Tuesday, May 25, 2010

Lessons Learned and I'm Grateful For Them

Last week something happened that shook me to my core; a diabetic experience that left me feeling so vulnerable and, for a while, like everything I thought I knew about this damn disease meant nothing.  It was the glycemic equivalent to that dream we’ve all had - the one where you are running as fast as you can to escape some dark force but the harder you run - the slower you move, like you are running the wrong way on a moving walkway.  I learned a couple of invaluable things during this experience that I will remember to apply to future experiences.  
* * * * * 
It was a soup and sandwich night - a supper that has two distinct perks: easy preparation and easy on Jenna’s blood sugar.  Nothing crazy-high in fat or carbs.  It was a straight forward bolus.  The night should have been a cake-walk, as blood sugars go.
A bedtime blood sugar check reveals a lovely 7.1 mmol/l.  Nice.  
Two hours later, at 10:00pm we perform one more routine check just to make sure things are still tickity-boo.  WHAM!  We get sucker-punched with a whopping 17.  I stare in disbelief at the meter while my heart pounds in my chest.  
I quickly come to grips with the reality that this night has taken a sudden, unpleasant turn, dial up a hefty correction, press Go on Jenna’s pump and set my alarm for two hours later.  
Okay.  So it’ll be okay.  I’ll check her in two hours and she’ll be on a slow descent back to a respectable number - maybe even single digits!  Back to bed I go and try to sleep for two hours while I put my faith in Dr. Frederick Banting and Charles Best and that bolus.
Midnight.  Another check. SMACK!  Another cheep shot from out of nowhere slaps me across the face with an 18!  I decide it’s time to check for ketones.  Yup.  She’s got ‘em.  Only trace but they’re there!  Time for some drastic measures.  I decide a site change is in order.  Her site must be tired given that it is almost four days old.  I feel guilty for trying to squeeze another day out of it beyond the recommended three.  But up until 10:00 pm she was getting great performance from that site.  Nevertheless, a change must be done.  I go for the site-change-in-her-sleep maneuver.  I’ve done it before with success.  I just have to be slick, organized and quiet.
I perform the site change and Jenna only stirs a bit. We load up another cartridge and perform a rewind/prime sequence on the pump, reconnect her and secure the pump in its pack around Jenna’s waist.  I then administer the correction for this last high reading with a little extra to help fight those nasty ketones.  I decide to leave the old site in place until morning when I can apply adhesive remover to assist in its removal.
Good.  That ought to do it.  A bad site!  That’s what it must have been.  All should be good now.  She’s got a nice fresh site in place, a solid correction is in play and I can breath a little easier.  I figure I should give the bolus a little extra time to work on that stubborn, ketone-laced high before I check her again. Back to bed and an alarm is set for two and a half hours later.  Time to log some zzzz’s.
2:30 am.  I stumble out of bed and make my way to the hall to clumsily load a test strip into the meter, grab the little flashlight and shuffle to Jenna’s bedside whispering - please let it be a good number - please let it be a good number -  but optimistic that things will be on the right path.  It has to be!  I don’t have many more tricks up my sleeve!  
TWENTY-FRICKEN-FOUR!!  
At this point I’m fighting panic.  I’m confused, angry, afraid and desperate to find the cause of this insanity.  I fight the urge to fall apart.  I check for ketones and, of course, they are increased.  What. The. Hell.  
J and I discuss what our next move should be.  We trouble shoot the problem.  The insulin.  Maybe the insulin has gone bad.  We need to break open a fresh vile to rule it out.  So as we discuss and open the fridge to retrieve a new bottle of insulin, Jenna wanders out of her room.  She sees the goings on and calmly inquires “Site change?”
J tries to allay her fears saying “No sweetheart.  We’re just going to change the insulin.”
At that moment something inside me steps in and takes over.  “Actually, let’s do another site change.  It couldn’t hurt.”  
I’m not sure what made me think that putting Jenna through two site changes in less than three hours was necessary.   I thought it would be a tough sell to both J and Jenna.    But J only briefly looks at me like I’m crazy then promptly gets on board with the plan.  Surprisingly, Jenna is game as well. 
We do a second site change, change out the cartridge with fresh insulin and give yet another correction.  Again I decide to leave the second cannula in place until morning.  We settle Jenna back to bed with a total of three cannulas in-situ - two duds and an active one - and return to bed as well.
5:00 am.  A glorious 12 stares back at me from the meter.  It’s still out of her range but it’s obviously on its way down from that ghastly 24.  Again I become emotional only this time it’s tears of sheer relief...and a splash of pure exhaustion.  
Later that morning, after breakfast and another blood sugar check confirms that things are indeed back to normal, I decide to remove the two cannulas that tell the tale of a long, anxiety-riddled night of hyperglycemic hell.  
This was the four day old site:


And this was the two hour old site:


A bent cannula that had not even penetrated her skin.  It left a bruised mark but did not puncture at all.  She was getting absolutely no basal insulin for more than two and a half hours, not to mention missing a correction bolus!  
I was horrified when I saw this.  It had never happened in our twenty months of pumping insulin.  But I was also incredibly thankful for my inner voice - my intuition that told me to perform another change on Jenna.  I shudder to think of what could have happened had I not listened to my gut and done a second change.  
So the two main lessons I have gleaned from this experience are that cannulas can malfunction and that I should always, ALWAYS listen to my inner voice.  The value of my mother’s intuition has already made itself known to me countless times in my seven years of parenthood.  But I still marvel at it’s incredible, unexplainable power.  And I am always thankful for whatever sense prompts me to heed it.
  
Note: I am not suggesting that anyone should handle a similar situation the way I have described here.  There are protocols that should be followed in situations like these.  If you have questions about how to deal with a similar situation, please contact your CDE or healthcare provider.  
  

Wednesday, May 19, 2010

Bravery

When a four year old has to have blood drawn it’s a big deal.  Even though Jenna has had more pokes in the past two years than a hundred non-diabetic adults combined (and I strongly suspect that is a gross underestimation), she still becomes anxious at the idea of having blood drawn.     
Recently Jenna had a routine appointment with our new pediatrician, Dr. M.  It went well, I guess.  He seems like a nice guy.  He certainly worked hard to make my girls laugh and impress upon me his rapport with children.  And he didn’t make any inappropriate references to Jenna’s weight or any ignorant assumptions about the diet I provide her.  Smart.  
Dr. M wrapped up the appointment by discussing the required, routine annual blood work that needs to be drawn on Jenna.  He stated he would write up a requisition and fax it to the lab of my choice.   I told him the lab we like to go to for all our phlebotomical needs (no, that’s likely not a real word) and he assured me the requisition would be there awaiting our arrival.  This isn’t the process I am used to when lab work needs to be done.  I’ve always been given a requisition at the appointment then taken it to the lab myself.  But I figured it was the way this doctor liked to do things.  Who am I to question it?
Almost a week later, on a Thursday,  a day I decided would be the least busy day to tackle this daunting task, I decided to take her in to have it done.  I had prepared Jenna the previous day for what to expect by casually telling her we would get her blood work done the next morning.  I thought a casual, "Oh yeah, by the way..."  approach would help keep Jenna calm.  I refreshed her memory, referencing the previous year’s blood work experience and  the Emla I would apply to help make the procedure ouch-free.  She seemed relatively unphased by our brief chat.
The next morning after the girls ate breakfast, got dressed, brushed teeth and hair, etc., I applied the Emla.  Jenna still seemed unconcerned.  An hour later we were off. 
We arrived at the lab and I approached the reception desk to give Jenna’s name so that her previously faxed lab requisition could be located.  But the woman at the desk would have none of my unorthodox “standing-in-line”, “name-giving” ways and curtly told me to take a number and have a seat.  
A number.  There were all of five people present in the tiny waiting room.  But the impersonal number system was to be strictly adhered to, nevertheless.  This set the tone for the next hour that we were at the lab.  That’s right - one whole hour to have blood drawn on a four year old that should only take five minutes. 
A few minutes later the woman at the desk called my number.  No one else had been called before me and I sat, literally, no more than three feet from her.  As I approached the desk the thought crossed my mind to ball up the numbered slip of paper and flick it at her.  Not that I would, but it was mildly satisfying to envision it.  I explained that my daughter’s pediatrician had faxed a requisition for lab work.  She reached for a stack of requisitions and began thumbing through looking for Jenna’s name.  
Nothing.
Again she sifted through the stack of papers and again turned up nothing.
My heart sank at the thought of having to go through the whole procedure all over again another day.  It wouldn’t be fair to Jenna.  Heck, it wouldn’t be fair to me!  I was doing my best to hide a truck load of anxiety related to how Jenna would fare while her vein was being tapped.  Every other previous blood draw has been an upsetting experience for Jenna.  I might not be able to convince her to be such a willing participant on another day.  So I decided at that moment that come hell or high water, this blood work was going to be drawn today and I was going to make it happen.
...somehow.
I explained our situation and made it clear that postponement was really not an option.  So she handed me the phone number of Dr. M’s office on another blasted little piece of paper and wished me luck.
I spent the next forty minutes or so on my cell phone making calls to his office as well as to our Diabetes Nurse Educator, leaving desperate voice mail messages and talking to medical office personnel - pleading for their help, then waiting for return calls and good news.  
During this time my girls kept themselves entertained with an assortment of story books and colouring books I, thankfully, had had the foresight to pack.   

Finally the fax machine hummed to life and a requisition materialized with Jenna’s name on it.  Dr. M had come through.  Right then I forgave him his forgetfulness where only moments before I was composing my “You Dropped The Ball HUGE, Doc” speech.   Actually, I was pretty impressed.  Obviously he had forgotten.  But I was also told by his staff that he wasn’t in the office that day.  So he must have given his staff a phone order on his own time.  That’s pretty cool.    
Jenna was calm right up until the tourniquet was applied at which point her anxiety came rushing to the surface and she began to cry.  I held her on my lap and restrained her little arm while the skilled lab tech got the job done quickly and efficiently.  Unfortunately Jazmine became upset not long after Jenna did.  I found myself in the torturous position of having to keep focused on Jenna to attend to the task at hand while Jazmine had to go without comforting.  Sometimes Mommies just don’t have enough arms.  
After it was over the lab tech handed Jenna two stickers and we all agreed that she was one very brave little girl.  Jenna, still weeping, disagreed with us saying that she wasn’t brave because she cried.  I told her even brave people cry and that she is, in fact, one of the bravest people I know.  She accepted her bravery stickers then wrapped her arms around me and gave me a big hug.
I sure wish she didn’t have to be so brave.

Sunday, May 16, 2010

A Cure

This is the last day of Diabetes Blog Week and I'm proud to say I saw it through to the end.  I'm even more delighted to have made so many new friends!  Thanks to Karen of Bitter-Sweet for making this happen.  And thanks to all the bloggers who shared your feelings so eloquently.  I enjoyed reading your words.  And given the sheer volume of blogs out there who participated I'll be enjoying your words for days, dare I say weeks to come.

The morning after my daughter’s diagnosis, while I sat cradling her weak little frame in my arms in a hospital room, the tears streaming down my face in a non-stop cascade, a doctor entered the room - the same doctor that doubted my suspicion that Jenna was displaying symptoms of diabetes and reluctantly wrote a requisition for lab work only three days before.

He sat and talked to me about Jenna's diagnosis.  He told me a cure was very close.  My heart skipped a beat and for a moment the flow of tears slowed. 

“Really?  ...a cure?!” I said with a sudden surge of hope.
“Oh yes.  A cure is no further away than five years” he responded. This gave me a great deal of hope.  As I type that statement now I feel foolish at how very naive I was.  
Since that day in the hospital I have done what I needed to do to cope.  I have educated myself so that I would be better equipped to manage Jenna’s diabetes and keep her as healthy as I can for the next five years so that the damage to her body is minimized for when she can line up for that cure that is so close.  But during this self-education I also became aware of the fact that doctors have been promising type 1 diabetics a cure “within five years” for the past thirty years.  My hope for a cure has been put firmly into perspective.  As much as I want to believe a cure will happen in my daughter’s lifetime, the most I allow myself to truly hope for is improvements in treatments.
I won’t stop fundraising or raising awareness though.  I’ll talk to whoever will listen and educate those who need educating.  I will keep fighting as long as I’m alive.  I’m the parent of a child with type 1 diabetes - a disease requiring attention every minute of every hour of every day of her life.  A disease that threatens her longevity and quality of life.  A disease who’s very treatment could endanger her life.  When Jenna gets tired and has lost her will to keep believing, as has happened to so many other adults living most of their lives with this disease waiting for a cure that never comes, I will still be fighting.   

But you can bet your next order of diabetes supplies I'll be throwing the grandest gala ever thrown if...IF a cure is found. 
I’ve written previous blog posts here and here on the subject of a cure.

Saturday, May 15, 2010

Images of The Past Two Years

 These snapshots follow a timeline starting from just before Jenna's diagnosis:


Two years ago, Jenna and I were spending an afternoon at the beach.  She was showing symptoms but had not yet been diagnosed.  For the first year or so after her diagnosis this picture as well as others from that day were very difficult for me to look at without becoming emotional, imagining how she must have been feeling.   

        
This was taken while Jenna was hospitalized for four days after diagnosis.  Her hospital room window looked out over a green belt.  She often saw bunnies out there eating clover and such.



   The girls and me just a few weeks after her diagnosis.


Jenna holding her brand new insulin pump.  This was taken at her pump start up right after her very first infusion site insertion, hence the tears.



Jenna's first Halloween with diabetes.  Thankfully, it was also her first Halloween with a pump!



We attended a wedding last spring.  Jenna enjoyed a luscious piece of chocolate cake - savouring every last crumb - while  Daddy was busy pressing buttons on the pump.   We guessed at the carb count and if memory serves, we battled a high all that night.  It was totally worth it though!



 
I was quite proud of myself when I got the idea to have a dry erase board on our fridge to keep track of carb counts for each meal.  We used it faithfully for a year or so.  Now we are seasoned carb counters and my mental math skills are smokin' these days.  For the most part the dry erase board sits idle now, save for the odd doodle or birthday party invitation.


This is just one heckuva sweet picture of my two babes walking hand in hand on the beach.  Yes, I'm a proud mama.  I won't deny it.



We made some paper pumps for Jenna's stuffed toys one morning.   Read more about that here.


Please understand - I don't condone this kind of behaviour.  But this is a testament to Jenna's spirit.  She has a great sense of humour with a delightful splash of attitude and it's what has seen her through many of life's trials up to this point.  I'm betting it will see her through many more.  Give 'em hell, sweetheart!



Thursday, May 13, 2010

My Moronic Moment

It’s day five of Diabetes Blog Week and I’m going to play my wild card.   I've got a moronic moment to share and it's a doozy.  I probably should just stick with the assigned topic and talk about exercise rather than expose my inner numb-skull but I've been meaning to share this one all week.  If I don't get this off my chest now I'll miss my opportunity to purge.  So I shall commence purging....now.
I’m human.  I screw up every now and then.  And I’m okay with that...unless those screw ups have an adverse effect on my child’s wellbeing.  Then I'm totally NOT okay with it. 
Jenna gets a break from her ever-present Animas One Touch Ping during two activities: swimming lessons and gymnastics classes.  During those activities her pump takes up temporary residence in my purse.  Now, for those of you who aren’t familiar, the Animas One Touch Ping is a pump and meter duo that communicates remotely with one another.  So you don’t have to actually handle the pump to administer a bolus.  It can all be done with the blood sugar meter from several feet away, if necessary. 
After her lessons are over Jenna heads to the change room to change from her body suit or swim suit back into her regular clothes.  At this time her pump should be extracted from the cavernous pit that is my purse, the lure-lock engaged and the case strapped back around Jenna’s waist.   
It SHOULD be.
I try to keep everything in order and be the organized anchor for my family. Like most moms, it is a job I take quite seriously.  So you can imagine how I’ve felt when not once, not twice, but three times I have forgotten to reconnect Jenna’s pump after a swim or gymnastics lesson and on one occasion have even gone so far as to bolus my purse for her snack, assuming the pump is where it should be - connected to Jenna!   The sickening moment of realization occurs when, sometimes up to two hours later I check her blood sugar and discover that it’s on a trajectory for the freakin’ moon.
If motherhood has taught me anything it is humility.  I have proven to myself time and time again that I am human.  But diabetes seems determined to poignantly drive that point home now and then.  Furthermore, as much as I love the remote bolusing capabilities of the Animas One Touch Ping, this is it’s one Achilles heel; it is too easy to forget to reconnect when you don’t have to actually handle the pump to bolus, setting the stage for precisely this scenario.
It is because of this that I’m thankful for another piece of technology - my iPhone and it’s ability to be programmed with reminders and alarms!  I love my iPhone almost as much as I love Jenna’s pump. It has since spared me countless potential episodes of self-loathing.  Just imagine if Apple and Animas combined their awesomeness and collaborated to create a new insulin pump - the “iPump”.  No...the “iPing”!  ...sweet.

To Carb or Not To Carb

Day four of Diabetes Blog Week has arrived and our assignment is to discuss what we eat.  There are two general schools of thought:  eat what you want and just bolus for it or limit your carbs to better maintain glycemic homeostasis.  Truthfully, I see both sides of the debate.  However, I was also raised in a household where the meals provided were wholesome, home-cooked and had carbs aplenty.  My mother is a fantastic cook and made nutritious meals from scratch, with love and on a shoestring budget.   Desserts were almost always part of our Sunday menu and were always homemade.  It’s what I lived so it’s what I learned and for the most part it’s what I practice now raising my own family.
Initially, after Jenna’s diagnosis, I tried to limit our carb intake.  I had been given a meal plan by our dietician which specified how many carbs Jenna could have at each meal and snack.  To stray from that would mean Jenna would suffer either a high or a low since she was on multiple daily injections and her insulin dosing was given long before her actual meal or snack.  So it was in her best interest to try to adhere as closely as possible to the plan. 
But Jenna was two at the time and if you’ve ever raised a two year old you can imagine just how difficult this task was for us.  Some days Jenna was super hungry and wanted more than just her 35-40 carb allotment for breakfast.  Other days she wasn’t as hungry and I would be pleading with her to eat her 20 carb morning snack that she had been dosed for before breakfast.  This clearly wasn’t working for us.  So after three months of MDI’s  we started Jenna on an insulin pump and began enjoying food again.  REAL food.  GOOD food.  Without quantity restrictions.  
Now, I can’t say that things have gone right back to the way they were before Jenna’s diagnosis.  But the changes that remain in play are good changes.  More careful thought is given to each and every meal and snack I prepare now.  Like most people affected by diabetes I have become an avid label reader.  Carb counts are crucial but so are other nutritional components.  I pay very close attention to fat and fibre content as these influence the glycemic index of foods which is important in determining how the carbs will be absorbed by Jenna.  I try to limit high fat foods and those foods that are notorious for messing with blood sugars like pizza and pasta.  Because these foods are commonly eaten for supper, they tend to creep up on a person with diabetes when they are in their most vulnerable state - sleeping.  Waking up in the middle of the night to the sound of Jenna chugging an entire sippy of water after a pizza supper means she is likely in the mid to high teens and the fatty, high protein, high carb pizza is to blame.  I won’t lie to you, I feel tremendous guilt when this happens.   It sucks.  
However, Jenna loves pizza and so does her sister.  So while I limit it, I don’t eliminate it from our diet completely.  I don’t want to make certain foods forbidden and leave Jenna feeling deprived.  I mean, what childhood is without the occasional pizza and movie night or spaghetti dinner with loads of parmesan cheese?  So we figure out how to make it work.  And if combo boluses and raised basals don’t take care of the inevitable blood sugar spike, we just correct the crap out of it until we stamp it back down into submission again.  In a perfect world the boluses would match Jenna’s needs and she wouldn’t have any episodes of hyper or hypoglycemia taxing her four year old body.  But then, in a perfect world there would be no such thing as diabetes.
  
So, as cliché as it sounds, for us moderation is the key.  Food is a huge part of how we socialize and experience life and Jenna deserves to live her life as fully as the next person.  So we do the very best we can.  The rest is beyond our control.
To find links to other awesome blogs writing about this very subject today visit Bitter-Sweet.

Wednesday, May 12, 2010

Our Biggest Supporters

Since diabetes is truly a family affair and since the youngest member of our family has it, we all support one another in different ways. 
Jenna gets support from all of us.  We manage her diabetes care and all the emotional stuff that goes along with it as a team.  And when things just get to be too much for her and she’s sick of being a human pin cushion or has been riding a stubborn high for too damn long and is feeling pretty rough we rally behind her and let her know we are there for her through thick and thin.  Sometimes, when she’s had it up to HERE with all the finger sticks, we will offer to let her give one of us a check.  She likes being on the other end of the lancing device for a change and I enjoy taking the occasional peak inside my own internal glycemic workings.  There are times when she doesn’t feel like doing her own check that her big sister happily offers to do it for her.  And when Jazmine does perform the check, she is always so proud to report the reading to me; She’s eight point two, Mom!  She needs a correction!  I'm left to quietly wonder how my six year old knows that eight point two warrants a correction.  It amazes me just how much Jazmine has absorbed in the last two years.  Evidently, she’s been paying attention!
But like I said at the beginning of this post, diabetes is a family affair and the rest of us need support on occasion as well.  Jazmine has had some difficulty in the past with witnessing the physical trials Jenna has had to endure.  She has been known to make a hasty exit when we’ve had to restrain an unwilling Jenna to have an injection or a sight change.  Recently, during some routine blood work at the lab (which I will be blogging about next week) Jazmine became quite emotional reacting to Jenna’s upset.  My heart broke for both my girls that day.  I was busy holding Jenna during the blood draw and was unable to comfort Jazmine while she watched her little sister endure yet another physical assault. 
J and I are always there for each other.  There have been many nights when I’m feeling tired and burnt out from too many wee hour checks or when diabetes seems hard pressed to relinquish control and I get feeling down.  Sometimes when we just can’t seem to chop down a high I get almost panicky at the though of just what kind of damage could be happening inside my baby’s body.  J knows just how I’m feeling, being the other half of this parenting team.  We both curse the “D” together.  Literally.  Nights like that--if diabetes was an ass, my shoe print would be all over it!  
My mother-in-law has also been a source of support.  She has been willing to learn all the diabetes “stuff” in order to fill in for us if we need her to.  She has mastered the blood sugar check and is presently in the process of becoming more comfortable with dosing Jenna using her pump.  She has even spotted a low before things got too crazy!   I’m thankful that she is open to this.  I’ve heard of other grandparents who are so afraid of learning these tasks that they refuse to care for their diabetic grandchildren.  As much as I can understand their fears, I find that to be terribly sad for everyone involved.
I’ve also had friends from my childhood support me in numerous ways.  Upon hearing of Jenna’s diagnosis, friends I haven’t seen since high-school graduation who have families of their own now and, like me have moved away to various parts of North America have let me know I’m not alone!  Whether it’s been a few kind words of encouragement on Facebook, donations to our annual walk to cure diabetes or offering their creative expertise to make things to sell to raise money for our cause, I have been reminded of the generosity and sense of community that is so much a part of the small town in southern Ontario from which I originally hailed.  
But some of the best support I have gotten as the mother of a child with type 1 diabetes has been from you.  That’s right, YOU!  The Diabetes Online Community.  And I’m so proud to be a member of this strong, supportive community and to be able to give support back.  No one knows quite as well as we do what we go through as people living with type 1 diabetes or as parents of diabetic children.  You truly have to live this experience to understand it.  
I have wondered many times in the past two years since Jenna’s diagnosis how parents got through it all twenty or thirty years ago or longer.  Odds are they didn’t have any other families in their social circles who could relate and there was no internet, no “online community” to draw support from; not to mention the less advanced methods of blood sugar monitoring and insulin delivery--the less predictable insulins they had to work with as well as the far more strict dietary regimens their children had to follow that they somehow had to enforce.  I salute those parents.  They have my utmost respect.
That’s why after only three days into this Diabetes Blog Week I am determined to see this project through to the finish line.
When I signed up for this I questioned my own sanity.  Committing to blogging every day for seven days straight?  Ya, right.  I can’t even get a solid five hours of sleep on any given night.  How am I going to write seven consecutive blog posts?  But this has been a pretty amazing experience so far - to read other blogs and realize that what we go through every day isn’t that different from what most of you go through every day.  You share my fears and frustrations; you know the 24/7 of it all.  
The wind is at my back as I blog with all of you.   
...but we still have a ways to go to get to the finish line of this blog-a-thon.  Three posts down - four to go!  Quick!  Someone hand me some sort of sport drink to throw back!  
I’m in it to win it, people!

Tuesday, May 11, 2010

Making The Low Go

Day two of Diabetes Blog Week.  I'm so proud of myself!  I'm still in this thing!  To find links to other blogs taking part in this Blog-fest, visit Bitter-Sweet.  But not before you read mine and leave a comment!

Our carb of choice for Jenna when she is low comes in tablet form. 

Carb tabs are convenient, fast-acting, have exactly four carbs in them, can be broken in half and come in an assortment of fruity (albeit chalky) flavours.  You can pack ‘em in your purse or your pocket or stash them in a variety of other handy places like glove compartments, kitchen cupboards, nightstands, etc.   And one tablet raises Jenna’s blood sugar two points which is handy to know to predict how many she will need if we factor in whatever insulin still remains on board. 
  
    
We used to use juice, back when Jenna was on on MDI’s.  But ever since she began pumping insulin and the whole management of her blood sugar has become more precision-oriented (at least in theory), it only made sense to use a more precise method of raising her blood sugar in the event of a hypo.  
One night, a couple of hours after Jenna had been settled in bed we tested her and found her to be quite low. I tried to use glucose gel to raise her blood sugar to within range.  But given her low number she was less than cooperative. The hypo passed thanks to carb tabs which I was finally able to convince her to eat.  But the aftermath from the glucose gel was a sticky disaster that made it necessary to give Jenna a late night shower and a complete bedding overhaul before she could return to dreamland.  She had thrashed around so much, pushing our hands away every time we came at her with a spoonful of the icky-sticky stuff that it got everywhere--in her hair, on her pajamas, on her bed sheets...  Needless to say this did NOT help her already agitated state. I swore we would never use the stuff again. 
I’m not really sure what made me think that attempting to force-feed a sleepy, hypoglycemic three year old super-sticky, snappy-thick gel would actually be a good idea, given that she was totally irrational and had absolutely ZERO tolerance for ANYTHING, let alone trying to swallow a gob of what must be the stickiest, most sickly-sweet substance known to man...but these are life’s little lessons learned.  
So there you have it.  Carb tabs are our weapon of choice when battling lows.  The reasons are numerous.  But suffice it to say, I’d sooner be on hands and knees searching for a lost carb tab, flung in a hypo-induced rage than attempting to wash glucose gel out of my sleep deprived, hypo-recovering, preschooler’s hair in the wee hours of the night.

Monday, May 10, 2010

A Day In The Life of a Warrior Princess


6:00am - The early morning quiet is broken by the sound of a sweet, tiny voice breaking out into song.  Bed sheets rustle then two little feet hit the floor.  I know the sound of Jenna’s feet versus Jazmine’s.  Jenna has a heavier foot with a faster pace.  Jazmine is always in stealth mode.  This is Jenna marching into my room with the determination of a warrior and the subtlety of a bull.   Within moments she is at my bedside, pulling back the covers and nudging her way in beside me.  Mornings like these I am thankful for both the early morning snuggle and for not having to lie in bed and wonder if Jenna is okay.  She is up.  I know she is safe.
6:10am - While I grab my morning shower J gets up to prepare breakfast for the girls.  A blood sugar check is done, cereal choices are made, carbs are counted, buttons are pressed on her pump and a bolus is administered.  
7:30am - J and I sit and enjoy our morning coffee together while the girls play.  Before J says his goodbyes and heads to work for the day a report of the details of Jenna’s breakfast is given--what and how much she ate, the dose of insulin given and what her waking blood sugar was before she ate.  This information gives me an idea of when Jenna will need to have a snack.  If she didn’t eat all her breakfast I know to watch for a low around 9:00am.  But even if she did eat all her breakfast, there’s no guarantee she won’t go low.  Diabetes is funny that way.  All the rules are subject to change without prior notice and often for seemingly no reason at all.
8:30am- School time.  My oldest daughter is in grade one, in a learn-at-home program.  I teach her lessons at home weekday mornings.  I also plan structured learning activities for Jenna most mornings.    
9:30am - Snack time--the highlight of the morning for Jenna.  Another blood sugar check before they tuck in to cheese, crackers and apple slices or corn cakes with peanut butter and banana; perhaps a piece of whole wheat toast lightly dusted with cinnamon sugar.  Another carb count, more buttons pressed and a bolus is administered.
11:30am - Lunch time.  Soup, sandwiches, the usual lunch fare.  Another blood sugar check, carb count, buttons pressed and bolus given.
12:30pm - For Jazmine afternoons are spent either in classes at her school, in gymnastics lessons, in swim lessons or art classes depending on the day.  Jenna also takes gymnastics, swimming and art classes.  I need to pay extra attention to the timing of snacks depending on the scheduled activity of the day.  For swimming I like to ensure that Jenna’s snack is no more that one hour prior to her lessons to ensure she doesn’t go low while in the pool away from my watchful eye.  The same is true for her hour long art class on Fridays when I leave her at the art studio with her meter in a little backpack and a tube of carb tabs.  I often spend this hour at a Starbuck’s writing on my laptop--trying NOT to worry.  It’s only an hour but still...  
1:30-3:00pm - Afternoon snack time varies.  But what never changes is the pre-snack blood sugar check and bolus.
5:00pm - At this point in the day I am usually immersed in the preparation of the day’s last meal.  But every three days a site change needs to be done on Jenna and this is often the best time to do that.  J and I work together like a well-oiled machine to get the job done; one of us removes her pump while the other loads a new cartridge by drawing up 100 units of insulin.  The insertion device is unwrapped from its sterile seal, unwound, cocked and ready for use.  Then while J holds Jenna I prep the area and perform the insertion as swiftly as possible to decrease the anxiety Jenna still has regarding infusion site changes.  Once this is done it’s a matter of reconnecting her pump to the new site and applying adhesive remover to her old site for easier removal.  If I feel a review of Jenna’s numbers is warranted (usually about every two to three site changes) I will take the opportunity to download data from both her pump and her meter to the PC.  I then print out two weeks of log data so that I can spot trends and determine the appropriate setting changes required.  I usually save data analysis till after supper though, when I can sit with my highlighter and a cup of tea.  Tea, for me, is a necessary accompaniment to a variety of life’s activities, not the least of which is effective data analysis and blood sugar trend spotting.
5:30pm - Supper is served after another blood sugar check is performed, carbs are counted, data is entered into the pump and a bolus to cover her supper is administered.  This bolus requires more thought, however.  It is what will impact her numbers while she sleeps, depending on what she ate and the type of bolus given.  A higher fat meal tends to delay it’s full effect on Jenna’s blood sugar, sometimes for up to 10 hours or more!   This is when we employ the help of the combo bolus to stretch out the dosing of her insulin to match the delay.  It doesn’t always work.  I’m getting rather bold though and often ramp up her basal insulin by 20-30% in conjunction with the combo bolus.  This helps prevent a horrible, stubborn blood sugar spike.  Unfortunately it can work too well and send her into a hypo.  I must be extra vigilant.  
7:30pm - Bedtime.  Teeth are brushed, a final sitting on the potty, faces and hands are washed and stories are read.  Of course, another blood sugar check is done and we take note of how much insulin is still on board to determine, in a best-guess sort of way,  what kind of night it will be; the kind of night where we can check her one more time at our bedtime and call it a night (a rarity), or the kind of night where we will be up every two or three hours checking and correcting.
10:00pm - A blood sugar check is done while Jenna sleeps.  The results will require one of three courses of action: a correction bolus of insulin for a high blood sugar, a carb tab or two for a low (followed by a water chaser to help rinse away the sugar bugs), or a sigh of relief that she is within her target range and all is well.
12:00am - If a correction bolus or a carb tab was required at 10:00pm, another blood sugar check is done at this time to ensure our intervention worked.   If further intervention is required at this time we set another alarm for...
2:00am - If a correction bolus or a carb tab was required at 12:00am, another blood sugar check is done at this time...yadda, yadda...
4:00am - If a correction bolus or a...well, you know the drill.
6:00am - We awaken refreshed (pfftt) and ready for another day.
*****
In spite of the broken sleeps and the constant presence of diabetes in our lives I am so thankful for our many blessings.  The routine testing, carb counting and bolusing to keep Jenna healthy has become just another part of our daily routine.  Oh, sure, sometimes it can be overwhelming.  On the days when Jenna gets fed up and cries out in sheer frustration I HATE having diabetes!  I wish I didn’t have it!  I want to join her in her moment of exasperation and, indeed, sometimes I do.   
But most days we just get on with it.  We aren’t going to let it slow us down and, knowing Jenna the way I do, she will never let it stop her from doing whatever she decides she wants to do in life. 

To look upon her beautiful, sweet face or watch her dance in one of her princess dresses and her “clippy-cloppy” shoes you wouldn’t know that, much like the style of her gait, Jenna is a warrior through and through.  Diabetes is the red cape and she is the fierce, charging bull.

Wednesday, May 5, 2010

Diabetes Blog Week!

Okay.  So I've gone and done something rather rash.  I've signed up for "Diabetes Blog Week".  In doing so I have committed to blogging every day for an entire week on an assigned topic-of-the-day, in relation to diabetes.


I'm pretty excited about this, actually.  It will be fun to be a part something that, so far, over 50 bloggers have signed up for.  I would imagine by next week when the blog-a-thon starts that number will have grown considerably.  I'm looking forward to a week of writing and reading the other blogger's personal interpretations of the topics.


However, I am the mother of two young, busy children with a multitude of distractions that can crop up at any moment on any given day.  Plus I have that pesky need for sleep that all too often I am forced to ignore as it is.  So, hopefully I am able to follow through with my commitment and see this week long blog-a-thon to the finish line.  And even if I can actually post every day, there is no guarantee that my posts will be good.  I tend to labour over my posts as it is - editing, revising and tweaking the bejeezus out of them until I drive myself insane.  This will be a fabulous little challenge for me, to be sure.  I can't promise quality won't be compromised for quantity.  But I will give it my best effort.


The list of bloggers who have opted in is pretty impressive.  Check it out at Bitter-Sweet.  This blog is written by Karen, the woman who created this event.  If you blog too and want to participate let Karen know.  She can add you to the list.


So here's my banner:




Wish me luck and...let the games begin!

Monday, May 3, 2010

Introducing Meatless Mondays

In our house, we have been trying to go meatless every Monday for a while now.  It's fun but it can be a challenge to find a variety of vegetarian meals that are pleasing to the 4 and 6 year old palate.


My husband and I dabbled in vegetarianism for a few years before we had children.  That was during a simpler time when two incomes and no picky kids to consider made it easy to have a huge grocery budget to prepare all kinds of cross-cultural, vegetarian culinary delights.  We would travel all over the world...in the comforts of our own kitchen, sampling the unique vegetarian dishes of each culture.  We especially enjoyed borrowing from the East Indian palate.  At the time I worked with several East Indian women and would pick their brains gathering the "how-to's" of East Indian cookery.  I wasn't above pulling out a notebook (usually reserved for taking down pertinent patient information during report at the start of my shift) to feverishly take notes while my co-workers gave me verbal instructions.  Measurements were purely approximations and some details were left out for me to discover on my own through trial and error.  I was forced to decipher instructions for methods that probably evolved over many generations and were likely passed down through word of mouth by women during actual meal preparation; not sitting around a staff room table explaining the process while sipping tea and munching on a bagged lunch.  It was truly an adventure.  I felt very lucky to have such a rich cultural, culinary resource available to me.  I would often bring left-overs to work the next day to have my "teachers" taste my interpretations of their time honoured dishes and offer advice on improvements.


Home made pakoras accompanied by a cilantro-garlic salsa were a staple for us.  And I became a fan of a dish known as Bindi - oven roasted okra in a garlic masala mixture of my own creation.  Nothing dresses up okra like garlic and masala spice.  

No dish could ever be replicated exactly because no measuring took place.  This is the true heart and soul of cooking, in my humble opinion.  I have strayed just a little from this adventurous style of cooking in an effort to please my young children.  But I feel it might be the right time to start gastronomically globe-trotting again.  My girls are no longer fussy toddlers and I think they just might enjoy the ride.  


I've recently stumbled upon this site:  Introducing Meatless Mondays.  It's a great site that helps motivate people to abstain from eating meat one day a week by offering vegetarian recipes, cooking videos and nutritional tips.


I'm looking forward to enriching our annual gardening endeavours with some interesting new cooking methods and flavours.  Furthermore, I am excited to teach my children more about social responsibility and stewardship of the Earth.  Reducing our meat consumption reduces our footprint on our over burdened planet.  Not to mention the moral and ethical issues regarding the abhorrent conditions in which many animals bred for food are forced to exist.




Above is a picture of a veggie kabob grill we did a couple of Mondays ago.  We served them over brown rice and garbanzo beans with a light sprinkling of soy sauce.  My girls were involved in the assembly of the kabobs and were very proud of their colourful creations.  I mean, look at these beautiful vegetal delights!  What kid could resist?


There's no denying that vegetables are healthy.  We all could stand to ramp up our consumption of veggies. Perhaps you'd like to climb on board this Meatless Monday band-wagon.  And if you know of any kid-friendly, healthy recipes, or any links to other great vegetarian sites don't be shy.  Share!

By the way, this is an excerpt from the welcome email I received from the "Meatless Mondays" site.  Notice how they are careful to make the "type-2" distinction - a small detail, but to those with type-1 diabetes, it means a lot given the amount of misinformation out there.:

Did you know: In Canada, it takes seven times more land to feed a non-vegetarian than a vegetarian. Also in Canada, rates of type-2 diabetes and levels of overweight and obesity have reached near epidemic proportions. About 1.8 million Canadians aged 12 and over, or 5.5% of the population, have been diagnosed with diabetes and 90% is type-2 diabetes; almost 60% of adults ages 18 and over, or 14.1 million Canadians, are overweight or obese.  
Going Meatless just once a week can reduce your risk of chronic preventable conditions like cancer, cardiovascular disease, diabetes and obesity. 
So pat yourself on the back. You are making a difference! 


...seven times more land?!  That is definitely food for thought, pardon the pun.