolate rabbit, but we're up to 2 bins of Easter creatures, games and toys. 

 

 

Santa Knows. We Proved It.

One Christmas when my daughter was about 4, she asked me what would happen if Santa came down the chimney while she was awake with a middle-of-the-night low blood sugar.

After I'd blinked the tears out of my eyes, I reminded her of a favorite Christmas song.  It's probably the one from which she got the idea Santa would skip over her if she was awake, but I managed to turn it around. "Santa will know if we're awake.  But he also knows everything about you, including that you have diabetes. He'll just visit other houses in our neighborhood first, and come back when you're asleep."

The same conversation has taken place regarding the Tooth Fairy and the Easter Bunny, with significant anxiety around the issue. 

Should your household have similar concerns, I hope the following tale will provide some reassurance:

On Christmas eve, around 9 p.m., my child was dozing off with a blood sugar of 110.  A check at 10 had her up for juice to treat a 77.  By 10:45, she'd balanced out to a nice 118, and around 11 we were all dreaming of sugar plums.  Yet at 2 a.m., I was rummaging around Grandma's refrigerator for more juice to treat a 79. 

We must have been asleep by 3 when my nephew claims to have been awakened by reindeer hooves on the roof.  But at 4:30, I was awakened by my daughter fumbling with her meter in the little guest room we were sharing.  She was 73.  More juice. 

We all (magically) fell back to sleep, and when we emerged to the living room around 7 a.m., the stockings were filled!  Santa had come.  Not close to 10, or 2, or 4:30.   Despite so much wakefulness, he knew when we were sleeping, and that's when he came. 

Maybe next year, if I'm really good, he'll put on a pot of coffee for me before he gets back in his sleigh.

Text Me A Picture

Today we're trying a new tactic in diabetes management.

There's a Thanksgiving feast at school today.  In elementary school, I always volunteered at these things.  I do enjoy being around kids, and probably would have helped at many events anyway, but the need to monitor what my daughter was eating made my attendance essential if she were to participate.  By 4th grade, she was able to handle some simple carb counting on her own, like a slice of pizza or a packaged snack.  Anything without a set portion size was, and still is, too much.

Middle school is a new world, though.  Parents are not invited in to help with class parties.  The kids are on their own.  We had to come up with a plan which would allow my daughter to participate in this event without me hovering over her.  The school nurse is a great help with many things, but can't be expected to know how to eyeball a buffet plate and pronounce the number of grams of carbohydrate on it.

Enter modern technology.  The school nurse will text me a picture of my daughter's plate.  My daughter will then call me and we will work together to tally the carbs.  I'm not sure how clear the photo will be.  Will I be able to tell if there are marshmallows in the sweet potatoes or how deep the pile of stuffing is?  The element of taste will be gone on my part too.  I'll sometimes have a bite of a pie or cranberry sauce and realize it's significantly sweeter or denser than I'd estimated.

We'll see how it all turns out.  I don't expect her to come home with a blood sugar of 130.  What I do expect is for her to come home happy.  She'll have enjoyed trying foods from other families' Thanksgiving traditions.  She'll have had a few bites of the cranberry sauce she helped prepare.  She'll have taken another small step towards diabetes independence.

Math or Guess? Some of Each.

Thanksgiving is fast approaching and a string of celebrations will follow.  It's time to dust off those carb counting books, or reacquaint yourself with your favorite nutrition info website, or download a new app.  Or probably all of the above.

While it's particularly true for this time of year, each season brings a unique set of foods which must be counted.  Every summer, I brush up on popsicles, ice cream cones and the crusty bread I like to serve with salads.  Late spring brings the start of picnic season, with its hamburger buns, pasta salads, and watermelon slices. This week, I'll be refreshing my memory on stuffing, winter squash, pumpkin pie, and cranberry bread.

I'll turn to my trusted resources - mostly Calorie King - in paper and electronic forms.  I'll read the labels on packaged items, and review the backs of my recipe cards with their penciled-in math problems from previous years.  That homework will provide the base of knowledge needed for the weeks to come.

Yet once faced with a plate of food which includes a 'spoonful' of this and a 'slice' of that, it gets complicated.  Unless the pie slices are measured with a protractor, variables have been introduced.  Unless I know what my hostess means by the 'splash of maple syrup' she added to the butternut squash, I'll need to improvise.  The unforeseen appearance of cornbread could have me suspected of inappropriate phone etiquette at the holiday table.

About a year after my daughter's diagnosis, I met with the nutritionist at our endocrinology office.  I explained that I had gotten pretty good at reading labels and was learning to do the math on favorite family recipes.  "But how will I ever figure out how many carbs are in the scoop of mashed potatoes Grandma serves her, or in the dish of ice cream that comes with her kids' meal?"

The nutritionist gave me a sheet which had to do with eyeballing portion sizes.  Specific measurements were equated with 'half a baseball' or a 'deck of cards.'  She then explained that while this might be sort of helpful, eventually I would just know.  By consistently using measuring cups and food scales at home, I would come to be able imagine how a pile of rice would fit into a measuring cup, or how the size of the diner's french fries compared to the frozen ones at home.

I have to say I doubted her,  But she was right.  Granted, sometimes the 'splash' of maple syrup turns out to be a half a cup.  Sometimes I misjudge the amount of frosting on the cupcake.  Usually, though, a combination of scientific knowledge about carbohydrates, practice with portion sizes, and intuition gives me enough information.

It allows me to make a pretty good guess.