Information?

'Oooh...great.  I don't have to weigh them,' I thought at first glance when I noticed the familiar chart on the back of my sandwich rolls. Then I looked closer.

 

 

 

 

 

 

Per the FDA Guidelines a baked good does not need to be labeled with nutrition information if it's made and sold on premises.  This label is within the letter of the law. 

 

It's just very disappointing.

 

 

In A Nutshell

We've all had this experience.  Maybe it's with a new aquaintance at playgroup or at a little league game.  It could be a curious bystander at the gym or the office.  Perhaps it happens when running into an old friend at a party, or a long-lost relative over the holidays.  Whatever the circumstances, this person wants to know about your, or your loved one's, diabetes.

"How's she doing with that?"

"Is it under control?"

"What's that like to deal with?"

How to answer these well-meaning questions?  Ideally, the asker will come away more knowledgeable about Type 1 Diabetes.  The asker will feel compassion for you and/or your child. The asker will understand how un-simple these seemingly simple questions are.

Sometimes circumstances require a quick answer.  My stock response is a variation on this theme: "It isn't easy.  Every day is a little different. We have to work hard at it, but she's usually good about everything and we keep up with it all as best we can."  Vague?  Very.  Yet it clarifies that, no, it's never 'under control,' it's a daily challenge to 'deal with,' but that we're 'doing' o.k. with it all.

Sometimes this ends the conversation, particularly with complete strangers or very new aquaintances.  More often there is a specific follow-up question.  Common ones include:

How often does she have to check her blood sugar?

Are there things she can't eat?

Does she have to wear the insulin pump all the time?

Somehow I'm never prepared for how surprised people are by my answers.  That my daughter pricks her finger at least eight times every day and that we must do complicated math problems for every meal are just part of our reality.  Of course we get up every night to keep track of her blood sugar.  Yes she does indeed have to visit the school nurse's office at least twice a day.

As much as I'd like to, it always seems too much to lead with these little bits of our reality.  They certainly give a much clearer picture of what our days are like, but they're hard to consolidate into a quick, simple answer.

I'm often left wondering how others answer these questions.  Feel free to comment if you have a way you've found to sum up your 24/7 diabetes life in a nice little nutshell.

Bits and Pieces 3

 It's another in an occasional series of posts collating and commenting upon some interesting (at least to me) diabetes links:

Animas has submitted for FDA approval for their Animas Vibe for use in the U.S.   The news is summarized here on Diabetes Mine. This product sends data from the Dexcom G4 continuous glucose monitoring sensor directly to the insulin pump, eliminating the need to carry an additonal receiver.  Also notable in the article is that Dexcom has submitted for FDA approval for pediatric use of their G4 product, hopefully greatly reducing the red tape families must currently weed through in order to obtain it for their children under 18.

While our family loves to travel and see new things, the airport experience has often left much to be desired.  If you haven't done so, please take a moment to sign this petition to standardize TSA screenings for diabetic persons using wearable self-monitoring medical equipment.  A look back at a couple of our family's airport experiences can be found here.

It was fascinating to follow Anna Floreen's experiences wearing a Bionic Pancreas.  There are seven pieces up on Glu, the first of which is linked here.  I'm a realist.  I know that the research process moves slowly and that the FDA approval process for even the simplest of things is grueling. Yet reading about someone out in the world wearing equipment which eliminated her need to actively manage her diabetes gave me great hope. One of many take-aways for me was that while this technology will not constitute a cure for diabetes, it will be life changing.  Yes, there will still be physical baggage of sites and technology to carry around.  Yet the mental baggage will be so much reduced it made me wonder what fascinating things I would think about should technology take over so much of the diabetes drudgery.

Some of these developments seem, perhaps, more significant than others.  Yet the bionic pancreas won't be completely anxiety-free if we can't get it through airport security without a fight or a panic attack.

Dinner?

Softball poses its own unique diabetes challenges.  For my daughter, game-related blood sugar fluctuations are predictable and we've learned how to manage those.  Her pump goes in a fanny pack and is nicely tucked under her uniform.  She's learned to find moments on the sidelines for quick blood sugar checks, and the roomy softball equipment bag has plenty of space for the meter, glucose tabs and a juice box.  At least one parent is always on the sidelines. We're cheering, but also ready to jump in should any diabetes needs arise.

The issue which seems unresolvable is the timing.  Weeknight games start at 5:30, which means warm-up begins by 5.  We're usually not home until 7:30 or 8.

I can only assume that every child plays better when fueled up.  Mine definitely needs something in her system before a 2-3 hour sporting event.  Ideally, she'll have a well-balanced combination of protein, and carbs with a healthy vegetable thrown in for good luck.  Ideally, we'll bolus this meal just right, leaving her a few carbs to burn off during the game until that nice bit of protein kicks in to sustain a lovely blood sugar through the 6th inning.  Ideally, this resulting steady blood sugar will provide her with the energy and focus she'll need to play well and have fun.

So, here's the question: does she eat dinner at 4:15 in the afternoon?

The answer has to be 'sometimes.'  Ideally, she'll eat dinner before the game, despite the early hour.  She feels better and plays better. Her blood sugar responds better throughout the game and into the evening.

Sometimes a pre-game dinner is just not possible. Today she has team pictures before the game, which would move dinner time to about 3:45.  Other days she has after school activities until game time, or homework which needs to be done before she's completely wiped out.  On these days she has to make do with a hearty snack such as yogurt and fruit or a quick pb&j in the car. 

Diabetes does not prefer 'sometimes.'  It prefers a set schedule.  Yet from time to time, we need to be flexible.  With a little planning we can be flexible and keep diabetes in its place at the same time.

I Didn't Mean To Be Rude

As a parent of a child with diabetes who is not constantly within 50 yards of me, I am dependent upon my cell phone.

It is within earshot whenever my daughter is not.

I'm incredibly grateful for this technology.  It allows me to be out and about doing my thing while she's doing hers.

The issue is that my cell phone rings often.  When it does, no matter where I am or what I am doing, I need to pay attention to it.  If it is the school or my daughter calling, I need to answer it.

As a result,

I am the woman blocking the aisle in the grocery store while completely focused on her phone conversation.

I am the woman texting during the concert.

I am the woman who didn't politely interact with the cashier at Target.

I am the woman answering her phone while on a date with her husband at a quiet romantic restaurant.

I am the woman texting in the dentist's chair.

I am the woman whose phone call interrupted the meeting. Twice.

When I am able, I make a quiet apology for the interruption my phone use has caused.  Sometimes, if
I know the situation could repeat itself, such as in a meeting, or during a long dental procedure, I'll briefly explain my behavior. 

More often those around me are left assuming I'm just terribly inconsiderate.  To those fellow restaurant patrons, concert goers, and grocery shoppers, I offer the following by way of explanation:

I'm sorry for altering the romantic atmosphere/creating a brief moment of light in the dark theater/standing in front of your favorite cereal.  It was my daughter on the phone.  She has diabetes.  She was calling because she had a low blood sugar/her pump was alarming/someone brought cupcakes for the class.  She needed immediate medical advice. 

I didn't mean to be rude.

Absolutely Not?

Would you allow your Type 1 eleven year old child to go to another child's house after school if you did not know the parents well, or at all?

Had you asked me less than a year ago, the answer would have been 'absolutely not.'  I may also have added a look which indicated I thought you should have your head examined just for asking.

Yet a couple of weeks ago, my daughter was invited to go to the home of a girl whose family I don't know.  It was last minute.  Several other girls were going, including a few of my daughter's closest friends.  They were going to work on team t-shirts for an upcoming school event.  She went.

Maybe you're thinking, 'of course she did.'  Maybe you're thinking I'm the most irresponsible parent in the world.  I'm still somewhere between those two myself, but I think it was the right decision.

I let her go because:

• I do everything in my power to never have to say 'no,' when it's qualified by 'because you have diabetes.'
• It's important that her middle school experience includes meeting new people and testing the waters of independence.  These aren't her favorite activities. I felt I needed to encourage her willingness to go. 
• I had it on good authority that the parents were kind and responsible people.
• If she'd made the shirt at home by herself I would have had to help her.  The project involved some sort of aerosol fabric paint. It sounded terrifying.
• She's responsible with her diabetes tasks when she goes to friend's houses, so I trusted she would check and bolus as needed there.
• She had her cell phone with her and could text or call me at any time.
• Close friends were going with her, who know about her diabetes.  They are girls I knew would support her if she needed it.

You know how this story ends.  It ends the same way as most stories about children who are gently allowed brief flights from the nest.  She bolused for some pretzels.  She had fun making her shirt.  She enjoyed hanging out with new friends and old.  She came home happy. 

For my daughter, now was a reasonable moment in time to allow this small yet significant step.  She didn't go because she was eleven, or in fifth grade, or even because I have a healthy fear of fabric paint.  She went because she was ready. We spend an extraordinary amount of time helping our children with diabetes develop the skills and confidence they need to care for their own diabetes.  Each is ready for a different step towards independence at a different time. Yet at some point, the time comes for each of us when we must clutch our cell phones in our fists and allow them to go out there and use what they've learned.

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.

Carving

I had a post almost finished for today when I looked at the keywords people have put into search engines to find this blog.  'How to carve a chocolate rabbit' brought not one, but two people to the following post this past weekend:

Every year, the Easter Bunny brings my daughter a chocolate rabbit. He seems to understand that while candy isn’t a part of her everyday diet, Easter should be an exception to the rule. And that if there should be an exception to the rule, it should come in the form of chocolate.

This year’s rabbit, pictured here, was originally 6 inches tall.

Now slightly shorter (and harder of hearing), his ears were solid, but most of the rest of him is hollow. Made of dark chocolate, he weighed 4 ounces yesterday afternoon.

Calorie King tells me dark chocolate has 13.5 grams of carbohydrate per ounce. Information is power, of course, but I can’t conceive of how I’d carve this guy up into 4 completely equal pieces. I’d need some sort of engineering degree. And if I cut him up, she’d miss out on the fun of biting the ears off, an opportunity every chocolate bunny eater should have.

So, for the record, I'd recommend NOT carving a chocolate rabbit at all. If you must, do so at your own risk of both injury and bunny owner disappointment.