I'm off to Indy for the Roche #dsummit12

I'm pushing 'publish' on this post and then leaving for the airport to attend the fourth annual Roche Social Media Summit in Indianapolis, Indiana. This is my first Roche summit so I don't know for sure what to expect. If I had to guess, I imagine that not unlike the Lilly summit that I attended recently, I and some of my favorite DOC bloggers will be asking questions, making suggestions and advocating loudly for all people living with diabetes and their families. When I get back, you can be sure that I'll share my thoughts on the summit as soon as I am able.

If you have any questions, concerns or suggestions that you would like me to pass on to Roche or the other diabetes advocates present, please leave them in the comment section of this post and I'll be happy to bring them up.

Those of you on Twitter can follow any live summit tweeting that may come from me or the other attendees by tracking hashtag #rds12. If you aren't on Twitter, c'mon, get on Twitter. It's a fantastic social media hub that connects people just like you to others with similar interests, concerns and thoughts. I have found Twitter to be an indispensable tool in my journey with diabetes. The ability to connect, support and learn with other people that live the same life as I do continues to be a great source of strength and joy for me and I think you'd benefit from it as well. You can find me on Twitter @ArdensDay.

Okay enough of this, I have to get to the airport and fly to Indianapolis for a busy few days of diabetes advocacy! #excited #proud #humbled

disclaimer. Roche will be covering my travel, lodging and meal expenses related to the summit. Roche has not asked me to blog about the summit or in any way made me feel like I had to react positively to this trip or their statements and I don't expect that they will. Even if they did, Arden's Day and my thoughts have never and will never be for sale or trade.

Kids First, Diabetes Second Book

Leighann Calentine's first book, 'Kids First, Diabetes Second' goes on sale this week. You probably know Leighann from her wonderful diabetes CareGiver blog, 'The D-Mom Blog' but if you don't you should take a few moments to get acquainted with her work. 

I've read 'Kids First...' and recommend it to families living with type I. While you're reading keep an eye out for sidebars throughout the book written by DOC members whose names I'm betting that you'll recognize. In fact on page 152 there is a particularly good piece about building a working relationship with your child's school. Bet you can't guess which DOCer wrote that one? 

Leighann's book is available in paperback and on your favortie eBook reader. 

disclaimer: I was provided a copy of 'Kids First...' at no cost by Spry Publishing and wrote a brief review that I allowed them to use. Though Spry will be publishing my forthcoming book in 2013, my opinions about 'Kids' are my own and motivated soley by the pleasure that I got from reading it. I was not compensated for my contribution to the title nor do I have a financial or other stake in it's success. 

Happy Birthday Arden!

Happy eighth birthday to best daughter in the world from the proudest parents you can imagine!

Diabetic ketoacidosis (DKA)

I guess it had to happen eventually? After five years, 10 months and two weeks of living with type I diabetes, Arden experienced diabetic ketoacidosis for the first time. The day after we lost most of Arden's diabetes related technology to a gust of wind and a swimming pool we woke up to a new and much more frightening problem.

Turns out that the OmniPod that we switched to after the pool accident (see the link above) experienced a bent canual at some point in the evening after the July 4th picnic, we didn't know because Arden's BGs where good and we put her to bed.

I'd like to be able to tell you that I hear Arden's DexCom every time it beeps but that wouldn't be the truth. Sometimes I sleep right through it. Her BG began to rise around 3 am and I was unaware. When I woke up in the morning I checked on Arden as I always do, I was surprised at her elevated BG but let's face it... it's not the first time I've seen a 300 number so I didn't over react. I tested her as she slept, bolused and went to the first floor to take a phone meeting that I had scheduled for Arden's Day Gives. About an hour later Kelly (who was home from work for the holiday) screamed that Arden was vomiting. We knew in an instant that this was type I related because no matter how sick they may get, our kids never vomit.

As I cleaned up the floor Arden sarcastically said, "I'm glad we have hard wood floors", great sense of humor on that kid...

We calmly but quickly flew into action. Ketone meter, insulin vial, syringes, new pod and a bottles of water. Her BG was very high but not at the point where I thought we needed the hospital. Then I checked her ketones and almost threw up myself... 3.8. I didn't think I'd ever see a ketone number over 1, this frightened Kelly and I both. I injected for the high BG and the ketones and told Kelly that I'd like to wait about 90 minutes before we made a decision about the hospital. Arden, feeling awful looked at me and said, "hospital?". We explained that she may need IV fluids if her ketones didn't come down soon and with that she drank two bottles of water over the next half hour. As sick to her stomach as she felt, Arden pushed that water down to avoid having to go to the hospital. She's one tough little girl! Ninety minutes later her ketones were 2.8 which felt like progress. 

Arden showed her toughness again about two hours after the insulin injection when her BG began to fall quickly. I couldn't believe I was asking her to eat when she felt so sick to her stomach but there I was and I was asking. I promised her that she was going to feel better soon (ketones now 2.1) but that she needed to eat to keep her from experiencing a hypo. This moment called on my bravery. I had to bring myself to bolus for the food Arden was eating, I so did not want to give her too much insulin and cause her to have to eat again but there was no way that I was getting on the diabetes roller coaster after the morning we were having, ketoacidosis was about all I could handle for the day.

Arden was fine about four hours after she vomited and for the remainder of the day and far into the evening she worked the word "vomit" into every sentence that she could. 

Please don't take this story as medical advice. You should immediately follow your Endo's ketone protocols when you or your child shows any of these signs.

This is water

We had lots planned for the 4th of July 2012, Cole's baseball game was at 10am, Arden didn't want to miss a 1 pm parade that we go to every year in the next state over and we were joining our family for a picnic and swimming at my in laws. Since the parade is about 35 minutes from our house (and in the same town Kelly's parents reside) Kelly and Arden left the baseball field as soon as Cole's game ended (they won) and I stayed behind with Cole so that he could hang out with his team for a while and then get changed before we left for the picnic.

Cole and I arrived at my in laws' home long enough after the parade had ended that everyone was swimming when we arrived. We walked into the house and made our way to the sliding glass door that leads to the pool. I paused for a moment to speak with someone, during our very brief conversation a gust of wind lifted one of the tall tables next to the pool. The gust, which came literally out of the clear blue, filled the orange umbrella of the table closest to where I stood, lifting it off of the ground. Without hesitation the table and it's contents clumsily tumbled into the pool. I was shocked by the site but not overly concerned as I saw that no one was in it's path either on the sidewalk or in the pool as it fell. At first glance this all seemed like no more then an annoying situation that would need to be cleaned up. Watching all of this through the glass door gave me the sensation of watching television with the sound muted. In an instant Kelly came from stage left entering my field of vision in a full sprint, she didn't slow down as she approached the pool and jumped in with an urgency that caused me to think that someone was pushed in by the heavy glass table. I began to move outside to help when Kelly held up her right hand over her head, she was clutching Arden's D-supply bag. The bag that we keep her OmniPod PDM in. My stomach turned. When I approached the scene, Kelly was handing Arden's PDM to my sister in law, followed by her DexCom CGM, Kelly's Backberry from work and her personal iPhone.

I immediately asked Kelly when Arden's last bolus happened and what her BG was at the time. We were managing Arden's BG completely blind now and without the ability to test, bolus, or suspend basal. Our conversation indicated that Arden's BG was in a good place so instead of ripping her from the picnic to make the trip back to our house, I left to bring new supplies to her. An hour and perhaps twenty or so broken traffic laws later I was back. I switched Arden to a new pod that I'd have to link to an old OmniPod PDM (b&w screen), tested and began monitoring her diabetes 'old school' without the assistance of her DexCom CGM. It was back to timers and worrying between insulin and food. Not good but we'll be fine, the reason I tell you this story isn't because of the drama or shocking nature of loosing so much important and expensive equipment. I tell it because of the book that was on my back seat as I made the desperate drive to and from my house.

During the mad dash to retrieve all of our backup supplies I couldn't help but to think about the book on my back seat. I had a copy of David Foster Wallace's 2005 commencement speech with me because I was going to give it as a gift to a recent graduate later in the day. 'This is Water' is a book that I give to every graduate in my life. It's not really a book actually, but the text of the speech in gift book form. I try to reread the text at least once a year because it's message about choosing how to think about reality is so close to how I try to think about my own life. Wallace makes a compelling argument that every situation can be reacted to in the direction of your choosing. He uses the example of a speeding car and asks you to imagine that the driver may be speeding because their child's life is in the balance. He admits that in most cases the offending driver is probably not in a dire situation but then asks, what if "the Hummer that just cut me off is maybe being driven by a father whose little child is hurt or sick...".

As I sped to my house I had two thoughts. One, the idea that Arden's bolus might drag her BG too low while I was gone and two that I was living a part of Wallace's commencement speech and playing both roles. I was the father driving like a nut and I was the man who choose not to judge him...

Watching two thousand dollars worth of electronics being pulled from a pool was nauseating and it was truly going to cause my family a financial hardship but I never thought about the money. I did my best to keep Arden's health and safety as my only thought or concern. As I took the steps necessary to make that happen I found myself doing what Wallace suggests is possible. I looked at the world, at this situation, in the way that let's me be happy. I remained aware "of what is so real and essential, so hidden in plain sight all around us, that we have to keep reminding ourselves over and over: this is water... this is water". I hope that you take the time to find Wallace's words, they are available in book form, online and the audio of his speech is on YouTube, I've included it below.

Diabetes gives us all plenty of opportunities to see the bad in life and in all fairness and devoid of any new age bullshit, a lot of it really does suck. I just hope that you can trust me when I say that you can choose to not think of it that way, it's difficult but really worth the effort. I've witnessed people like myself who from time to time struggle greatly with the difficult moments that diabetes can present. These moments offer us the very real and easy opportunity to not just see the bad but to lay down in it and make ourselves at home. It's easy for me to say that you should resist that urge but because I know from my own life that choosing to be happy is not the simple task that just saying the phrase suggests... Consider checking out 'This is Water', it helped me to find the right path and I hope it helps you as well.

July fourth 2012 started out in fine form and then quickly deteriorated into a day we'd rather forget. I originally thought that this story was going to end with the image of our gadgets in a bag of rice but diabetes had more in store for us then I imagined. Too much for one blog post, so I'm going to have to wait until my next writing to tell the story of July 5th.

part1

part2