Sidekick

When V was little she was a rather picky eater. However, as she grew older, she became more open to trying different foods. By the time she was seven, she was unrecognizable. She approached food with open curiosity and willingness to try new and different things. Dining out with her became lots of fun. We discovered that we shared many likes and dislikes, save for our differences of opinion on cilantro and mushrooms. She and I ventured into exploring new restaurants and new foods together. We would order a couple of things from the menu and share them. V became my dining-out sidekick.

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Diagnosis of diabetes a month after her 8th birthday, followed by celiac diagnosis two months afterwards, changed everything abruptly. In the beginning, we briefly halted eating out as we were still adjusting to carb counting and insulin administration. Then we found ourselves restricted to a handful of restaurants that had nutrition facts menus because we needed to have an accurate carb count of V’s meals. Planning and restrictions became the norm; spontaneity was no longer possible. We could not just go out and find a place to eat when it was time. As we transitioned to a gluten-free diet, our choices became even more limited. Now we needed nutrition facts AND a gluten-free menu, and an assurance that the restaurant was following at least basic precautions to prevent cross-contamination. We found ourselves eating at boring chain restaurants a lot, even though most of their gluten-free options were limited and rather unexciting. I would still try to order something new and fun from the menu but often it was not GF so V would not be able to try it. She felt disappointed and I felt really sad for her. Also, I really missed my sidekick, my partner in crime, my fellow food explorer.

As time went on and we became more skilled at diabetes and celiac management, we started to break out of the chains, pun intended. Fortunately we live in a city with an abundance of restaurants providing gluten-free options. We got more confident at SWAGing (scientific will-ass guess) carb counts, so we felt more comfortable dining in restaurants without nutrition facts, as long as we were reasonably assured of safety of gluten-free foods. More and more often I found myself trying things from the GF menu. Sometimes it was out of consideration for V; other times it was out of plain curiosity. How was her GF food? Did it taste good? Could you even tell a difference?

And then an unexpected thing started to happen. I began developing a taste for GF foods. It may have started with the In-n-Out, when I tried lettuce wrapped burger for the first time and decided that it was the best thing ever. 

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Or maybe it was the GF cinnamon roll pancakes at our favorite little restaurant? They were to die for and tasted way better than regular pancakes.

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Armed with the power of the internet, Find Me Gluten Free phone app, and newfound determination to discover any and all GF dining gems that our city has to offer, we began exploring in full force. Gluten free food can be good and exciting! Who would have guessed? Bread is overrated. Gluten-free pizza crust is bees knees. Gluten-free pasta can taste just as good as regular pasta. Ethnic foods? No problem. We found Italian, Mediterranean, Chinese, Thai and Mexican restaurants with impressive GF options, to name a few.

Nowadays, when we do out to eat, I often choose to order from a GF menu. V and I sit together, peruse the GF menu, order a few things and share. It is almost just like the “good old times”, when she was my sidekick. Except now I am her sidekick. I am her partner in crime and exploration of the great big gluten-free world out there. I follow her rules and restrictions. I have to be that annoying customer and ask about cross-contamination precautions. Together we SWAG the carbs. We still have to plan ahead and our choices are definitely limited compared to the regular menu, but I would not want to have it any other way.

Goofing off and exploring gluten-free dining in Denver International Airport

Goofing off and exploring gluten-free dining in Denver International Airport

Gluten-free and absolutely delicious!

Gluten-free and absolutely delicious!

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Behind the scenes of a brag

A few weeks ago I posted this bragging picture on Twitter

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I was very pleased with how we rocked BG management during V’s swim team practice, when she’s prone to going low. On a surface, it took a few simple steps: check BG, tweak insulin dosage a little and give her a snack. But come backstage with me. I will give you an exclusive tour of what it took on that particular day to get such a stellar outcome.

4:30 PM

I pick up V from school and we are driving to the YMCA. She checks her BG; it’s 216. “The pump recommends 1.65 units of insulin for correction”, she says. I mull it over and we talk about options. V is hungry and she typically has a snack before swim – usually a protein bar. If she boluses for her snack, she will have a lot of active insulin in her body when she is swimming and she will definitely go low. If she does not bolus for a snack, she may get too high and stay high. We haven’t yet pinpointed exactly what the threshold is.

I ask V to check if she already has any insulin onboard (active insulin in her body from a previous dose). She checks her pump and says that she does not. I ask her to look at her CGM and tell me what the trend is. CGM tells us BG is holding steady.

“What are you going to eat?” Normally I pack something but that day I completely forgot. I offer to buy her something when we get to the YMCA.

“Chips!”

“Yeah, right. No way. You need to have something that’s a mix of carbs and protein. How about chocolate milk?”

After some back and forth we settle on a yogurt, which is about 20-25g. of carbs.

“OK, let’s do this. Give yourself 1 unit. Don’t bolus for a snack.”

“But the pump says 1.65 units.”

“No, give 1 unit only. One unit brings you down about 60 points. (This is knows as correction factor and is different for every individual; V’s happens to be 60 points to one unit of insulin.) 216-60 = 156. It would be great to stabilize you there. The snack should help sustain your BG during exercise.”

V gives herself 1 unit of insulin and we keep on driving.

This is how the pump calculates the amount of insulin for correction

This is how the pump calculates the amount of insulin for correction: Current BG  minus target BG divided by correction factor. 

4:55 PM

We are at the YMCA. V quickly eats her snack. I glance at the CGM, she is still around 200 and steady. I have a spidey sense about it, I know she will go low even if she had a snack. I temporarily cut her basal (background) insulin rate by half for an hour.

5:00 PM

V starts her swim team practice.

5:30 PM

A routine check half-way through her practice. She is 98. Not bad but not great. Think about it: she started at about 200 and had a good snack. Half an hour later she is 100 points lower. She has 30 more minutes of intense practice and another 30 minutes of a private lesson. I give her a couple of glucose tabs to prevent her from dropping.

6:30 PM

V is done and wants to take a shower. She tests and is 82. Not bad. However, she says she is feeling borderline low. Or maybe she is really tired after 1.5 hrs of intense swimming? I ask her to sit it out for 15 minutes and re-test, and I have a spidey sense that her BG will level out and be OK.

6:45 PM

V says she is feeling well. She tests and gets a 53. What? Re-test, and now she is 85. We deem it to be an accurate number and I clear her to get in the shower.

7:00 PM

V gets out of the shower and CGM displays a perfect 100! She gets dressed and we head home.

Perfection!

Perfection!

7:40 PM

V tests before dinner. 103. We win at diabetes for once!

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V proudly displays her ribbons after her first ever swim meet. Our BG management during that day is a whole different story and does not deserve any ribbons.