She'll Have The Usual
Eating out usually involves much angst about how many carbs there are on the plate and about how much of the meal will be consumed. And therefore about how much insulin should be given before or (lets be realistic here) as the food starts to be eaten.
We've started to play 'guess the carbs' together most times we eat out. My daughter figures out a number first, then I add my input and we discuss. At several recent restaurant meals she's guessed between 40 and 50 every time.
When it's been my turn to give input, I've eyeballed the plate and said something like, "If you the eat 2 pieces of the battered fish and about 20 of those fries, it's probably around 50."
Or at the Thai place, "You think you'll eat around half of that bowl of pineapple fried rice? Maybe about 50."
Or at the diner, "Three blueberry pancakes? Probably 50."
Fifty.
It's the going rate. Sometimes we add a few at the end if the fries are irresistible or the pancakes arrive heavily dusted in powdered sugar. Sometimes we'll ease down into the low 40's if the fried rice is skimpy on the pineapple or if she's not as hungry as usual.
But lately we've been starting at 50 and adjusting from there. It's nothing more than a mental math trick, really, but I find looking at the food and asking, 'is this about 50?' somehow much less stressful than starting from zero and trying to add up the plate. There is, of course, always a generous margin of error in figuring restaurant carbs. And this method doesn't work when she orders a big salad for dinner.
But if we're going to eat out, we need to start somewhere. For now, we've decided to start at 50.
Out of the Midst of Chaos
Last night was much like many recent nights around here. I thought I was finishing up dinner prep and that I had about 20 minutes to relax before I had to be back in the kitchen cooking. And then:
"Mom, it's site change night."
And simultaneously I realized that one element of dinner remained unpeeled, despite that step being necessary for edibility.
So a game plan was concocted on the fly.
"Why don't you bring the insulin and the cartridge out here and fill it. I know you know how but you rarely do it- it'll be good practice. And I'll talk you through it while I peel these."
So she did it. I've been filling the cartridges for so long that watching her struggle with this task which seemingly requires 3 hands was eye opening. But she figured it out.
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| I wonder if this is how someone taught me to do this or if I made it up? |
Then, we retreated to her room to do the other half of the job. I am still the primary site putter-inner. But then:
"Should I try to do it? In my hip I mean?"
Her voice was filled with cautious excitement laced with apprehension. I heard self-confidence and self-doubt all at once.
"Of course you should."
Then came the string of questions and worries. "What if I mess up?" "What if the tape gets all folded up and I can't get it to lay down right?" "What if I can't see well enough what I'm doing?" And on and on.
"I think you can do it," I said more times than I can count.
"Get Ruby. I need her here," requested the 14 year old. So the bear with diabetes was fetched from the basket of dolls, webkinz and teddy bears in the corner of her room.
With the inserter in one hand, her torso and head twisted at an extremely awkward angle, and the ear of her Ruby squeezed in the other hand she eventually squeezed the device and inserted the site.
Insert two smiles of pride here.
I know some kids are regularly inserting their own sites at 8. I know that some parents push the issue long before 14.
Neither of these were true for us. And I was okay with that.
She'd put in a handful of sites in her leg, out of wanting to prove she could do it, and once out of necessity. But the leg turned out not to be a preferred site spot, and her 'rear hip,' shall we say, did. It was awkward to try to do by herself and so I let it go.
Our endocrinologist was beginning to ask when she was going to take over the job. I was a little embarrassed to share with other d-people we know that this step hadn't been taken. But I knew the day would come. And I knew my kid. And I knew that I couldn't make that day come no matter what I said or did or suggested or threatened or bribed.
But then it did.
You Don't Know What You've Got 'Til It's Gone
At first it was kind of a novelty to live like we did in the olden days.
The element of surprise added interest to every finger stick.
The highs and lows made us think a little harder about the why's and the what next-s.
The nightly 2 a.m. finger sticks let us relive the old familiar moments of rescuing the stuffed rabbit from the floor and wrestling a hand out from beneath layers of covers.
The once-again regular calls from the nurse's office made my day less lonely.
But the lack of a working Dexcom is beginning to take its toll.
We miss the ability to see highs and lows coming on before they're 50's and 300's.
We miss relying on the graph to show us a steady upswing after a low instead of drawing blood every 15 minutes until we're absolutely sure the number is stable.
We'd like to sleep.
We're all caught up on everything that's going on in the nurse's office and its environs.
So I was glad this morning to find in my inbox the shipping notification for our Dexcom's new transmitter. A combination of my slowness to order it as soon as the low battery notification appeared and the slowness of getting insurance approval for and shipping a new one has left us Dexcom-free for a week.
Which isn't the end of the world, and I'm grateful we have the technology at all, but now that we're used to having the data and the safety net, it's really hard to do without. Even my daughter, who is still understandably ambivalent about the insertion of and constant wearing of another device, asked yesterday about the status. "I can't wait to have it back- I'm so tired of not knowing what's going on." Me too.
Food: It's What's for Eating
An 8 year old relative of a friend of mine was recently diagnosed with type 1 diabetes. A couple of weeks post-diagnosis, my friend e-mailed saying that the family is really struggling with what to feed him. He was previously very much a junk-food fan. What ideas and advice did I have?
My initial e-mail response was lengthy and probably a little confusing. It's such a complicated and loaded question.
My first response was to look for good articles and posts on my favorite blogs and websites. After twenty minutes of that, I found twenty different ideas of how best to eat with diabetes. No wonder they and so many other newly-diagnosed families are confused.
I imagine the hospital team sent them home with a meal planning guide and some hand-outs about carbohydrate counting and the value of consuming protein and carbs together. He's on injections for now, so limiting the injections is part of meal planning too. But he's 8. And everything's different. And he'd probably really like a big stack of pringles and a snickers bar.
So here's what I said in a nutshell, hopefully more well-thought out this time (I'll be sure to get them the link to this post):
1. If nothing else, count the carbs. Learn how to read the labels, learn the carb ratio, learn the math and give the insulin. A snickers bar is not an apple. French fries aren't steamed brown rice. But if you give the right amount of insulin for them, his blood sugar won't spike astronomically and you'll be learning and practicing the carb counting skills which will be the basis of diabetes care for the foreseeable future.
2. Rome wasn't built in a day. Protein plus carbs is great. The combination streamlines the blood sugar levels. Vegetables, fruits, whole grains and low-fat proteins are important too. Foods with fiber affect the blood sugar less than straight white bread. BUT eating is great too, and sometimes compromise is necessary. I had a child who ate nothing but cold cereal, milk, chicken nuggets, goldfish crackers, baby carrots, sugar free jello jigglers and animal crackers for several months of her toddlerhood. She lived to tell the tale. Not only that, but this weekend she ate Moroccan spiced chicken stew with whole wheat couscous on Saturday night and roast salmon, salad with balsamic dressing and a brown rice medley on Sunday night. We actively chose (after a few weeks of frustration) not to force the food issue when she was 2. Now she's a good healthy eater, because that's the way her parents eat and she slowly learned that a variety of foods are delicious.
3. Dessert is okay. We never stopped having treats. One cookie instead of 3? Yes. Parsing out the Halloween candy over a couple of weeks. Absolutely. She had animal crackers and a glass of milk most nights until she was 5 or so. Eventually, other cookies, frozen treats and brownies began to be included in the mix. Holiday pies and birthday cakes have never been forbidden. As a result, (I think) I have a kid who has rarely snuck extra treats or cried because she was left out of a celebration.
Should this newly diagnosed kid be eating a scrambled egg wrap for breakfast, bean soup for lunch and a plate with 2 veggies, lean protein and whole grains for dinner? Probably. Should his primary treat be roasted almonds? Yup. But he's 8. And his world just turned upside down. And no kid or adult really eats like that anyway (well- very few, and they're probably not the happiest people).
In the real world, balance is necessary. This newly diagnosed kid should be eating the healthiest combination of foods he's willing to eat on a daily basis. He should be learning about good nutrition from his family, his healthcare team, and others who care about him. He should be learning to read a nutrition label with help from adults, so that he can take the right amount of insulin for whatever he eats. He should be learning about low carb and carb-free snacks he can eat when he's hungry but doesn't want to take an injection. Meanwhile, his favorite foods should remain available and he and his family should learn how to cover the carbs in them. And he should have the occasional junk food if he wants it. Having diabetes is hard enough as it is.
So Easy
There's nothing easy about living with diabetes.
We live with a Mobius strip of a to-do list.
The required tasks involve varying degrees of difficulty and frustration.
So every time the pump battery needs to be changed, I smile.
Someone at Animas took the time to make this particular chore as easy as it could possibly be.
If only all of our electronic devices came with an almost life-sized pictograph complete with the type of battery printed on it.
You Don't Send Me Flowers Anymore
Two years ago my husband stopped sending me flowers for Valentine's Day.
Our favorite florist has not gone out of business. The magic is not gone. We have not gotten a cat like my childhood one who eats the flowers and then throws them up all over the house.
We just decided that the following is true:
Flowers die. Children shouldn't.
The Spare a Rose, Save a Child campaign asks us to donate the cost of one Valentine's Day rose ($5) to Life for a Child, which is part of the International Diabetes Federation. Life for a child's mission is "Saving the lives of children in the developing world." According to their website, Life for a Child is currently helping 17,000 children and youth with diabetes in 46 countries. Also from their website, the program aims to provide:
Can you imagine being unable to access insulin for your child with diabetes?
Can you imagine dosing insulin with no access to a glucometer or test strips?
Can you imagine being handed insulin and syringes with no meaningful education on how to use them?
Can you imagine seeing your child ill and suffering and subsequently die from undiagnosed diabetes?
I can't quite imagine any of those scenarios, but I know that they're happening in at least 46 countries around the world. And I'm certain that if there's anything I can do to help even one child have access to basic diabetes care, I need to do it.
So once again, we'll spare a dozen roses their Valentine's Day fate.
Please join us, and save a child instead.
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