Singing the Post Breakfast Blues

"Couldn't find any with five kids"

I must say that for us;  the hardest blood sugar reading to contend with in our house full of diabetics is the Post Breakfast one.

It is bloody relentless.

I for example take 50% more Novorapid to cover any carb with my breakfast dose of insulin. That's right, 50%. 

Rowan, is no different, and the most frequent calls from the school are when they do her mid morning glucose check and I get the text that reads; "Hi Trev, her readings say 25 Mmol,(Divide by 18 for US) should I ask the wizard what to do?"

This happened a lot in the beginning but we are starting to conquer the post meal spike.

Dr Berntein, in his book, The Diabetes Solution discusses this issue at length, and thus recommends eating only 6 gms of Carb for breakfast. I can do that, but tell that to a group or more accurately a pack of hungry wolf cubs ripping into a box of cereal.  He further explains in detail the increased hormones(Cortisol) that cause an increase in blood glucose readings in the first two hours after waking.  It is a good book, however, very rigid.

It is also recommended that taking your meal time insulin 20 min (for rapid) prior to that first bite as this lessons the 2 hours spike in glucose.  This I found scary when Rowan was 18 months, and throughout her toddler years. You all know how predictable small children are with eating(sarcasm).

Okay for the most part we try to adhere to the above recommendations, the key word here is try. Now if you have children of school age(or even know these little creatures), and you somehow forget to pre-make lunches, pre-put out the clothes, and end up doing what we do 50% of the time and wing the "Launch Sequence" out the door in the morning;  then you can hopefully understand how following Dr B's recommendations are tricky, and next to impossible most mornings.(I know that sentence structure sucked, never liked writing, lots to say, so little time)

However, I will say this:  When we do give the insulin 20 min before a meal, and we make the eggs or some other  good source of protein, I don't get any text messages from the school during the week, and we don't have any post meal blues on the week-end.

Trev

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.

Challenges:  

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,

Trev