False Advertising

I love this sale.

We will stock up.

They will fit perfectly into my daughter's diabetes bag.

I am grateful for portion-controlled 15 carb. servings of juice.

But I will not. Ever. Refer to them as "Fun Size."

Crisis! (Averted)

'AAAAH CRISIS'

That text arrived around 11:30 the other morning.

Having a 16 year old girl, lots of possibilities came to mind. Forgotten clarinet on a band day, wardrobe malfunction, unexpected test? Turns out it was a diabetes crisis.

'I bolused 10.8 for lunch then 2 more for muffins so then I looked at Dexi and I was skyrocketing and then I looked at history to see if I had bolused and I only saw the 2 units so then I bolused 8.8 more ahhhhh'

So, I confirmed with her via text, she had bolused 8.8 units of insulin with no matching food? She had forgotten that she had bolused for the main part of her lunch, panicked at the rapidly rising blood sugar, and therefore given insulin for it twice?

'YES I RLY SCREWED UP'

While she freaked out, knowing that an overdose of insulin had the potential to be catastrophic, I trusted that her friends would take care of her mental health while I focused on how to fix the problem.

'What's the current insulin to carb ratio?'

'1:8.'

If 1 unit of insulin covers 8 carbs, I reasoned, then 8 units covers 64 carbs, 9 units covers 72 carbs- essentially reverse-engineering of the math to figure out a game plan. She would need to consume some serious carbs to balance out the equation.

'I'm currently eating a tootsie roll pop which is 15 carbs.' (There's a teacher who sells these, essentially at cost, in his classroom...a little mysterious but very helpful at that particular moment.)
'And then I need how many more? Math for me.'

I'll spare you some details, but because to it turned out she was, indeed, skyrocketing we decided that the tootsie pop, one juice box and the pretzels which were to be her snack after school before play rehearsal would be a sufficient start as long as she kept a close eye on the Dexcom. It was a total of about 50 carbs.

It worked out pretty well. At the two hour mark from the error, she was about 150 and continued a slow downward trajectory during play rehearsal but was over 100 when she got home- hungry because she'd eaten her afternoon snack at 11:30 a.m.

Reading is Fundamental

My daughter had a few late afternoon and evening lows last week.

When she's out and about, she carries juice boxes, glucose tabs and smarties. When she's home she prefers something different. There are occasional seasonal choices in the fridge like fresh apple cider or high-test lemonade leftover from a cookout. Usually, though, the home juice of choice is orange juice. She pours four ounces into her pink sippy cup and waits for the low to turn around. Nine times out of ten, unless she's under 50 or been exercising heavily, those 4 ounces bring the low up within 15 minutes and life goes on.



Last week, not so much. The lows seemed slower to respond. If it was dinner time and she hit 70 after 15 minutes, we'd eat and subtract some bolus insulin. Otherwise, she found herself adding more juice, or a little snack of fruit or crackers to make sure she came all the way up.

A couple of seemingly sticky lows in one week was weird. And a nuisance, especially at dinner time. What was going on? Maybe it had to do with impending full moon or some other such mysterious and passing variable. Or maybe something had changed and my daughter's new normal involved closer to 20 carbs per low.

Then I walked into the kitchen as she poured the last of the orange juice into her cup:

I accidentally bought low-carb orange juice. I don't drink it and my husband hadn't noticed when he slugged it down still half asleep in the mornings.

I read a lot of labels: cereals, snacks, bread, starches and countless other packages are fully assessed before they're consumed. I missed this one. Which explains why those lows wouldn't come up.





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 Highlight Of My Week

I was disproportionately excited
to find this amazing bargain at my local
grocery store this week.
We now own an extraordinary number of juice boxes.

Juice Epiphany

The Dexcom buzzed at 4 a.m.  Low. (!!!)  A fingerstick confirmed it: 60.

Still mostly asleep, I considered my usual routine of going down the hall to the kitchen, finding a sippy cup, measuring 4 ounces of orange juice, finding a straw and bringing it back to the sleepy child.

As I put the meter down, my hand grazed the junior-juice box it shares its case with.  I picked it up, stuck the straw in, and roused the low person.  I was back in bed in under 3 minutes.

What have we been thinking?

When she was littler, it took less than 4 ounces of juice to treat a low.  So we reserved juice boxes for their convenience to carry away from home, but usually ended up throwing away half or a quarter of every one. Knowing how many ounces of a juice box had been consumed was impossible when awake in the daylight, let alone at 2 a.m. in a dark bedroom.  But fast forward a few years and now, for most overnight lows, one juice box is just enough.

When she treats lows at home, during regular awake hours, she still goes for juice from a cup.  Orange juice and apple cider are rare treats.  Despite the circumstances, she's happy to enjoy them.  Yet at 4 a.m., she's not savoring the flavor.  She wants to snuggle back under the covers.

So it seems the juice box is the way to go at night. It requires no rummaging in the kitchen.  It requires no lights.  It's literally right at hand every time we check her blood sugar.

I wasn't sure if she'd noticed, but she did.  "I was trying to figure out why my juice was so warm last night- but I noticed you used the box from the meter case."

"Yeah- I decided it was easier than coming out to the kitchen."

"I liked it.  I can drink it faster when it's warm."

And everybody lived happily ever after.

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.

Sippy Cups

Today's Diabetes Blog Week topic:  Share the (non-medical) tips and tricks that help you in the day-to-day management of diabetes.  Want more tips?  Click here!

Despite our attempts to keep it on the QT, most of my daughter's friends know that despite being 12 years old she sometimes drinks out of a sippy cup:

The lids are long gone, replaced by fun straws.  The spill-proof aspect is no longer (usually) the important part.  We keep them around for the numbers down the side.  They allow us to measure how many ounces of juice she is drinking when she is low.

On the go and at school, it's Elmo or Clifford juice boxes all the way.  But my daughter really likes orange juice, so when she's low at home, that's her preference.  Enter the sippy cup.  We can measure varying amounts based on her blood sugar number right into the cup she'll drink it from.

It's strange to still have sippy cups around, and will be stranger still when she takes them to college with her, but measuring juice quickly and accurately is great when we're in hurry to bring that blood sugar up.