Whack-A-Mole

Streaks of high blood sugar are becoming frequent visitors.  I'm upping the insulin:carb ratio, the correction factor and the basal rates regularly.  My methods are sometimes scientific, with thoughtful basal testing and downloading of information. Some other changes have been made more impulsively, in exhausted frustration.  Either way, numbers seem to settle in for a few days to manageable if not perfect.  Then it's over.  She's stuck at 250 again.

So we start again.  Because of her health, of course.  And also because a 13 year old with consistently high blood sugar is not someone you want to live with. Trust me.

There was a time when we adjusted very few things between endo appointments.  One basal rate might change, or I'd need to up the breakfast carb ratio.  A little growing, or a change from school to summer schedule would require a bit of work, but not much.  Sometimes we'd do nothing at all and she'd be just fine. For 3 months.

I was warned this was coming.  I knew I'd have to start making regular changes in her insulin regimen.  I imagined it would be hard work.  What I didn't fully understand was the emotional component of the whole thing.  It's akin to playing a never-ending game of whack-a-mole.  There's that brief moment when all the little moles are in their holes and you take a deep breath hoping you've whacked them all.  Instead they start popping up faster than before.

I'm certain my little smile at the flat dexcom line from 1 a.m. until 7 this morning will be justly rewarded with an astronomical  spike before the day is out.  Or tomorrow's 1-7 line will be straight at 200 instead of 108. If we ever hit a day completely in range, I'm sure it will include a request from my child to go out to lunch with her friends to restaurant with uncountable carbs, or be followed by another lethargic snow day.

This challenge, like whack-a-mole, will take some skills to get through.  We'll keep looking at the big picture.  We'll keep moving.  We'll stay calm. We'll show the enemy who's boss.  And we'll know that this era, like any game of whack-a-mole, must eventually come to an end.  It can't last more than 4 more years, right?

One Of Us Is Happy To Be Home

To celebrate my daughter's 13th (ack!) birthday, we spent a long weekend in Washington D.C.

We stayed in a lovely downtown hotel.  We walked everywhere and once we got to our destinations, walked some more.  We toured the Capitol and visited countless monuments and statues including a trip to the top of the Washington Monument. We enjoyed a few Smithsonian museums and got pictures of the White House from every allowable angle.  Our only Metro train trip was to the National Zoo where Bau Bau, the baby panda was adorable.   We ate in a couple of incredible restaurants, and on the actual birthday we ordered room service breakfast as a very special treat. We had an amazing time.

Except...

She was low at the Library of Congress, the Jefferson Memorial, the National Archives, the panda exhibit, and on many street corners.  She was high, and drinking contraband water, in the Capitol building and at the top of the Washington Monument.  And here's a hint: don't eat a room service continental breakfast complete with a yummy cinnamon roll and then get in the car for several hours.  Your birthday morning will be spent in a haze of dexcom alarms, people handing you bottles of water, and highway rest stops.

I can't remember a vacation Diabetes hated more than this one.  The Dexcom graph looked like a never-ending roller coaster.  High right after breakfast.  Low by 10.  Creeping up by lunch, then high-ish by 2. Crashing by 4.  High after an incalculable restaurant dinner (with dessert!!!) but coming down alarmingly quickly during the walk back to the hotel.  Or the complete opposite, depending on the day.

Most frustrating was that we were actively trying to prevent these swings.  She checked often.  Dexi was a constant companion.  There were temp basals and calorie king app checks and taste tests of foods to judge their contents.  Yet we were left wondering if the end result would have been just the same if we'd put in much less work.

We kept going, with our usual 'diabetes isn't going to stop us' attitude and enjoyed the capitol to its fullest. My daughter was a trooper and despite feeling the effects of those highs and lows, kept enjoying everything she was seeing. The only thing I wish we hadn't seen so much of were the city's benches and stone walls.

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.

Weird

All day: confusion.

Check: 115.  Dexi:  250.

Check:  287.  Dexi:  140.

Lots of  'Recheck...that doesn't make sense.'

And 'Really...that's what it says.'

All day.

It probably didn't help that we left Dexi home for an errand outing.  Or that we went to the pool.  She finds that very confusing. Always.

Yet from dawn to dusk, nobody could agree.

Beditme was the most bewildering.

Check:  270.  Dexi:  240.  We thought there had finally been a meeting of the minds.  A small correction was given and some reading began.

Fifteen minutes later, Dexi asked for more blood.

Check:  138.  Dexi:  still 240.  I thought we were in for a long night for sure.

But by 10, the anticipated low had not occurred and did not occur all night.  Dexi and the meter had kissed and made up.  Today, they were all in synch...like they'd been together forever.

Technology is great.  We really love it and are grateful for all the help it gives us in managing diabetes every day.  But please visit www.stripsafely.com.  Sometimes things to awry.  They shouldn't.

Armed (and Dangerous?)

The birthday party challenges keep coming this spring.  The latest was an invitation to a celebration at a restaurant serving a buffet brunch.  Mulling it over, I shared the invite with my daughter, offering her an alternative option. If she didn't want to manage the diabetes aspects of a buffet brunch alone, she could join the group after brunch for the pool party which would round out the afternoon.

"I really think I can do it!" was the overwhelmingly self-confident response.

What could I say?

What was the worst that could happen?

How would we ever get to an overnight road trip with friends without first allowing smaller steps like this one?

So she went to a very nice restaurant with beautiful water views to have brunch with a few of her friends and two brave parents.  Armed with her pump, dexcom, cell phone and calorie king app, she was otherwise on her own.

After a two mimosa brunch of my own and a comforting mid-afternoon ice cream stand stop, I picked her up at the pool at 5:45.  She was smiling from ear to ear and recounted in great detail all of the food she'd enjoyed.  She loved the restaurant, being with her friends, and playing volleyball at the pool.

Diabetes-wise? The Dexcom graph included dots on almost every level of its screen.  By 6 it just read 'high,' and stayed that way for over an hour despite two major corrections. The meter's remote showed that over 100 grams of carbs had been bolused for at brunch, and that corrections had been given at 2 and 4 for numbers in the 150-200 range.  She had unplugged the pump twice to swim but not for long since the water was "freezing."

As far as I can tell, she did all that she could, and I made sure she understood that.  A discussion of the desserts she sampled leads me to believe she under-calculated their carbs but since miniature pastries aren't on our regular menu, she was forced to guess.  The real problems didn't start until almost 4 hours after brunch, probably when the fat from the {still unclear to me number of} pieces of bacon she ate met the 105 + brunch carbs and the handful of pretzels she bolused for at the pool.  Truth is, she could easily have hit 400 whether I was with her or not.  Buffets are hard.  Mystery foods are hard.  Add into the mix frigid pool water which tends to spike her, unplugging to swim, and a healthy amount of excitement, and the results are not entirely unexpected.

All we can do is try to learn from the experience.  Mini pastries have more carbs than expected and should be consumed in limited quantities.  Balancing high carb and fatty foods from the buffet with a few lighter options might mitigate disastrous blood sugar results.  Following a heavy meal with an adrenaline-producing dip in ice water while the pump is unplugged shouldn't be a regular occurance.

You may think it was dangerous to send a 12 year old with diabetes to navigate a buffet brunch.  Perhaps a little bit.  But really, on some level, it's dangerous to send a 12 year old with diabetes anywhere.  The best I can do is to arm her with the tools and knowledge she needs to take care of herself, and with confidence. Despite the results, this was definitely a confidence-building experience.  For both of us.

Why We Look Tired Today

My daughter called from school mid-afternoon yesterday to report a blood sugar in the 300's.  "Correct it and we'll see what happens by the time you get home," I suggested.

"Why do you think I'm so high?  Do you think it's the site?  I can't see it too well."

"Maybe. You've been high lately in the afternoons anyway you know.  Not this high, but let's see what happens. You'll be home in less than 2 hours."  By the time she got home, she was 82.

I didn't think of it again, at least in terms of it being an urgent problem.  I recorded it on the log sheet and vowed to take some time this week to look at the after-lunch time frame.  Her dinner number was good, and after dinner wasn't terrible either.  By 10 she was creeping up to 200-ish, which I corrected.

At 1 a.m., the Dexcom was buzzing.  HIGH.  She was 310 and apparently I'd slept through it's first attempt to alert me.  I got up, confirmed the number, and corrected.

By the time I got back in bed, the wheels were turning.  Was it the site?  Why hadn't I looked at it when she got home?  What else could be going on?  She had some Irish Soda Bread after dinner for which I approximated a carb count, but I can't imagine I was that far off.  We've been changing basal rates overnight and things were starting to even out.  What was with this number?

For some sleep-muddled reason I chose to wait out the correction and see what would happen.

Forty-five minutes later, she was higher with a diagonal arrow up.  I un-snuggled her from her covers and unceremoniously peeled back her pajamas to take a look.

"Ick" is the G rated version of the mumbling which ensued.

I gathered the super-sized flashlight and the site change supplies.  I woke her (which is her preference...I know of people who simply proceed with site changes while their kids sleep).

"You're super-high, sweetie.  I need to put in a new site.  I'm sorry I had to wake you up."

"(Unintelligible mumbles) I'd rather get up and do it.  You can just turn on the light," she said in a disgusted yet somewhat understanding voice.

I got the new site in and operational as quickly as I could and tucked her back in with a kiss.

Now, how to do the "math" to lower the blood sugar?  I'd corrected this number once, but nothing had happened.  The pump now suggested only a small amount of correction because so much insulin was on board.  Some of that insulin had probably been delivered, but certainly not all.  She'd likely missed some basal insulin too from the gunky infusion set.  I looked at the suggested dose and compared it to the total dose the pump told me it would take to drop her back to her target blood sugar. I picked a number in between and pressed 'o.k.'

An hour later, I was still awake but happy to see her blood sugar slowly trending down.  At 3:30, Dexi roused me from my dozing.  "FALLING," she said.  The actual blood sugar was still in the low 200's, but insulin was infusing and doing it's job.  I finally fell asleep.

The story has a happy ending.  Her blood sugar at breakfast was 120.  Now for another cup of coffee.

A Mystery Story

The phone rang.

'School' read out on the caller ID.

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

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

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

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

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

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

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

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

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

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

Home:  290

Personal Nurse's Office:  260

Purse:  266

Nurse's spare:  254

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

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

An Unlikely Outcome

After a long day of cooking, cleaning and yard work in preparation for hosting Easter dinner, we were grateful to adjourn to a local family-friendly Irish pub for dinner.  My daughter knew what she wanted before we walked in the doors.  'Remember how good their fish and chips is?  I'm getting that.' 

I was pretty sure she hadn't come close to finishing the plate the last time we went, so I delivered insulin for 40 carbs to start and waited to see what she would eat.  My estimate was 12 per fillet and 2 per fry with a few carbs thrown in for good measure.  I figured the 40g to be about half her plate, and knew giving some of the insulin a head start could only help the cause later on.

I guess the combination of cleaning her room, helping me cook, and softball batting practice built up quite an appetite.  Before I knew it her plate was almost clean. 

I bolused for another 40 carbs despite her sharing 2 or 3 of her last fries and a small piece of fish. 

It's extremely rare that she eats more than 50 carbs per meal.  Consuming 80 is almost unheard of.  When there is fat involved, I usually actively discourage it.  No matter which 'tricks' we try to contain it, her blood sugar inevitably objects.  In the back of my mind, I worried what those blood sugar numbers would look like later, but after a long day I was just happy to sit and relax over my own meal and let her enjoy hers.

As she set out her Easter basket to be filled, her post-dinner blood sugar was 234.  I figured that to be only the beginning.  Yet that correction brought her quickly down to 175 an hour later.  By 2 a.m., the meter read 133.  At 7 a.m.?  93.

This story contains no advice.  My daughter consumed a significant amount of fried food while I haphazardly guessed the carbohydrate content.  I used no temp basals, combo boluses or other diabetes tricks of the trade to yield this result.   I can almost guarantee you that next time she orders the same entree the blood sugar results will be wildly different.

All I can figure is that in recognition of our hard work and the occasion of Easter weekend, the diabetes gods chose to smile on us Saturday night.  On a day when you most need it, I hope they are similarly gracious to you.

Insanity 2

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

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

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

What did I think she should do?

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

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

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

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

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

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.

The Sleepover

The possibility had been brewing for a while.  A sleepover.  At somebody else's house.  It sounded luxurious and terrifying all at the same time.

At the end of the summer, we made it happen.  As part of a friend's birthday weekend, she wanted my daughter to stay overnight at her house.  Could she?  A few factors made us say yes.

1. Of all of my daughter's friends, this one lives closest: one block away.  In case of emergency, we could be there in a flash.  And in terms of every-kid issues, cold feet at bedtime would require only a very quick trip to retrieve her.

2. We've known this family since long before my daughter was born.  They know her well.  She's comfortable in their home. They know the questions to ask before she visits for a meal.  They're comfortable with her diabetes routine.  They wouldn't hesitate to call us at any time for any concern.

3. We'd been thinking about this possibility for a long time.  By 5th grade, most kids have slept over at somebody's house.  We couldn't hold her off forever.  So I had a game plan in my head which we were able to implement.

How did we do it?

I brought her over at 5:30 and spent 20 minutes in the kitchen going over the dinner, dessert and breakfast menu.  I made copious notes for my daughter on portion sizes and carb counts.  Then I kissed her goodnight.

As is the way of diabetes karma, it had been a day of wild blood sugar numbers.  My game plan was to set her up for a bedtime blood sugar in the high 100's so we wouldn't have to worry about the lack of a 2 a.m. blood sugar check, but at this point we were reduced to troubleshooting. She had strict instructions to text us with each check so we could help her address any more outliers.  Or so we could rest easier knowing things were evening out.

Neither girl was one for staying up until all hours, so at 10:30, I got a text. 'Bedtime.  BG is 110.'  Ordinarily, that would be good news, but with no middle of the night check in the works, I had her consume about 15 carbs before going to sleep.  Not ideal diabetes management, but the alternative of walking a block up the hill at 2 a.m. and breaking an entering seemed less desirable, so it's what we did.

She woke up early, as she tends to do.  I was already wide awake, willing my phone to chime, when she texted me at 6:45.  Her blood sugar was 180, and she was reading her book until her friend woke up.  She was o.k.

The luxurious parts of the night were fun. My husband and I enjoyed a leisurely dinner, with wine we'd been saving for a special occasion. It was a gorgeous night to sit in the back yard. It felt very strange to be left home alone. But it was a long night, hard to completely enjoy with a cell phone clenched in one hand at all times. I can't say I slept well. Once I heard from her in the morning, I was able to relax a little to enjoy my coffee and newspaper in peace.

My daughter had a great time, and wants to sleep at other friends' houses now. The second sleepover is coming up in a couple of weeks, at another old and trusted friend's. I'm the weird mom who hopes they stay up late.  I'd love a text of a perfect midnight blood sugar.  Sleep would come easier then.

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.

Rolling the Dice

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

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

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

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

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

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

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

"Ninety-eight."

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

"NINETY-EIGHT, MOMMY."

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