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.

Share Scare

Marching band practice started at 6:30.  Soon thereafter my phone started emitting a sound alarmingly similar to a fire alarm in a large building.  I grabbed it and discovered this:

 

I don't text my daughter for moderate lows in the 60's range. Those I trust she can handle just fine on her own, just like she did 3 weeks ago before we had this technology.  The same is true, so far at least, for any issues at school.  She's got teachers, friends, and a school nurse there to help her. 

 

But this was unsettling.  The band was outside.  It was getting dark.  What if she'd stepped aside to check and nobody noticed her?  I texted:

 

My phone is alarming about this low...assume you're treating it?

 

Five minutes passed with no response. It felt like 15. The next time the number updated it was 46, still straight across. I could hear the band from the high school, just up the hill from our house. I texted again:

 

???

 

A few more minutes passed and another glance at my phone showed me this disconcerting screen:

 

As the minutes continued to creep by with no return text, I considered all kinds of possibilities. Was she:

 

Keeled over in the dark on the sidelines somewhere far away from her phone and supplies?

 

Being taken care of by a responsible adult somewhere not near her bag?

 

Still marching, unaware she was this low?

 

Perfectly fine and wearing a 12 day old Dexcom sensor that was giving flaky information?

 

I started to gather my shoes and my jacket.  How long was it okay to wait before going?  How horrified would she be if I showed up there and it was a false alarm?  What if I didn't go and it wasn't a false alarm?  A few more minutes passed as my thoughts swirled. I decided to wait it out until 7:30 when I was planning to leave the house for a meeting anyway.  I'd just casually drive by on the way...even though it wasn't on the way at all. 

 

But then, finally ... a text!

 

I was actually 79.  Drank a juice and kept marching.

 

We're finding lots of reasons to love the 'share' technology.  This evening of scary misinformation wasn't one of them.

 

 

In The Back Of My Mind

The Other Half of Diabetes - Tuesday 5/17 We think a lot about the physical component of diabetes, but the mental component is just as significant. How does diabetes affect you or your loved one mentally or emotionally? How have you learned to deal with the mental aspect of the condition? Any tips, positive phrases, mantras, or ideas to share on getting out of a diabetes funk? (If you are a caregiver to a person with diabetes, write about yourself or your loved one or both!)

Always, in the back of my mind, is the possibility that, due to diabetes, my child will become unconscious when I'm not with her or that she will die at night.   When I hear an ambulance headed towards her school I wonder if my phone is about to ring.  When my child is sleeping in, or when I don't hear from her early on the morning of a sleepover, I wonder if she's asleep or passed out, or if she's even alive. Despite our attempts to push it into the background of an otherwise productive and happy life, diabetes is a dangerous and sometimes deadly disease.

I feel better when she's wearing the Dexcom. With it, I know she's got a safety net when it's a strenuous gym day or when she's out with friends.  When she's sleeping in I can check the graph and wake her if necessary. But even then a lost signal or a night of inaccurate readings will leave me glancing at her bedroom door, wondering.  Will I need the glucagon? What if she doesn't wake up?

It's not an overwhelming fear, nor do I dwell on it.  It just lingers in the back of my mind. Yet it certainly sets my concerns apart from those of other parents. They complain about their sleepy, lazy teenagers, but they rest assured that by noon these kids will appear in their kitchens no worse for wear.  This isn't a conversation I have with the mom's night out crowd.  It's a huge jump from, "I wish Susie would get her butt out of bed and do something useful on Saturday mornings," to "Well at least you know she's getting up- when my kid sleeps in , I seriously consider the possibility that she's unconscious or dead.  Please pass the chardonnay."  Sharing this anxiety could, mental health professionals may contend, be helpful to me, and it would certainly be a form of advocacy and awareness-raising.  So far, beyond a couple of very close friends, I'm not there.

How, then, do I keep these thoughts from paralyzing me...how do I keep them in the back of my mind?  Fortunately I'm generally not prone to episodes of panic, so my overall temperament helps. Writing and reading here in the diabetes blogosphere reminds me that I'm not alone, which is a huge source of support. When I notice I'm beginning to dwell on this (or any other) anxiety, I know it's time to take better care of myself. I push myself to engage in incredibly simple but sometimes seemingly impossible tasks like making myself a cup of tea, taking long walks, eating well, ensuring that I'm spiritually engaged, doing something fun, and/or talking to someone I trust. I can't eliminate this particular anxiety without eliminating diabetes altogether, but I've remained able to keep it from becoming more than an occasional fleeting thought.

Living with diabetes means living with a unique collection of stressors, fears and other emotional challenges.  I'm curious to read how other people deal with the ways diabetes impacts their mental health, interpersonal relationships and sense of self.  Click here to read more posts on today's topic.

You Don't Know What You've Got 'Til It's Gone

At first it was kind of a novelty to live like we did in the olden days.

The element of surprise added interest to every finger stick.

The highs and lows made us think a little harder about the why's and the what next-s.

The nightly 2 a.m. finger sticks let us relive the old familiar moments of rescuing the stuffed rabbit from the floor and wrestling a hand out from beneath layers of covers.

The once-again regular calls from the nurse's office made my day less lonely.

But the lack of a working Dexcom is beginning to take its toll.

We miss the ability to see highs and lows coming on before they're 50's and 300's.

We miss relying on the graph to show us a steady upswing after a low instead of drawing blood every 15 minutes until we're absolutely sure the number is stable.

We'd like to sleep. 

We're all caught up on everything that's going on in the nurse's office and its environs.

So I was glad this morning to find in my inbox the shipping notification for our Dexcom's new transmitter.  A combination of my slowness to order it as soon as the low battery notification appeared and the slowness of getting insurance approval for and shipping a new one has left us Dexcom-free for a week. 

Which isn't the end of the world, and I'm grateful we have the technology at all, but now that we're used to having the data and the safety net, it's really hard to do without.  Even my daughter, who is still understandably ambivalent about the insertion of and constant wearing of another device, asked yesterday about the status.  "I can't wait to have it back- I'm so tired of not knowing what's going on."  Me too.

Wandering Around Town

The latest bit of independence I've allowed my daughter is the freedom to wander around town with a friend or two.  The middle school is in the middle of town, and our house is just a few blocks from the main drag.  After school, the girls will sometimes stop to buy a snack before walking home.  On a half day or a weekend, they may walk around the park or go for lunch. 

We had this past Wednesday off for Yom Kippur.  My daughter and a friend walked around the park in the afternoon and headed home via the convenience store.

The phone rang an hour and a half into this expedition.

"I just stopped to check and I'm 62.  We're sitting on the grass at the edge of the empty lot."

"You had juice?"

"Yes- a whole box and I bought mini York Peppermint Patties at the store.  The whole bag is...let me check..."

"49,"  piped up a familiar voice in the background.

"Yup...49 grams...thanks. I'm only going to eat about half of it.  It's a lot."

"O.k.  Stay there for another few minutes and check to make sure you're coming up.  Then you should probably bolus for some of the candy if you're going to eat it on the way home or you'll end up high."

She was fine.  She was fine because she stopped to check her blood sugar.  But also because she had a friend with her.  A friend who knew about her diabetes, and who'd even learned to read a nutrition label.

I worry about her wandering around out there without a diabetes-savvy adult.  But in a way, I'm happy when something does go awry.  Because it gives her a chance to prove she can take care of it, and because it's so reassuring to know that her friends have her back.

A Volleyball Spike Would Have Been More Fitting and Less Exhausting

Volleyball started this week.  We tried to hearken back to volleyball a year ago to figure out how to handle it diabetes-wise.  We could recall very little.

We did know she needed to eat dinner before the 6 p.m. start time, not wait until after.  At 5, her blood sugar was on the high end, around 240.  Dinner was a chicken pot pie with biscuit topping.  I don't usually make this version anymore because there seemed to be no way to bolus the biscuit part that worked.  But I'm still recovering from my accident of 2 weeks ago, and looking for anything soft to make that we can all enjoy. So the ease of making one meal all of us could eat won out.

We bolused dinner and corrected the bg, assuming the pot pie topping would be hanging around helpfully during volleyball.  She poured a bottle of G2 - the low carb gatorade - to bring to practice.  Sipping a few carbs of this at each break seemed helpful last year, as best as we could remember.

After practice, at 7:30, her bg was 142.

Frozen treat season started in earnest this week too.  It was a friend's birthday, so her mom took the girls for ice cream or italian ice after practice.  My daughter bolused for a cup of root beer italian ice at a place we've been before.

At 9:45 as she finally crawled into bed after a shower, finishing homework and regrouping for the next day, her blood sugar was 115.  Which seemed great.

At 10:20, I heard footsteps.  "I just checked and I'm 34."

34.

She drank eight ounces of juice (double her standard amount for a bg of 50-60).  We cuddled on the couch for the end of the baseball game.  She checked again.  56.  Better.  After another four ounces of juice she crawled back into bed around 10:45.  Now may be a good time to note that when the dexcom sensor came out on Tuesday we decided she could go a few days before starting a new one.

I stayed up, checking every 15-20 minutes.  The next check was 82.  I realized we should have set a temp basal as soon as 38 read out on the meter screen, but did so belatedly hoping that would preempt the need for more juice.  Next check:  78.  I waited it out, hoping for a turn around, not wanting to overdo. Fifteen minutes later:  65.  Another juice box.  A few more pages of my book later: 116.  Maybe we were finally out of the woods.  But for some reason I didn't trust it, so I stayed up.  Twenty minutes later?  72.  I reset the temp a little lower for another hour and went back to the sofa for another chapter.  87.  I finished my book.  One more check: 95, and my husband's alarm was set for 45 minutes from then.  I couldn't keep my eyes open any longer.

A quick prayer to God, and the diabetes gods - just to cover all the bases - and I crashed.

By the time my husband checked, she was up to the 160's and stayed there until morning.

Lessons learned?  Volleyball catches up with her. (This lesson sounds familiar in retrospect).  This establishment's italian ice seems to have fewer carbs than the standard calorie king estimate.  (This lesson also sounds familiar).  She probably should have stayed up until she hit a blood sugar of at least 70-ish and followed the juice with some peanut butter crackers.  (This lesson was taught to us while still in the hospital 12+ years ago).

Last lesson?  If you're going to have a night like last night, it should always precede a beautiful giant-iced-coffee-worthy day like today.

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.

Missing Class

Low blood sugars have been frequent around here lately.  My daughter seems to go through a streak of them every fall, but the implications are getting harder to manage.  Missing class time in 7th grade is much different than it is in 3rd.

Our current in-school low blood sugar protocol is this:  She checks in the classroom to confirm she's low and is escorted to the nurse by a classmate.  She has a juice box and waits 10 minutes.  She rechecks and if she's back in range she heads back to class. Usually, one juice box perks her back up, but she's had a few 2 box lows lately.

Nobody's comfortable with her wandering back up to class at 53, hoping that second juice will kick in. So there she sits with the nurse.  The nurse, as we all know, is lovely.  But she's not accredited to teach geometry, or geography, or grammar.

So when 4:00 homework time rolls around, I'm called upon for help.  I'm able to help with English. Geography is easy enough with the textbook at hand, and it's interesting.  Geometry?  Forget it.  Helping with math homework consists of me sitting near her, muttering encouraging words while she reads the textbook out loud until she figures it out.

Fortunately she's a smart kid, and can catch up pretty quickly.  But it's frustrating for both of us.  The question is, can we make it so she doesn't have to?

Obviously we're tackling the low blood sugar issue.  No matter when they happen, sticky low blood sugars shouldn't happen on a regular basis.  Adjustments are underway.

But I'm also wondering about our low-at-school game plan.  What could we do so that she misses less class time when this does happen?

As usual, sitting here writing has brought ideas to mind, some of them pretty obvious.  Like when she tests in class and she's 58, she should drink the juice she has with her on her way to the nurse, not wait until she gets there.  And maybe we need to talk with the nurse about whether any lows could be treated by my daughter in the classroom.  For her, some lows are very functional lows at which she can drink juice and keep doing what she's doing.  During others, she feels much safer taking a time-out in the company of a caregiver.  How to quantify or describe this on a 504 plan, I'm not sure.

Any other ideas or suggestions which will keep me from (re?)learning more geometry or algebra are most welcome.

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.

Her Voice

Sometimes my daughter will treat a low at school and I'll find out later when the nurse has a moment to call. Other times, particularly when she's really feeling the low, I'll get a call right away.

The phone rang the other afternoon.

"I'm... 59," the voice at the other end of the line said.

There was a brief pause.   "I'm...I'm drinking juice."  Slurp.

"Good.  What were you at lunch?"

"I..I...don't know. Should I...go... back to class?"

"Um...no.  I think you should sit with the nurse and check again in 10 minutes."

"O.k.  Yeah.  I will."

I'm certain the nurse would have kept her there anyway, and that the phone call was mostly to hear my voice.

What was unsettling was to hear her voice.  It was quiet, hesitant, scared.  Her thoughts came slowly, foggily. It made me want to get in the car, drive over there, and hug her tight.

Ten minutes later, the phone rang again.  "Hi!  I'm up to 79.  Should I do anything else?"  The confident, happy, energetic, clear thinking kid was back.

"Chew a glucose tab just to be sure and check again between periods."

"O.k.  Bye!"

"Love you. Bye!"

And she was off.

Fall-ing Blood Sugars

During my daughter's first autumn with diabetes, almost a year after her diagnosis,  something weird began to happen. She started to experience low blood sugars.  Lots of them.  At all different times of day.  She wasn't eating less.  She wasn't more active. This new pattern seemed to have come out of nowhere. 

Stumped and worried, I called our Certified Diabetes Educator.  She instructed me to cut back the dose of long-acting insulin.  I agreed to do so, but asked if she had any idea why this might be happening.  She made a couple of guesses.  Maybe her pancreas was giving insulin production one last effort in what clinicians call the 'honeymoon period' of diabetes.  Maybe she'd been growing for a time and had stopped.  More likely, though, we'd never know.

We still don't know, but what's really curious is that it's happened every fall since then.  It makes very little sense. In fact logic would lead one to assume the opposite would happen.

Fall is the season of slowing down.  She's settled into a chair at school all day, and homework takes up a good chunk of every afternoon.  School leads to more moments of stress. Apple desserts, heavy dinners and in our family, birthday cakes should be leading to high blood sugars.  Yet usually around the first of October, this bizarre pattern begins.

Yesterday's mid-morning low blood sugar call from the nurse's office after a bowl of cereal and an apple for breakfast was unprecedented.  Monday's post-gym low was less surprising, but that she didn't crest over 100 again until evening was unsettling.  Eating a brownie covered in m&m's at noon on Sunday with a blood sugar of 110 an hour afterwards was pretty awesome, but disconcerting at the same time.  Last night's blood sugars of 65 at 1:30 a.m., 80 at 2:30 a.m. and 90 at 3:30 a.m. and their related juicing and basal rate tweaking were exhausting. 

Needless to say, her fall A1C is always the best of the year.  Disappointment inevitably follows when the inexplicable cloud of pixie dust has passed and the high blood sugars creep back in. 

A quick internet search revealed no documented evidence of this phenomenon.  Sharing of similar stories and amateur speculation as to the root causes are welcome of course!

Performing

My daughter's middle school musical was this past weekend.  She had a few lines and one phrase of song around the middle of the first act.  Throughout the show, she sang and danced as part of the 'chorus.'

It seems theater will require the honing of some new diabetes management skills. The first night, her pre-show blood sugar was in the high 100's: just fine for shortly after dinner.  At intermission, after her big part, she texted me from backstage.  Her blood sugar was 301: very high.  While in the back of my mind I was factoring in adrenaline while helping her tweak the pump's recommended correction, I had her dose a substantial amount of insulin.

I do know that adrenaline affects her blood sugar, and that depending on the circumstances, some or most of the resulting high will resolve itself on its own.   Revisiting my spelling bee post might have refreshed my memory, or reading this Diabetes Forecast interview with Crystal Bowersox.  Particularly the following:

Q. Does performing affect your blood glucose? It does affect it, actually. Right now my routine is: I’ll check my sugar one to two hours before hitting the stage. And then if it’s too high or too low, I can adjust accordingly. If it’s too high, I’ll take half the amount of insulin I’m supposed to take because adrenaline makes your blood sugar go up. But it also comes down on its own. You don’t have to correct for an adrenaline high, and if you do, you end up bottoming out after the show. It’s been a struggle to find that fine balance, but I feel like I’ve got it now.

It's hard to let a number like 301 ride, but I definitely overreacted.  I therefore found myself up all night chasing low blood sugars. The physiology is beyond me, but somehow that spike disappeared on its own, leaving a boatload of insulin to keep working well into the night.

Saturday saw a similar pattern, with a 308 at intermission.  This time, having learned something Friday, I had her give about a third of the suggested insulin.  Despite pizza, chips and a cookie an hour later at the cast party, then more pizza and a dessert buffet at a friend's after-party, she stayed in the 100's all night. 

She thoroughly enjoyed rehearsing for and performing the play, so I expect we'll have some more theater experiences ahead of us.  As with many other diabetes tricks of the trade we've picked up over the years, we'll figure this one out too.


 

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.

How Low Is Too Low?

An hour or so after tucking her in, I checked my daughter's blood sugar. 

85.

What a great number.  Unless it's 9:30 at night.

At 10:15, she was still 85.

At 12?  85.

Bizarrely consistent.  Maddeningly sleep depriving.

I set a temporary basal rate and set the alarm for 1:30.

150.

Good enough to set the alarm for morning.

Breakfast number? 89.

On the one hand, seeing 85 for every blood sugar check would be excellent.  It would, of course, require a cure, but a girl can dream.  At 9:30 at night, sans cure, it's frustrating.  It's not really low.  During the day, I'd certainly let it go and have her check again in a little while, or if she started to feel it. 

Yet when she's sleeping, it's a tough call. Ten points lower, and I'd be reaching for a juice box, but 85 is no reason to wake her from much-needed sleep. Even a smidge of juice would probably raise her into the high 100's, less desirable than 85.  Yet 85 is not comfortable.  It's a quick drop from there to significant hypoglycemia: a dangerous proposition in the middle of the night. I should have set the temp basal earlier on in this scenario, if for no other reason than for my own peace of mind.  But otherwise, I don't know what else would have helped.

The worst part is that the reason for hours of straight 80-somethings was not some fabulous basal rate tweak or the discovery of a perfect dinner menu. 

It was the cold she woke up with this morning. 

Sad

We really do our best around here to move on with life despite diabetes. It doesn't get a say in where we're going, or a choice of how we get there.  It's constantly with us, and does get its needed attention, but we make every attempt not to let it weasel its way into places it doesn't belong. 

Yet, this philosophy isn't fool-proof.  Diabetes has its ways.  Often it doesn't even need a major ploy to get to us, just a well-timed nudge.

Take last night. 

My sleepy daughter reappeared at 9:15 p.m. after being tucked in at 8:30.  Wearing her pink and red angry bird jammies, squinting in the living room light, she said, "I couldn't sleep.  I'm 65.  I'm also out of test strips in my room."

We rose from the couch. I fetched the juice and my husband fetched the test strips.  There was a dreary quiet about these tasks.  I walked my daughter back to her bed, retrieved her stuffed rabbit from under the covers, and gave her a hug.

"You ok?"

"Yeah."

"I'll check you again in a little bit. Hopefully you'll sleep now."

"I hope so.  I'm tired."

"I know.  I love you."

"Love you too."

Sometimes I can tough out this routine mindlessly.  Juice, kiss, bed.  All in a day's diabetes work; better luck next time.

Yet last night, it just felt extraordinarily unfair.  All she wanted to do was get a good night's sleep and wake rested for school. Instead she was up needing juice and worried about her supply of test strips.

It made me sad.

Snow?

As I watch the snow begin to fall on our already beleagured neck of the woods, I'm headed downstairs to dig out the snow shovels and boots.  A crock-pot of stew is bubbling, and we're trying to reconcile our quick transition from hurricane season to snow season.  In case you too are engaged in a sudden search for your sleds and snow pants, I thought I'd reprise a post from last winter:

There's been no sledding yet, but in winters past, it's been our nemesis. The initial experience of being very cold, combined with the thrill of the hill causes an adrenaline rush for my child. Her body is fighting off the chill and the fear. Her blood sugar skyrockets. Then, usually suddenly, her body realizes that she's just spent an hour repeatedly climbing a hill. Were there a life-sized graph of this decline, it would be the best sledding hill ever.

I periodically dig the meter out of my inside coat pocket, where I've (hopefully) stashed it to prevent the "I'm frozen" error message. We test and correct, or treat with something unfreezable like glucose tabs or smarties, and she's off again.

I can't really figure out a better way to manage this situation. Upping the insulin prior to sledding would, I think, just exacerbate the low later on. Testing more often is always a great diabetes management tool. But testing while sledding is near impossible. The mittens, the snow, the wind, the lack of anywhere to put anything down, the numb fingers and their related bloodlessness all combine for an unpleasant five minute ordeal.

So, if we get any significant snow here, we'll need to pack up the meter and the smarties (along with the sled), and head for the nearest hill. We'll manage the diabetes the best we can. I'll stand at the top of the hill, and each time she appears, I'll say, "feeling ok?" or "need to check?" Eventually, I'll force her to stop. She'll be high and correct about half of it. Twenty minutes later, she'll be low and have smarties. We'll bring enough to share with her friends.

Sledding is a rare treat, and in my opinion, we do the best we can while being practical. If she decides to join the Olympic luge team, we'll need to come up with something better.

When my daughter returns home today from what could turn out to be her only full day of school this week, some hot chocolate will be in order for both of us, I think.  And perhaps tomorrow, she'll sled before it melts into a slushy, muddy mess!

Big Blue Crash

We'd just finished a big family dinner which included a very rich dessert.  There was fun music on.  The grown-ups were washing the dishes. 

"I should do the Big Blue Test," my daughter said.

The Big Blue Test is described on its website as follows:

The Big Blue Test is a program of the Diabetes Hands Foundation that encourages people with diabetes to test their blood sugar, exercise for 14-20 minutes, test again and share their experience on BigBlueTest.org. For every test, people with diabetes in need receive life-saving supplies through Big Blue Test grants that are awarded to humanitarian diabetes charities in the US and around the world, made possible thanks to the program sponsor.

In 2012, Roche Diabetes Care, makers of ACCU-CHEK® diabetes products and services, sponsors Big Blue Test once again, to help us touch even more lives. Be part of the 20,000 people who will do the Big Blue Test this year.

Some good exercise for a good cause sounded like a win-win situation.

"O.K.  You've got to check first and after."

She checked.  "I'm 123." 

That seemed a little odd after the big meal we'd just finished, but I figured she was on her way up.  She went off to have her own little dance party in the living room.  The kitchen timer was set.

Fourteen minutes later, the dishes were about done.  She checked again.  "I'm 48."  Juice was administered and the numbers were logged in to the Big Blue Test website. 

She came up very slowly.  Ten minutes later, she was 58.  More juice.  Ten more minutes.  71.  More juice.  Were we overdoing it?   Perhaps, but bedtime was nearing and I preferred to give a little extra juice and correct later, than to wake her up in an hour. 

An hour after starting to dance, she was back up to 102 and ready to get tucked in.  Later checks reassured us the numbers had evened out.

We proved the Big Blue Test's premise that exercise lowers one's blood sugar.  More importantly, by submitting our results we generated a donation to help people with diabetes here and around the world. 

We'll do it as many times as we can between now and its conclusion on November 14th, World Diabetes Day.  I encourage you to do so as well.  Our participation will help generate funds for some fabulous programs.  And focusing on the effect of exercise on blood sugar might give us some helpful insights as well.

To participate, visit www.bigbluetest.org.

Insanity

Albert Einstein is said to have defined insanity as  "doing the same thing over and over again and expecting different results."  Those of us in the diabetes community would twist his words a bit. 

To go truly insane, try doing the same thing over and over again and getting completely different results.

Every Thursday for three years now, my daughter has taken a ballet class at 5 p.m.  The class is the same length and includes a similar combination of exercises each week, in about the same order.  The degree of difficulty has increased over the years, but more in terms of balance and flexibility than intensity of exercise. 

Every Thursday she has an after school snack around 3 or 3:30 and save the occasional outlier, begins the class with a blood sugar in the mid-100's.  We go for stretches where that blood sugar holds nicely through the class, with a slight decline of maybe 20-30 points, but nothing significant. 

Then for no apparent reason, the class starts to tank her.  Last week, I thought it was the new site.  The week before I thought was a fluke.  Three weeks in a row seem to point to a new pattern.

She started yesterday's class with a blood sugar of 120.  For a little insurance, she chomped a glucose tab before she headed in the door.  A little snack might have been preferable, but none was at hand. She finished the class at 49.  She'll need a temporary basal rate and/or a semi-substantial snack next week before she begins dancing. 

This has happened before with ballet. We change our pre-class diabetes routine and it works for a few weeks or a couple of months. Then suddenly the numbers will start to creep up during class instead of down.  We'll stop the temp basal or the pre-class snack again, and she'll begin to come out even. 

When I create my revolutionary giant spreadsheet of all possible blood sugars cross-referenced by all possible physiological and environmental factors, cross-referenced by daily routine, I might find an answer.  I could find this issue correlates with growth spurts, a concurrent preference for eating apples, the atmospheric conditions, or when the site was last changed.  It seems just as likely I'd find no cause at all.

It's one of those many diabetes situations to which all I can do is react.  We'll put the stop-gap measures in place which are necessary to keep her safe, and keep checking to see if they've worked. It's a most maddening aspect of this disease.  A + B doesn't always = C.  And the factor which led to a different outcome is often a mystery.

As we left the dance school yesterday, my daughter lamented the situation, but for different reasons.  "I like it best when I'm 75 or 80 when we leave.  Then I can take one of the lollipops from the front desk for the ride home."  A worthy goal for next week, indeed.

What Happened?

The call from the nurse's office at 2 p.m. started the mysterious chain of events:

My daughter's blood sugar was 70 after gym, having started at 208 with no insulin given for a correction.  I suggested eating her 15 g. snack and checking again before walking home.

At 3, it was up to 294...an extreme jump.  Uncertain of the cause of this high, and factoring in the coming walk home, I advised giving a little over half the correction.

After a 15 minute walk, she arrived home with a blood sugar of 358.

We made a site change the first order of business.  The cannula area appeared dark red and somewhat crusty.  I'd never seen one quite like it.  When I pulled it, it turned into a gusher.  It required a clever yoga move by my daughter to get her site area above her heart, but this basic first aid tactic did stop the bleeding and allow us to continue.

New site nicely inserted,  I determined that this grusome looking site had simply conked out, causing all of these blood sugar issues. I delivered a hearty correction for the 358 plus a few goldfish crackers. 

My daughter was able to move on to homework, but we lost a precious 20 minutes of our busy Thursday afternoon to diabetes troubleshooting.  Math homework was done in the car on the way to ballet.  Typing of the short story would have to be finished after ballet and dinner, in lieu of watching the baseball playoffs. Very sad.

About 40 minutes into the ballet class, she was next to me on the bench outside her studio.  "I need to check."  She was 49. 

"I guess the new site works," I muttered, shoving the straw into the juice box.  She sat and slurped.  She valiantly returned to her class and participated, resting on the window ledge between exercises.

What happened?  I wish I knew.  There are several possible scenarios:

The site was obviously shot, but maybe not as completely as it looked. Perhaps there was more insulin on board than I assumed when I gave the correction?

Maybe some of the high was from the bad site, but some was from another cause.  Perhaps she was lower than 70 sometime during gym and had a rebound reaction?  Gym or a math quiz might have prompted an adrenaline rush which spiked her blood sugar?  In either case, it would have been prudent to be more careful with the correction.

Maybe our correction factor is way off for that time of day?

Trying to complete a complicated math and logic problem with about half the possible information is nearly impossible.  If we're lucky, we guess the missing information correctly and solve it accurately.  Just as often, we'll guess wrong and have to hope that missing a little bit of ballet class is the worst outcome we'll see.