Thursday

My daughter and I had dinner around 5:45. It was a regular meal. In fact it was leftovers, so it was the exact same thing she'd eaten earlier in the week. She bolused for the carbs with no correction since her blood sugar was in range.

She left at 6:25 for jazz band. I left at 7:10 for choir rehearsal. My husband, who we usually leave home alone on Thursday nights, was out late for a work event. By the time I pulled into my destination, I had a Dexcom alert on my phone. My daughter was low-ish. She was in the 60's. Which had happened the night before after dinner too, and she'd gotten kind of stuck there. There are a couple of days every month when sticky lows tend to occur, and I began to wonder if that was what was happening.

I texted her suggesting that, given the stickiness of last night's low, suspending the pumps's insulin delivery for a while might be a good idea.

By the time I got upstairs to my rehearsal I had another Dexcom alert and she was now in the 50's. She had not texted back. I resorted to texting, "Please tell me you are okay." Which at the time I felt might not be well received, but I was nervous enough not to care.

She replied that she was, that she would suspend insulin delivery on her pump, and that she'd had a juice box.

For the next 25 minutes I sang and texted and watched the Dexcom app and wished my husband was home, two blocks from my daughter, to run her up some more juice. The Dexcom alarms went from low to urgent low. I realized I'd stopped singing entirely.

By 7:55 my daughter had consumed everything in her bag and a sugar packet she'd scavenged from the band director's desk. Her blood sugar had dropped into the 40's.

I left rehearsal, clutching my phone, mysteriously muttering, "I need to go," and zipping out the door.

By the time I got in my car, 2.5 miles away from the high school, the Dexcom app read 'LOW.' That meant her blood sugar had dropped below 40.

When I texted my daughter I was leaving, she replied, 'Why? No. I'm fine. Go back. Don't Worry.'

That didn't work.

I did not drive the speed limit. I texted and drove. I Dexcomed and drove. And I prayed that my daughter would continue to text me and that all of the steps she'd taken so far would tide her over until I could help.

I ran in and out of my house to grab a juice bottle. I double-checked I still had glucagon in my purse from our Christmas trip.

She was back 'up' to 44.

I texted her I was on the way to the school with the juice.

'Well I can't leave.'

I left a bottle of Apple and Eve outside the band room door, hoping nobody would think it was anything other than a sealed bottle of apple juice, and asked her to let me know when she'd gotten it. I assumed she would come to her senses and sneak out and retrieve it quickly and surreptitiously. If she didn't I'd have to go back in and make a scene.

She'd retrieved and consumed it long before I'd driven the two blocks back home.

As I obsessively refreshed the Dexcom app while trying to distract myself with something on the Food Network, I saw the numbers begin to rise and I began to breathe.

When jazz band was over at 9, she drove home with a safe blood sugar of 90.

This wasn't a case of being unprepared. Maybe she was un-overprepared. But when leaving the house for two and a half hours, it's extraordinary to expect to be in a situation where you consume 45 grams of carb and suspend insulin delivery while your blood sugar continues to drop like a rock. At least after an accurately bolused dinner, and no unusual level of activity.

I'm grateful for whatever combination of grace, steps taken by us, and dumb luck saved us from a bigger disaster. From 7:30-9 last night was the most scared I've been of diabetes in years. We work so hard to keep things predictable and on an even keel but this was a sobering reminder that diabetes is, inherently, a dangerous disease.

Every diabetes scare we've had has resulted in steps towards preventing a repeat. Extra juice bottles will be squirreled away around my daughter's home-away-from-home in the band room and stage area of the high school. She'll stuff a few more airheads in her diabetes bag.

Unfortunately we know that there's always another unpredictable moment lurking, on any given Thursday.

Trick-or-Treat

It was 8:45 on Halloween. The doorbell hadn't rung for almost an hour. And then it did. We paused Survivor, and my daughter got up to greet the trick-or-treaters. She had enjoyed her door-answering responsibility all night, and I was glad to let her get up one more time.

Peeking through the living room window, she recognized a life-long friend at the door, dressed as Kim Kardashian.

She opened the door, and I could hear another voice, in addition to my daughter's and Kim's. There was a little chatting about the nice weather and what the girls had acquired in their travels. "There was a house handing out apples. Honeycrisp ones though, which are amazing, so I guess if I wash it I can eat it?"

My daughter then offered as much of our loot as the girls wanted to take. We didn't have as many kids as usual, and so generosity was in order.

"Are you sure? Thanks so much," Kim Kardashian exclaimed.

"Ugh, my mom won't let me eat most of it anyway," replied the other voice, which I was still trying to place.

"Take the airheads" was my daughter's quick response. "They're great for low blood sugars!"

Now, of course, I was able to narrow down which friend was accompanying Kim Kardashian on her rounds.

"Ha! Yes- I will! My mom buys terrible glucose tabs at Costco. I can't stand them."

Now Kim Kardashian's friend has a nice stash of airheads for her low blood sugar needs.

Who says Halloween and diabetes can't go well together?

Another Opening, Another Low

It's been a couple of years, and we forgot. Performing in musicals makes my kid low.

Except for an occasional adrenaline-induced high, especially on opening night. For which insulin should be dosed sparingly, not aggressively.

Exercise is the most obvious cause. This year's show was particularly dance intensive. At two and a half hours long and involving at least five quick costume changes, every performance resembled a marathon. Saturday's double-header was made possible by a giant between-shows order of Thai pineapple fried rice.

Being in a show also puts her off schedule. Diabetes likes to eat, move, sit still and sleep within the confines of a predictable routine. Dinner at 4:30 on show nights, 8:30 on dress rehearsal nights? Both unusual. Dancing and performing in the evening instead of sedentary homework? Unusual. Diner pancakes or cast party food post-show? Her insulin to carb ratios are set pretty accurately for regular mealtimes, not so well for midnight. There was lots of overnight juice.

Exhaustion is another probable contributor to the show lows. The weeks leading up to opening night involved long rehearsal days followed by late homework nights. Schoolwork didn't stop. Regularly scheduled music rehearsals didn't stop. She burned more energy than usual just to keep up with the long hours.

It's absolutely true that kids with diabetes can do the same things others do. They can even make it look effortless. Waking a couple of times per night for juice, calculated intermission snacks to improve the odds of stable second act blood sugar, checking and double-checking the backstage bag of supplies, and maintaining an overall high level of diabetes vigilance are invisible tasks, even to most of her cast-mates.  To her all those tasks are totally worth it to be able to participate in her high school's musical.

Wouldn't it be nice, though, if she could just do the same things other kids did without all of the extra effort?

Gringotts

One last story from our Universal Studios vacation:

We arrived at Gringotts, the goblin-operated bank frequented by the characters in Harry Potter. We stored our belongings in the lockers provided. No bags were permitted on the ride. Before a similar ride that morning we'd stuffed our pockets with airheads candy before stashing the rest of the supplies in the locker. This time we forgot.

Ten minutes into what was reported to be a 35 minute line to board the ride, the Dexcom alarmed.

"70 with a down arrow," my daughter reported. I had one airhead left in my pocket from the morning, which I handed over.

Three minutes later, the Dexcom alarmed again.

"It's double down now and says I'm 55."

"Do you feel low?"

"Yeah- I can't wait here."

There was a staff member nearby.

"My daughter is having a medical issue," my husband explained." What's the best way to exit?"

"Just walk up this ramp and you'll get out."

"Is there any way we can skip some of the line when we come back- it'll be about 10 minutes we think."

"Yes- absolutely- just tell the person at the entrance that Maya said you can come in through the express pass entrance. It shouldn't be a problem."

"Awesome- thank you so much."

So we went out and emptied our locker. We sat on the ground near a statue of a goblin holding a stack of gold while my daughter checked with her glucometer (55) and drank a juice.

We waited there a few minutes, people-watching.

"You feeling a little better?"

"Yeah- I'm definitely coming up."

A recheck showed 68. She ate another airhead for good measure, and we stuffed our pockets full of them before getting another locker.

The staff member at the entrance allowed our reentry through the express line, and with an elapsed time of under 15 minutes, we were soon standing next to the people who had been ahead of us in line before we exited.

The ride was great.

It's November...Diabetes Awareness Month! My plan for this month involves stories. Simple, everyday, real-life stories about living with diabetes. I plan to tell them here as narratives, like this one, just snippets of a day with diabetes, and I plan to tell them, or stories like them, more often in the 'real world' this month when friends ask, 'How's it going,' or relatives ask what I've been up to.  

Upper Hand

Last week, diabetes had the upper hand. It issued a series of decrees.

They included:

*Alarms will sound nightly from midnight until four a.m.

*You will wake a sleeping teenager for Cookie Monster Juice at least twice per night.

*Delirium will lead you to wonder if the nightly need for multiple juice boxes has something to do with the Cookie Monster themed branding. As in, 'Me Want More JUICEEE.'

*You will wake each morning to say, or to hear your child say, "Uck- juice box breath again. This is so gross."

*You will become so exhausted by overnight low blood sugars that you will increasingly limit dinner and bedtime boluses until the alarms turn from low to high, though still reliably from 12-4.

*You will try multiple tactics to stabilize overnight numbers and each will backfire more mysteriously than the next.

Diabetes, I have news for you. You don't get to win.

We issued only the only decree we need:

*We will not give up.

With perseverance and patience the trend is abating as mysteriously as it appeared. Maybe we finally made the right basal adjustments. Maybe we fixed the bolus dosing for the evening hours.

Or maybe it's all because we switched back to Juicy Juice boxes.

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.





A New Low

There have been two evening concert band rehearsals this winter, from 6:30-9 p.m. These are intense monthly rehearsals during which the kids are playing challenging music non-stop.

The nights after both of these rehearsals have been multiple juice box affairs.

After 14 years of T1D, we have learned when to expect most lows.

Running, dancing, swimming, and miscalculating the number of carbs in a meal are the causes everyone knowledgeable about diabetes would expect. 

Slow but steady walking, staying up late even if it involves no physical activity, and being sick with a cold all also trigger lows for my kid.

Could playing a wind instrument for an extended period also lead to dropping blood sugar?

The first post- concert band rehearsal low seemed to come completely out of the blue. She hadn't been having any overnight lows at the time, and the rest of the day hadn't involved any unusual food or activity. The only variable I could come up with was the rehearsal. Could the physical exertion of playing her clarinet for that long combined with the mental energy to concentrate on and learn new and difficult music be what led to a 50-something blood sugar so slow to budge? Maybe, I guessed, but since one instance doesn't make a pattern, we chalked up to a mystery low and set the episode aside.

Until it happened again this week. Both times she was at a nice 90-ish number when she came home and had a snack. Then around 1 a.m., she tanked.

Despite using a variety of search terms, my research turned up only one mention of this phenomenon. It's master's thesis from 2006 by Derrick Alan Crow called 'The Effect of Instrumental Rehearsal on Blood Glucose Levels of Five Low Brass Players.'  The link will take you to a several-page preview of the study, which was all I was able to access. His participants, as far as I can tell, did not have diabetes. The blood sugar checks were before, during and immediately after rehearsals, not hours later. But his preliminary background research was interesting and, based on it, he posed some logical hypotheses. His results, while inconclusive mostly due to the small sample, did note some trends of lowering blood sugars during long rehearsals. His theory was that between the mental, aerobic (from breathing), and muscular energy expended by a wind instrument player during a lengthy rehearsal, blood sugar levels drop.

I'd love to see this study repeated in instrumentalists with diabetes. I'd love to see the research include investigating a delayed drop of the sort people with diabetes see with some other kinds of exercise. Clearly, I need to befriend a musical scholar. Or convince my kid to become one.

Meanwhile, we'll plan on covering fewer carbs on concert band nights, and/or setting a temporary basal rate. Or maybe next time this won't happen at all.

Gym Win

Out of all the anticipated diabetes challenges of high school, gym has been the biggest thus far.

Marching band's 14 hour days, including an outdoor week in the August heat? We handled it.

New nurse? She's great.

An intense and stressful academic schedule? Intense and stressful, but managed.

Gym? A disaster since day one.

I wrote about it in the fall. Gym is always in the morning but that's where the predictability ends.

Gym class happens three out of every four days. At 8 or 9 or 10 a.m. Some days are 'fitness days' with sprinting or other heavy cardio. Some days they play volleyball which my kid enjoys playing at a moderate pace. Some days feature floor hockey, during which the senior boys apparently dominate the puck and give nobody else a chance to play. Some days gym is preempted by 'peer leadership,' which can involve either active or sedentary group bonding activities. All we can be certain of is that the whole thing is totally unpredictable. Therefore, adjusting basal rates didn't help. And changing the breakfast bolus was useless. Our next best hope was this:



Squeezy Applesauce!

Toddler applesauce has greatly reduced trips to the high school nurse's office. It's fifteen carbs provide slightly more nutritional value than a straight juice box. It's easier to consume while changing into one's gym clothes than a clementine or a handful of grapes. It's even sort-of fun? And, most importantly, it's working.

She makes the decision whether to consume a pouch before gym based on three factors: what her blood sugar currently is (usually based on the Dexcom, inclusive of arrows), what the day's anticipated activity is, and what time it is (she's more likely to drop fast if there's still a bunch of breakfast insulin on board). There are occasional problems, like when an anticipated floor hockey day becomes an unannounced outdoor running day due to good weather, or when she's had an unusual breakfast and the 'insulin on board' factor is harder to predict. But overall, this tactic is (thus far...knock on wood...fingers crossed) a winner.

Also a plus? We won't be running out of squeezy-sauce anytime soon due to today's 5/$9 sale at the grocery store. She's not sure about the new 'applegrape' flavor, but if you're sucking it down in three gulps, how much does flavor really matter?

Dear Diabetes

Dear Diabetes,

Please stop.

You have had your fun.  Now please leave us alone. 

The blood sugar of 400 after dinner was sarcastic, no?  Yes, we forgot to bolus for the little baked potato until after it had been eaten, but a bg that high for maybe 15 missed carbs?  Get a grip.

Then you showed up at gym the next morning.  You and gym had finally started to get along I thought.  But you threw in a random 40 to start the day. Why? 

Oh- yes.  I remember.  So that my kid could have a moment to ask the nurse about the next day's standardized testing plans.  Where would she be taking it?  What were the accommodations for you, diabetes? This question ended in a lunchtime meeting with the guidance counselor, a series of emails and still no firm answer.  We'll have to go with the flow for this one it seems, partly my fault for not taking note this test was coming and asking earlier. But we would've gone with the flow anyway, without having the opportunity to ask the question and waste an hour of the day with stressful communication about the answer.

As if the testing question fiasco weren't enough, the low also resulted in missing most of Spanish class, where the assignment to do a project on a famous Hispanic person was handed out.  By the time she got back to the classroom Big Papi and Freda Kahlo, her first choices, had been taken.  She chose Pedro Martinez, but while the choices on the original list included links to articles in Spanish to work from, that wasn't the case for off-the-list options.  So while the class had the opportunity to complete most of the initial portion of the project in class, my daughter spent an hour at home finding an article in Spanish about Pedro and answering questions.  On a night she was supposed to have no homework due to the aforementioned tests.

Diabetes, we've had enough.  We see you.  We hear you.  We feel you.  We get it.  You've got power to derail any day you want to.  And you did.  You won the day.  Please go somewhere else to celebrate.

Respectfully,

Us

Information

 

 One bit of wisdom shared often by both professionals and veterans of the diabetes community is about how we react to blood sugar numbers.  The numbers are, the wise people tell us, neither good or bad.  They are simply information.

 

A blood sugar check should be a 'no judgement zone,' the theory goes.  The sole purpose of the number is to tell us what needs to happen next:  a juice box, a correction bolus, a regular meal bolus, and nothing at all are all possibilities.

 

It's pointless, we're told, either to express elation at a perfect 100 or to throw the meter across the room over a 357.  Tying feelings to the numbers has the potential to lead to unnecessary frustration.  It can lead to checking less often for fear of getting a "bad" result.  It can lead to spiraling emotions when things inevitably derail; emotions which could get in the way of being clear headed enough to make necessary adjustments. 

 

So it is with this philosophy in mind that I look at the now-constant stream of blood sugar numbers available on my phone thanks to our new 'share' technology.  Take this day for example:

 

The information tells me that my daughter's blood sugar was more often higher than her target number and lower than her target number than it was anywhere near her target number.  I'm informed that if we averaged all of the numbers together, we would come up with a number close to the target  number.  The graph informs me that steps were taken throughout the 24 hour period to return blood sugar levels closer to the median but that those attempts had more than the desired effect almost every time.

 

But it's incredibly difficult not to look at this graph and utter a few choice words, non-informational in nature.  It's hard not to see how crappy a day this was, and to wonder what we're doing wrong to make this happen; how things have spiraled out of control like this. 

 

While I don't discount the wise people's theory, I think there's a balance. I do not want to get so frustrated that I stop looking at the numbers.  I do not want to say things about the numbers which imply a sense of guilt.  But sometimes, at least for me, it takes a little anger and frustration to get me moving or, in the case of this fall, keep me working until we figure this whole high school schedule out.  Because, really, I'd prefer the information steaming onto my phone screen always looked a little more like this:

 

 

Locked

On the first day of outdoor gym, after running increasingly fast sprints for half an hour, my daughter's blood sugar was low.  She grabbed a friend and went to tell the teacher.  The teacher, apparently a man of few words, pointed to my daughter's friend and said in what my daughter describes as a deep, gruff voice, "You. Take her to the nurse."

So off they went, to the door from which they had exited the building.  Locked.

They tried the 2 other doors on that side of the building.

Locked.

As they debated whether to go back to the gym class (a couple of hundred yards away) or to go to the building's front door which has an intercom system (maybe a bit closer but out of sight of the gym class), someone discovered them trying to get in and opened a door.

Yesterday there was more running outside and, despite an interim round of insulin adjusting, another low. 

"You. Take her to the nurse."

"Is the door unlocked?"

"Go to the front."

They were buzzed in.  Ten minutes later, still in the nurse's office, my daughter heard the bell ring.  She was still wearing her gym clothes and all of her belongings were still in the locker room which, they had been told, was locked when nobody was in it.  The nurse walked her to the gym (her bg was still 60) where the locker room was, indeed, locked. 

As my daughter wondered what her next move should be, the gym teacher of few words appeared . Unlocking the door, he asked,  "You wear a pump?"

"Yes and a dexcom- it's a continuous glucose monitor."

"Does it go to your phone?"  (Wait- what?  Does this guy speak my language, however succinctly?)

"No but my new one will."

"My niece has that."

"Cool.  Thanks for unlocking the door."

Gym blood sugar management may take a while to sort out and there are probably more impeding locks to contend with.  But at least we've learned that the gym teacher of few words gets it.  Even if he's a little brusque about it.

What Time is Gym?

Here's our latest challenge:

The high school has block scheduling.  This means that while kids take 8 classes, they only go to 6 per day.  There is a continuous rotation through A,B,C and D days.  Each day has 3 morning classes and 3 afternoon classes which always remain in their own day parts, but not at the same times. The first challenge is, of course, end up in the right classroom at the right time more often than not. 

Then, to up the degree of difficulty, add diabetes.

This schedule means that gym, like all of the other classes, only takes place 3 out of every 4 days. It's always in the morning, but rotates between 8 a.m. 8:58 a.m. or 9:54 a.m. depending on the day.

Yesterday was the first day the kids changed and had a full gym class. It was during the 8:58 time slot. It turns out, to provide an additional diabetes challenge, that one day per calendar week the class has a 'fitness activity.'  Yesterday's was running sprints outside, promptly followed by the first high school visit to the nurse's office due to low blood sugar.  Other days will be spent on traditional gym units like volleyball and badminton.  This fitness activity day will not occur predictably, so it is not as though we can know that every 'A' day will be different.

Every school year has required an adjustment in the basal insulin delivery rates on my daughter's pump. The summer schedule of waking, sleeping and activity is different from any school schedule.  Each year of elementary and middle school brought a different time for lunch and daily gym class. A couple of weeks into September we were able to see the new patterns and tweak insulin doses to prevent most post-gym or pre-lunch lows.  There were still variables like going outside on a gorgeous spring day to run the track instead of playing badminton; and half days threw everything off.  But generally there was some predictability to the daily schedule and its requisite insulin needs.

This year?  I really have no idea how to proceed.  I dropped the morning basal rates a bit last week after it became clear that being up and active at 6 a.m. was leading to a different pattern than the more civilized summer hours did.  Last night I further lowered, and changed the timing of, the morning basal rates as the first stab at addressing the gym issue.  But I fear that on no-gym days highs will creep in, and that the changes will be more effective on some days than on others due to the range of class times and activity levels. 

In a perfect world, my daughter would check her blood sugar an hour before gym class and then again when class was beginning.  She would know what the day's activity was and use all of the available information to decide whether to set a temporary basal rate or have a snack.  Or we'd have a few different basal patterns set up and change them based on the day's school schedule.  Maybe she would eat different breakfasts depending on when gym was scheduled in order to, theoretically, stabilize her blood sugar at the right times of morning. 

Life as a high school freshman is nothing akin to a perfect world..  At this point she's lucky to make it to the gym at the right time and to find the locker room. Arriving at school for 7 a.m. choir fed, bolused and with enough insulin left in the pump cartridge for the day (oh- and dressed, homework finished and carrying her backpack containing everything she needs for the day) is almost more than we can ask.  So for now at least, we'll play a little bit more with the basal rates to hope we can find a happy medium for the mornings.  And she'll keep the juice boxes close at hand.

Last Field Day!!!

This week marked our 9th and final field day. I never much liked it as a kid.  As a parent of a kid with diabetes, I like it less because:

It's always hot.  Dehydration and diabetes don't mix well.  Insulin and heat don't mix well.  And the whole 'am sweaty and weak because I've just run a relay in the sun or because I'm low' question is on replay all day.

Everyone is in constant motion.  The obvious risk of this for my child is exercise-induced low blood sugar, but there are other risks to her from the chaos.  Teachers are just barely keeping their groups together and the events going, let alone keeping an extra eye on my kid to potentially notice symptoms of low blood sugar.  My kid is encouraged to keep up with the group and less likely to have a moment to assess how she feels and use her glucometer or drink water as needed.  The nurse is busy because constant motion means constant bandaids and ice packs, which means my kid may find a line at the nurse's tent if she shows up there needing help.

The distractions are endless.  When she was little it was worse, but even today my daughter is still less likely to notice an approaching or full-blown low blood sugar when there are lots of other things going on.  The constant sensory input from the events, the people, and the novel outdoor setting could easily cause her to miss the sensation of dropping blood sugar.

Field day often includes a treat.  This week, for example, she played volleyball, did some activities on the track and then ate a popsicle at 11 a.m.  For the first 3 years of elementary school there was a pizza lunch between the morning circuit of games and the end-of-day tug of war and popsicle event.  Managing unusual and unusually timed exercise is challenging.  Managing unusual and unusually timed treats is too.  Putting the two together adds yet more variables to an already very complicated equation.

Field day got easier over the years as my daughter became more aware of and responsible for keeping an eye on her blood sugar.  Once she started middle school I no longer felt compelled to send extensive communications to the staff imploring them to look out for her.  And I've felt decreasingly anxious over the years that something truly disastrous would occur.  But this year, like most years past, she ended up in the nurse with a low blood sugar by the time it was over, and the following hours provided a line of peaks and valleys on her Dexcom graph. 

At least her team won the day.

Where My Rope Ends

The phone rang at 10:30 in the morning again.  I spoke with my daughter, trying to calm and reassure her as she finished her juice box.  When I hung up, there were tears in my eyes.

This kind of reaction doesn't happen often for me.  I'm ordinarily even-keeled and able to roll with the punches diabetes doles out on a daily basis. 

It's not the dramatic, emergency-type  moments that send me over the edge.  I'll treat a 30-something with great calm, and move past a night of high post-birthday cake blood sugars with a deep breath.

It's when I can start to see it in my daughter's eyes, or in this case hear it in her voice, that I lose it.

This was the fifth or sixth time she'd had to leave music class or gym (back-to-back favorite classes) to treat a low blood sugar.  It was the third day in a row.  She was mad. 

I'd been making what I thought would be helpful insulin adjustments. I'd even downloaded the Dexcom, which is a rare event around here.  But there she was.  With the nurse, while her two friends worked on the guitar trio as a sad duet.

And I sat less than a mile away, helpless, wishing things could be different.

What If...

My group of seventy-five jurors was called into a courtroom at 11:15 a.m.  We sat and were given the required lengthy speech about jury service.  The attorneys and defendants were introduced.  We were then handed the jury questionnaire.  By then it was noon.

The judge went through the first two pages of questions one at a time.  People who answered 'yes' to any question were asked to stand and give their names to the judge.  He made a note of each.  A dozen questions later, 40 people had stood up and it was 12:30.

Then he brought every person who had answered 'yes' to any question up to the bench one at a time to talk about their concerns.  It was nearly 2 p.m. when we were sent to lunch.

The second item on the questionnaire had to do with whether there were any medical, financial or personal problems which would prevent you from serving.  With that question came a sentence about the Americans With Disabilities Act under which many accommodations could be provided as needed. Nearly three hours of hungry boredom gave me plenty of time to consider possibilities.

If I had Type 1 diabetes and part of my personal management plan was to eat at approximately the same time every day, I would have needed an accommodation 45 minutes into what was turning into a nearly 3 hour affair.  What would I have done?  Stood up and asked to approach the bench? Tried to eat something without anyone noticing?  Sat there and hoped an emergency didn't develop?

What would happen if a person with diabetes experienced a significant low during testimony and needed a few minutes to regain the power of concentration?  What questions would be raised about someone repeatedly looking at electronic (diabetes) devices throughout the trial?  Would the beeping of devices and glucometers prove to be a distraction?

With a Supreme Court justice who must occasionally need to munch glucose tabs during a hearing, I'm certain diabetes isn't a barrier to jury service.  It's more of a question of when and how a potential juror would disclose the concern.  And of what specific information would need to be shared with the presiding judge.

All I can tell you is that if I were that person who'd been sitting there anxious about when or whether I'd get lunch before my blood sugar crashed, I would have been extra upset when we returned from lunch to learn that the morning's process had been all to find only one more person to fill an almost-complete jury.  Even I, being merely hungry and bored, was somewhat irritated that people were not dismissed more efficiently in this situation.

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.

Doopities

"Do my doopities?"

I still remember the first time my daughter asked this question.  She was very low.  She had some juice.  I breathed a sigh of relief.

Within a couple of months of being diagnosed with diabetes at the age of 13 months, my daughter had made up this word.  "Doopities" meant checking her blood sugar.  Nonsensical?  Absolutely.  But when it was time for food or bed, we'd say, "let's go check your blood sugar," and she'd say "doopities."

"Do my doopities?"  The first time she asked this out of the blue, she was maybe 24 months old.  She felt low.  She knew what she needed to do.  It was a bittersweet moment for sure.  Mostly, though, I was relieved.

From the day we brought her home after being diagnosed, we spent every waking moment watching her like a hawk.  Was she slowing down?  Were her eyes glazy?  Was she pale?  Why was she crying?  Was she lying in the grass because it was fun or because she didn't feel well?  Was it o.k. to let her play in the sandbox by herself 40 yards from where I was weeding the vegetable garden?

After this first request for 'doopities,' we were not, of course, home free.  She was 2. We watched her like a hawk for several more years.  We still usually picked up on lows before she did.  We still needed to be responsible for keeping her safe.  Yet at that moment, we turned a little bend which brought us all the way to where we are today.

Now that's she's 12, it's increasingly rare that I'm the one suggesting she check her blood sugar.  Once in a blue moon there will be excessive crying.  Those eyes still noticeably glaze over sometimes.  More often than not, though, she catches lows on her own.

But these days she just says, "I need to check my blood sugar."

Cereal Lows???

Here's a sentence you won't read often:

Twice in a the span of a week, my daughter has ended up in the nurse's office with a low blood sugar and I think it's because of her breakfast cereal.

You see, breakfast cereals are notorious for causing high blood sugars, not low.  Also, blood sugar tends to spike in the morning, making any breakfast carbs harder to cover with enough insulin.  So I'd say these may be the first 2 times in 7+ years of school my daughter has ended up in the nurse's office low before 10 a.m.

Our tactic for combating  post-breakfast highs has worked well of late.  A few years ago, a registered dietitian at our clinic suggested trying cereals with 5 or more grams of fiber per serving, which would slow the digestion of the cereal and thereby even out the spike.  Occasional experiments with old favorites like Cheerios and Kix prove that the extra fiber in the new choices really does help.

In her quest to reduce breakfast boredom, my daughter spotted a new cereal in what might be referred to as the 'healthy' aisle of our grocery store.  We enjoy other cereals of the same brand, so we picked up a box.

This cereal has 6 grams of fiber per serving, the same as several others my daughter eats.  The serving size, and the number of carbs per serving are comparable. The same almond milk is added.  The first time she ate it she needed 2 juices to get her back to class.

Several days of her usual breakfast foods and standard post-breakfast blood sugar results went by, and then she tried again.

Despite mediocre reviews the first time around of both flavor and chew-a-bility with braces, she had a bowl of the new many-grained flakes this morning.  Already suspicious of last week's low, we subtracted a handful of carbs from the total per serving, and she ate 3 slices of my peach which we never covered.  Again she ended up with the nurse and a blood sugar of 58.

I guess if she really loved this cereal, I'd put on my scientist cap and try to figure out what was going on here. Instead, I'll finish the box (which will require lots of peach slices for flavor) and we'll move on.

Sippy Cups

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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.