Monday, January 31, 2011

Have your Cake & Eat it Too

Meet Dareian;  my older Type 1 in our  house of  Diabetics.  She is one amazing teen!

Dareian the baker!
This is her story, and how she has learned to manage her diabetes through carbohydrate counting, glucose monitoring, and MDI so she can live life how she wants, not how Mr Diabetes dictates. 
Sure she still occationally gets abducted by aliens (See post) but she usually returns the same day.

We partook in a study here in Edmonton called the Trial Net  to determine if any of our non-D kids had autoantibodies for diabetes. If  these autoantibodies are present  the risk of developing Type 1 D in the future is increased. So we took the remaining 4 children and had the blood drawn.  To our surprise, becasue you never really expect it, our oldest child(Dareian) had the autoantibodies.  Crap!

Anyhow, we proceeded with our day to day life, managing Rowan our youngest D and myself of course. Waiting, worrting, and uncertain if or when Mr Diabetes would attack. 

A little over a year later, after many random and fasting home glucose checks, he attacked! We went to the ER and had the blood work done to confirm what we knew.  "Your daughter has type 1 diabetes" There was that dreaded statement again. Once in a lifetime is enough but three times, come on already!

The next day we went through the same training we had with Rowan a few years earlier.  We felt like employees at the diabetes center since we'd spent so much time there.

Dareian was amazing, like her younger sister. She immediately caught onto to Carbohydrate counting, self injecting, I thought, man this kid is smart.  She took Mr Diabetes buy the horns.  We on the other hand felt overwhelmed, and once again went through a whole range of emotions, she was still our baby, even though she was 11 at diagnosis.

Upon arriving home, Dareian has her days, like all PWD where she is angry, sad, and in denial.  But she also has that essential quality or characteristic that I equate with success in diabetes management.  That is; she truly believes she can control it from the inside out.  She has learned and continues to learn about managing diabetes; what works for her and what doesn't. She is active and is a track star! I know I am bragging, but that's my job. She has learned, and managed well enough and knows that she can have her cake, and eat it too!  Great job Dareian!
The Cake she baked for her Moms B-day

Sunday, January 30, 2011

Diabetes Supplies vs. Rent & Groceries?

The personal economic impact of diabetes often presents itself as the title suggests.

In Canada the economic impact is best illustrated in a report put forth by the Canadian Diabetes Association called the  The Cost of Diabetes in Canada: The Economic Tsunami 

This report outlines the economic impact from a national perspective; how much it is costing tax payers, and the burden diabetes places on our health care system.  It does not however discuss the personal struggles individuals experience financially when managing their diabetes.

It's a no brainer that, with out appropriate coverage for diabetes supplies diabetes control is worsened. 

There's been a number of instances in 28 years where I've had no coverage. Times when I'd have to limit the number of test strips I use, or the type of insulin I choose.  Recently I changed jobs, and went with-out coverage (for myself and 2 type 1 kids) for four months. 

I went off my pump for 3 months to offset the cost, and spent $1400 per month to cover test strips, insulin, supplies, infusion sets, and the usual regime of Rx medication associated with diabetes completely out of pocket. 

We are still catching up.  I am speaking from a Canadian perspective, and couldn't imagine having to pay out of pocket for basic medical care. 

It frustrates us as a family. It has been a "thorn" for many years, simply because Type 1 diabetes is a disease that you can not delay or avoid, you simply wake up one day and are told you have it.  

It's unfortunate that anyone has to pay for essential medical supplies. It's not like we can choose not to test, or take insulin.  Some PWD(people with diabetes)choose the best therapy and often have to choose between rent or groceries, and whether or not to continue insulin pump therapy.  

Fortunately some Canadian provinces are catching on and have implemented programs that provide pumps and supplies to individuals free of charge.  Notice how I say most...

Most people fear job losses, and general economic set backs, but when you have diabetes one must also fear worsening control and choosing between rent or buying essential medical supplies. 

That's just not right! 


Saturday, January 29, 2011

The Diabetic Caveman?

I have a bit of an obsession.  Yes I know, it is not good to obsess over any thing, but I do think this is a good one!

I have been on this reading kick, and the theme lately has been low carb eating.  So in the past couple of months I have read three books and I am on my forth book related to this particular topic.

Natures Candy!
I woke up today and the first thing I craved was something sweet.  Tested the sugar and it was 3.9 mmol.  A little bit on the low side but it explained my unusual craving for something sweet.  The first thing I noticed was the beautiful ripe delicious looking orange sitting in the fruit bowl.  Of course I popped 1 dex tab to get me into normal range.  But it got me thinking about one of the books I really enjoyed.  

The "Paleo Diet" written by Loren Cordain, Ph.D.  It is a great read!  The book's premise is based on the fact that since the industrial revolution and agriculture our society no longer eats what we were genetically designed to eat, and as a result we have a huge growing obesity issue in all modern societies.  

It is commonly referred to as the "Cave man diet"  Hence the title.  

If you think about it, our ancestors could only eat what they killed, trapped, plucked, picked, and in rare occasions found in nests (eggs) Basically, berries, leafy greens, seeds, lots of lean animal protein, and the occasional egg when the opportunity presented itself.  

In other words, no processed food, bread, potatoes, anything modern agriculture and manufacturing have placed in our grocery stores. 

The modern diabetic caveman could hunt for lean meat(turkey), pick up a huge bag of frozen berries, find a small bag of unsalted seeds, and one dozen free range eggs.  Notice they are all found on the perimeter of the grocery store. 

The book ranks turkey as the highest source of protein, and nuts the lowest in terms of net protein.  

It discusses the American Food Pyramid and the recommended starch servings, and how they differ dramatically from the way we as a species used to eat.

I have put these principals into practice and feel great while eating loads of lean protein, fresh fruit, and lots of veggies.  

I am not a Diabetic Caveman, but can honestly say this is one diet that is easy to put into practice and satisfies that sweet craving.


Friday, January 28, 2011

Here's a Toast to Alcohol and Diabetes

Well it's Friday, thank goodness! 

It got me thinking about Alcohol, not sure why, oh yes because it's Friday.

We all know that 1 to 2 drinks has been toted as good for the health, but what about alcohol and diabetes.

Well personally it has never stopped me, and yes I have gone through the dry heaving and porcelean worshipping in my days with alcohol, and promised to never do that again, and of course I did it again.

However, it has been awhile since I have overindulged, but I do enjoy my 1-2 drinks per day rule.

Where am I going with this, you ask; just  how does alcohol effect diabetes?

It is kind of cool really!  It slows down glycogenesis in the liver, or decreases the amount of glucose the liver is releasing into the blood stream.  Good right, well that depends.  Like, if you have food on board, insulin  levels from past boluses, blood glucose level, delayed uptake of glucose from an earlier bout of intense interval training.  In other words a drink just isn't a drink for us diabetics.

As per the usual, us folks have to think, analyse, and drink methodically, to be safe. Why can't life be simple, well it can if you know what you're doing.

The usual recommendation is to eat something prior to drinking, or have a drink with dinner. But lets face it, sometimes, you just want a cold one and thats it.
Here is a good info guide for alcohol and diabetes and the associated risks.

Dry wine and diet sprite, dry wine, diet cola and rye, or my favorite Diet ginger and aged whiskey, what ever your tastes try to make it diabetes friendly.  Check your glucose frequently, try to have some Carb, and make sure you are in good company if you do get out of hand, meaning, you've decided to go over the 1-2 glass recommendation.

So, happy friday!  Cheers!   Time to put the kids to bed, and have my Fave!


Thursday, January 27, 2011

Exercise, Diabetes, and Pacman

Now what does Pacman have to do with diabetes, and for those newbies, what the hell is Pacman.

This analogy was inspired by my youngest Type 1 in the household.

Let me explain.

We were trying to explain to our daughter how exercise helps with diabetes control.

So my wife said to her that when she runs, bike, jumps around, and is active the sugar in her blood get gobbled up, and then she did the sound effects, "gobble, gobble, gobble" while tickling her.  I thought to myself wow that's a great way to explain the concept.

If you actually think about it, we exercise and any excess glucose circulating is used up in two ways.  First, it get gobbled up like the old video game Pacman by our muscle cells for energy.  Second it get gobbled up by our Liver to replenish the good old glycogen stores.

So the next time you are exercising or encouraging your loved one to exercise just think Pacman, or Mrs Pacman, depending on your preference.

I still smile when I think about my kid giggling and my wife saying "gobble, gobble, gobble!"



Wednesday, January 26, 2011

What's up with the Food Guide!

Hello all you wonderful people!

As a nurse educator I am required to teach others with diabetes how to eat properly(well that's not all I do)  Yes, we have dietitian's for that during group programs.  However,  I do a lot of follow up with my diabetic patients.

I am required to cover the basics like, food choices, portions sizes, food types, fiber, etc.

So before every meeting, I must  reluctantly grab the Food Guide.  I say reluctantly for a few reasons.

The original Food Rules was designed and published in the 1940's, yes, the 40's when people were actually needing to gain weight, and suffered from malnourished diseases like scurvy, vitamin deficiencies.

Fast forward to now.  Go to the mall and look around and it is unfortunately obvious that we are no longer malnourished.

So I enter the room to advise my patient on proper eating, using a tool invented in the 40's, although it has been modified over the years.  At least now in Canada the fruits and vegetables are prioritized to the top, not starches like before. Unfortunately protein is on the bottom.

It is let's just say a professional dilemma for me to advise a person with diabetes to consume huge amounts of carbohydrate. Let's just kill the little Islet cells they have left shall we(Sense the sarcasm) Anyhow, I need a job so I have to follow the rules.

So there I am sitting across from an individual who tells me "I have been following the guide as recommended, and I am gaining weight, my blood fats(lipids) keep getting worse, and my diabetes is getting harder to control"
What do I say?  I can tell you what I want to say, which is,  stop eating so much carb, and grill yourself some lean steak and omega three eggs for breakfast instead of the 2 cups of cold cereal loaded with 80 grams of CHO(carbohydrate)

Back to reality. Don't worry, I rely on other tools.

I discuss the fact that obviously the plan is not working, so perhaps try reducing your carb intake by 10-20 grams per meal, add some lower carb vegetables, and increase the leaner proteins. I also explain the concept of glycemic index, fiber, and the role of fat and protein in satiety.

I encourage them to simply explore the literature, trial and error, and to ask themselves if their current method is actually working.

Basically I give them some food for thought, no pun intended.

I am glad that more and more people are considering lower carbohydrate diets as a healthy and legitimate weight loss strategy.  I am also glad that more and more research is being done on the effects of a lower CHO diet.

One final note: I tell them to shop on the perimeter of the grocery store and avoid the inner isles where all the super-carb loaded food is stored.


Tuesday, January 25, 2011

Accidental Overdose

I have now done this three times in 28 years with Type 1 diabetes. 

My house is, let's just say a little, no, a lot crazy in the morning;  five kids running around, lunches, breakfast and three diabetics to test, bolus, calculate, and inject.  Not using this as an excuse, but it describes the setting for you.

So I am asking my daughter on the pump what her sugar is, and she is yakking to her sister about princesses or something and I am simultaneously dialing up my Levemir(so I thought) to 16 units, and I gave it.  I then removed the needle tip to discard, and my heart sank, oh crap....I knew immediately that I just injected myself with 16 units of rapid acting not my Levemir. It is the same kind of the feeling you get if you have ever shut the car door and thought crap my car keys are in there.

Of course I had already taken my rapid acting dose of 4 units, so I now had to chase 20 units of rapid with an enormous quantity of carb.  Lovely (Sense the sarcasm) Normally I would eat 5-10 gms Carb in the am.

What to do?

First time I did this was like over 20 years ago and I went to the ER and they screened me for being suicidal for which I was not.  Back then they jammed the intravenous in my vein and filled up the tank with a dextrose drip. 

The 2nd time I just drank a gallon of regular pop, not good, can we say nausea.

The third time they say is a charm, but not in my case. I had to head to work, drop kids off, basically remain some what functional for the remainder of the day.  I am definitely going back on my pump!

I decided to fill up a 1 litre mixer bottle(the ones you make protein shakes with) with milk and 10 tbsp of liquid chocolate milk, you know the yummy stuff (in the right quantity)

I guzzled that down, took 10 units of Levemir (triple checked this time) so I wouldn't rebound later in the day. Off to work I went.  One  hour later I was sitting at 11 mmol, or 198 in the US.  but  still waiting for the peak.

Lesson learned.....Always triple check your insulin vial, especially with a house full of kids!


Monday, January 24, 2011

It's Never Good To Be Unaware

To be unaware, in general,  is usually not a good thing but with Diabetes it can be out right life threatening.

Hypoglycemic unawareness is a frightening reality for some of us with Diabetes.

It is usually a complication brought on by long term damage to the nervous system from many years of diabetes, usually poorly controlled diabetes. 

I say usually because I have discovered it can also happen in children diagnosed with type 1 diabetes that are under the typical onset age of 7-9.  

We have a daughter who was Dx at 18 months, she is now 6.  She has never been able to tell us or recognize when she is having a low glucose.  

In the beginning this was expected, but now we are hoping even praying that soon she will show some insight when she is hypoglycemic.

We have searched for answers, especially in the beginning.  The explanations from the literature and the health team was that her nervous system was immature and in time she would eventually feel and display the signs (sweating, shaking, mood change) and symptoms (anxious, headache) 

We're still waiting.....

In the mean time we do what is essential to keep her safe. We advocated for a pump, we test multiple times, and we lose a lot of sleep.  

So, if you have a child with Hypoglycemic unawareness, we understand. Here are some suggestions below.

Treatment options are: 
-Peak-less insulin
-Continuous Glucose Sensors(these are expensive and the needle is huge!) 
-Insulin Pump therapy
-Frequent testing to ensure glucose is safe throughout the night. 
-Ensure the last rapid insulin bolus is no later then 8 PM.

So, if you have a child with Hypoglycemic Unawareness, we understand, hang in there, and unfortunately it's up to us to have the awareness, perseverance and diligence until our child's system develops.


Sunday, January 23, 2011

Welcome Back Mr Wizard

Well today's the day Rowan goes back on the pump.  Her tiny arms and hips needed a break from the large cannula.

She has been pump-less for about 4 weeks.  First time since she was 2.  However we desperately need "Mr Wizard" to return to our family.  Mr Wizard is Rowan's pumps name.

What now?  We ready our supplies.

1.  Pump and new battery
Mr Wizard and his fuel
2.  Reservoir and Novorapid

3.  Silhouette infusion set(Rowan's Least favorite component)

4. Clean skin(Bath time!) Just imagine toys, barbies and lots of bubbles!

4. Pep Talk
Rowan, ready to invite Mr Wizard back!
6. Insertion

7.  Connect Mr Wizard and Fix Prime

8.  Glucose Check

Hugs, cuddle, hug, and lots of TLC.
Rowan, Mr Wizard, and I

Welcome back Mr Wizard!  You are a pain but you make our life so much easier, thank-you Medtronic

I remember trying to self manage my own pump therapy and found this site the most useful in terms of actually sharing info for pump adjustments, assessing your rates etc.  It is located in Canada but the principals are universal The Diabetes Clinic

Saturday, January 22, 2011

For the Love of FOOD

I wrote this around the holidays just after opening a box of home made treats! 

Food and diabetes, as we all know are intimately connected. 

On a personal note….My readings have been like a yo-yo as of late, opened up a huge box of home made Christmas treats and wham….there goes the control----mmmm gotta love the home made caramel popcorn!


I am still figuring out the focus of this site/blog.  There are a lot of sites that  explain the intricate details on the physiology of carbohydrate metabolism and all that exciting stuff, which I encourage all of you to study.  But, I'm not interested in re-inventing the wheel. 

I want to share with you what works for me, and my 2 kids (the ones with diabetes) 


I have read an abundance of information on diabetes and diet during my life.  The diet books are all slightly different in their premises but I can sum it up into the following schools of thought:

1.  Low carb/mod protein/mod fat

2.  High carb/low fat/low protein diets

3. Variations of the above

The recommended diabetes diet is basically the high carb(60%)low fat(<30%)low protein(20%)kcal diet---I'm Not even remotely sold on this concept, however, that is what the guidelines stipulate.

Personal notes:

If you can’t measure the carbohydrate content---proceed with caution because you’re likely to miss-guess. I hear that the food labels can be of by 10-15%.

The larger the amount of food (especially carb) the more variable the readings after eating will be.


It is way easier to manage post-prandial (after meal) blood glucose spikes if you consume less then 30 grams carb per meal. 


It is essential to take your Rapid acting insulin 20 minutes prior to taking the first bite.  Keep in mind the type of Carb---like pizza I will shoot up during and if pumping use "Mr Wizard's" square wave bolus.  Pizza is really tasty but I swear it takes 24 hrs to digest!

Cold cereal sucks-----taste great but wreaks havoc on your after meal sugars, normally because its eaten when your body is pumping out the hormones to resist insulin. Yes 2 hours after waking.

Always choose unprocessed whole food-In theory, but be human-eat the cake at a party, and personally I never turn down a free beer.

Protein is great for diabetes control and essential for controlling blood glucose, hence my disagreement with the 20% daily allotment.

Fat is not the enemy-well the good fats(omega 3`s) Eat some eggs, just hold the cereal and 80 gm bagel.


Always shop on the perimeter of the grocery store, the inner isles are loaded with processed crap

If you don’t buy it and take it home you won’t eat it(referring to the “junk food”)

I am not going to endorse any particular way of eating.  I recommend testing your blood glucose after a particular meal and decide for yourself.  If after eating cereal for example your glucose stays with in your target range (mine is under 7—yes after eating) then you will determine what food to avoid/include.

I recommend checking the recent diet books on the market.  Read them with an inquisitive mind.  Test the principles out.  Discuss with your health care provider; get lab work done before and after.  I call myself the lab rat.  Now don’t become a mad scientists, always check it out with your physician. Keep in mind that they likely have not researched the diets you are referring to. 

I view food in many ways:

First and foremost it is a tool to help me and my children manage our diabetes

Second, it is attached to many cultural and emotional events in our lives, hot chocolate after playing in the snow, huge turkey dinners at thanksgiving, etc.

Third…stress---most people eat when they are stressed or they reward themselves after a hard days work.


As a diabetic I try to endorse the first on the list, but to deny the pleasure of a hot chocolate, or a burger and fries on a Friday night to reward you for a week well worked can be dangerous. 

The trick is to behave 80% of the time and give yourself the guilt free permission to indulge in the forbidden food, while remaining conscious of the slippery slope of over consumption.

I guess to navigate all the forbidden food out there you need to have a plan to indulge, on your terms. 


Friday, January 21, 2011

To Pump or Not to Pump

Over a month ago we decided to give Rowan (our 6 Year old Pumper) a vacation from her pump.  The decision was not an easy one to make because her "Mr Wizard" is truly a wonderful device.  For those new to insulin pumps the wizard feature basically figures out a bolus calculation based on what her glucose level is and how much carb we want to feed our princess.  In other words it saves my brain cells.

So off came the pump.  Next we figured out her pump totals, and started her on multiple daily doses.  To my surprise Rowan was in great spirits! I can relate, as it is nice to take a pump vacation, you can roll around, wrestle with the kids, and not worry about snagged tubing, or a knee in the old "site"

It went well until Monday, the first day back to school.  She was now requiring a lunch time insulin shot to cover her lunch.  The school team have been absolutely fabulous and fully Pump trained but not injection trained.

Oh, why did we even take her off the pump?  Sorry getting ahead of myself.  Rowan's tiny arms, and hips/buttocks, were getting swollen, as the infusion set cannula(needle) is not small.  We needed to give her body a break.  Now we are giving more injections using a very tiny(4mm)needle and can rotate to different areas.

Okay lets get to the point, we all miss her pump, strangely enough Rowan doesn't.  She like the freedom, and doesn't mind the multiple daily injections.

In order for the school workers to give her needles, they need a physician to sign forms, we see the endo in March.  As much as I have enjoyed spending my lunch hours with Rowan, it is very cool for Rowan to eat lunch at school with her dad, it is not a good long term plan.

So "Mr Wizard" we miss you and want to formally invite you back.  Your brain is far better then mine, and I can visit Rowan for lunch for fun not out of necessity.  Rowan's arms and site areas are looking way better and are now pump ready again.

So if given the choice for school age diabetic control I would definitely go with the pump.


Thursday, January 20, 2011

Kids Don't Come with Instructions

Wish they did though!

Parenting a child or in my case children with Type 1 D is like parenting any other kid, but with a catch.

Whats the catch? 

Well when they are irritable beyond the point of what we perceive as normal kid behaviour we have to ask ourselves; "Is the mood swing related to the diabetes or is it them just being a kid?" 

I know other parents with diabetes in their family can relate.  So what do we do.

Depends on the kid of course but for the 6 year old we always do a quick finger poke to check her level, then if it is normal we send her straight away to the naughty bench and let the temper tantrum proceed, telling ourselves, well that is simply her being an emotionally dis regulated kid. You know, the old 1 min per year rule on the bench. 

The dilemma rises when her glucose reading is high.  Then the act of discipline (to teach) is a little more comprehensive.  We have to explain that her glucose is high, but this is still not an excuse to beat your sister with the barbie(kidding)but true.  It is not as simple, like most things with diabetes, eating, exercise, whatever, there is way more extra thought involved. 

Our goal with our 6 year old is to teach her boundaries, appropriate behaviour and coping strategies for dealing with her feelings.  But we also have to teach her that high blood sugar can effect her physical and mental well being.  It is a tedious and challenging process, especially for a child as young as six.  

Disciplining my 13 year old Type 1 involves allot of the same principles. Although the Naughty bench has lost its effect.  Key differences include; her increased self awareness, and her ability to self-test.  I do however notice a trend (not too often) when she uses her glucose level as an excuse.  Once again this requires us parents to have a discussion about making different decisions when feeling unwell.  We recommend she test, correct, let us know, and spend some quiet time in her room. This of course is not always the case.  There are the verbal outbursts "That's not fair" or "It was her fault!!!" accompanied by stomping feet, and the occasional door slam.

Disciplining children with DM is really the same as any other kid; but always ask yourself is this the Diabetes talking or is it just the kid?

Then teach your child how to cope and deal with the situation, feelings, and behaviour.

Unfortunately they don't come with instruction books.  Like Diabetes, each kid needs to be treated slightly different.  Some days you wish they came with a receipt, to return them when their behaviour has pushed you to the brink of insanity.  But then they go to bed, and you think, man they drive me mad but I love em more then life itself.


Wednesday, January 19, 2011

Mood and Diabetes, What Gives!

I have been reading alot of other Blogs this week.  Got to say I love "Six Until Me"!  Great blog!  I am not a great writer, so I will ask you all to bear with me.

I do note that I enjoy the quicker to read blogs, the ones injected with stories and humour.  I think this is what my Blog writing goal shall be for the new year---no promises though

Let's talk about mood and diabetes...lets face it keeping the mood up for the avg person can be a challenge in this day and age. 

I've noticed that when the sugar reading is up the mood is down(be it; irritable, grumpy or as my wife would say angry) "Test your sugar you are acting crazy"  Sound familiar. 

Inversly when the sugar is low our mood also swings, for me I talk more, "I feel low but did you hear about so and so....." Then my wife will pipe up and say; "Test your sugar already...or shut up and drink the juice already!" 

What ever the case, each of us with diabetes act or shall I say,  react differently to lows and highs.  Unfortunately some of us don't feel any different at all. 

Mood, what about it though, I mean really, stats tell us that diabetes and depression generally go hand-in-hand.

Gee I wonder why---could it be because we have to think about the damn thing 24/7 and the minute we don't we throw the control out the window!  Of course denial is great for the mind but lousy for the body!  Hello grieving process if you are newly diagnosed.

I notice it is often over looked during physician apts, the doc or nurse will say things like, your last A1C was *** and your fasting Lipids were *** but what they should do is say so "How are you feeling about managing this diabetes"  Maybe its just me.  I find I have to blurt out that I am tired of it, for them to notice.  It should be the other way around.

My point is more attention needs to be given to this topic!

Damn, I am blabbing again.

Perhaps I should do a quick poke!  Phew not low. 

Well, until next time.


Tuesday, January 18, 2011

Hand Washing Prevents a Rash

When the diabetes team tells you to wash your hands and change your needle tip after each use, they aren't kidding.

If you read my last blog I mentioned a trip to the ER with my Type 1 daughter Dareian.

She developed small red bumps on her upper arms and belly.  The areas she commonly uses to give herself her injections. Anyway, over time these bumps  (kind of looked like ingrown hairs or giant zits) got worse, more inflamed, and resulted in a cellulitis (infection of the skin)  She was picked up early from school in extreme pain.   The arms went from single bumps to a uniform area that was bright red,  that had a clearly distinguished edge, and was very warm to touch.

I was thinking crap!  I should have done something sooner, how did we let this happen.  We did try some cortisone cream thinking it was inflammation, and some antibiotic ointment as well.  But it came on very quick!

So nine hours later, yes that was the official wait time (not criticizing just stating the facts) we were finally assessed.  Sure enough, it was cellulitis.  Then came the lecture.

"Wash your hands, change the needle after each use, rotate to different sites."---or something to that effect, I was busy being embarrassed.

 Needless to say I did not mention to the staff that I was a Type 1 myself and also a Nurse, I conveniently left that out.

So after nine hours of waiting, a 10 min assessment,  5 minute lecture from the ER doc a nurse came in.   She stuck my kid with large bore needle and 2.5cc of antibiotic into her butt.  Ouch, poor girl was in good spirits up until that point.   We were then sent home with a Rx for oral antibiotics.

The point is this:  If you notice a rash stay on top of it---see your doc.  Wash your hands before all injections and pokes, rotate your sites, and change the needle tips. Most infections be it skin, sinus, lung, stomach are more difficult to overcome when dealing with diabetes.  The infection itself may cause the sugar level to climb, which in turn makes healing that much harder.  Even those of us with great control can have more difficulty kicking the butt of a common cold.  Not to mention glucose is great food for bacteria.  Just some food for thought, no pun intended. 

I know its inconvenient to change your needle tips after each use but you really want to avoid the fate my daughter met, that is, the gigantic needle filled with stinging antibiotic.

As you can well imagine she has improved her hand-washing and needle changing tactics.


Monday, January 17, 2011

Diabetes and Puberty Don't Mix

I have been told many times that when my tween Type 1 hits that time, you know that time---Yes,  I am talking about Puberty.  The big P word.  By the way I did mention I have five daughters living in one house who will eventually all experience this transition.  Fun, Fun, Fun...I plan to pick up lots of overtime.

Well that time has come, well it is actually in passing as she just turned 13.  I was forewarned about the increased need for insulin and rollar coaster blood glucose levels, but wholly crap there is way more to it then glucose and insulin.

Someone or some thing I believe has abducted my daughter and replaced her with a replicate from another planet.  The old one comes to visit on occasion then returns to the mother ship.  Okay, perhaps I am being a bit too harsh.

The challenges of raising a teenager with diabetes is a daunting, and very tricky task.  To her, her friends are now way cooler then us, and she would prefer to be with them instead of under our careful watch. Let the autonomy struggle begin!

We ask her daily to track her readings, count her carbs, take her insulin.  But all she wants to do is be a teen, free to hang out at the mall, socialize with friends and talk about the latest movie.  Notice how I didn't mention boys, yes I am in denial and I'm totally OK with that.

This got me thinking about when I was a teen with Type 1 diabetes.  It sucked. But I survived.  I was active, so is she.  I survived with no testing, and 1 shot a day.

This amazing alien that was sent takes her own shots, counts carbs better then most adults, knows how much to take to correct her highs, and usually tests a minimum of 4-5 times a day.  All this stuff and has a thriving social life! A promising track career, and she is passing school. What more could we ask for, really.

Even though Puberty and it's surge of hormones has made it extremely difficult to manage her diabetes I think she is doing Great!

The only major issue (which I will blog about next time) was a recent trip to the emergency department.  It wasn't DKA or a Hypo.

Oh and another thing, I like it when the mother ship leaves her for more then a day.



Sunday, January 16, 2011

A Diabetes Mind-Game


I swear it speeds up with each passing moment, days turn into weeks, weeks into months, and before we know it a decade has passed.  Your probably thinking, does this have anything remotely to do with diabetes?

Well for me it really does.  Life is crazy for most of us, in this modern day we live by the clock, work, family, home, and the list goes on. 

One thing for sure, diabetes is an additional thing that must take importance in our lives and thus also eats up time. Pharmacies, testing, doctors appointments etc...

There is also one more thing; WORRY.

We constantly hear things, be it in  the media or from others in general.  "My aunt lost a limb from diabetes" or "Diabetes is the leading cause of blindness" You get my point, its mostly negative, sensationalized crap.

As a long time diabetic I inevitably find myself  in silence thinking, how long will I live, will I go blind, or be on dialysis for kidney failure. 

I have actually looked up mortality rates for those with diabetes.  Crazy! But true.

Then I decided to look at some facts. Like, with tight control you can prevent most of the complications associated with Diabetes.  Really, I thought, many years ago now. 

Now I realize that for every sad story of someone with diabetes there are many positive stories.  Like, folks with diabetes who have lived well into their 80`s.  Athletes with diabetes, and many others.

I have to be honest though. For me it's a daily struggle. Since it's the kinda thing you can`t really place in the back of your mind.

For me "The Worry" is a constant mind game.  Many moments spent telling myself "good control equals a long complication free life." But one can`t help to worry, when the mood is low, or when you get a horrific reading on your meter and a terrible A1C, you can`t help the dance that ensues in your mind thinking; will I make it or will this bloody diabetes finally catch up with me.

Most days I feel I can control it, beat it, and  I'm up for the challenge.  But there are those days, you know the ones, you just can`t seem to look at the bright side.

Then I say to myself, "let the mind-game begin" and most often I go to bed at night with renewed faith that tomorrow I will get up to face the challenge that diabetes brings.

For those who live with diabetes you are not alone and know one thing for sure; it is absolutely possible to live a long and healthy life with diabetes. 


Wednesday, January 12, 2011

It's a Love Hate Thing

A colleague asked me yesterday why I work in the diabetes field. "Like, aren't you completely sick of it!"
By the way I am a Nurse who does Chronic Disease management.

I paused... and thought about the question....then responded, "well you'd think I would be, being Type 1 myself, and having to manage my 2 type 1 kids, and then working 40 hrs a week where I generally help others manage their diabetes"

Then I said to her I guess I feel good knowing at the end of the day I am helping others manage their diabetes and hopefully they will feel better and live a better life.

However, the question stuck with me (obviously I am still thinking about it today)

I love helping others, I enjoy doing research and using myself as a "Lab Rat" ,changing regimes, and trying to improve control through self experimentation. I love the feeling of nailing a good A1C, or a good 24 hours worth of normal glucose readings, it empowers me.  Now lets talk about the dark side.

I hate worrying about future complications, I hate how much time it takes for managing diet, tests, doctors, pharmacies, recovering from lows, interrupted sleep at night (from hypos) I hate that my 2 kids(out of 5-Ya I have a whack of offspring) have to struggle with diabetes.  I hate when you get thrown the old hormonal curve ball. I especially hate how it is always there, 24/7-365.   

Diabetes can take you in two main directions.  One of self discovery, learning, and the motivation to meet the challenge that it presents. The other direction is pretty much the opposite; refusal to learn, feeling of hopelessness, poor health and future complications.

However, nothing is that simple, and I think it is more a tug of war between the above two directions.

For me there are days I love diabetes, how its changed me and how I am now able to help others, but other day I absolutely hate it.......Definitely a Love-Hate relationship.


Tuesday, January 11, 2011

Insulin Pumping for Toddlers–Rowan’s Story

As I mentioned in my profile and previous blog I have 2 children with Type 1 diabetes.
Here she is:

Rowan was diagnosed when she was 20 months.  She exhibited the typical signs of onset like; unquenchable thirst, frequent urination, increasing irritability, and she generally looked unwell. 

We decided to use my meter to confirm what we suspected---and her blood glucose reading was 32mmol.  We were emotionally shocked----yet intellectually aware of what was going on.  My personal thoughts were “my damn genes are responsible for this”

We proceeded to the hospital to confirm the diagnosis of diabetes.  They re-hydrated her little body with intravenous fluid, sent off some blood work, gave a dose of rapid acting insulin, and referred her to the Pediatric Clinic the following morning. 

This forever changed her little life and also ours.  When you have a child with insulin dependent diabetes you really never truly sleep (especially the moms) or stop worrying.

The following morning we went through the standard curriculum for pediatric diabetes; diet, insulin injection teaching, targets, and hypoglycemia/hyperglycemia management.  We met the Social Worker, Nurse Educator, Pediatric Endocrinologist, and Dietician.

My wife and I were still experiencing the shock, so needless to say we didn’t retain nearly as much as we would have liked.  Nevertheless we did attend subsequent follow-up visits and did a lot of our own research on type 1 diabetes and children. 

Rowan was absolutely amazing! She took everything in stride.  It was three long days to us adults, but to a little child it probably felt like an eternity. There were two other families present during the education sessions.  Both were older children more typical for the onset of diabetes.  Rowan was so tiny, so innocent, and so brave.

What changed in our life?

Mental Health:  We were very overwhelmed in the beginning and really did not have time to deal with the emotions that we were feeling.  This subsided with time, increased knowledge, and new habits.  This aspect should always be addressed and is often not.

Food:  everything had to be measured with precision (we were told a small amount of error has a huge impact on her blood glucose) in order to avoid wide swings in glucose levels.

Insulin:  she did not like needles (go figure) every injection was met with resistance (Let the chase begin) Rowan didn’t know why we suddenly had to “poke” her 2-3 times daily. It broke our hearts.   

Blood testing:  Rowan didn’t mind the finger tests. Thank the lord.


Toddlers are the most unpredictable eaters, so even though we’d carefully measure her meal and give her injection pre-meal we struggled with her to eat all her food, and this often resulted in last minute substitutions---usually less desirable choices.

Hypoglycemia is the “thorn” for us, and based on our own research and self discovery children under the typical onset age of 7-9 often do not feel the symptoms of hypoglycemia (The neurological system is too immature) Rowan is now 6 and is just beginning to recognize when she feels “low”

What did this mean for us?  Well a lot of sleepless nights and a complete change in her insulin regime. 

We struggled for months with her insulin regime.  There were nights she would drop low and other times where she would maintain normal readings.  There was no obvious pattern despite having the same routine and insulin/food amounts.  Very discouraging….

Then came the pump---and this greatly improved our quality of life!  The pump provided Rowan with continuous amounts of insulin 24 hours a day and required a “poke” or plastic catheter needle to be inserted every 3 days.  It provided us with the ability to safely give smaller doses of insulin to more closely match her requirements. It has also been proven to lower the risk of night time lows---which we can contest to.  

In summary: 
-Deal with the emotions----or they will deal with you.
-Learn all you can about your particular type or your child’s type of diabetes
-Consider the best therapy (insulin pump, pills, combination) for your diabetes. 
-In the beginning it may seem insurmountable but with time, effort, understanding, trial       and error, you will manage to effectively cope with diabetes. 
-Do not blame yourself if the numbers aren’t normal----simply ask “why, and what”
Why is the reading low?  To active, to much insulin, didn’t finish eating….
What caused the off reading?   Sick, stressed, forgot to bolus….
Most often you can attribute it to something and learn from it. 

Day-to-day life with diabetes is a challenge, and that’s how I view it, a challenge, something to beat, or manage successfully to avoid long term complications.

Yours in Health,

It Started with there's 3

Three to Treat is my attempt to reach out and share some experiences of dealing day-in day-out with this challenging thing they call Type 1 Diabetes. 

When I was nine my mom took me to the doctors office (get this) becasue I was peeing all over the toilet seat and my urine felt like syrup.  I could barely reach over the toilet at that age. Anyways, we went to the doc and I urinated in a cup, and was admitted to hospital.  This of course was almost thrity years ago. I should also mention I was constantly wetting the bed prior to diagnosis, and my mom was likely sick of doing laundry. 

Back then you were admitted in hospital for 2 weeks.  They would set you up on a diet, use these massive "razor blades" to lance your fingers for samples, and also take blood three times a shift to check glucose levels----am I ever glad times have changed. I remember the coolest thing for me was building a model airplane with my dad and running up and down the ward pretending to fly, the wall TV was cool too!  I was just a kid, no idea what was in store, what this whole diabetes thing really meant.

Then came the news, lousy timing on the hospital staffs part, "You are going to have to take a needle every day forever.....I remember looking up at the nurse in the common room shocked, and then my parents entered(right ater the news)and then I started to cry.  I think because of my mom's expression more then anything.  I still really didn't get it. Crazy I remember that moment like it happended yesterday.  I felt different somehow.  What the hell---I am a grade 4 student, likes to draw, very shy and now I have diabetes.

The 2 weeks ended with a ride home---of course they did a lot of teaching, figured out an insulin dose, and set us up on the good old diabetes exchange plan of the day--then discharged me home.

Then it all started to sink in.....I started to realize they weren't kidding when they said a needle every day.
You can't have pop anymore(by the way I think Diet tab was the only sugar free drink back then) "You have to eat all your meal, don't forget your snack" (believe me the low taught me to remember)

My point is this:  Type 1 Diabetes changes you whether you accept it early on or not, it can define you, motivate you, discourage you, down right piss you off!  In my case it defined me, heightened my interest in the human body, influenced my career choice, motivated me to be in fit shape, eat healthy etc.  Your probably thinking, blah, blah.

It was a process, I actually failed the diabetes exam during a course I took in the earlty nineties, talk about denial, I would get so discouraged, angry, wanted to give up or throw in the towel, but never did.

I am now the Father of five gorgeous daughters, I have a very supportive wife of almost 20 years.  I advocate and teach others how to best deal with chronic diseases such as diabetes.

Now for the Kicker---I have 2 type 1 daughters with diabetes. 
Hence the title;  Three 2 Treat. 

Thanks for letting me share.