Saturday, October 25, 2008

Life's Little Pleasures/Lessons

I'm getting good at managing Jenna's diabetes with the pump~ REALLY good! Certain carb factors are now committed to memory so I'm not having to flip through pages of a book to look them up, pre-meal blood sugar checks are almost never forgotten these days and measuring all carbohydrate containing foods before they are placed on Jenna's plate is just becoming part of our daily routine.

I'm also finding that I have gotten to know Jenna's diabetes quite well. I know how certain foods are going to behave after she has eaten them and I can often predict what her blood sugar is going to be before we test her.

All of this sounds like good news, and it is! I'm enjoying feeling more confident about managing Jenna's diabetes. I find I have a bit more free time and my mind isn't constantly being taxed, racing around trying to keep three steps ahead of things.

I do, however, find myself plunging into episodes of sadness again, similar to when Jenna was just diagnosed. I think this is because I have become so fluent with the insulin pump and with the over all management of things, I have more time to think! And when I think, I still find myself in a state of disbelief that this has happened to my little baby girl! She's just brand new, for crying out loud! Shouldn't this kind of shit only happen to old people when the passage of time and a life-time of wear and tear, overindulgence and under-activity causes organs and systems to malfunction and fail?!

Being a registered nurse, I know a lot about this disease from a clinical perspective. I spent a great deal of time studying diabetes while I was in training and certainly had plenty of insulin dependent diabetic patients in my practice (most of them were geriatric patients and type 2.) But in this situation I am the Mom. The nurse in me must take a back seat because my heart is way too involved to be able to maintain the kind of perspective my nursing training might otherwise afford me. And like all Moms I want to know why. Why MY child? How did this happen?

Adding insult to injury is how guilty I feel when I do allow myself to get upset and angry at the cards my Jenna's been dealt. I know how lucky we are. There are mothers and fathers out there dealing with far more heart-breaking scenarios with their precious little ones. This is a manageable disease! Odds are Jenna is going to live a long, healthy, fulfilling life if she is diligent about her care and I'm determined to educate her to the very best of my ability on how to do just that.

But I keep thinking about life before the diagnosis; before the carb counting, food measuring, blood sugar monitoring and infusion site changes and I get so sad knowing that those days are gone for good.

I was out running some errands today and decided to stop and pick up a couple movies to enjoy with my family tonight. While I waited in line to pay, another mom was waiting behind me with her three year old daughter. From their conversation it was apparent they had a fun little night of movie watching planned just the two of them. The little girl picked up a giant bag of M&M's and looked at her mom with a hopeful, pleading expression on her face.

"Sure. We can share those while we watch the movie," was the response her mother gave her without even a moment's hesitation.

Admittedly, I felt feelings of envy at that moment with maybe just a hint of jealousy. I certainly can't sit down with my girls and a giant bag of M&M's while we mindlessly and repeatedly plunge our hands in and indulge. Not that I would have done that anyway. But I have been known, prior to the big "D", to sit down with my girls and a giant bowl of cherries while we all gorge ourselves silly. To diabetes, the source of the carb doesn't really matter a whole lot, be it candy or fruit or starch. A carb is a carb is a carb and each carb needs to be matched with the appropriate amount of insulin. It doesn't discriminate.

Gone are the days of eating with complete disregard to quantity. Everything must be measured and weighed. There can be no more eating from one big communal bowl like most families are inclined to do with things like chips or popcorn. This is a little family ritual that, I must admit, I took completely for granted before the arrival of diabetes made it necessary to closely monitor Jenna's carb consumption. We have to measure out quantities for Jenna and give her her own little portioned out bowl. And to prevent her from feeling like the "odd-man-out" we all get our own little portioned out bowl now as well.

I confess, I kind of miss all of us eating from the same popcorn bowl.

Maybe it was the sight of this Mom and her little girl planning a fun-filled evening with chocolate being part of the festivities or maybe it was my own craving for chocolate which I seldom allow myself to indulge and just couldn't ignore any longer. But later, at the grocery store I found myself looking in the candy section for some little extra indulgence I could bring home and share with my girls while we watched a movie together.

I discovered these neat little "thin" chocolate bars designed, I think, for weight-conscious chocolate lovers who don't want the massive carbohydrate hit of a standard sized chocolate bar. They are only 12 carbs each; perfect for an extra special treat for my family movie night. My girls were just giddy with delight when I presented them with these little goodies and I admit that the choc-aholic in me was pretty chuffed too.

The movies and the snacks were a big hit and as I sat with Jenna snuggled up on my lap and Jazmine nestled in my arms, the three of us enjoying a post chocolate buzz and watching a movie together, I felt so incredibly thankful for my blessings.

...and even though Jenna's sugars have done a delayed climb, as I anticipated they would, and just now, at 11:30pm, I had to do a correction bolus for a blood sugar of 17mmol/l, I have to say that it was worth it, just this once, to enjoy one of life's little pleasures with my girls. These moments won't come very often, but when they do I'll be damned if I'll allow them to be punctuated with guilt and regret~ life's too short.

...and maybe next time I'll employ a combo-bolus to take care of the chocolate carbs.

Thursday, October 23, 2008

More on the whole Halloween hoop-la...

So I've been reading some other blogs, namely SUM (Kerri rocks!) and I've been inspired by some of her readers to re-examine my approach to Halloween, just a little.

I think I'm on the right track with the "Candy Swap" idea, but I don't think I'm being very realistic or... well, let's face it... FUN expecting Jenna to do back flips at the chance to trade her Halloween candy stash for books. How lame is that?

So I'm going to learn from the wisdom of some of Kerri's readers and purchase a few fun little toys to swap. That's not to say I will omit the book idea entirely. I'll just limit it to one or two books. I do get tired of reading the same books to my girls at bedtime. I usually like to take advantage of any opportunity to broaden the selection of reading material.

It was also suggested to allow a treat to be enjoyed during the trick-or-treating; the idea being she would burn off the carbs of the treat while ripping around the neighbourhood. Makes total sense. Only problem is it breaks rule #1. And this is a rule that, as I discussed in yesterday's blog entry, I, myself had to observe in my trick-or-treating days. It was a safety measure since in my day the big urban, Halloween folk-lore was that some kid in some other obscure city somewhere had been poisoned by a treat that had been tampered with. That along with the "razor blade in the apple" horror story caused freaked out parents all over North America to forbid the consumption of candy before it had been thoroughly checked over at home, and to promptly toss all apples obtained during trick-or-treating into the trash. I actually think one would be hard pressed to find a single apple in the bag of any little ghost or goblin on Halloween night to this day. That kind of bad press tends to stick, even though I read not too long ago that it was just an urban myth and never did actually happen.

But I'm getting side-tracked.

My point is that, even though it makes good sense to let Jenna nibble on otherwise forbidden goodies while she gets a little cardio work-out, I think I'll refrain from doing that. It could snowball into a "one treat leads to two, then three..." situation. I also like the idea of looking over all the treats at home for safety sake. You can't be too careful when it comes to your kids.

I will also heed the advice to concentrate more on the costume than the treats. Maybe we will also limit trick-or-treating to just a quick trip around the block then come home to help hand out candy to the other kids. Jenna would love that!

OK. So it'll be alright. I just have to remember not to make that big a deal of it. Jenna shouldn't feel like we are centering her out just because of the big "D". I want her to feel no different than any other kid... at least as much as that is possible, given that she has diabetes and it's Halloween we're talking about here.

Wednesday, October 22, 2008

What's been going on lately...

It's been a busy couple of weeks with Thanksgiving and Halloween preparations, battling more bugs (I'm currently recovering from a little cold virus that, up to this point, I've managed to keep to myself~ fingers crossed), and other assorted tasks of managing the daily operations of our busy household. I've wanted to blog for several days now but the need for rest won out every time I had the urge.

However, today Jenna had a check-up with her endocrinologist and we were "graded" on how well we've been managing Jenna's diabetes so far. Her HgbA1C is... drum roll please... 8.1! Yes, we were quite the hit at the clinic today with that little beauty of a lab value! So with such good news to brag about, I was extra motivated to snuggle up in bed with the ol' lap top and get to typing.

And while I'm here, I may as well mention a couple of other items that have been praying on my mind and are relevant this time of year.

First, I had an experience a few nights back that had me quite puzzled and somewhat concerned. We usually check Jenna's blood sugar around 10pm before retiring for the night. From this reading we make our judgement call as to weather we need to check her again in the night or if we are safe to assume she'll be fine till morning. Usually this is done with little or no problem. More often than not Jenna cooperates and sometimes she sleeps right through it! This night, I'm not sure if we just woke her at the absolute wrong time or what, but she just came unhinged. Crying turned into full on screaming. No amount of consoling would comfort her. In fact, the more we (her Daddy and I) tried to comfort her, the more upset she became. Jenna would tolerate no physical contact from us and adamantly demanded that her Daddy leave the room. She wanted me to stay but to keep my distance. So I sat a few feet away on the floor feeling quite helpless while she screamed and cried and curled herself up into a ball in her pile of stuffies next to her bed.

If this had happened with Diabetes out of the equation, I would have chalked it up to waking a sleeping toddler up in the middle of some pretty intense dreaming. But with diabetes being part of the picture, I couldn't help but wonder if perhaps Jenna was feeling a little off at the time (her blood sugar was slightly high at about 12)and this, coupled with being awakened yet again for another finger stick, which has got to get somewhat annoying after a while, brought her to a breaking point.

Over all it took nearly an hour to finally get Jenna settled and back to sleep again.

The whole episode had me reliving moments of my childhood when I would be suffering with severe asthmatic episodes and had absolutely no patience for anyone trying to offer words of comfort. The intense physical discomfort and sheer terror of being unable to breath would make anyone trying to calm me down seem like they were patronizing me and trivializing my urgent need for medical intervention, adding to my anxiety. Although I know Jenna wasn't in that kind of crisis, I sensed a similar impatience from her with our attempts to calm her distressed state. This is why I can't help but wonder if she was experiencing some kind of physical distress. I don't know but I can certainly imagine that having a high blood sugar would make one feel pretty icky. Or perhaps it was just a strange sleeping state we were unfortunate enough to catch her in which caused her a similar amount of mental stress.

I guess I'll never know, because by morning it seemed all but forgotten by Jenna and any attempts to discuss it with her were more or less ignored. And I don't imagine she would have been able to express how she was feeling at the time anyway, given her age. So we just let it go. I did, however, mention to Jenna the next evening at bedtime that I would be in to check her in the night like always to make sure she is safe. Jenna agreed to cooperate and I think I detected a little bit of embarrassment from her for her actions the night before. The expression on her face was almost apologetic.

It hasn't been repeated (thank goodness) and I hope I'm not speaking too soon when I say that I think it was an isolated incident.

The next topic I want to mention is HALLOWEEN, that dreaded anti-diabetic holiday that has all us parents of type 1's trying to figure out new and creative ways to allow our pancreatically-challenged little ones to enjoy the festivities without sending them into DKA!

I know it should be as simple as allowing Jenna to do what all the other kids will be doing and just bolus her for treats consumed. But even before the big 'D' I was hard pressed to allow my kids to eat candy at all.

So last Halloween, before diabetes became a part of our lives, I started a little tradition I call the "Candy Swap". After trick-or-treating my girls return home with their candy at which time I reveal a stash of pre-wrapped, new books that they can swap their candy for, auction style. It was a hit last year, but Jenna wasn't even two yet. So she was oblivious to what was going on and just happy to be included, following her big sister's lead.

Having spent another year with Jenna getting to know her spicy little personality, I anticipate that it will be a chore just keeping her from sampling the candy before we even return home. I've already started creating rules to govern the evening:

Rule #1. No eating candy until we get home.
Rule #2. Any candy sampling before we return home will result in an immediate termination of the trick-or-treating portion of the program.

OK. So that's all the rules I have up to this point. And now that I look at them, I'm pretty sure these were the rules that governed my trick-or-treating and are likely the same rules that most kids have to follow each October 31st. It's probably sufficient since I don't really want to suck all the fun out of the evening. But I also don't want to spend the whole night doing blood sugar and ketone checks and bolusing the bu-jeezus out of Jenna in an effort to regain the upper hand.

Maybe I shouldn't stress too much about this crazy Halloween business after all. I'm sure my little candy swap scheme will take care of a good portion of the junk food and what ever is left I can confiscate and hide away to ration it out slowly until it is a dim memory, at which point I can pitch the remnants wiping the slate clean for that other occasion of over-indulgence~ CHRISTMAS!

Wednesday, October 8, 2008

Here's To Sisters!

The best sound in the world to me, the sound that makes my heart sing and my eyes well up, makes my mouth involuntarily broaden and turn up at the corners is the sound of my children's laughter. Any parent will tell you that this is a sound sweeter than any symphony or anything audible in nature.

I am so lucky to have been blessed with two wonderful little people to call my daughters. And what's the icing on the cake is that they seem to adore one another. They make each other laugh genuinely and heartily on a daily basis. Oh sure they have their sibling moments of arguing and competing. But overall, they are closer to one another than anyone else is to either of them as individuals. Not to minimize the relationship I share with them, but speaking as both their Mother and as someone who also is blessed with a sister (I love you, Shelly), nothing will ever compare to what they share between the two of them.

My oldest daughter, Jazmine is so protective of her little sister and has a high degree of empathy for her. If Jenna is upset or distressed Jazmine can't stand it and goes to great lengths to assist her. Jazmine has gotten quite cross and impatient with me in the past if she perceives that I'm not addressing Jenna's needs in a timely enough manner. I tend not to get too annoyed with this and, in fact respect it, as I relate to it very much in my experiences growing up with my older sister.

When Jenna first came home from hospital with her newly diagnosed diabetes, Jazmine was incredibly upset with all that Jenna had to endure; numerous blood sugar checks, three insulin injections per day, etc. I was quick to inform Jazmine that Jenna finds all this just as scary as she does but she doesn't have a choice in the matter. Jenna has to have her blood sugar checked and she needs her insulin to stay healthy. To watch my five year old "suck-it-up", for lack of a better term, and get brave for her little sister was just awe inspiring.

Jazmine went from crying and running away during these procedures to staying close by, observing and actually encouraging and cheering Jenna on! "It's OK, Jenna... you can do it... Hurray for Jenna!! You did it!!!"

I can't express in words how fortunate I feel to have been blessed with such delightful, kind, caring, fun-loving, fascinating, strong, smart, brave (I really could go on and on and on...) little girls. I am so very lucky to be a part of their lives.

Friday, October 3, 2008

Carboidrati Ossessione?

To update you on the battle of the bug, things didn't get too bad. Jenna did come down with cold symptoms but it occurred on Wednesday, two days earlier than my estimation.

Tonight I'm pleased to report both Jazmine and Jenna are well on the road to recovery; only an occasional sneeze and cough and the mucus factor has decreased significantly. Jenna's blood sugars have been pretty stellar too, considering the fact that she has been immune-compromised. Giant sigh of relief... ahhhhhhhhhhh.

Things have actually been the best ever with regards to Jenna's blood sugar readings. We have been slowly and methodically adjusting and fine-tuning all the variables on Jenna's pump... and there are many variables to adjust! It seems all our fine-tuning is paying off. We are seeing numbers that are well within our target ranges. I'm feeling rather accomplished as an insulin pump operator, actually!

I must add that accurate carb counting is partly to thank for this success. I began carb counting well before Jenna started on the pump in preparation for it. However, I wasn't as meticulous about it before the pump as I have had to be since. Likely because it is not the easiest or most convenient thing to do and since it wasn't crucial, I wasn't as motivated to put in the time or effort. Thankfully, with practice comes proficiency and I'm far better at carb counts now than I was only a few short weeks ago. I have numerous food count reference books aligned neatly on my kitchen counter, well within reach and my trusty food scale and calculator are always at the ready.

Occasionally, however, I'm faced with a challenge and tonight was one of those times. Supper was pretty easy; I had made ham, potatoes au gratin and broccoli. The potatoes were a minor challenge, but I just weighed Jenna`s portion and used a carb factor I use for mashed potato to calculate the carb count.

Dessert tonight was an unexpected challenge. I had bought a bag of imported Italian wafer cookies at a quaint little country market a few miles out of town earlier in the day. I figured a couple of these cookies would be a nice little way to cap off the meal without blowing Jenna's sugars out of the water and having to bolus the crud out of her afterward. Problem was the nutritional info was in Italian!

Now, I have a few years of French education under my belt so I can occasionally fake my way through some rough translation of certain words in Spanish and Italian. I had no trouble finding the "carboidrati" count, but problems arose when under the "per wafer" column two values were listed; 4.5 and 2.5. So which one was it? The second figure was labelled "di cui zuccheri". What the heck is that?

So my husband and I looked at each other with matching "...what the...?" faces and then, like a superhero being summoned to the scene of a crime, I dashed downstairs to the computer to do some rapid research. Super Mommy to the rescue! (Can you tell, I've been exposed to far too many viewings of The Incredibles lately?) I Googled Italian-English translation and found a site that helped me decode my bag of wafer cookies. The phrase translates as "...of which is sugar". Case solved. Back upstairs I sprinted feeling rather clever and dessert was served to a couple of very delighted little girls.

Tonight we can rest easy in the knowledge that the accuracy of our carb counting remains uncompromised and feeling relatively confident that Jenna has received just the right amount of insulin to see her through the night.

After proof-reading this entry, I'm left to ponder the possibility that this demon-driven desire to achieve an accurate carb count is becoming somewhat of an obsession with me. I mean, a couple of carbs shouldn't impact things that much. But, I must be doing something right, given Jenna's excellent blood sugar readings. Hey, she's my baby and I'm going to do whatever it takes to keep her as healthy as I can for as long as it's in my hands to do so. If I obsess, it is with very good reason... and without apology.