Let's Talk Turkey

There is a sequence of events that is played out on average of 10 times a day—every day, in our house. The blood sugar check. The lancet clicks, piercing Jenna’s little finger tip. I squeeze her finger, summoning the glistening red bead of blood to form and await the test strip. I close in on the jewel of sticky-scarlet tissue with the meter and allow the strip to absorb the drop. The meter beeps its confirmation of receiving the sample. A moment later, another beep and the number appears precipitating an emotional reaction within me that ranges anywhere from calming satisfaction to considerable anxiety and frustration.

The only results that afford my mind respite from the worry are the ones within range, obviously—the five’s, six’s, seven’s, even the eight’s. Anything below four triggers my heart to beat faster and my protective instincts to kick in while I set out to locate carb tabs in earnest. Numbers in the mid teens or above elicit within me both physical and emotional responses of sympathetic nausea, guilt and sadness knowing my little girl is likely functioning at less than peak physical condition. To be more to the point, she’s feeling like crap.

But things really suck when she has repeated high readings in spite of correcting. Her temper shortens and her appetite for water increases dramatically. Consequent trips to the washroom become more frequent as her body attempts to rid itself of the excess glucose circulating in her blood. When this happens I’m left feeling desperately frustrated and wondering why. And often that question is difficult to answer with any amount of certainty. I can sometimes attribute it to what she ate or the onset of illness. But when the obvious culprits are ruled out and I have nothing more than my own creative devices to work out the “why”, my rationalizations can reveal my desperation to make sense of such a seemingly senseless disease. I’ve been known to ponder if the earth’s position in relation to the sun or perhaps a polar shift has caused an inexplicable high! Especially when I read that other people in the type 1 diabetes blogosphere are experiencing the same phenomenon at the same time.

But occasionally it's the wacky explanation that could very well be the cause.

Jenna had a pasta meal on Friday night—a meal that is notorious for causing a delayed climb in her blood sugar long after her meal bolus has played out. We employ a combo bolus to deal with these poky carbs but we must still get up at least once, usually twice in the night to ensure she is in the good range. More often than not and in spite of the combo bolus, Jenna requires a correction for a high reading in the night in order for her to wake up with a good number. This night, however, she stayed hovering around 9—slightly high but not too outrageous. Jenna’s waking number on Saturday morning was 8. Not too shabby, all things considered! And we were pleasantly surprised that our combo bolus worked so well.  Her blood sugar didn't stray too far from its target all morning.

Mid afternoon found us at a petting farm where Jenna sustained a bite to her right hand when she attempted to pet a turkey (it is a petting farm, after all). Her initial shock was quickly followed by a minute or so of solid crying. No blood was drawn but there certainly was evidence that this turkey inflicted quite a pinch on Jenna’s hand.

Over the course of the next five hours blood sugar readings rang in at 19 and 20 respectively, even though corrections were given for each high reading. I began preparing for the likelihood that a site change would be necessary. And as I was contemplating why this high occurred the thought crossed my mind that the turkey bite experience may have caused the spike. At first I called myself crazy for thinking it. But the longer I ruminated over it the more it made sense.

I mean, why not? It was a sudden, upsetting experience that likely caused a release of adrenalin thus triggering a subsequent discharge of glucose reserves from the liver—the classic fight-or-flight response. The high hung around for the remainder of the day and by bedtime we had to perform a site change just to rule out a bad site. We checked her blood for ketones and miraculously found none. I also dialled up a 20% increase in her basals for four hours. We were up twice in the night to check her and each time her reading was lower than the last. All of this seemed to do the trick. By morning she was 6.3—nice.

I don’t know if it was the unfortunate incident with that cranky turkey that caused this sudden, prolonged blood sugar spike. My gut tells me it’s well within the realm of possibilities. But one thing’s for certain: in spite of my tireless efforts to keep Jenna’s blood sugars on the straight and narrow, I am no pancreas. I can’t possibly know what is happening inside her body at any given moment or how each life experience is going to affect her. I must accept that I will never be able to fill her pancreas’ shoes perfectly, even though I so desperately want to. But my close attention to the subtle nuances of Jenna’s diabetes just might help me anticipate its next move from time to time and that’s what keeps me going.

And as for that turkey—well, there’s a saying I’m rather partial to in situations like this: what goes around comes around. See you next Thanksgiving, bird.

The Wisdom of PEZ

Remember PEZ?  

Those hard, little, rectangular nuggets of candy that come in their own reusable dispenser—a clever device with the head of a cartoon character that is hinged on one side.  When the flipping mechanism is activated the reward is one candy. 

These nifty little items have been around since the 1950’s!  I remember having a Woody Woodpecker one as a child which, as it turns out, is now a collector’s item.  I’m wishing I’d had just a splash more "nerd" in me.  I might have thought to save my Woody Woodpecker PEZ dispenser—but I digress. 

This is a product with staying power.  Timeless appeal.  So much so that it begs the question:  Why? 

Perhaps the answer isn’t really that difficult to determine.  I am fairly confident in my own conclusion that it is the dispenser itself that appeals to people.  It can’t be the candies since the candies...well...let’s face it.  They are a far cry from gourmet jelly beans, Jenna’s absolute favourite for treating lows.  (I’ve even been known to feign a low for a gourmet bean or two from time to time.)  

Yes, there’s a lot to be said for an effective, convenient, ergonomically sound dispensing device.  I could likely awaken from a deep sleep in the middle of the night and, without turning on a single light, dispense a PEZ candy into my mouth with minimal effort and little chance of frustration, if I was so inclined.  Of course, that would be unwise given the risk of choking, but that’s neither here nor there.  My point is, unless I was experiencing nocturnal hypoglycemia, I would have no reason to do that.  And somehow I doubt that sufferers of hypoglycemia are the consumers that the makers of PEZ had in mind when they developed their product. 

Now, I may not be popping PEZ in the wee hours of the night.  But what I am doing at least once between the hours of midnight and 3am is awakening to my alarm to check my daughter’s blood sugar.  I shake off just enough sleep to perform the task as efficiently as possible and react appropriately to the reading on the glucose meter.  If it is too high, I need the wherewithal to enter the necessary dose of insulin on the pump to correct.  If it is too low, I must summon the cognitive functioning to enable me to give adequate carbs to bring her number up—but not too much causing her blood sugar to launch into the stratosphere.  Ideally I prefer not to shake off more sleep than is necessary to allow me to get the job done and return to dreamland in a reasonably short period of time.

We are using the most advanced insulin delivery system to date to control Jenna’s diabetes—the insulin pump—a  highly specialized technological device capable of delivering minuscule amounts of insulin to enable the best control possible.  It goes without saying that I am grateful for this technology.  But there is another aspect of diabetes management that seems almost primitive in comparison; the test strip container—a small-in-diameter, flip-top vial that holds twenty-five strips, each one not much bigger than two match sticks side-by-side with an annoying propensity to stick together. 

When I'm alert I find it a challenge to obtain a single test strip from the small vial utilizing only one finger, especially when the vial is full,  limiting the room my lone finger has to maneuver inside.  The degree of difficulty is amplified when I attempt this task moments after waking up in the middle of the night.  At this hour my manual dexterity is akin to that of a drunken person with severe carpal tunnel syndrome.  More often than not I pull out two or more strips, dropping several on the floor in the process.  And since I try to pull off this whole procedure in the dark in an effort to maintain my semi-sleepy state, I invariably find myself on hands and knees blindly feeling around on the floor for the wayward strips.  At a buck a pop, test strips are precious and the idea of losing any conjures visions of financial ruin (I really do wish I’d saved that Woody Woodpecker PEZ dispenser.)  And I challenge anyone trying to pick test strips up off of laminate flooring to do so without letting a few choice expletives fly in the process!

I’m not one to bemoan the small stuff.  That’s really not my style.  I can suck it up.  She’s my kid and she needs me to just get the job done which is precisely what I do.  I can shake off the sleep and turn on a light if need be.  But what about severely hypoglycemic people who test their own blood sugar?  I would imagine my issues with the process would be a walk in the park compared to what someone with a blood sugar of 2mmol/l might experience.  I’m sure there have been plenty of test strips lost and little plastic vials lobbed across rooms in frustration by someone in dire need of juice.  Call me crazy, but it seems to me to be an unreasonable thing to ask of people with acutely compromised manual deftness and cognitive abilities—not to mention a little sadistic.  I would imagine its right up there with inserting the straw into that tiny, foil-covered hole on the juice box during a bad hypo!

Performing the ubiquitous blood sugar test is an act d-parents and people with diabetes carry out anywhere from 8 to 12 times a day or more and not always under ideal circumstances.  That’s a lot of little moments of angst in one 24 hour period, on top of all the other frustrating aspects that is part and parcel of this disease.  

We have the capability to dispense candy more effectively!  Why not test strips too?  And I’m pretty sure that if we were to follow the lead of the PEZ candy makers in designing a better strip dispenser the end result would be a more environmentally friendly approach.  PEZ refills can be purchased and loaded into the reusable dispenser.  Why can’t there be test strip refills sold in reduced packaging and loaded into specially designed, reusable dispensers?  Goodness knows we could stand to reduce the amount of waste generated in the management of this disease!

So I guess what I’m proposing is a revolutionary method of test strip dispensing that addresses the needs of the hypoglycemic person as well as humanity’s need to preserve our planet.   

I can even see a window of opportunity to personalize the dispenser and make it more fun for kids with type 1 diabetes. And any opportunity to do that should be taken full advantage of!    

You're Among Friends

Have you visited D-mom blog yet?  You should head over there and check it out!  It's an incredible compilation of resources you're sure to find helpful and interesting, including a list of other great blogs about families living with type 1 diabetes.

The Day She found A Cure

Will I always have diabetes, Mom?

I've had to answer a few difficult questions from Jenna since she was diagnosed and I’m sure to be confronted with many more in the years to come. I make a point of answering the questions that either of my girls have regarding any subject with age-appropriate honesty—even the tough ones. They deserve that. So when Jenna asked this question I told her that unless a cure is found she will always have diabetes.

We talk about the possibility of a cure whenever we discuss the annual JDRF walk. We explain that the reason we walk is to raise money to help find a cure. But I never really gave much thought as to what the term find a cure might mean to a three year old.

Last November I was with Jenna at the pharmacy waiting for an order of diabetes supplies to be filled. It was the week of November 14--World Diabetes Day. Displays had been set up in the pharmacy advertising various blood sugar meters and diabetic cookbooks. The word “Cure” had been cut out of black paper and the letters placed on a display table. Jenna asked me what the letters spelled. I told her they spelled Cure. Jenna looked at me with such genuine excitement and innocence and exclaimed “Mom! I found a cure!”

The simultaneous urge to laugh and cry canceled each other out and all I could do—all I wanted to do was wrap my arms around her tightly, kiss her and tell her how much I love her. Then I did what any good blogger would do; I snapped a picture on my phone to accompany the post I knew I would eventually be compelled to write.

Plush Pumpers and Other Assorted Type 1 Critters

We have made some exciting progress with regards to site changes; Jenna has been agreeable to sites on her upper arms!

We were able to persuade her by explaining that to keep using her pump we need to use other sites. Her bottom is getting tired. If we can't switch sites we'll have to go back to MDI's. That did it. Jenna wants no part of the whole three-needles-a-day club anymore. I told her that she would likely be surprised at how easy she would find insertions on her arm. When it was done Jenna said, "You were right Mommy! It wasn't bad!" She still has no intention of allowing us to do an infusion site on her abdomen. But after today's little art therapy session I have better insight as to why she is so opposed to this. Let me explain...

Earlier this week I was forwarded a link to a site called Haiti Houses. I love this idea of creating little houses out of paper and selling them to raise money for the people of Haiti and thought it would be a good craft project that would also teach my girls a sense of global community, good will and the spirit of giving. Since the devastating earthquake in Haiti I have had numerous conversations with my girls about what happened there. They are aware that people are suffering and they have voiced a desire to help. So I gathered the necessary materials last night after my girls went to bed and began prepping for a crafting session later this week. As I created a little house to serve as an example and inspire my girls, my mind began to ponder other paper crafting possibilities.

And then it came to me.

Jenna has several dolls and stuffed animals that have type 1 diabetes, so she has told me. I thought, why not make these little critters some insulin pumps out of paper! And Jenna can perform site changes on them using an old insertion device from one of her own site changes (sans the needle, of course).

So this morning my girls and I got busy with some colourful card stock, glue, googly eyes (they make the best pump buttons), and some butcher's cord for tubing. It was great fun! We made paper pumps in an array of stunning colours and then matched each pump with the perfect doll or stuffy. Each toy got an infusion site on a different body part:

Lumpy opted for a thigh placement,



Cookie-Pookie got one on her upper arm,



Boo went for the bottom,



And one brave but nameless lion attempted the very first site ever performed on a tail!




And as Jenna was deciding on a site placement for Elmo, I asked her if Elmo was willing to try a tummy site. Jenna told me of course he was.



"Elmo is very brave," she explained. "But I won't be having a tummy site." I asked her why. She told me that the last time she had a site in her tummy she accidentally scraped it against a bar stool in our kitchen as she was trying to get down. It hurt a lot.

So at least now I know why she is so disagreeable to this. I don't know if I would have found this out had it not been for the little art therapy session we were immersed in prompting the dialogue about site changes under non-threatening circumstances.

By the end of our crafting session we had a small army of plush pumpers with pretty paper pumps stuck to them! It was an impressive site, to say the least.

Most days I feel like I'm clumsily fumbling through this whole parenthood thing with the best of intentions but with all too human an approach. But today, I felt rather accomplished.

It felt pretty darn good.

Road Trip

We took a road trip this weekend; many hours of road travel and a couple hours logged on a ferry were involved. A very well stocked first aid kit, about two weeks of diabetes supplies, several changes of clothing and pajamas for myself and the girls, two cameras, two tripods, laptop, and a portable DVD player with about 8 of the kid's favourite shows were among the items crammed into our travel bags, all for a mere overnight stay away from home. And I haven't even mentioned the smaller version of my medicine cabinet I routinely pack for ailments ranging from headache, fever, indigestion and, of course, lactose intolerance.

We were ready for almost anything.

I couldn't help wondering, as I was assembling items and personal belongings prior to leaving, if I would be feeling foolish in a day and a half when I would find myself having to unload a vehicle full of stuff, most of which was completely unnecessary. But as it turned out, this was one trip I would be thankful for my penchant for preparedness.

Jenna experienced her first G.I. bug ever this weekend...at 4 am on Sunday morning...in a hotel room...500 kilometers from home. I have been dreading this inevitable encounter with the barf-bug since her diagnosis. How would it affect her blood sugars? Would she go too low? And if so, how would I treat a low if she isn't able to keep food down? But the question that did NOT occur to me was, what if it happened while we were away from home?

We had been getting up every two hours checking Jenna's blood sugar and bolusing to battle the delayed high from a pasta meal she'd had for supper at a restaurant Saturday evening. I tried in vain to talk her into stuffed mushrooms and soup. But she was set on pasta.

At 4 am Jenna sat up in bed. Mommy my legs are achy and I...*cough*...*barf*...

James and I sprang into action. I stumbled around in the dark trying to find the switch on the lamp between the two queen-sized beds. My mind started racing, trying to trouble shoot the problem. "Get her to the bathroom! Where's the checker?!" I quickly put together a worst case scenario in my head. Achy legs...vomitting...she's probably sky high complete with ketones because of that damned pasta. Or maybe her site went for a crap sometime in the night and she's been going without her basal--maybe even missed a correction. I checked her and braced myself for what I was sure would be an astoundingly high reading. But it was only 14. Definitely out of range but not nearly as high as I was expecting. A correction was given. I decided to check for ketones anyway just to be safe. No ketones. No fever. And Jenna reported feeling better after she vomited. So we cautiously settled her back to bed (after some necessary house keeping duties were performed) and hoped for the best.

But she vomited twice more after that requiring a total of three pajama changes.

We decide to ditch our plans for that day, admit defeat and book it home. At 7 am we packed up the vehicle and our two sleepy babes and that's precisely what we did. Thankfully, Jenna didn't have any further bouts of vomiting and she never developed a fever. Her blood sugars ran a little high for the first couple of hours of travel but eventually settled softly into the normal range. It was a very brief session of gastric upset that initially had me worried but was quick to run its course.

By the time we got home seven hours later Jenna was her usual self, albeit tired and in need of a bath, comfy jammies and a home-cooked meal. When we parked the vehicle in our driveway I reached over to unbuckle her belt. She looked at me and with a beautiful, contented smile on her face and said, "Well, that was an adventure."

That's my girl.

The Sadly Misinformed and The Dangerously Uneducated

I get somewhat annoyed with the ignorance that is everywhere with regards to type 1 diabetes. If you are reading this because you or someone near and dear to you has type 1 diabetes then you know what I’m talking about.

I’ve been relatively lucky so far; since my daughter’s diagnosis nearly two years ago I've only had a handful of uneducated people reveal their ignorance to me with ridiculous statements that they attempt to pass off as firsthand knowledge because an elderly relative of theirs has (or had) diabetes. Let’s face it; chances are their experience is with type 2 diabetes. But they claim to know “all about diabetes” because of this feeble link they have to a disease that is vastly different from type 1 diabetes. If they really do know so much about the disease my daughter has and will have for the rest of her life, barring a cure, why on earth do they say such oblivious remarks as, “So is your little girl diet-controlled?” And why, when I answer their questions about how often I check Jenna’s blood sugar with “...usually six to ten times a day,” does their jaw drop to the floor?

So I guess I could cut these people a little slack. Obviously there is a huge information vacuum out there with regards to type 1 diabetes. It truly is a disease that you can’t possibly know everything about unless you have had some extensive firsthand experience with it. So what this really says is that we have a lot of work to do educating the public. But that excuse doesn’t hold water when it comes to medical professionals.

A pediatrician once doubted that a quarter unit of insulin would have any real effect on my then two year old daughter’s blood sugar. This doc actually scoffed when she looked at my dosing record! I believe her statement went something like this: Do you really think a quarter of a unit does anything? Hind sight has me wondering why I didn't counter her query with: Do you really think they would have bothered manufacturing insulin pumps touting the ability to deliver a basal rate as low as 0.025 units per hour if it were that insignificant?

A GP once told me with obnoxiously arrogant certainty that illness has no effect on my daughter’s blood sugar. I was in such disbelief that I wasn’t sure I heard him correctly. How can people trained in the medical arts be so misinformed? How is that possible? Am I alone in feeling somewhat unnerved by this?

This is unacceptable. I think we all have an obligation to our loved ones with type 1 diabetes to spread some much, much needed knowledge. Evidently, we have our work cut out for us!