Monday, March 29, 2010

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.

Tuesday, March 16, 2010

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!    

Sunday, March 14, 2010

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.

D-Mom Blog

Thursday, March 4, 2010

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.