Teenage Thoughts Interrupted

This is only a sample of what I imagine is circling through my daughter's mind, on repeat, every day:

when am I eating next
4x+y=47...where do I start
what's my blood sugar
when is that English essay due
we're running in gym today so I might be low
I wonder if Molly can come over after school
I'm sitting for an hour and a half in the assembly- I'll probably be high at lunch
I love the new Nick Jonas song
the school schedule changed for the day so lunch is really early- that'll mess up my blood sugar
should I get a new mirror in my room
should I have dinner before or after tennis so I don't go low
my piano recital is on Saturday
is it site change day
which dress should I wear for 8th grade graduation
why am I high
I need to get something for grandpa's birthday
should I ask all my friends to stop and wait for me while I check my blood sugar
why are my friends arguing over where to go for lunch on Friday
how many carbs are in this dish of Italian ice
are the Red Sox on tv tonight
should I correct again or will I crash because I might only be high from being nervous about the quiz
when are auditions for the summer musical
did I silence the dexcom or is it going to alarm during the concert
maybe I'll call my cousins tonight
why are there no clean measuring cups so I can measure my rice for dinner
that panda video is adorable
should I go to the nurse for this 69 blood sugar or just eat a couple of glucose tabs at my desk
should I ask for a new phone case
I need more dexcom tape
maybe we could shop for shoes for the 8th grade dance this afternoon
I have to bring more juice boxes into school tomorrow for the nurse's office
does the library have the book I'm waiting for yet
where did I leave the meter
is it my turn in words with friends with grandma
I have to remind mom that we need to reorder the pump supplies
should I post a selfie on Instagram today or is it too soon since the last one
maybe I'll just have cucumbers and hummus for snack so I don't have to count carbs
I'm so excited about this ancient Egypt history project
I can hear the alarm but where did I leave the dexcom
this box of tic tacs is almost gone

Stuck

The Dexcom buzzed incessantly for days.

Friday: High.  High.  High.

All weekend, Monday, Tuesday: High.

It was like we'd swapped out the insulin in the pump cartridge for simple syrup.

We tried every trick in the book:

Site change?  High.

New insulin?  High.

Walk around a museum for 4 hours (which has never failed to result in a low)?  High.

Walk around the mall (also tried and true).  High.

Another site change.  High.

Up the basals.  High.

Rage bolus, repeatedly.  High.

When she wasn't across the alarm line of the Dexcom, she was skirting it and dropped below the mid-100's only twice over several days.

Then suddenly after dinner last night?  120.

All night:  120-150.

This morning:  115.

Why?  I can't be sure but I think perhaps the hormone factory ceased its overtime production.

Since last week, she's been HUNGRY like only a 13 year old can be.  And she's been 13 like only a 13 year old can be.  A scientific explanation of growth hormone and puberty, and of their impact on blood sugars can be found here.

A less scientific description can be found above.

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.

Not a Full Moon

As we pulled out of the parking lot and headed towards home, I turned to my daughter and asked, "Is it a full moon?"

"I don't think it's even close, but wow."

This week's endo day was full of chaos.

The traffic on the way in was full of terrible drivers making bizarre decisions.

As we turned into the parking lot, I let out a sigh of relief.  "Finally someone will take this car away from me for a little while." That was before the valet attendant nearly ran over my daughter as she tried to enter the building.

The bustle was evident as soon as we entered the clinic doors. Phones were ringing.  There were several patients waiting at the front desk.  Staff were scurrying around.  We took the last available waiting room seats and waited to be called for the traditional first step of height, weight, A1C and meter downloading. We were half an hour early for our 4:00 appointment, so expected to sit a little while.  A big dent had been made in homework when at 4:10, our endocrinologist himself came around the corner.  "Do they know you're here?" he asked.

"Yeah...I mean we checked in..."

He disappeared into the height, weight, etc. room and seconds later my daughter's name was called.

He took us into his office before her pump had finished downloading and started with the preliminary conversation. Soon the pump and its information had been delivered.  "So we were talking about lows, but I'm seeing a lot of high numbers here in the evenings."

Indeed, the week we were viewing had some awful looking 270's and 300-somethings.  Which didn't sound familiar at all.  Knowing that sometimes they print out a week or two back, I glanced over at the date.  "This says it's from August."  (Vacation week to be exact.)

On we went like that, with the doctor needing to take my daughter's pump in hand to accurately see and discuss the current basals, total daily dose, correction factors, and insulin to carb ratios.  We used the downloaded Dexcom graph to discuss some potential treatment changes. We came away with a few suggestions for dealing with the recent school lows, and a minor tweak for afternoon.  But it was hard to see the direct impact of insulin doses on blood sugars without the pump download. We never received the A1C results.  They'll let us know.  Maybe, I guess.

This is a top-notch clinic, with which we've always been happy.  I'm sure there's a good explanation for whatever trouble the medical assistants were having. There was at least one unfamiliar face in the back room, either new or subbing.  I overheard at least one other conversation about difficulty downloading data.  I'm pretty sure the whole thing was a fluke.  It would just make more sense if I could blame a full moon.

A Mystery Story

The phone rang.

'School' read out on the caller ID.

When I answered, I could immediately hear the fuzzy echo of speakerphone.

My daughter's voice: "I don't know what my blood sugar is."

She has 2 meters at school, one with her and one in the nurse's office.  There are 3 other kids with diabetes and the nurse has a back-up.  There's no way this information wasn't available.  "What do you mean?"

"I checked with the one in my bag in the classroom and I was 195 but I felt really high so I came down here anyway.  I washed my hands and the one in the nurse's office says I'm 348.  I checked again with the one in my bag and it said I was 297.  Then we tried the nurse's spare one and it said I was 140."

The nurse chimed in throughout the story and concluded with, "We really aren't sure what to do next."

There I was, on the other end of the phone, expected to solve this problem.

Ultimately we decided that I would come to school with her meter from home, the one we use all day every day. She was instructed to drink some water and went back to class for the time it took me to get there.

I remembered on the way out the door that I had a bottle of control solution. I threw it in my pocket with the trusted meter.

Our meters at school checked out with control solution. The nurse's was a different brand so we couldn't test that one.

My daughter was called down from the classroom.  She checked on 4 meters.

Home:  290

Personal Nurse's Office:  260

Purse:  266

Nurse's spare:  254

We corrected using 260 as a safe average and sent her back to class.  I left her home meter with her for the day with newly opened test strips.

Meanwhile, Strip Safely anybody?  We need to keep encouraging the FDA to tighten standards.  I can't figure how this was caused by anything but technology failure.

Another Site Change Twofer

As a rule, we have very few site change issues, and very few sites which conk out on us.  We had gone for many months with nary a hint of a problem.  Then we apparently entered the dark hole of terrible site issues.  Last week's glitch-ridden site change seemed like maybe it should fulfill our mishap quotient for a while?

Alas, somehow the diabetes gods did not get the memo.

Yesterday started as just a run-of-the-mill, because it was time, site change day.  The old site came out fine, and all of the pump-related tasks were uneventful.  Finding a new site is more challenging in swimming season since she really likes it to be under her bathing suit.  An acceptable spot was negotiated.  The 'o.k.' was given.  I squeezed the inserter, and it popped in.  Sort-of.

The tape bunched up into layers which I had to very carefully unstick before I could pull the inserter out again.  A closer look left me wondering.

"I think it's in."

"Whaddaya mean, you think it's in?"

Well, I can see a little more of the tubing than usual, but it's definitely in...does it feel in?"

"Yeah...I mean I think so?  Can you push it further in?"

"No...the tape's all stuck down.  And anyway...I'm not sure if that even could work?"

"I think it's o.k."

We finished the post-insertion details and headed upstairs.  Periodic questions about how the site felt were met with one word answers such as "fine" or "o.k."

Two hours later, just as I'm finishing  dinner, "I think we should change this site."

It was tempting to blurt out, "you're telling me this now???"  I'm certain my face said it, even though I held my tongue.  The rational side of my brain urged me to keep calm, to be proud of her for still thinking about it and recognizing the need to act.  Regardless of the timing, bolusing for a carb-heavy dinner with a questionable site seemed like a bad idea.  I did my best to put dinner prep into suspended animation and we headed back to site change central. 

The old one (from 2 hours before) was bloody and awful.  The new one went in better. While the tape bunched again (atmospheric conditions? any ideas?) the cannula was definitely all the way in and it felt 'great.'  High praise indeed.

I hope we've now fulfilled whatever diabetes karma debt we were up against.

Insanity 2

Last week, I complained a bit about how in the diabetes world, A + B does not always = C.  Mysterious things happen for what appears to be no apparent reason.  Sometimes in retrospect, we can look back and realize the cause: an impending illness or growth spurt.  Sometimes we'll never know.

We're forced address these issues with whatever information is at hand, even if it is insufficient.

Today, for example, my daughter called at lunchtime (still 10:17 a.m.).  Her blood sugar was 97, but she said she felt like she was dropping.  I suggested she eat first and bolus later, subtracting a few carbs when the time came.  Forty minutes later she called back.  She still felt low so tested before bolusing. She had eaten 51 grams of carbohydrate and now had a blood sugar of 81.

What did I think she should do?

I had no idea what she should do.  Yet I had to come up with a plan for her so she could move on to her social studies quiz. 

Once again, I was faced with solving a medically critical math and logic problem while missing a significant amount of critical information.  My tactic was to err on the side of caution. I heard clearly in my daughter's voice that she felt low and that it was unsettling.  I also reasoned that she could test and correct a resulting high blood sugar before it became astronomical, but that a low blood sugar during the variety of tests and quizzes scheduled for the afternoon would be more problematic.

"Bolus half the carbs. Check in 20 minutes to make sure you're coming up. Or sooner if you feel worse."

It turned out o.k. In 20 minutes she was headed up. She was 180 at 2, and 144 when she got home.

I guess I did the right thing.  I just don't know how.  And I don't know why I had to do it in the first place.

Rolling the Dice

Last night we attended the community pool party for all of the baseball and softball teams in town.  This event, as with most of the activities at this time of year, is a food-fest.

My daughter began the party with an undesirable blood sugar of about 260.  With that corrected, she promptly unplugged her pump and got in the pool.  Half an hour later she emerged to air which was colder than the water. She was chilled, and I envisioned her blood sugar creeping even higher as a result.

Dinner was served, consisting of pizza, some fritos, some doritos, and a token portion of raw veggies with dip. My bolus calculation involved thoughts like, 'the pizza crust seems thin-ish,' and 'eh...those chips look like about 12 carbs I guess.'

Ordinarily at this point, I would have insisted on a somewhat 'countable' dessert.  But a team-mate brought a big tub of italian ice from a great local ice cream shop.  It was too fun to resist. 

Fortunately, I'd overheard talk of this plan at a weekend game, so had looked up a generic italian ice carb count.  Eyeballing my child's enormous portion of frozen goodness, and mushing it around in my mind's eye to fit into an imaginary measuring cup, I crossed my fingers and bolused an enormous amount of insulin.

An hour of running around on the playground brought her back to the table claiming she was 'starving.' Once the team awards were handed out, a handful of fritos was taken for the road. We headed to the car, two hours after the initial 260 blood sugar mark.

With much trepidation, I handed her the glucometer.  "Let's see what happened," I said.

"Ninety-eight."

I made her repeat it, thinking I'd perhaps  missed the first number which surely should be a two or a three.

"NINETY-EIGHT, MOMMY."

I'm certain that no diabetes expert would suggest the preceding course of events as the best way to lower one's glucose level 162 points. While I'm happy when a moment like this comes our way, I'm convinced that much of it is just a lucky roll of the dice.