Spare a Rose


https://lifeforachildusa.org/


I reorganized my daughter's insulin this morning. I discarded a vial of Lantus which expired two years ago- a vial we had on hand only in case her insulin pump failed and we needed to give her an injection. We had never opened it. We have a new container of long-acting insulin on hand, which we also hope never to use. 

I took the oldest vial of her usual fast-acting insulin out of the refrigerator so that we can start using it to fill pump cartridges, and then I reorganized the butter compartment with several more vials, enough for a couple of months.

I also restocked the diabetes supplies in her room: test strips, lancets, insulin pump paraphernalia, and the stash of juice boxes we keep on hand for overnight lows.

What a hassle all this acquiring, organizing and using diabetes supplies is. And how fortunate we are to be able to do it.

The International Diabetes Foundation's Life For a Child Program helps families who live in places where having a butter compartment full of insulin and a drawer full of lancets and test strips is unheard of. There are children in underdeveloped countries around the world whose lives have been saved by this program. Children who would otherwise have no access to insulin or any other diabetes care supplies. Per the organization's website,

The program currently supports over 18,500 young people in 42 countries. There is so much work still to be done, we estimate that over 100,000 young people still need our help. Together we can achieve our vision that no child should die of diabetes.

This will be the 5th year that 'Spare a Rose' will be part of our Valentines' celebration.

Sparing one rose from a bouquet of a dozen and donating that $5 cost to Life for a Child provides a month of insulin, syringes, and diabetes education to a child in need. Donating $60 and foregoing roses altogether provides a year of life.

Want to learn more, or participate? This is the link!

Happy Valentine's Day!


Driving!


"GOOD MORNING! Go ahead and get in the driver's seat. You'll tell me if you're feeling high or low, right?"

And that's why we waited for this driving instructor.

My daughter turned 16 in November and passed the written part of the state driving test at the end of that month. The next step, per our state's motor vehicle department, was to begin six hours of behind-the-wheel instruction through a certified driving school.

The high school's gym teacher of few- but loud -words I've written about here is an instructor with the driving school most kids in town use. Other instructors were available in December, but we waited.

That little interaction at the beginning of the first lesson made me glad we did.

We wanted her first few hours on the road, since it would not be with us, to be with someone with whom she was comfortable sharing any diabetes-related needs she had during the lesson. This guy checked all the boxes. My daughter knew and liked him. He was, professionally as a gym teacher, aware of low and high blood sugars and the seriousness there-of. We also know that he has a niece with T1D, so would be attuned in a more personal way to the issue.

As it turned out, diabetes was a non-issue during any of the three lessons.

As with so many things diabetes, though, we were comforted knowing that while we hoped for the best case scenario we had a safety net in case things went awry.


Crisis! (Averted)


'AAAAH CRISIS'

That text arrived around 11:30 the other morning.

Having a 16 year old girl, lots of possibilities came to mind. Forgotten clarinet on a band day, wardrobe malfunction, unexpected test? Turns out it was a diabetes crisis.

'I bolused 10.8 for lunch then 2 more for muffins so then I looked at Dexi and I was skyrocketing and then I looked at history to see if I had bolused and I only saw the 2 units so then I bolused 8.8 more ahhhhh'

So, I confirmed with her via text, she had bolused 8.8 units of insulin with no matching food? She had forgotten that she had bolused for the main part of her lunch, panicked at the rapidly rising blood sugar, and therefore given insulin for it twice?

'YES I RLY SCREWED UP'

While she freaked out, knowing that an overdose of insulin had the potential to be catastrophic, I trusted that her friends would take care of her mental health while I focused on how to fix the problem.

'What's the current insulin to carb ratio?'

'1:8.'

If 1 unit of insulin covers 8 carbs, I reasoned, then 8 units covers 64 carbs, 9 units covers 72 carbs- essentially reverse-engineering of the math to figure out a game plan. She would need to consume some serious carbs to balance out the equation.

'I'm currently eating a tootsie roll pop which is 15 carbs.' (There's a teacher who sells these, essentially at cost, in his classroom...a little mysterious but very helpful at that particular moment.)
'And then I need how many more? Math for me.'

I'll spare you some details, but because to it turned out she was, indeed, skyrocketing we decided that the tootsie pop, one juice box and the pretzels which were to be her snack after school before play rehearsal would be a sufficient start as long as she kept a close eye on the Dexcom. It was a total of about 50 carbs.

It worked out pretty well. At the two hour mark from the error, she was about 150 and continued a slow downward trajectory during play rehearsal but was over 100 when she got home- hungry because she'd eaten her afternoon snack at 11:30 a.m.






And to Drink?


The waiter at the BYOB restaurant arrived, opened the wine, and started pouring it into glasses that were preset on the table.

One glass, two, three...

"Uh...only two glasses," my husband said, with a pointed glance towards my 16 year old daughter who was our only dining companion.

"Oh- yeah- sorry- I wasn't paying attention... Can I put in any appetizers for your table?"

We ordered something that had caught our eye and then my daughter asked for unsweetened iced tea.

The waiter returned a minute or two later with a glass of clear bubbling liquid. "You said Sprite, right?"

"No...iced tea please."

"Sweet or unsweetened?"

"Unsweetened."

He returned again with a glass of tea. "All we have today is sweet- I hope that's okay."

All three of us shook our heads.

"No? No sugar then?"

"Right."

"I think all I can offer you then is water or seltzer."

Eventually she received a very small glass of plain seltzer.

"I should've asked for a lime or something," she said regretfully.

But in the end she was just happy to have gotten something to drink.

The Sensor Order


I ordered Dexcom sensors at the beginning of December.

Two weeks later I got an email from Byram telling me that an order was shipping. Good news, I thought- the sensors would be here soon.

Early on a late December morning a box from Byram arrived on my doorstep. It seemed big for a three month supply of sensors.

That's because it wasn't. It was our quarterly, automatically refilled, shipment of pump supplies. I hadn't clicked on the email details, mistakenly thinking that we weren't due for any more pump supplies until January so assuming it could only be about the sensors.

I looked up my sensor order on Byram's online patient portal. 'Order in progress,' it said. But it seemed unusual to me that an order placed over 2 weeks ago would still be 'in progress.'

I called Byram and explained the situation to a representative who really seemed like he cared.

Side note: all of Byram's representatives really seem like they care and I'll be deeply disappointed if next year's new insurance company does not allow us to continue to do business with them.

'I see here it needed insurance authorization, but that should have happened quickly. Can you hold a moment while I look into this a little further?'

So I held.

'So it looks like, as I said, it needed insurance authorization, but it seems nobody followed up on the order. I've expedited the claim and it should be taken care of within an hour or two. And I've set the order up for free express overnight shipping because it was our mistake. Would it be alright if I call you back when it's taken care of?'

'Thank you so much, and yes- a call would be great.'

An hour or so later, the phone rang.

'It's been processed and headed out for shipping. You should have it tomorrow.'

I thanked him again, profusely.

So many things about diabetes are hard, and the grind of procuring supplies and insulin is often punishing. This interaction was anything but.

Choosing New Health Insurance


We have spent hours this month investigating our health insurance options.

Since my husband began working at his current company 12 years ago we've had the same insurance. Until now, his company contracted with one insurance company, offering 3-4 plan levels each year. When he began employment there, we chose a plan with a lower deductible, lower coinsurance costs and a lower out-of-pocket maximum. And, of course, a higher monthly price. The per paycheck cost and copays went up a few times, but the coverage remained essentially the same. We glanced at open enrollment paperwork every year, but never considered changing.

This year the company rolled out a completely new system, with choices!!! There are now plans available from 3 different insurance companies, so that, including the various levels of coverage, there were a total of 15 options to consider. Fifteen.

The idea is that each contracted insurance company offers 3-4 levels of plans. The levels are equivalent across insurers. so, for example, the 'gold plan' from each insurance company includes a $20 primary care visit copay, 80% coverage for hospitalization, and $8 monthly copays for tier 1 medicines.

Speaking of pharmacy benefits, also new is that those will now be through the health insurer we choose. For several years now, the employer has contracted with Caremark for drug benefits instead of them coming through the health insurer. And the coverage was excellent. Now we have to factor coverage for insulin, test strips, and other family members' medicines into the health insurance choice.

Our initial instinct was to look into the plans from our current insurer. The devil you know is better than the devil you don't, right? There's a plan with coverage similar to what we have now. We double checked some things, like making sure the deductible was about the same and that the coverage for pump supplies seemed equivalent. We knew our physicians probably participated but we double checked the key ones to be sure they were in this particular plan. Things looked good.

Problem was: that particular 'gold' plan costs about $5000 more per year than one offered through a different insurance company. For a few hundred or so per year I might have stuck with my 'devil you know...' philosophy and bit the bullet. For $5000 we were back to the drawing board.

And it looks like we're rolling the dice and trying a new insurance company this year.

Our doctors all participate. We'll pay more for insulin and supplies, but not anywhere near $5000 more. Humalog is the insulin of choice, with our current Novolog not covered on any tier of the formulary.  I'm worried that I'm unfamiliar with the culture and mechanics of this company, diabetes-wise, and that there will be unpleasant surprises. There will be lots of things to try to get covered this year, with an inevitable switch away from Animas supplies and a possible switch in CGM sensors as well.

But on paper it looks reasonable enough to try in order to save thousands of dollars. I'll let you know how it goes...

One Last Story For November


Once upon a time there was a girl with diabetes who survived the whole month of November!

She ate some leftover Halloween candy but not too much.

She took an airplane trip to Florida where she celebrated her 16th birthday in the Wizarding World of Harry Potter. In Orlando she figured out how to bolus insulin to cover Butterbeer. She ate at restaurants and guessed the carbohydrate content of every meal, sometimes more successfully than others.

She had some long, busy days in November, including one when she ate dinner in the car on the way from a piano lesson to jazz band rehearsal. And another when she took two difficult and stressful tests.

She had a couple fun but out-of-the-ordinary evenings, like one which found her eating Nutella pancakes at a diner at 10 p.m. after working backstage for the school play. And another spent at the last Friday night football game of the marching band season, when she ate dinner on a school bus before spending 3 hours playing the clarinet in the freezing cold.

She thoroughly enjoyed Thanksgiving dinner, especially the stuffing, the cranberry bread, and the pumpkin pie. And the turkey sandwiches with cranberry sauce on white bread the next day. And Thanksgiving dinner round 2 (a.k.a. leftovers) on Saturday.

All through November, she checked her blood sugar, changed her pump sites, used her Dexcom, explained her diabetes needs to TSA agents and teachers, carried her supply bag wherever she went, counted her carbohydrates, corrected her highs and drank juice boxes for her lows. But those aren't the parts of November she'll remember.