Roll Over Beethoven

I heard it from across the crowded room. The unmistakable melody. A terrible electronic version of 'Fur Elise' was coming from my daughter's insulin pump. What, I often wonder, would Beethoven think?

Eye contact confirmed that this wasn't a simple 'Bolus cancelled by user button push' or 'Unable to communicate with pump' Animas Ping alarm. My kid looked both concerned and irritated. I made my way through a few conversation groups.

'I forgot to do a site change before we came. I'm out of insulin. It gave all it was supposed to give to cover what's on my plate but now I'm out.'

We were really enjoying this party. I was reveling in the opportunity to hold an adorable baby whose mom needed a civilized plate of food and adult conversation. My daughter was enjoying helping the little ones at the cookie decorating table. We were having great conversations with friends both new and old. To add atmosphere, it had just begun to snow. This particular festive gathering was exactly what we needed after a whirlwind weekend of holiday shopping and preparations.

We were not, I decided, going to let diabetes win the afternoon. My daughter ate a little less than she'd bolused for, to provide a cushion. We kept an eye on her numbers. She held steady for almost an hour, then her blood sugar started to creep up very slowly. We considered leaving then, but I had to return the baby, and then on the way to get our coats we found other people we wanted to talk to. The rise became more significant about twenty minutes later, and we started our round of goodbyes. But considering the homework that still needed to be done and the football that needed to be watched we wouldn't have stayed much longer no matter the diabetes circumstances.

We got home, replaced the insulin and the site, and bolused for an hour and a half worth of missed basal insulin in addition to the suggested correction for her blood sugar at the time (about 220...not bad at all). The rest of the night was uneventful blood sugar wise.

There were few minor downsides: I needed to heat up some leftovers since she had stopped eating anything but raw vegetables once she ran out of insulin. She missed out on a great spice cake. And the electronic Beethoven theme repeated itself every few minutes- but I'm guessing it probably wasn't audible to anyone but us over the music and conversation.

Looking back, I'm glad we didn't panic. There was no need to. She disconnects her pump at the pool for an hour at a time all summer. At the beach it's often longer. We do the same thing we did last night: make up the insulin once she's hooked back up to the pump. Ideal? No. Medical advice? Absolutely not. But sometimes it's more important not to let diabetes ruin a good time.

Impressive

“You should probably check before you go to bed.”  It was late and every second before climbing under the covers felt like an eternity but it seemed smart to head off any problems before we slept.

“191.”

“Not bad- do what it takes.”

“It says to give .5.”

“Go for it.”

We relied on the Dexcom for updates, in lieu of setting an alarm, and Dexi slept through the night.  Morning blood sugar was around 140.

I realized days later that I had said nothing else to my daughter about any of this.  On a normal day, these were okay numbers, nothing to celebrate, nothing to panic about.  On this day they were impressive, and I forgot to be impressed.

These numbers came after our annual Christmas open house. The buffet table included chicken fingers, egg rolls, mini hot dogs, teriyaki meatballs, three or four kinds of chips and crackers with assorted dips and salsas, raw veggies and fruit, and at least five desserts.  My daughter visited this spread several times, and I think she sampled all but one of the desserts.

We’ve been hosting the same party every year since Kindergarten, inviting families back to our home after Santa lights our town's tree.  For the first couple of years, I made my daughter a plate and bolused her for it before sending her off to eat with her friends.  We'd do round two of this routine when the cookies were served.  By third grade or so, she graduated to making her own plate but she still needed to have me calculate the carbs.  Last year was a mixture of her bolusing for the foods she knew (ritz crackers, my homemade cookies, grapes, the egg rolls from Costco) and needing to ask for help with the more complicated items.  This year, for the first time, she was completely in charge of her own carb counting.  This was amazing for two reasons:  first, I got to focus on being hostess and spend more time socializing with our guests, and second, the end results were much better than usual blood-sugar-wise.


It makes sense, really.  Who better to keep track of the carb intake than the person putting the food in her mouth?  Who better to dose the insulin than the person watching the Dexcom graph while she dances around the basement to Christmas music?  Reaching the point where we're both comfortable with her managing her diabetes in these types of situations is a huge plus for both of us.  Especially if she does so as successfully as she did the other night.  It was impressive.

I'll have to remember to tell her so.
 

What Did I Miss?

Today, we'll look back 2 years to a pool party for all girl scouts from our area.  As troop leader, I was there, in charge of feeding and keeping track of my group of fifth grade girls. 

This was our first pool visit of the season.  My daughter disconnected her pump and got in with her friends.  They then got out and opened a couple of bags of chips.  "Can I?"  "Just a few."  We'd delivered  a correction bolus for a 200-ish number on the way to the pool.  With the exercise, I figured a couple of chips couldn't be too bad.  Plus, to be honest, it seemed like such a 'normal kid' thing to sit on a circle on beach towels with your 11 year old friends, talking, braiding each other's hair, and muching on chips.

After another swim, the pizza arrived.  I did (to my credit) remind her to plug her pump back in and check.  230.  I juggled the meter-remote, paper plates for all the girls, opening the grapes and watermelon, pointing out the drink cooler and providing napkins.  I bolused for pizza and watermelon.  I might have added the bg.

She ate, unplugged, and headed for the water slide.  An hour later they came back for dessert.  A cupcake and 2 mini girl scout cookies.  She was already partway through the cupcake when I realized she hadn't checked again.  She was reading the box for the cookies (reclaiming a bit of good will).  "4 each, mom."  I had made the cupcakes, so had a number in my head for those.  Still juggling dessert requests and napkins, I bolused.   I glanced over.  She had no pump attached.  She plugged in and we bolused again.

Half an hour later, she found me talking with a mom on the other side of the pool.  A friend's sister's troop and given our troop mini fire cracker pops.  Could she eat hers (which she was holding, open, in her hand)?  From the cobwebs of my brain came the knowledge that these were 'only' 9 carbs.  I gave the o.k.  She was standing there with her friends, on the way to the shuffleboard court.  She bolused for it when she got back to the table.

Once we'd packed up and gotten in the car, her blood sugar was around the 250 mark.  She corrected and had some water when she got home.  An hour later, still 250.   Obviously, the whole evening was riddled with diabetes mis-steps.  Chips with no insulin (probably more than a few), not accounting for missed insulin in the pool, a dinner diet of pizza, chips, watermelon, cupcakes, cookies and popsicles. Everything was bolused for on the fly, often after the food was partially consumed.

Yet, you diabetes detectives out there, there's one more big reason that high number didn't come down. 

Anybody guess it?

I had bolused for dessert while the pump was detached.  Then again when it was.  The pump included all of that insulin in the insulin on board total.  So when we went to correct the 250 after the party, it gave very little, assuming a whole extra cupcake and 2 cookie's worth of insulin was still hanging around.

Any 'party by the pool' event is a challenge, diabetes-wise.  The level of difficulty rises exponentially if I'm in charge of more people than my own kid.  In the end, it was a fun evening and the 250 came down quickly once I'd realized the error of my ways.  But keeping track of diabetes at this kind of event is a full-time job.

Birthday Day and Other Heavy Eating Occasions

My daughter's friend had a birthday last week.  It was on the same day as mine.  The kids have found a way to skirt the school nutrition policy of 'no outside food for celebrations' by bringing in treats to share at lunch. So lunch that day included oreos, hershey kisses, doritos and munchkins.  To her credit, she ate the sandwich and grapes I packed first, but she sampled the rest as well.

For dinner we went to a Thai restaurant and she had an uncountable portion of pineapple fried rice. We came home and had mini cupcakes and cannolis for dessert.

Our household diabetes philosophy (yours may vary) allows sweets, and even junk food.  Birthdays include cake.  S'mores over the fire pit or a trip for italian ice are part of summer fun.  A little bag of chips for the walk home is o.k.  Most days include cookies or a non-dairy frozen treat before bed. Taken one at a time, or even two in one day, we're o.k. with both the questionable nutrition of it and with the diabetes challenges.

'Everything in moderation' is the general idea. But on days when moderation goes out the window, I'm left feeling torn.  Should we ever let her eat this way?

"Yes!  You can eat anything except poison...or cookies made with poison..." is one side of the coin. But she really can't eat anything and maintain the same kind of blood sugar numbers she does when she eats healthy, countable things.  Twenty carbs of oreos and doritos is not the same as twenty grapes. Half a restaurant portion of pineapple fried rice and a bakery cupcake simply can't be counted and dosed for as accurately as portions prepared, weighed and measured at home. Add the 'one more dorito because everyone else is still eating,' or the picking all the pineapple out of the fried rice despite bringing home 'half,' and the challenge increases.

Still, I lean towards letting her learn from her mistakes over outright forbidding her from eating like this. She'll encounter days with heavy eating potential for the rest of her life, so perhaps helping her develop a healthy sense of how to handle them is the answer.  Last week's birthday day was an example of how not to handle it.  And she knew it.  She was upset that her blood sugar was high for hours.  Between that lengthy high and the general junk food overload, she had some lingering indigestion into the next day.

Sometimes she makes better choices.  Last weekend, she said no to lunch out with a friend before an evening birthday party because it would consist of too much uncountable food in one day.  She's come home from parties and told us she was the only one who ate the proffered grapes or salad to balance out the junk. She will report with alarm how many cookies or cupcakes some kids consume in one sitting.

I guess it's like all things diabetes, really.  We do our best.  We try to fit the diabetes stuff into what we consider a normal, healthy lifestyle.  We try not to let it ruin our fun.  We learn from our mistakes.  And we're never quite sure we're doing it right.

Today's Menu

Breakfast

              

This is one of our protein-containing, 5+ grams of fiber cereal choices which somewhat diminish the post-breakfast blood sugar spike.  

More excitingly, I bought a whole pint (well, several pints actually) of blueberries for less than one million dollars this week!!!

Lunch

Sunflower butter to protect her peanut-free friends at lunch, with great grandma's homemade spiced pear jam, which she makes special with less sugar just for my daughter.  With an occasional substitution of pretzels or sun chips, this is lunch every day.   

Snack

Snack varies every day.  Sometimes it's more substantial, like a smoothie or peanut butter crackers.  But today she's saving room for Grandpa's birthday dinner.

Dinner

I'll smash up half a sleeve of townhouse (ritz, etc. are all fine) and mix them with 3-4 tbs. of melted butter.  I might remember to squeeze in some lemon juice and add some pepper.  The fish goes in a greased (or better yet, buttered) glass baking dish.  The cracker mixture is spread on top.  Bake at 400 for 10-15 min. until it's flaky.  Yum!

We've nicknamed this rice blend 'crazy rice,' at our house.  It's got tons of flavor and a variety of textures.  Much more fun than regular brown rice.

Grandpa's Birthday Cake

I know- all kinds of problems with this.  Its's processed beyond belief.  It contains artificial everything.  The glycemic index is off the charts.

But it's Grandpa's favorite, and a family tradition.  So we'll indulge!

Food is one of my favorite topics to read, think and talk about.  So I, for one, am looking forward to reading the rest of today's Diabetes Blog Week posts which can be found HERE!

We Had To Say No

"You can do anything other kids can.  Diabetes can't stop you."  For the past 11 years, there have been very few exceptions to that rule.  This time, though, we had to say no.

My daughter was invited to a birthday celebration, overnight, at a friend's vacation home two hours from here.  This (very brave) family invited eight or nine girls to come celebrate.

Let me begin by saying how happy I am that she was invited.  I'm always incredibly grateful when no assumptions are made by other people about when and where diabetes becomes an obstacle. No matter how difficult the ensuing conversation was, I love that my daughter was included.

I thought carefully about this invitation before telling my daughter about it, weighing how to approach the conversation.  In the end, I let her read the invite, and respond however she chose to.

"That sounds so fun.  I don't think I can do it, though.  I wish you could come too. But that might be weird."

"I wish I could too, but even if it wasn't weird, Daddy and I set aside that Saturday for {insert awful activity daughter would love to have an excuse to get out of here}. I'm really sorry."

As I said, I considered the possibility carefully. Maybe she could do it.  She could text me pictures of the food.  She'd be wearing the Dexcom.  She's responsible.  She's 12!  Then came the what-ifs, and they were plentiful.   What if the pump site failed?  What if the Dexcom conked out?  What if she forgot to check often or missed the Dexcom alarms since she was having so much fun?  What if she needed glucagon?  What if she ate more or less or differently than what we agreed on?  What if she forgot to plan ahead for activities involving exercise? What if her low blood sugar symptoms got lost in the chaos of a crowd of partying tween girls? I would be 2 hours away, a 4 hour round trip.  For over 24 hours. She's only 12!

The birthday girl and her family are great people. But while our families have spent time together, my daughter hasn't spent time alone with them. There would be a big learning curve, diabetes-wise.  A party at their house a few blocks away?  Absolutely.  Two hours away?  As much as she wanted to go, even my daughter knew this was impossible.

We talked at length about all of this.  It precipitated a conversation about when something like this might be possible.  We came up with a list of things to work on.  They include being able to do her own site change, knowing how to give a shot if she needs to, becoming more proficient at and confident in counting her own carbs, actively planning for periods of exercise, and consistently responding to alerts on her Dexcom.

My daughter finds this list overwhelming.  Understandably.  But then we looked back.

"Three years ago, did you ever think you could go to a sleepover party?"

"No."

"And now you've been to a few.  Did you think you'd be able to go to things like the school social or a movie and pizza birthday party without me there to help you with your diabetes stuff?"

"No."

"Six years ago, I came and stayed with you at almost every playdate.  Look at all you've learned to do. You'll figure it out, when you're ready.  Soon enough, something like this will be no problem.  And until then we're here to help you as much as you need."

The conversation continued with a tirade about the awfulness of diabetes, a few tears, and the promise of finding a few minutes of fun amidst the aforementioned boringness of the weekend in question.

In the end, I think we made the only decision we could.  We had to say no. I wish it were otherwise.

Helicopter Parenting

I'm one of those parents.

I'm the last one to leave the birthday party and the first one back. If I leave at all. 

If parents are allowed on the field trip, I'm signed up.

I'm on the sidelines of every softball game from pre-game practice 'til the end and I insist on stopping by the bench at least once during the game to check in.

I hunt her down at the town pool to ask her if she's o.k.

She must text me when she starts walking home from school.  If she's not home in less than 20 minutes, I'm headed up the street to look for her.

During school dances, I like to plan an outing with my husband or a friend at a restaurant across the parking lot from the entrance to the gym.

If she's somewhere without me, I'm constantly texting to check in.

I watch her while she sleeps.

People judge those parents.  (Actually, people judge just about every kind of parent but that's a topic for another day.)  'Their kids will never gain any independence.'  'Their kids will be wishy-washy'  'Their kids will have no sense of self.'

For the judgers out there, two things to consider:

First the obvious, based on the theme of this blog.  You may not know why a parent is hanging around the roller skating party or watching their child like a hawk on the museum field trip.  This disease is unpredictable, and when put in unusual situations like the ones I've described, my daughter is very likely to have issues with her blood sugar for which she needs a trained adult's help.  I hover because there's a real and ever-present risk, beyond what you can see, to my child's safety.

Second, the interesting part.  The same words have come up at every teacher conference since preschool. My daughter is described as responsible, self-aware, and self-confident.  How did this happen with me hanging over her for her entire life?  I can't say for sure but I try to strike a balance when I can. When it's safe, I encourage independence.  She walks home from school with a friend and her cell phone.  She's been using a paring knife since she was 8.  She attends sedentary birthday parties with uncomplicated food by herself.

When I feel, for her safety, that I must hover I try to be as invisible as possible.  I don't roller skate with her (to be fair, there's more than one reason for this decision). I stand back while she hangs with her friends on the field trip. I'm at the umbrella table with the best view of the pool, but I'm usually reading my book.  She knows that I'm there to help her with diabetes, not to be incessantly involved in the minutia of her life.

I often wonder if I'd be one of those parents if it weren't for diabetes.  It's impossible, of course, to know. I've been hovering over her since before she could walk.  It will get harder as she gets older, and I'm grateful for today's technology which makes hovering from a distance much easier.  Hopefully I'll continue to be able to strike the balance between being available to help and letting her spread her wings.

Sometimes We Forget

One highlight of last weekend's 12th birthday celebration was a day out with two of my daughter's best friends.  I took them to lunch, then a to pottery painting place. The party ended at our house with presents and brownies.

She checked her blood sugar as usual before her huge plate of french toast, and we guesstimated carbs as best we could.

We walked half a block over to the pottery place where the girls thoroughly enjoyed painting their own unique pieces.  Almost two hours later we headed home.

Presents were opened.  Happy Birthday was sung and brownies emerged from the kitchen complete with a candle.  The girls enjoyed two apiece with tea or milk.

My daughter was well into her second one, approximately three and a half hours after she tested for lunch, when I realized she hadn't checked since.

At this point, did I:

1. Stop the giggly conversation and send her immediately to wash her hands and check?

or

2. Let her eat her brownie and giggle with her friends, bolusing for the carbs and hoping for the best?

For a couple of reasons I chose 2.

First of all I couldn't bring myself to allow diabetes to break up this birthday moment.  She won't have another 12th birthday but diabetes will be a part of every day for the foreseeable future.

Secondly she appeared to be fine; not lethargic like she was very high and not out of it like she was very low.  I really did think this through, and if looking at the big picture I'd had any cause for concern then I would have called a time-out.

Thirdly (and maybe I'm just rationalizing here) she was well into the second brownie. What information, exactly, were we going to get from this check?  If she was high, would I correct the high and bolus the carbs?  Or would I assume the high was at least partially from the brownies?  If she was lowish, would I take off some of the carbs I would have bolused or assumed the brownies would shoot her back up anyway?

The end result?  Her 90 minutes post-brownie number was 148.

This is obviously not medical advice. We check before eating 99.99% of the time as recommended by every endocrinology team on earth.  We simply got lucky with the end result...a little extra birthday gift, perhaps.

Once I'd realized the mistake, the scene took on a bittersweet tone.  I guess this is how other kids celebrate their birthdays.  There's no awkward pre-cake pause.  No blood is involved.  There's no possibility that the dessert will be downsized due to an astronomical number. Nobody hovers as the candles are blown out to tally carbs and deliver insulin.

It was nice, if only for a moment, to forget.

Performing

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

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

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

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

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

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

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


 

Pizza and Hot Dogs and Ice Cream, Oh My!

It's currently party season in our little neck of the woods.

In the past two weeks there have been exactly three days when my daughter did not eat pizza or ice cream or a hot dog.  With maybe a bagel thrown in for good measure.  Or a piece of cake.

Birthdays, Father's Day, cookouts, end of softball celebrations, end of girl scouts celebrations, end of school celebrations, graduations...it's endless!

These are not diabetes' favorite food groups.  Fat + simple carbs usually = very high blood sugars for my child.  We try some tricks with the pump which sometimes help, but her body would be happier with grilled chicken, a nice salad and some brown rice.

Yet somehow, maybe because she's been going at break-neck speed at all of these events, there have been few blood sugar disasters in this mix.  Perhaps it's a phenomenon similar to the 'vacation mystery' we encounter.  We're being precise and proactive about counting the carbs.  Then she runs around the party they're served at at a much more active pace than usual.  So it somehow balances out.

Once the end of the school year pace slows down, the eating will follow suit.  We'll resume a healthier and more diverse menu with the occasional fun diversions.  Unfortunately when the pizza is combined with a sedentary summer afternoon at home, those unpleasant high blood sugars will once again accompany it.

As always, we'll try our best to keep the high blood sugars at by. But really, I'd do anything at this point for a sedentary afternoon at home!

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.

A Priority

Diabetes care is always a priority in our house.  An even keel of blood sugar numbers results in a happier, more energetic child on a day-to-day basis, and will hopefully lead to a longer and healthier life.  There are some days, though, when good control jumps from 'a priority' to 'the number one priority.'

Take the birthday party of a couple of weeks ago.  Considerable attention and energy was committed to frequent checking, correcting, and careful carbohydrate counting throughout the day leading up to the party.  Starting that evening with a pattern of decent numbers in the book increased the chances of a disaster-free evening.

The same attention is needed this week during the state-wide standardized tests at school.  While, as evidenced by last year's nurse's office work-out, rogue numbers are always a possibility, we're doing our best to keep them at bay. 

This week, great care is being taken in hopes of steady blood sugar through the morning tests.  The breakfast insulin bolus is given before the milk is even poured.  The measuring cups and scale are in use to calculate carbohydrates as accurately as possible.  Protein and fiber are players in the meals to lessen the possibility of big blood sugar spikes.  Mid-morning snack is also carefully counted prior to being packed up for school.

Should this happen every morning?  Of course it should.  Some days, though, a bit of unfinished homework or my own priorities for the morning distract us or limit our time.  The strawberries look like about 8 carbs but don't get measured.  The lure of toast with butter instead of peanut-butter is just too tempting.  The 'did I bolus?' conversation takes place on her way out the door. 

Diabetes drops down on our priority list once in a while.  Sometimes it's on purpose. Faced with the opportunity to eat our way through a vacation or hike a mountain, we enjoy it and do the best we can with the diabetes part.  Sometimes it's inadvertent.  We get distracted by the morning rush to school, or by an unexpected bit of fun and need to pick up the diabetes pieces afterwards.

Making diabetes the first priory all of the time does not seem reasonable.  There are times like this week when it becomes necessary.  There are other times when it's necessary to let go just a little bit.  It needs to remain a priority.  Completely forgotten, it tends to make itself known in very unpleasant ways.  Making it the only priority, though, would be letting it win, and we can't have that.

First Steps

The tickets were purchased in December. Joshua Redman, a favorite jazz artist, would be performing in a small theater half an hour from here.  They were a perfect Christmas gift for my husband.

The birthday invitation arrived a month ago.  The party would be in the private room of a pizza parlor, for a very good friend.  The girls would design t-shirts, eat pizza and enjoy a 'cookie cake.'  At the end, there would be a fashion show of their creations. 

Both big events were scheduled for last Friday night.  Could we pull it off?

The logistics were easy.  We took the front end of the carpool, dropping the girls off before a rare dinner out ahead of the concert.  Grandpa was happy to be asked to be here when my daughter was brought home. 

The diabetes part required a leap of faith.  The only other party my daughter has eaten at without me  involved one unfrosted cupcake for which I calculated the carbs when I dropped her off.  This party required checking before pizza, and bolusing for pizza and dessert. When she got home, she had to check again before bed and independently make a decision about what to do with that number, since by then our concert was underway.

In an effort to simplify, we negotiated a dessert alternative of packaged chocolate chip cookies. The birthday girl's mom had brought these for a guest who was allergic to an ingredient in the cookie cake. The comparative ease of counting these compared to a yet-to-be-cut square of frosted cookie cake made them a safer choice.  We armed my daughter with a carb count estimate for pizza and kissed her goodbye.

When we saw her again around 11:00, she was sound asleep with a blood sugar of about 170. 

Five years ago I thought this type of evening would be impossible.  It seemed like diabetes would always be way too much for her to handle by herself.  Yet a slow transition to independence is happening.  The expression on her face Saturday morning reminded me of the one after she took her first steps. Soon there will be no stopping her.