How Would You Handle a 75 BG?
Always fighting rebound highs? Maybe you're over treating...
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There's not much text needed for this post, it's more for you to follow (orange numbers) and ask yourself, "What would I have done". Find the cause and effect that I created and use the information to help you make a better adjustment next time.
1. Arden's BG was 145 at 7 am. I bolused. .45 to try and get her as close to 90 as I could.
- It got a bit lower than I hoped.
2. The drift I caused with the .45 took her BG to 75 where it stayed steady.
- I may not have done anything if she was home but at school we wanted to bump it.
3. I set a temporary basal rate on her OmniPod, stopping insulin for a half hour and Arden ate one four carb glucose tablet.
4. No reason to panic, 75 BG is staying steady. Trusting that the temp basal and carbs will do what I expect. It does 40 minutes later.
- Temp basal can take 30-60 minutes to take effect.
5. Watching up arrow, don't want to get much higher.
6. Perfect landing! #A1cYaLater
I see London, I see Florida, I see Arden's Dexcom CGM data
As our children get older our family is sometimes required to split up to accomplish everything on our calendar. You know, our son Cole my have a baseball game on one side of town while Arden has a game three towns over, stuff like that. Kelly and I never like to miss the kids stuff but it happens.
Last week presented us with a twist on that theme when Kelly's job took her to London the day before I was to leave for a Florida based college baseball recruiting weekend with Cole. Kelly left on Wednesday and was returning late on Friday night. I was leaving early Thursday morning and not returning until Sunday evening. Arden had school on Thursday, she was off Friday - okay, you following the set up? Kelly in London, Scott in Florida, one day of school and a day off to cover before Kelly returned home... what ever should we do?
My first inclination was to take Arden to Florida but that would mean her missing a day of school and to be honest, I didn't want to buy her a plane ticket and drag her from one hot baseball field to another, she would not have enjoyed the trip and I wouldn't enjoy spending the money.
Too expensive + too boring + too much school missed = Arden stays home.
The only person available to stay with Arden at our home was my mother and she knows exactly zero about managing type 1 diabetes, but did it matter that she didn't know anything about the day-to-day of type 1? Not if I can see Arden's BG on my phone it doesn't.
I thought about all that could 'go wrong' while I was gone and wondered if I could control the variables remotely, the possible issues that I could image were:
Could Go Wrong
- OmniPod insulin pump could need to be changed (Arden can do this on her own.)
- Dexcom sensor could need to be changed (Arden has never done this but without the Dexcom, none of this works.)
- Overnight (Arden wouldn't wake up overnight if a tugboat crashed into our house.)
- School (I can run school remotely as we normally do... as long as my plane had WiFi)
Plan for Could Go Wrong
- If a pod needs to be swapped Arden will do it but we don't keep insulin at school so I sent Arden to school on Thursday with pods and insulin and wrote to the nurse explaining what was going on. CHECK!
- Having a working Dexcom is the lynchpin to this entire plan and neither I or Kelly can come home if it stopped working. Arden has never changed a sensor by herself. Hmmm, wait... a boy in Cole's grade wears a Dexcom! I called his mother (who I know at best tangentially) and explained the situation. I told her that it was unlikely that Arden would let her try to put a sensor on her but asked if she could be there to oversee if necessary. She rocks and agreed to help if needed! CHECK!
- Overnight what I really needed was an adult to answer the phone and wake up Arden for me, my mom can handle that. CHECK!
- I booked a flight on an airline that has WiFi. Kelly was prepared in London to take over while I was in the air should I encountered a connection issue. CHECK!
Best laid plans and all, but how did it go in the real world?
During my flight
Everything worked out as planned. I woke up early for the plane, made Arden's lunch, counted carbs and packed up her pods and insulin. My mom woke Arden up in the morning, we texted while she was getting dressed to get her BG in place for the morning. The WiFi on the plane was great but we still maintained a multi-person text message thread so Kelly could watch what was happening from London and take over if I dropped out of the thread. We bolused once or twice while Arden was at school that morning, all from 35,000 feet.
I was on the ground for Arden's lunch time pre-bolus and on a ball field when it was time to talk about her pre-bus routine. My mom cooked dinner and I pre-boluses for it. On Friday I managed Arden's BGs and mealtime insulin from my phone while Cole made the catch you'll see below. Arden changed her OmniPod during a playdate late that afternoon without incident. Kelly returned to our house around midnight and took over the diabetes stuff. I slept that night like a baby.
My Take Away...
With a reasonable, but not heavy amount of pre-planning, we left our eleven year old daughter at home with a person who had almost no working knowledge of type 1 diabetes and everything was fine. Arden experienced a low BG (53 on Dex, 61 by finger stick) Thursday night around 2:30 am. My Dexcom Follow app alerted me, I called and woke up my mother who in turn woke up Arden and she drank juice as I instructed. I then waited up to make sure that the juice had the desired effect and when all was good about twenty minutes later, I went back to sleep confident that I would be alerted if something changed. In the twenty-four hour period that began at school and ended with that low, Arden's Bg was mostly stable, largely in range and only spiked to 200 twice. Two spikes and one low felt like a huge win to me.
Tomorrow night Arden goes to a sleepover at a friends house, no one in the home has the slightest idea about type 1. We will arrive ten minutes early to install the Dexcom Follow app on the mother's phone, I'll talk about how to handle emergencies and that'll be it.
Your Take Away...
Long run in centerfield. Cole saved a game while in Florida with this catch in the last inning of game 2.
I'm forever telling you that diabetes and fear do not have to go together and I wholeheartedly believe those words. Last week I put my money where my mouth is for two reasons. A. It was the right thing to do for my family and B. I wanted you to see that even in this completely odd and distant situation, things would work out.
I want to encourage you to take a chance too. Who knows, maybe you can move your life with diabetes a bit closer to where you want it to be.
I'll be talking more about this trip and other topics on next weeks episode (#34) of my podcast. If you haven't tried the Juicebox Podcast yet, it is available on this site, iTunes, Stitcher and everywhere else that podcasts are available. Subscribe today to be automatically notified when new episodes are online - It is 100% free.
Six Nights of Sleep
The insanity of youth sports may have just saved my life...
I've lost track of how long it's been since I've had a revelation about type 1 diabetes parenting that I felt should be shared. It has bothered me that I haven't written as much over the past year on this blog, professionally and for fun as I expected that I would, but I've rationalized the drop off by telling myself that I didn't have much to say.
Today I have something to say
Last week very early on Thursday morning I drug myself out of bed after only sleeping for a few hours because of a stubborn blood sugar and turned on the shower. It was just before five in the morning and I was about to drive to the airport with my son Cole. Cole is fifteen and his baseball team was about to compete in a week long tournament in Georgia. Cole and Arden have both played in tournaments in the past that have required a night or two in a hotel but this was my first experience spending a full week away from home where my wife and I had to split up to care for our kids.
I went to Georgia, Kelly stayed in New Jersey
Initially the trip caused us some angst. The cost of spending a week in Georgia is oppressive and felt ridiculous when considering that Cole is only 15. There was the specter of Arden's Omnipods and Dexcom CGMs needing to be switched during my absence, not to mention that Kelly had to use precious vacation time so she could stay with Arden. But I digress, let's get back to me in the shower.
Cole making a crazy catch in centerfield - Georgia
I was standing in that shower last Thursday morning completely sapped of physical and mental resilience. Next month Arden will have type 1 diabetes for nine years and I am so far past the day where I ignorantly believed that I was the one human being on the planet that didn't need a good night's sleep, that I now exist day-to-day in a zombie like manner dragging myself to the next handful of hours of sleep. Never-the-less I dutifully washed myself and woke my son, we drove to the airport and made our way to Atlanta where I met up with my son's team, each parent that accompanied had their own ideas about how to pass the time in Georgia - I was no different.
We all attended the games but there was so much downtime. One group of lone dads took the opportunity to relive their youth; some families traveled together and took day trips in between games... I slept because I had just enough focus left to recognize that if I didn't I wasn't going to make it much longer. The first two nights I slept for close to twelve hours respectively, on the third night I crammed in ten hours. On Sunday afternoon, my brain restarted. Some fathers were sitting around talking about the election and I was following what they were saying. The conversation moved back and forth, the topics were deep and flowing and I was keeping up and having thoughts of my own. I had not felt like this in a very long time. I then remembered a few months prior having a (semi) conscience thought that I was unfocused most of the day and that I was having trouble thinking. One night, not too long ago, I recall sitting up with a low blood sugar and feeling like my heart was going to burst. Yet after only three days of sleep here I was able to keep up in a fast-paced and thoughtful conversation.
I took some ribbing over the week for my early to bed late to rise game plan but I was undeterred and I tried to explain my exhaustion to a few of the other dads, they did not come close to being able understand, though I could tell that they thought they did. Yesterday Cole and I flew home after seven days of baseball in the unrelenting Georgia heat. I spent six glorious nights sleeping on a sketchy Marriott mattress that in any other situation, I'd have thrown out a window. Today I am a new person but that's not the end of my story.
While I was sleeping Kelly and Arden were at home living
Arden swapped two Omnipods by herself while I was gone and Kelly applied her first Dexcom sensor! I was super proud of both of them but not surprised in the least at the deftness at which they handled the tasks. It turns out that by removing me from day-to-day life, we removed a few misconceptions that have been solidified by time. You see up until five seconds after Kelly inserted Arden's Dexcom sensor, Arden was sure that only I could do such a thing. Now she knows that Kelly can as well and I'm betting that Arden is now on her way to believing that she can too. The girls also had fantastic control of Arden's BGs during a week were Arden played or practiced softball almost everyday and we all know that in itself, is no small feat.
The only thing left for me to do is to find a balance that keeps me from sliding back into the brain fog that allowed me to fall so far from feeling human without allowing Arden's care to suffer. It's too nice feeling like this again and I can't and won't ever go back. You have no idea how relieving it is to write this today... I thought I had lost my ability to write. I would have been heartbroken by that feeling, you know, if my brain wasn't numb. Instead my life was drifting away like a slow iceberg trudging along without me noticing the direction that it was taking.
If you are a long time diabetes parent please talk to your loved ones and find a way to get yourself significant quantities of rest and please don't stop sleeping until you feel like yourself again. You aren't the only person on the planet that doesn't need sleep and the fog that you are in right now is very likely clouding your reactions, thoughts and ability to live well.
If you are a new diabetes parent, heed this warning. You will not be the exception to the human need for sleep. I thought I was for years and had it not been for this baseball tournament, I may have died prematurely still believing that I was. No matter how badly I want Arden's blood glucose to stay in range, not sleeping to accomplish those numbers can't be the answer. A balance must exist and I'm going to find it.
We all need to sleep
Spotlight: Type 1 Diabetes Community on Facebook
One of the goals of my (and many other diabetes bloggers) advocacy is to bring the community, comfort and guidance of the Diabetes Online Community into the real world - because not everyone is online but everyone should have the ability to find others who understand their lives with diabetes.
During the recording of episode #23 of my podcast I asked Jack's Mom and Dad about the guidance that was provided to them at the hospital during their son's type 1 diagnosis. I was thrilled to hear that insulin pumps and continuous glucose monitors were on the menu but I couldn't quite believe my ears when Beth told me that their doctors recommended a Facebook support group. My heart leapt and I instantly thought of Cherise Shockley the founder of DSMA... she is always talking about bringing the goodness of the online community into the real world. Looks like it's happening and wait until you hear how that advice has benefited the Tran family.
Below is some information on the Facebook group that Jack's parents are members of and an inline player that you can listen to their podcast episode with... you can also listen at iTunes, Stitcher or on your favorite podcast app.
A little history from the TOFN founder, Alison Zettle:
"TOFN- is for parents(grandparents) of school-aged children or younger with type one diabetes living in Texas. The parents wanted to keep the topics focused on kids issues and not adult issues. We have three networks TOFN-North Texas, TOFN-Central Texas and TOFN-South Texas which includes Houston.
How it started: Andrew was dx in March 2010. I was so overwhelmed and I felt so alone. I read and read and read and I kept coming across the statement made by adults with type one "I felt so alone and different as a child". That broke my heart and I knew that in today's day and age our kids did not have to live/feel like that. We have to be aware the mental strain of having type one as well as the physical one.
I knew there had to be other parents living near me that had a child with type one. I wanted to meet them and learn from them and have Andrew meet other kids living successfully with type one. But no one could give me the names of anyone living with type one near me due to HIPPA laws. So I decided to create a local network so that parents and children could meet each other , learn from each other and support each other.
TOFN works closely with JDRF and the local children's hospitals. It took a lot of work to get it going but Andrew and I wouldn't be were we are today without the support of all our fellow D mom's and dads. The reason TOFN is so successful is because the TOFN members themselves. Someone is always there day/night to give you a much needed virtual hug or a "way to go"! I hope TOFN has made a difference in many families lives as it has certainly made a difference in mine."
Guest Post from Teddy's Mum
In a recent Juicebox Podcast Scott Benner said he wanted his daughter to ‘be herself as much of the day as possible’. That really struck a chord with me.
I want you to be yourself...
I just want him to be normal. I thought this over and over again during the first few months after my son’s diagnosis. It is very hard to accept that your child has changed forever. I grieved the loss of his carefree childhood. I felt over-whelmed by the responsibility of keeping him alive. He was three and he was our angel.
EVERY MINUTE of EVERY DAY we try and keep our son’s blood glucose as close to normal as possible. Teddy is now seven and his HbA1c is low enough that most of the time I am able to brush away dark thoughts about his long-term health.
I just want him to be normal. I still do. I want him to be himself and FEEL himself. I look at Teddy’s BGs and each number makes me wonder how he feels inside.
A low number can make this sweet natured boy become bad-tempered and rude, clumsy and sad. He drops his finger-pricker when I ask him to test. How does Teddy feel? Is his reality skewed? He is not himself. He needs sugar.
With a high number I sometimes see Teddy staring into space. He doesn’t listen to me. Can’t concentrate. He can be unhappy. I imagine the sugar pumping through his veins making him feel sluggish and his senses less sharp. He is being poisoned. Water. Give him water, and insulin of course.
Teddy
Recently at school Teddy was told off for shouting out in class. He started to cry. He cried and cried and said he wanted to go home. His carer realised that his blood sugar was quite high. Maybe this caused him to shout out. It was out of character. They couldn’t stop him crying and all the time his blood sugar was rising because he was distressed and this was making him cry more. They felt really bad for him and took him for a walk outside and gave him computer time to cheer him up. At the end of the school day his eyes were still puffy and red. We all learnt a lesson from that day.
For the last 4 weeks things have been good with Teddy’s BGs. Lovely Dexcom graphs lower my stress levels. But I have noticed his mood swings and behaviour changing with lower highs and higher lows as if he has become more sensitive to being out of range. I work all the time at keeping him in range. I feel so responsible for changes in his character and behaviour that may be caused by lows or highs. When he is yo-yoing I can’t imagine how he feels in his mind and body. But my little boy is amazing as he always bounces back to being his gorgeous sweet happy little self.
Anna Hutton - Teddy's Mum
Anna was a recent guest on my podcast... You can listen here.