"LO GLUCOSE"

So, whenever we change any type of setting on C's pump (basals, carb ratios, etc.), I'm not sure why, but it always takes a good 4-5 days until the true result is seen and felt.  So, this time was no different.  Slowly and ever surely, her numbers were calming down.
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Usually when we go to an appointment, her endo knows not to overwhelm us (me) with too many changes at once.  But this time, C had been so high for so long, around the clock, that I knew I had to throw some of my caution to the wind and trust that it was for the best.  Also, her doc was out on vacation, so I was working over the phone and the CareLink website with one of the nurses.

We increased every single basal setting and even added a couple new ones.  We changed several carb ratios during the times of day when she would really shoot up high.  And, lo and behold, this sweet nurse recognized that C's active insulin time was set at 3 hours, not the normal 2 hours...meaning the pump would calculate corrections knowing that any insulin coverage would last 3 full hours.  Sweetly, and calmly, she told me that the 3 hour setting is "really only used for babies and toddlers."

"If we change it to the normal 2 hours, that will really help with her correction doses."

"Huh.  Well, I guess it's still at the 3 hour setting because, huh, she started on the pump when she was still a toddler!  Thanks for noticing that!...I was never told to change it once she got older."  I had been enlightened. : )

"Now, be sure to do a few nights of 12 and 3 checks," she said as we were just about finishing up.

"Oh yes, yes we will.  I'll email her doc in about a week so she can go over the new numbers.  Thanks so much!"
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Days passed.  And, like I mentioned before, C's numbers gradually started dropping back into range.  Then a sneaky little low popped up of 60...and honestly, I was kind of glad. Numbers in range...ahhh!  But then one low turned into 2 in a row.  And then, there were more lows than highs.  I backed off corrections.  I began second-guessing my high-level carb-counting skills.  The midnight and 3 am checks were continuing.  And the "ZING" of anxiety shot through my body as I woke early in the morning.  I lowered a couple of the basals again...

...and then, it was America's birthday!

We were busy with pancake breakfasts, parades, bounce houses, friends and family all weekend long.  And C kept experiencing lows all weekend long.  And, when we were standing in line to go into the local high school football stadium to await the glorious fireworks show, it happened. 

I looked down at C, who was sitting on the sidewalk since the line wasn't moving.  She looked pale.  I tossed her meter to her and told her to check.  And, then intuition kicked in.  Slightly panicked, I shoved everything I was holding into my husband's arms.  I dropped down and took over testing her finger.  And, this is what the meter spewed back at us:

LO GLUCOSE

Okay, my heart did a swan dive into my stomach.  I tore through her bag and ripped open a juice box.  She downed it in seconds.  I held the meter up to show the husband.  I couldn't really even speak at this time.  I shoved another test strip in the meter:  58.  **Gigantic sigh**  58?  We can deal with that!  But what in the world was that LO GLUCOSE reading???!!!

I had never seen that before.  In all the 6 1/2 years we've been doing this thing called diabetes...not once.  I wonder, Has anyone else ever experience this nasty message?

Now, if you look closely (at my poorly photographed image), you'll notice that C tested at 58 only one minute after the LO reading.  So, maybe that means, she really wasn't too much lower that one minute before.  So, I'm still not understanding that message.  Oh well. 

To say the least, it was unnerving.

And, after contacting her endo the next morning, we gladly followed her advice to back off on some of those changes we had made the week prior.  I asked her about the LO reading, but in her email, she didn't make mention of it.  I'm sure it will be a topic at C's visit next month!

(Still uttering big sighs around here.)

Let's Get Moving...

Day 5 of Diabetes Blog Week:  Let's Get Moving...

Although sports and different activities can be challenging when diabetes is involved, we're determined to not let it stop C.  Whatever she's shown an interest in, we've let her try and try again.  Here is a run-down of her experiences:

Sitting out of a soccer game because of a low blood sugar number.

sport/activity and their biggest diabetes challenge

• dance (ballet and tap)...skin-tight leotards over a pump site
• swimming...the old "unhooking/hooking up" pump trick
• soccer...trying not to go low and staying in the game
• gymnastics...skin-tight leotards, again and rolling/falling on site
• softball...protecting the pump and staying on top of bgs
• beach time...pump site and sand...need I say more?

And of course, along with all these forms of exercise, there is the danger of hypoglycemia, when and how often to test, and how to shove down a snack if need be.  The biggest upset is when, in fact, C does test low and she needs to sit out of the class, game or practice and wait for that bg number to come up.  It's happened on many occasions with just minutes to go in an exciting game.  Ug.

Sometimes we fly by the seat of our pants.  But we're determined to let her try new things.  It takes constant thought and preparation.  It takes mine or the husband's continued presence at all practices and games.  It takes open and honest communication with coaches and teachers.  But when we see her hit that ball or make a winning pass, she's beaming.  That makes it all worth it.

Making the Low Go

Day 2 of Diabetes Blog Week:  Making the Low Go

I was just talking to another D Mom last weekend about this actual topic...fast-acting sugar sources. I'm always curious about what other type 1s use for lows.  Juice is an obvious choice.  For us, a juice box can get C's number up fairly quickly but continues to make it climb until she's left with a nasty high number and then the yo-yo effect takes on a life of itself, not settling down for, sometimes, hours.

As we talked, a flood of memories came back to me, surrounding all the gobs of information we tried to digest at the time of C's diagnosis.  We were given a matter-of-fact sheet of paper with a list of fast acting sugar options.  They included:  packets of sugar, tubes of frosting and life savor hard candy.  Of course I ran out and bought it all.  We had 2 tubes of frosting at the bottom of her diabetes bag for nearly 2 years.  Never used it.  Finally we got rid of them after one exploded from being jostled around for so long.

Yeah...a tube of frosting..."yuck," we both agreed, my new D Mom friend and I. 

She told me that her son, now 17 years old, had always been told by his endo doc to use the standard glucose tablets.  But when he was younger (diagnosed at 6), she would fix him a "sugar shot."  This was a mixture of 1 tablespoon sugar dissolved into a Tupperware Tiny container of water.  "It was one gulp," she said.  "It was quick, easy and he loved them."

During my tweet-up time with Melinda, another D Mom,  her advice on bringing up a low, was chocolate milk.  It kind of goes against the rules of fast-acting sugar sources as it contains more than just sugar.  It has fat and protein, as well.  I've always had the understanding that anything but pure sugar-y carbs can possibly slow down the blood sugar rise.  I wasn't too sure about this one, but we went for it recently.  And, by golly, it seems to work like a charm!  We've gone through several containers of chocolate milk in the last couple months.  There is a high enough sugar content to get that blood sugar up quickly.  The fat and protein help prevent any crashes, especially near bedtime or in the middle of the night.

***I guess this is where I must reveal that, although I have a ton of experience with my own daughter's diabetes management, I am not a medical professional.  And, any information you may read here is not meant to be advice for anyone to try at home without first seeking the professional, medical advice of your own doctor.

I'm always on the look-out for new ideas.  Those glucose tabs really do their job quite well.  They're convenient, portable but kind of expensive.  And sometimes, I hate shoving those big chalky things in C's mouth.  We've ventured a bit, in the last year or two, into the candy realm:  Smarties, jelly beans, Skittles.  But candy has been a little unreliable for us.  She may clock in at 63, eat a couple candies and retest even lower.  At which point, we tend to panic and over correct.  Then we ride the rollercoaster for several hours.

We're liking the chocolate milk thing, at the moment.  We might try the sugar shot idea next.  I can't wait to post this thing and cruise around the blogosphere to find some new ideas from others out there!

Sleep by Number

Well, C's blood glucose was all over the board during the "Sleep-Over." 

The bounce castle...the hypoglycemia culprit.

From 32 after the bouncer...to 378 after birthday cake.  And everywhere in between.  Maybe the first sleep-over should have been with 1 or 2 friends not an entire house full of little girls.  Live, learn.

The 32 was quite unnerving, especially since it was only about a half hour after the party started!  There has only been one lower known number on her meter.  I remember a 27, but that was when she was in the hospital at the time of diagnosis.  Needless to say, I hung out at the party much of the time.

As all you type 1 parents know, it is quite the guessing game, this diabetes.  I thought I had set her up pretty well before the party started.  She was around 180.  I felt good about it.  I knew she was running on excitement and would need the extra "umpf."  But, like I wrote above, she crashed to 32 within a half hour. 

So after helping her come up to 78, I didn't correct for pizza at all.  Two hours later...102.  Good call?  More like, good guess.  The 32 really scared me.

Then came a 230.  But they weren't finished with all the games, nail-painting and jacquzzi time, so I left it.  Movies and popcorn.  (I mean, this party had it all!)  Lots of guesstimating.  Lots of manual bolusing.  I wanted C to be carefree.  I hope she felt like that.  I certainly did not.

So when all those cute little girls were snuggled down into their sleeping bags, I checked her, yet again.  378.  Oh well.  A delayed pizza reaction?  Bad guess on the cake?  Popcorn always sends her sky-rocketing.  How about all those things put together?  We dealt with it.  But I didn't want to correct it entirely.  So I half-bolused it.  I went home (two doors down) and set my alarm for 1:00 am.

I crept in the house about 1:03 and made my way to C.  To my surprise, about 1/2 of the girls still had their eyes open, watching a movie!  C was sound asleep.  Check...68...ug.  Wake her up.  Juice box.  Waited.  66!  Patience.  70.  I fumbled in the fridge for some milk.  Kisses.  Back home.  Set the alarm.

At 3:00 am, I repeated the scenario.  195.  I could live with that...or rather, I could sleep with that.  Back home and back to bed.  The party mom was dozing on the couch and I whispered to her, "I'm done.  I won't be coming in again until morning...well...until they're all awake!  She's 195."

The phone woke me about 7 o'clock.  "They're all up!"

When I got there, C checked in at 108.  Wonderful!  Perfect number to have a donut!  In a couple hours, she's home again.  Check...101.  Whew!  We did it, I thought.  It felt so good to have her home again.

What a sleep-over.

32...48...78...102...230...378...68...66...70...195...108...101.

Sleep-Over Anxiety...

As I write this, every nerve in my body seems to be standing at attention.

Cupcake carb count = lots!

C is going to her first sleep-over this weekend.  She's so excited!  I'm so nervous.  She's thinking of the pillow fights and cupcakes.  I'm thinking of hypoglycemia and the 3 am check.  She's thinking of which pajamas to take.  I'm thinking of which medicine to take--Tylenol or Advil.  I'm feeling a tremendous headache coming on...

Granted, we are fortunate.  The party is taking place 2 doors down the street.  We like this family, a lot.  They are friendly, responsible and generous.  The mom has always taken an interest in C and her diabetes issues.  So, she is very willing to work with me on this.  If I want to stay every minute?  She's good with that.  Sneaking in their house at 3 am?  She's fine with it.  Coming over at 6:00 am for coffee in her kitchen?  It's all okay.

**BIG BREATH**

This is going to be good, right?  It's going to be fun for C.  A challenge for me. 

I wish I could see what's around this huge corner that we're turning.

The First Flu Bug w/Diabetes

answer:  "At least it's manageable."

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It was summertime, 2003...the first summer with diabetes for our family. C had received the diagnosis in December. It was now August. We had been coping with this beast for several months now. And except for a few sniffles here and there, we had managed to stay fairly healthy since that time.

Summer activities were in full swing. Both the boys were in VBS (Vacation Bible School) at our church. This left a little time each morning for just C and me.

Day 3 of the week -- I picked up the younger from his group time. We raced around doing some errands. Picked up the dog from the vet. As we left to go home for lunch, middle C announced that he was "going to throw up!" Got the dog in the car, C strapped in, and gave middle C a baggie, just in case.

We made it home.  I rushed everybody inside.  Middle C proceeded to do exactly what he told us he was going to do.  Needless to say, there was no lunch for him...just a wet washcloth and trash can by his bed. After settling him in his room, I turned my attention to C's lunch.

Only two years old at the time, she crawled up into her high chair.  I checked her finger.  As C munched away on lunch, I drew up the insulin for the carbohydrates she was consuming.  Back then we, almost always, gave her the injection after she finished her meal.  It was so hard to know if she would actually eat everything in front of her or not...she was a two year old!  When she was close to finishing, I gave her the shot.  Honestly, the way I remember it...it wasn't 5 minutes later that she hopped down from the chair, began to fuss and threw up all over the kitchen floor.

Did you get that?  She just ate lunch.  I just gave her an injection of insulin.  And she just threw up all over the kitchen floor.

I scooped her up, took her upstairs and began cleaning her up, all the while, she was fussing and crying.  I remember catching a glimpse of the two of us in the bathroom mirror.  C...with vomit all over her cute little outfit and strung through her hair.  And, me...with a look of terror in my eyes.  My thoughts raced.  She just ate lunch.  I gave her insulin.  And, she threw up.  Those were the phrases swirling through my brain.  I had to get a hold of myself and, the situation. 

While I put C in her room, middle C needed help.  The poor kid would have to fend for himself for a while.  I was panicking big time.  I ran to get C's meter.  I remember checking her blood glucose frantically.  It was somewhere in the 70s.  This was not good.  No food in her tummy.  Lots of insulin at work.  All I could do was hold her and rock her and wipe up the next round of vomit. 

BG check.  She was dropping and fast.  62.  Juice.  Vomit.  BG check, 54.  Juice.  Vomit.  Oh, my God!  What was happening??  Lord help me!

I cannot clearly explain the desperation I was feeling.  I ran to get the phone.  I called the emergency hotline for CHLA.  Thankfully, I got through quickly.  A lovely nurse was on the other end of the line with me in an instant.  I'm certain that I was quite incoherent, but I tried my best to tell her what was happening.

Vomit.  Oh Lord!

"Okay, dear," the lovely nurse said.  "Okay, I want you to put me on speaker and check C's blood glucose again."

"Okay," I said.  I know I was blubbering at this point. 

I hit the speaker button and dropped the phone.  BG, 41.  My hands were shaking.  "41," I cried.

"Okay," the lovely nurse said.  In such a calm, sweet manner she asked me, "do you have a glucagon kit handy?"

"Uh, uh...yes.  Wait, it's downstairs," I muttered.

"Now, leave C and go down and get it and come right back to me, okay?"

"Okay."

I got back to C's room, dropped to the floor.  "Okay," I said.  "Got it."

By this time, C was quiet, laying on the floor, next to me.  I checked her once again.  37.  I felt like the world was caving in on us.

The nurse gave me specific, detail by detail, directions.  "I'm going to walk you through giving C small doses of the glucagon, okay?"

"Okay."

"I want you to go get a few syringes and come right back," she said.

"I've got some right here in her bag," my voice was so shaky.

The lovely nurse continued to direct me in mixing the solution, drawing it up and giving tiny doses of it to C.  After every 5 minutes or so, she would tell me to check C's glucose.  I remember repeating the cycle over the next couple hours.  Her number would rise to 54.  Then it would drop to 47.  60.  And then 58.  It was like a cruel game.

After an eternity, her numbers came up above 70.  When the lovely nurse felt C was in a good range.  She told me to let her sleep.  Then, I should check on her every 15 minutes and call the lovely nurse back.  I did.

Of course, after C hadn't vomitted for several hours, we went back to using juice to correct the lows.

I know my memory is foggy at best, but I can remember camping out on the floor in her room for about 2 days, ready to do whatever was necessary for my baby.
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question:  What is the number one thing a mom of a newly diagnosed 2 year old doesn't want to hear?

The "D" Card

Do you ever play the "D" card? I do. I did this morning. Otherwise, I felt like diabetes was going to win this hand.

C's endo appointment is next week. Our doc wanted us to go in to get lab work done a week prior. The orders were to fast for bloodwork. This is tricky, as all you D folks know. Her number needs to be near perfect upon waking, or we miss the opportunity. So I started last week...each morning being prepared to go in with an "in-range" number...but not too low. I never know how long the wait will be.

Well, this morning she woke up at 85! Kind of miraculous in our book. So, we jumped on it. We dressed, put hats on and we were out the door. We walked into the lab. It wasn't just kind of crowded, it was packed. There weren't even 2 available chairs for us.

I started out very apologetic and kind. I told the young receptionist gal that we were there for C and that she's type 1 diabetic. I said I wasn't quite sure how long we would be able to wait without eating. And if it's too long and she goes low then we would have to come back. And we are running out of time because her endo appointment is next week, and... You get the picture.

Well, she told me she would do her best but that she has to take people in order. I bit my tongue and walked over to stand next to all the occupied chairs.

Now, I would have classified myself as a fairly patient person B.D. (before diabetes). However, diabetes is never patient with us and it has rubbed off on me. I also would have classified myself as a mild-mannered person B.D. and B. C. (before children). This disease has forced me to step far away from my comfort zone many times.

So, about 30 minutes later, not surprisingly, C told me she was feeling low. Okay, we dropped to the floor and very publicly displayed her meter kit. We checked. Hmmm?...71. Not super low, but not good if we need to continue to wait. My patience and mild manners were beginning to fray. I walked back up to the counter with C's meter showing the number 71.

"Just wanted to know where we are in the line-up..." I said with a semi-smile. "She's 71 and if she goes lower, the fasting thing is out the window."

"Well, we have to get this other girl in before you. Her mother has been asking the same thing." The gal said. "Then we'll get your daughter in."

"Thank you, thank you!" I said.

I went back to C. I told her we'd be up really soon and that I would have this juice box ready for her. It wasn't 1 minute later and we were called. Phew, I thought.

We got her blood drawn with relatively few tears. She took a some sips of juice. I thanked the phlebotmist. I wanted to skedaddle right out of there as I felt the angry stares from those who were still waiting. But, just as we were heading for the door, the receptionist handed me a speciman cup. C also had to leave a sample. Ug.

I failed to remember this part and of course she didn't "have to go." So, instead of slipping out we had to sit there, drink water, juice, more water. It took several tries. Finally she was finished. We left.

I am grateful that we actually were treated with exception after showing the 71 on her meter. But then, when we had to wait, drink water, and wait some more, it was a little embarassing. I just wished I could have said to everyone in that waiting room "I'm sorry...I can wait...but my daughter's diabetes won't....thank you for letting us go ahead."

The "D" card. Do you play it? Maybe we should have just gone back another time.

Fast-Acting Sugar of Choice

C was diagnosed at such a young age...22 months. She was still in diapers. She was still a baby. She had never even had a piece of candy before.

So, when diabetes came into the picture and an entire double cupboard in our kitchen was dedicated to all of her supplies, we started stalking up on all the suggested fast-acting sugar sources. We included juice, of course, sodas, sugar packets and even tubes of frosting. But no candy.

In the early days, the item of choice was a juice box. We would buy those cute little 4 oz. boxes of apple juice with "Clifford" on the front, Hansen's Junior Juice. The size was great since she really only needed about 2 ounces to bring her number up. It was easy to use. It didn't need refrigeration. And, it had Clifford on it! The only downside was carrying it around long-term.

I remember our Grand Canyon train ride. Before exiting the train, we checked, and of course, C was low. When I searched her bag for a juice, they both had been jostled around so much and worn down that they were slowly leaking. We scrambled for something else. Some nice lady gave us a regular soda. After this experience, we started carrying glucose tabs.

Glucose tabs really are wonderful. They are portable. C likes them. They bring her number up nicely most times. Juice can spike it, but the tabs bring it up to a good range. However, they're quite expensive. And while we've used them for years now, I'm beginning to look at different options: candy.

I know how tempting and addicting candy can be. Up until this time, I really didn't want to put that temptation out there for C. But, as I read more and more blogs surrounding diabetes, I've discovered that so many type 1's have their favorite candies to treat lows. I go back and forth with this idea. We have used Smarties, jelly beans and such, on occassion. When certain candies are handed out to the kids, I've always allowed C to receive them. She used to be happy just to give them to her dad or brothers. But now, we stash them in her bag in case of a low. The main problem with this has been rearing it's head lately...

C will announce to me "I feel low." Okay, let's check...189...nope, not low! Then she'll ask "When I am low, can I have the lollipop I got from the party?" Ug...okay. I fear that she may create a low just to get the candy! I've talked with her about it, telling her how dangerous this could be. I really am fearful about this possibility. But her reaction to me when I mentioned this, she really seemed genuinely (at 7 years old) surprised that I would think she would do that. I don't know. I feel like I'm going into unmarked territory with this.

I suppose we'll do what seems best at the moment. I guess diabetes is just like that.