Upper Hand

Last week, diabetes had the upper hand. It issued a series of decrees.

They included:

*Alarms will sound nightly from midnight until four a.m.

*You will wake a sleeping teenager for Cookie Monster Juice at least twice per night.

*Delirium will lead you to wonder if the nightly need for multiple juice boxes has something to do with the Cookie Monster themed branding. As in, 'Me Want More JUICEEE.'

*You will wake each morning to say, or to hear your child say, "Uck- juice box breath again. This is so gross."

*You will become so exhausted by overnight low blood sugars that you will increasingly limit dinner and bedtime boluses until the alarms turn from low to high, though still reliably from 12-4.

*You will try multiple tactics to stabilize overnight numbers and each will backfire more mysteriously than the next.

Diabetes, I have news for you. You don't get to win.

We issued only the only decree we need:

*We will not give up.

With perseverance and patience the trend is abating as mysteriously as it appeared. Maybe we finally made the right basal adjustments. Maybe we fixed the bolus dosing for the evening hours.

Or maybe it's all because we switched back to Juicy Juice boxes.

Reaction Time

A favorite mantra of our first Certified Diabetes Educator was, 'one day does not make a pattern.'  She was right.  One or even two unpleasant 250's could be caused by any number of factors: a bad site, a new cereal, an oncoming illness, bad luck.

Seven makes a distinct pattern, though.  In most cases, three or four should really be enough.  Yet sometimes we're a little slow to react to patterns, particularly of high blood sugars, particularly at night.

As a child with diabetes grows, insulin needs grow too.  The only way to know when to make adjustments is to watch for strings of high blood sugar. 

If the issue is occurring during school hours, I get to work pretty quickly.  The daily 10 a.m. and noon calls from the school nurse begin to annoy me, and I act. 

Overnights, on the other hand, are my downfall.  Regularly checking blood sugars during the night is not the problem. My husband always visits her before he goes to bed, and we check again at 2 a.m.  We even correct highs at those times, though not too aggressively.  It's the next step that trips us up. Any significant changes in insulin during the evening or at night require more work and less sleep.  The dangers of nocturnal hypoglycemia are real.  During the day, my daughter can tell us if she feels low, or someone around her should notice the signs. At night, she's asleep, alone in her room. Therefore overnight changes must be done slowly, and with more frequent monitoring.  It takes many incremental changes to see results.

The coffee budget becomes strained.

Yet letting my daughter's blood sugar linger in the 200's all night is clearly not a better choice, so eventually we address it.  I just procrastinate a bit, rationalizing that I need to make sure it's really 'a pattern.' 

Reacting to these numbers before a week or so has gone by is my one thing to improve for diabetes blog week.