Slowly but Surely

Our household diabetes policy (yours may vary) has been for my daughter to take on diabetes responsibilities as she feels ready. The understanding has been that while we do not expect to live in her college dorm with her, she should not feel rushed. Every diabetes task will ultimately be hers, for the foreseeable future.  For now, we're here to help.

Slowly but surely over the past sixteen years, one or two things at a time, my daughter has taken over her own care: blood sugar checks, carb counting, then insulin pump site changes, and so many more in between.

The Dexcom was at the center of the two lingering exceptions.

Because of the awkwardness of the G4's insertion device, I continued to assist with putting in a new sensor every 7 or so days. She did it once, to prove to herself that she could in case it failed while she was traveling without me, but it was super-awkward and I was happy to keep helping. The insertion device for the G6 is a much easier to handle one-handed push-button device. My daughter inserted the first and second ones with no problem. It's easy and nearly painless, she reports, though the spring-loaded insertion contraption is alarmingly loud.

The second area of responsibility we've recently relinquished (to some extent) is overnight diabetes care. Until the G6 arrived, the Dexcom receiver remained on a parent's bedside table each night. We got up to deal with its alarms while my daughter slept, or roused herself briefly for juice. That routine, of course, followed years of setting 2 a.m. alarms for fingerstick checks.

The new plan is that my daughter keeps her phone, and the Dexcom receiver, on her bedside so that she can awaken to deal with the alarms. She started with just the phone, but the Dexcom app alarms were not loud enough to consistently wake her (though they woke both of her parents in the next room). She's added the receiver, which she keeps on the bed with her to feel its vibrations, and so that two alarms are blaring at once. She still does not consistently wake to the alarms, while I, of course, still do. But things are improving. She did wake up and treat a low this week without my hearing anything, which was good news. And the alarms are diminishing after the Thanksgiving leftovers are gone, and as we use the Dexcom data to work on keeping numbers more consistently in range...which is the ultimate goal.

It's bittersweet to watch my kid take on these responsibilities. Yes- by all rights they're hers to deal with and it's important for her to practice with the safety net of mom and dad around to help. But how I wish she didn't have to.

After Midnight

"Mom?"

"Mom?"  My eyes must have opened slightly, or I mumbled something.

"Something's wrong with my pump."

And then I was awake.

"It was beeping when it woke me up … booEEp, booEEp … but now it's dead. Nothing happens when I push the buttons. And it's hot."

It was the wee hours of the morning. We were on vacation in a cottage near the beach.

"Ok- let's see."

I got up and followed her back to her little room where we turned on a light and set to work.

Hoping the simplest explanation was the right one, I took out the battery, using a coin from the pile on her bedside table set aside for an expedition to the penny candy store. The battery was hot.

I inserted a new battery and screwed the cap back on. I prayed, thought good thoughts, and implored the diabetes gods for mercy. The pump would spring back to life. We would not, in the middle of the night, on vacation, have to go back to injecting insulin for the first time in 13 years.

Time stood still for an infinite moment and then, there it was, the familiar alien-like startup beep of the Animas pump. I confirmed, when prompted, the battery type, and the date and time, which were reassuringly still correct. Then, as the pump requires with every battery replacement, I set in motion a full rewind of the cartridge area. Knowing that the full rewind also signals the pump to perform a full system check I once again sent out pleas to the universe that a pump failure would not, please, be among our vacation memories.

The motor whirred. And whirred. And whirred. And then...

"beep!" Just the usual, friendly little 'I'm ready,' beep. I finished the process and my daughter reconnected.

Still more than a little freaked out, and now wide awake, I photographed every pump setting, not sure if my most recent records were recent enough. I tucked my daughter in and returned to bed where I lay; not at all optimistic that the crisis had actually been averted. I considered all of the options for obtaining a replacement pump if need be. I sorted out what I could remember about multiple daily injections. I tried to figure out what had happened in the first place. I got up twice to make sure her blood sugar was staying steady- that the pump was still working correctly.

In the light of day, with the pump working properly again, the explanation seemed fairly logical. The hot battery was familiar from times we've changed it after the 'I'm going to die in half an hour or less' warning. The initial low battery warning, indicating a couple of days' power remaining, had been visible on the pump for at least most of that day, my daughter said, and she'd planned to change it during the next day's site change.  But it's possible it had been there longer, since we were in vacation mode and, as is our custom, paying less attention to diabetes than usual while enjoying vacation things. Or maybe the battery died a little faster than usual with all the extra use for vacation food. Maybe the pump alarmed for the full half an hour foretelling its imminent demise, and simply didn't wake my daughter from her vacation-induced deep slumber - we'd been out late and came home tired.

All that really matters is that the new battery continues to work just fine, a couple of weeks later, and we were able to enjoy the rest of our vacation.

A Long Night

It's 10 p.m. The teenager has been home for an hour from band practice. She has showered and is thinking about going to bed. She checks her blood sugar in order to calibrate the Dexcom.

"WHAT?!?!"

The parents watch warily from the couch while the teenager gets another test strip and rechecks her bg.

"WHAT IS GOING ON??? HOW IS THAT POSSIBLE??? HOW DID THAT HAPPEN???"

The teenager is distraught.

"Mom...can you help me do a site change so it goes faster? APPARENTLY I'M 485."

The mother rises wearily from the sofa, her plans for quiet time with her book followed by a good night's sleep dashed. She fetches a large glass of water for the daughter, in hopes of keeping ketones at bay.

"Yup. Drink this first. What happened do you think?"

"I DON'T KNOW!!!"

The teenager is grumpy, irrational and teary. Probably because of the blood sugar of 485. She gathers herself for a moment.

"I don't know... I was fine at dinner - 130 something. I don't remember Dexi alarming at band but it must have. It alarmed again a little while ago. But not that high. It's been iffy all day- it's like 10 days old - but I didn't know it was that far off and now I'm really high and I don't know WHY!"

The mother and teenager go off to the teenager's room to change the site. The chain of events leading up to the current situation is reviewed.

"I bolused dinner - I'm sure..." opens the pump's memory and double-checks "yup- and it wasn't a lot of carbs and you used the measuring cup. And then I just went UP! And I didn't eat anything at band- I just drank my water and I never had anything when I got home and now I'm SO HIGH FOR NO REASON."

When the site is removed the cannula is gunky, clearly clogged up. The mother thinks out loud.

"I don't think, in 13 years of pumping, you've had a pump site conk out that quickly. Usually they take a gradual turn for the worse, but this one seems to have suddenly and completely stopped working. That's the only logical explanation to go from 130 to almost 500 in 4 hours."

The teenager curls up on her bed, nursing her second pint of water. She is clearly miserable. She complains of a headache.

"... not just in one spot but like...my whole head...it just hurts...it's awful."

The mother initiates calming conversation … a friend's new puppy, a funny story someone posted on Facebook. Eventually, it's been 30 minutes since a correction dose of insulin was given. The teenager rechecks and is now just barely over 400. She gets up to brush her teeth and finish preparing for bed. The Dexcom alarms... FALLING! … and hope increases that the correction dose will work.

The teenager goes to bed. The mother gets to read her book, but for much longer than she'd intended, staying up until 12:30 a.m., when the blood sugar has dropped to 230-something.

The mother is awakened at 2 a.m. by the Dexcom alarm (which is now, incidentally, spot-on again) and gives the teenager some juice for a bg of 76.

The father gets up at 3:45 to give more juice for a bg of 68.

The family gets up in the morning. The teenager has a bg of 77. They are all tired. They are all grateful for the discovery of insulin. But moreso now for the discovery of caffeine. .

Apparition

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

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

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

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

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

"Okay...  Let's go."

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

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

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

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

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

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

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.

Sleepover Dilemma

Sleepovers at friends' houses always pose dilemmas: uncertain menus, late night activity, relying on the Dexom for alerts of overnight issues,  heavy breakfasts, and more; but this weekend was the first time I found myself in a quandary right here at home.

Home game sleepovers aren't completely uneventful, diabetes-wise.  We've had to check blood sugars at 2 or 3 a.m. with another child in the room, and even had to give juice or corrections.  To my knowledge the friend I desperately try not to step on as she dreams in her sleeping bag has never woken up.  Snacks and bedtime involve a more structured routine than most of our guests are used to but they are, of course, kind and flexible as any good friends would be.

Sunday morning presented a new quandary though.  I woke up at 7, and my daughter and her friend were, as expected, still silent in my daughter's room.  The Dexcom read 80, straight across.  At 7:30 it read 76 straight across and it was still very quiet in the house.  At 8, it alarmed:  69.  Here's my thought process:

At 2 a.m., the friend would certainly sleep through my barging in, but at 8 a.m., chances are good I'm going to wake her up.  I don't want to do that.  The sensor is only a day or two old and it seems to have been running a little low since we revved it up.  It's probably just still a little bit off.  And with the margin of error on all blood sugar readings if  I wasn't running in there at 76, how different is 69, really? But, of course, what if it's off in the other direction and she's really 50 and I don't do anything about it? If she's 50, that's bordering on dangerous.  But maybe it'll go back up.

By the time I'd hemmed and hawed over all of this, it was 8:20 and the Dexcom alarmed again:  under 50.  It buzzed four times since we had it set to vibrate first, then to beep if the vibration went unacknowledged.  Now at this point, I'd been listening very intently, hoping for any sounds of life from the bedroom.  I was pretty sure I'd heard my daughter moving around in her bed (there's a squeaky spring). So I put Dexi in the bathroom, on a shelf which backs up to the head of my daughter's bed.  A minute or two later it blared, "beep beep beep beep!" 

At which point I heard her get up, grab her meter and check, and get back into bed.  It was still quiet.  The rattles, clicks and beeps of the blood sugar check hadn't woken her friend.

Within 10 minutes, the line on the Dexcom graph started going back up.  My daughter's friend woke up a few minutes before 9, and they came out for breakfast soon thereafter.

"I guess you corrected when Dexi alarmed at 8:20?"

"No- I was 88.  I just got back into bed."

Should I have acted sooner?  Probably.  A severe low blood sugar emergency would have been worse for the friend to wake to than me creeping around her air mattress.  But am I  glad I didn't wake her up for nothing?  I am.  What would others have done in my shoes (or slippers)?  I'd love to know.

From The "It Gets Easier" Files: Sleepover

My daughter came home Friday with a request.  She'd been invited to sleep over at a friend's house that night.  Could she go?

The first sleepover terrified me.

A few subsequent ones caused significant anxiety and loss of sleep.

There was one for which we had to say no.

But this one felt surprisingly easy.

It was at the home of her oldest friend, at whose house she's slept several times before.

It's just a few blocks from our house.

The mom would never hesitate to call me about anything.

She'd eat dinner at home first and then go.

The house is always stocked with plenty of pre-packaged snack choices with their easy to use nutrition labels.  Since sleepovers and snacks go hand in hand, I'll take well-labeled junk food any day.

She'd have Dexi with her, which wasn't the case at the earliest sleepovers.

So aside from considering the next day's plans and the potential ramifications of sleepover-related lack of sleep, there wasn't much to think about.

"Yes. You can go." was an easy reply.

She checked on the way to her friend's house.  She texted me at 11 with a 'bedtime' number.  She texted me when she woke up at 7:30, and at before breakfast with a carb counting question.

The half an hour or so before 11 when I was struggling to keep my eyes open until her goodnight text was long.  The 45 minutes I was awake waiting for her good morning text was longer. Overall though, it truly felt like no big deal.

Would I still say no to an overnight 2 hours away?  Probably.  But small steps are being made for both of us, and that's a good thing.

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.

Dexi Sings Queen

Saturday night went a little like Queen's song, 'Bohemian Rhapsody.'

My daughter's Dexcom, 'Dexi,' buzzed around 1 a.m.

Caught in a landslide
No escape from reality
Open your eyes
Look up {to the skies} and see

I squinted at Dexi's message:

"LOW"  How low?  I clicked to see the estimate.  "67."

I shuffled off to my daugher's room.

Flashlight, meter, test strip, lancet.  "207."  Huh?

Is this the real life?
Is this just fantasy?

Back I went to grab Dexi from my bedside table so I could set her straight.  I informed her of the meter reading, and she asked for another.  Once I'd put that in, the graph showed a reasonable '193.'

As I started do doze off again, the buzzing resumed.  "HIGH"  "275."  Unconvinced, I checked anyway.  I informed Dexi both through her computer buttons and verbally with a few choice words, that "170" was the number she should be aware of.  An apology would have been nice.  Something like

Mama, ooo
Didn't mean to make you cry.

No apology was forthcoming, but she did get herself straightened out by morning, having overcome her night of ambivalence.

A little high, little low
Anyway the wind blows, doesn't really matter to me...to me.

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.

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.

Stealthy

This article appeared in our local paper a week or so ago.  From the Associated Press, it describes Medtronic's 'smart pump' research, with its automatic shut off for low blood sugar.  While a furrowed brow is usually the end result of my reading diabetes articles in the popular press, this one seemed fairly well fact-checked. 

What caught my attention was this sentence related to fear of overnight hypoglycemia:

Parents of children with diabetes often worry so much about this that they sneak into their bedrooms at night to check their child's blood-sugar monitor.

I clearly need to change my modus operandi for 2 a.m. checks. 

My current method involves stepping on several squeaky floorboards on the way in.  I turn on the flashlight.  About half the time I manage not to shine it right in her face.  When I put a strip in the meter, it beeps.  I stab her finger, then squeeze it, sometimes pretty hard, to get blood on the test strip.  The meter beeps again.  A couple of times a month, I have to wake her up to give her juice.  I can't say I never drop something on the floor sometime during the process.

With a CGM midnight finger pricks aren't always necessary, but beeping and waking for juice are still standard parts of the picture.

Clearly I'm doing it all wrong.  I need to get myself a black ski-mask and memorize the squeaky floorboards.  I'll also need a 'diabetes device silencer,' but I'm not sure I have the black market connections to make that happen.  The outstanding question is how to sneakily give a sleeping child juice...

Thoughts From The Middle Of The Night

ALTERNATE TITLE:  MY NEW BIRD LISTENING HOBBY

2 a.m. on a night in May:

Alarm.

Wow...it's really hot in here.

Is it still raining?

I'll crack the window before I go check her.

Do I hear birds?

Flashlight, meter, lancet, where are the test strips...here they are.

Wow...it's hot in here too.

Ugh.  302???   New pasta brand?  The heat?  Please don't be getting sick.  Correct.

I'll crack her window too.

I need to reset my alarm and make sure she goes down.

Those birds are really loud.  What are they doing up at 2 a.m.?  I think I hear more than one kind.  Maybe there's an owl.

I can't fall back to sleep.  Those birds are noisy.  Are there some kind of nocturnal birds?  I don't remember ever hearing about that.  Or is it just somehow close enough to day that they're getting up?

It's been 45 minutes...I guess I'll just go check again.  230 with plenty on board.  Good enough for me.  Her room feels much cooler.  Why isn't mine cooling off?  I'll shut off the alarm.

Owl calls.  I know I've heard them, but I can't be sure any of these are owls.  Maybe I'll have learn more about owls...

In the light of day, I decided to find out more about night singers.  Audobon informs me that mockingbirds sing at night during mating season.  They're also known for mimicking a variety of bird sounds as well as other noises, so that would account for the diversity in last night's concert program.   I continued on to listen to some owl calls here but I can't be sure.  We do have a patch of woods within a block of our house, and from local nature center visits and a recent family birding walk, I know there are owls in the area.  Working on my owl identification skills will lend new excitement to 2 a.m. blood sugar checks.   It's good to have things to look forward to.

Haiku

Night 

Quiet.  Floor boards creak.
Meter.  Flashlight.  Lancet.  Blood.
Low. Drowsy juice. Kiss.







This year Diabetes Art moves up from the Wildcard choices as we all channel our creativity with art in the broadest sense. Do some “traditional” art like drawing, painting, collage or any other craft you enjoy. Or look to the literary arts and perhaps write a d-poem or share and discuss a favorite quote. Groove to some musical arts by sharing a song that inspires you diabetes-wise, reworking some song lyrics with a d-twist, or even writing your own song. Don’t forget dramatic arts too, perhaps you can create a diabetes reality show or play. These are just a starting point today – there are no right or wrong ways to get creative!

Wild Animal Kingdom Wildcard

What is the ideal diabetes service animal? Think beyond the obvious and be creative in explaining why your choice is a good one. For example, maybe a seal would make a good service animal - it flaps its flippers and barks every time you get a good blood sugar reading!

Hoppy would make an excellent service animal.

He's my daughter's stuffed rabbit.  She has fallen asleep with Hoppy in her arms every night of her life.  As she sees it, Hoppy is a nocturnal rabbit who stays up all night watching over her while she sleeps. 

What could be better than to train Hoppy and his many peers as diabetes service animals?

Imagine the training class.  An educator is surrounded by a circle of teddy bears, stuffed dogs, cats, cows, and frogs.  Perhaps there's an American Girl Doll, or a Barbie.  They spend time discussing signs and symptoms of hypoglycemia in the children they love. They're all schooled in glucometer use, parameters for treatment of high and low blood sugars and how to administer glucagon.

Who could be more suitable for this job?  Except for the rare time he's accidentally thrown on the floor, Hoppy is at my daughter's side all night.  His primary purpose in life is to look out for her while she sleeps.  He has a tough job already, don't get me wrong.  He's responsible for soothing the anxieties of a middle-schooler after a long day.  Further back in his job description, he's been in charge of closet monsters, bad dreams, thunderstorms, the dark, and a myriad of other concerns.

Yet as a best-loved toy, his dedication to his owner knows no bounds.  It's time to set up some training sessions for Hoppy and his peers.

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.