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.

Apparition

I woke slowly, confused.  It was definitely the middle of the night.

I thought I'd heard footsteps, which would ordinarily mean my husband had gotten up, but he was still in bed.  I opened my eyes as my husband sleepily said, 'Hi?'

There she was, in front of me: my kid. I said her name groggily, with a question mark at the end, like I wasn't sure who she was.  But the real question was what she was doing there, a foot from my face.

"What's going on?"  The more awake I got the more worried I got about the possibilities. She was sick, or something had gone awry in the house (flood? electrical?), or something had scared her terribly.  I could not remember the last time she'd showed up in our room in the middle of the night.  There was definitely a problem.

"My pump is alarming.  The battery is dead."

"Okay...  Let's go."

She and I stumbled back into her room.  She found a quarter and I found a battery.  We switched out the battery and rewound and re-primed the pump as per procedure. 

"I don't know how I missed that the battery was low," she said by way of apology, "I guess I use the meter remote more now so I don't notice it as much."  The pump screen does give fair notice- usually at least a week for us- that the battery should be changed and we ordinarily change it with a regular site change after we've been warned.  It's preferable to 2:38 a.m. on a Wednesday. 

"I'll try to check more often and notice."

What could I say?  "I'm guessing you will...this isn't much fun."

She checked her blood sugar, not knowing quite how long the pump had been alarming and how much insulin she'd missed, but it apparently hadn't been long enough to cause any real spike. 

So I shut her light back off and tucked her back in with a kiss, grateful that it didn't turn out to be a true emergency.  It was just another night with diabetes. 

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.

All Out

Last week was a hectic one.  After returning Monday from an extra-long weekend with family on my husband's side, I got right back into the business of helping my dad pack up his house.  He moved from house to condo on Friday. 

In the midst of the packing and moving, unpacking and organizing, there was still school and homework, piano and volleyball, the orthodontist and a weird fast-moving stomach bug, plus a Friday night school social. It was a fast-paced week.

My dad's new little dining set was delivered at 11 on Saturday morning, completing the string of deliveries and installations. My husband, daughter and I were there helping unpack boxes and screw in paper towel dispensers.  We'd brought sandwich stuff with us and by noon we decided to christen the new table. Happily ready for lunch, my daughter entered her carbs into her pump, scrolled up to a dose, and hit 'go.'

Fur Elise played merrily from the pump.  "No delivery.  Pump is busy."  (Which I've always thought was a weird phrase to program it to say...busy doing what, exactly?)

In this case, it was busy preparing to tell us the bad news:  "Empty Cartridge.  No delivery." Oh. Oops. In retrospect she remembered the low cartridge alarm going off overnight but didn't think of it again in the morning.  In retrospect I remembered thinking when I changed the site Tuesday night that if Friday was as chaotic as I imagined it would be we might have to put off site change until first thing Saturday morning before we went to help unpack.  That was the last I thought of it.

Fortunately, Dad's condo is only three and a half miles from our house.  My husband was kind enough to make the insulin run and within half an hour, my daughter was eating lunch.

We had a good run.  This is the first time my daughter has run out of insulin since she stopped making her own in 2002.  But as summer day-trip season approaches, it led me to re-evaluate what we carry with us when we're out.  For a trip within a few miles, like this one, I'll probably still not bother carrying insulin, but we've gotten lazy about bringing it with us when we're headed places farther afield for the day.  What if we'd been an hour away at the beach or at a museum?  This could have ruined a whole day, rather than just delaying a much needed lunch.  

So I've ordered a Frio insulin cooling case to add to the collection of things we bring when we go out.

Choose your closing saying below:

All's well that ends well.  Live and learn.  Better safe than sorry.  Be prepared.