The 40 Year Old....

"Self Portrait"

Almost got you to say the "V" word didn't I.  

Besides I have two years before the big 4-0. The title was more catchy then the 38 Year old Paper-Boy.

No, I am not on drugs, or intoxicated, or having a low blood sugar.

 Get this; I spent Friday night doing my oldest daughter's paper route and I thought of the title; "The 40 Year Old Paper-Boy" resembling the movie title "The 40 Year Old Virgin" (which is hilarious by the way)

So,  I get home from work and the majority of my family are incapacitated due to a relentless head cold.   With the exception of my 10 year old, the toddler and I,  who were healthy enough to move and function.

The first thing I notice is the bundle of newspapers, and sears catalogues awaiting to be delivered for a very cheap, borderline exploitation wage.  Friday is paper route day. So, by default the job landed with the 3 able bodied family members.

I immediately took charge of the situation. Abby, "get dressed" we are doing the route. Off we went.

I drove, with the hatch of the mini-van open, threw a Princess movie in the vans DVD player for the wee one, and we proceeded.

What does this, if anything, have to do with diabetes?  You ask...

More then you may think.  For instance, prior to the days of pumping, or MDI and even basal rates, this adventure would have been far more challenging.

Current therapies enable PWD to fit diabetes into their lives not the other way around. So instead of coming home, timing my meal to match my long acting(like in times past) I arrived, tested, grabbed a quick bite, took a shot of Rapid (I am on a Pump Vacation) and arose to the challenge and task at hand.

I guess I am grateful that we have newer technology, pumps, CGM's, awareness, knowledge, that we can do what we want when we want to, even if that means, becoming a 38 year old paper boy for the evening.

Happy Saturday!

Trev

PS: If you are wondering about my self portrait, read the post on Wego Health

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

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!

Trev

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.

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