Fully Loaded

The holidays are here and we are ready to eat all the things! Tomorrow we are having a Christmukah Eve potluck with our friends. Sunday we are having Christmas Day potluck with the same group of friends. Because why have one holiday meal if you can have two?

Last night we had company over for dinner, which gave us a good opportunity to do a dry run of holidays diabetes management. In line with how we handled Thanksgiving dinner last year, I decided to be aggressive with insulin and rely on Dexcom to monitor trends. I eyeballed the meal, overestimated the carb count, gave V a generous amount of insulin upfront, and spread out the other half of the dose over three hours. She wanted more dessert and we said yes, and gave more insulin. “Mom, do you realize I already have 11 units onboard?” “Yep. Give yourself more!”

All evening V’s BG stayed in the 130-180 range, which is fantastic. She gave herself some insulin before bed, which brought her into a nice low 100’s range for the duration of the night. It was a thing of beauty. This weekend’s goal: replicate this as closely as possible.

It was time to change V’s pod tonight. I was about to fill it with around 170 units of insulin, which normally lasts for 3 days with some extra to spare. Then I remembered about all the eating that will happen this weekend. For the very first time in three years of pumping, I loaded V’s pod with 200 units, filling it to the maximum capacity. Pod is fully loaded and we are ready!

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Wishing for good BG numbers this holiday weekend

 

 

Within Goal

Stay within the lines, the lines are your friend… Screw that, says diabetes…

Our lines are between 70 and 150. We try to beat diabetes into submission by forcing BG to fit between the two lines. Now, this range is rather arbitrary. 70 is fairly standard, as that’s usually the bottom normal for people without diabetes. Some people with diabetes actually feel pretty lousy in the 70’s, so they may shoot for a higher bottom target. V feels excellent in the 70’s, so unless she’s going down or running around/being active, we are perfectly happy there. 150 is a total crapshoot. People with functioning pancreases hardly ever get BG above 120, and that’s usually after consuming a massive amount of carbs. For us, getting through a day without going over 150 is almost unprecedented. It usually happens when V has some sort of GI upset, which makes her run low. So that’s not anything to celebrate or be proud of.

But rarely, very rarely, magic happens. (Full disclosure: we are going to pretend a little here, because at 11:30 V actually dropped below 70. However, my day ended at 11 and, after I snapped the photo below, I fell soundly asleep as soon as I hit the pillow. I did not even hear Dexcom alarm. Hubs got up to handle V’s BG while I blissfully slept through it all.) So, for all I care, March 19th was a perfect day with V’s BG staying within the lines.

Within goal: 100%

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When your kid has T1D…

When your kid has T1D, sometimes you stay up way past your bedtime because she’s low, and low again, and low still. Even after glucose tabs, followed by cutting the insulin, followed by gatorade, followed by cutting more insulin. And you know you’ll write about it in the morning, wishing you could give a better explanation as to why. Or any explanation, for that matter. Because who the hell knows why? And while you think about all of it you check your Starbucks balance because you know you’ll need something with an extra shot or two in the morning. And maybe in the afternoon too. And then you sit down and write a nasty-gram…errr… a polite but strongly worded letter to school officials who are thinking it’s a good idea to save some $ and replace school nurse with a health tech. You think about Flint, Michigan, but decided it’s too dramatic and drastic of a metaphor. You proofread multiple times because you don’t want the letter to read as a nasty-gram. You forget to make kids’ school lunches because you are all upset about the school nurse situation, Dexcom is blaring alarms every 15 minutes, and your brain is fried. You wonder how far Dexom will fly if you throw it. Then you remember how grateful you are to have this helpful technology, so you continue to love-hate it without physical violence. You think about laying down on your kid’s bed to rest but you can’t because the laundry is piled up high on her bed. And she is sleeping on the floor in a sleeping bag because of the laundry pile on her bed. You kind of laugh because it’s funny and absurd, and walk out of her room, only to come back two minutes later to silence Dexcom, again. After checking BG for the umpteenth time, you pump your fist when it’s 87. And you finally go to bed, way past your bedtime, wondering if a rebound high alarm will wake you up in the middle of the night, and you dream cruise ship wreck and coffee dreams. And when you wake up in the morning and write this, you’ve completely run out of f***s to check for spelling errors, so there may be some in this post. Don’t judge, OK?

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Diabetes Awareness Month, Day 12

Good sick day, bad sick day.

Well, there is no such thing as a good sick day. V has a cold. The combination of stress on the body, inactivity, and who knows what else, is not kind on BG. Yesterday was not too terribly bad, actually. Today, despite feeling better, BG decided to revolt and stay in high 200s and beyond most of the day. Stupid diabeetus.

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Diabetes Awareness Month, Day 6

Cross-posting from Facebook:

#‎diabetesawarenessmonth‬
It’s late, I’m tired and need to get to bed, so I will make this short and sweet. V had her Endo appointment today and her A1C is back to 7.0, down from 7.5. I knew her A1C would be better this time than 3 months ago but it was way better than I expected. And we heard the words “fabulous” and “great control” come out the Endo’s mouth. Happy Day! I’m totally using the occasion to recycle a photo from an old blog post.

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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.

She blinded me with science

When Katy commented on my review of Genteel lancing device, she asked a very important question: are blood glucose readings from alternate test sites reliable and accurate? Is there any special magic to finger blood?

I confess: it crossed my mind before but I was avoiding this question. Blood is blood, so it should all be good, right? Besides, I confess that I did not want to find out, after getting really comfortable with alternate sites testing, that it was not as good as finger testing. Alas, Katy’s question sprung me into action. Naturally, first thing I did was consult with Dr. Google. It directed me to several reputable (or reputable-appearing?) diabetes websites that told me in unison that there is, indeed, magic to finger blood because it reaches fingertips quickly. Alternate testing sites can produce blood sugar readings 20-30 minutes old. When BG is relatively stable, it should not be an issue. However, when it is going up or down rapidly, such as during exercise and after eating, and when a low blood sugar is suspected, we should only test on fingers.

I did not like the sound of it at all. How useful is testing on alternate sites if we can’t do it most of the time? How often are a child’s BG levels stable? Almost never, that’s how often. My kids are active, they are constantly in motion, and they are also constantly eating.

Just another day of V's blood sugars. Do you see a lot of stability? Neither do I.

Just another day of V’s blood sugars. Do you see a lot of stability? Neither do I.

There was only one way to find out if the internet was right. Fortunately V was game for it, and in the name of science we began our experiment of comparing BG readings from alternate sites to BG readings from finger pokes. If I were a real scientist, I would meticulously check BG both ways every time I tested. However, I really did not want to subject poor V to poking herself twice as often (she already tests 8-10 times a day), nor do I have an unlimited budget for test strips, nor can I actually remember to poke her twice every time. Instead, we tested a few times for several days, making sure that we do it under different circumstances. Behold our (almost) scientific results!

Day 1

11:45 AM: We’ve been at the amusement park since 10 AM; V says she is feeling low. Finger = 72; Above knee = 95. Hmm, maybe Dr. Google was right? While the difference is not that significant per se, when it comes to suspected lows it is a big difference and suggests a different course of action. We are more likely to treat for 72 and more likely to leave things alone for 95.

7:05 PM: Dexcom alarms indicating a low (set to alarm at 75 and below). This is also within 1 hour of eating, and since we totally guessed carbs for dinner I suspect that I over-bolused her. Finger = 60; Arm = 59. Hey, that’s spot on!

11:00 PM: V had been asleep for about an hour and I am testing her before my bedtime. Finger = 133; Arm = 130. Score!

Day 2

6:00 PM: Testing after V just got out of an hour-long intense swim practice. Finger = 111; Above knee = 109. 

10:15 PM: Dexcom sounds a low alarm. Finger = 80; Above knee = 84. (Gotta love those false alarms! NOT.)

11:45 PM: Testing again because at about 11 PM V had a low for real and I treated her with two glucose tabs. Finger = 111; Above knee = 111. BULLS EYE!

All three readings are very close despite very different circumstances and lack of BG stability in all of them.

Day 3

1:30 PM: Testing V after she spent 2 hrs jumping in a trampoline park. Finger = 67; Arm = 67. Aha!

10:30 PM: Dexcom indicates that BG has been inching up, and it’s not surprising as there was ice-cream for dessert. Finger = 235; Arm = 261. Wait, this does not make sense. If BG from the arm site is delayed, how come it is higher than BG in the finger, given the upwards trend? And anyway, these readings are not terribly far from one another.

Day 4

7:10 PM: Testing before dinner and one hour after administering a correction for high BG. Finger  = 215; Arm = 248. At least this makes more sense if the delayed readings theory is right. Still, the readings are not that terribly far apart and we could easily test twice on fingers and get the same results. In fact, I can test BG twice from the same finger poke and get a difference of about 20 points.

10:45 PM: Testing before my bedtime. Dexcom graph is showing a very slow upward trend. Finger = 168; Above knee = 150. This is pretty close.

Day 5

4:30 PM: Testing within an hour of giving insulin for a snack, with Dexcom indicating an upwards trend. Finger = 295; Arm = 284. Very close.

So what do I make of this data, be it limited and not particularly methodical? In my opinion, there is no special magic to finger blood. I find readings from alternate sites close enough to finger poke readings and now I feel a lot more comfortable about alternate sites testing under any circumstances.

What do you think about our little experiment?