Zeus, the "Tattoo Guy" getting the OIL massage...and a mild LOW

Hmmm ... Z-E-U-S..."the father of gods and men"...ah OK or maybe "god of the sky"? I dunno, maybe my analysis at the end of the photo stream will shed some light onto the Zeus "WORD ART" (nice name for graffiti).

Bridget, Joe, and I went hiking for a couple of hours today at the Winooski Mill. My kids call it "Mill Winooski"...they have been hiking here since they were pre-schoolers and this is what they "dubbed" it. Joe's BG started out at 133 with one arrow DOWN on "Dexter" (CGM), so I gave him 2 Starbursts to "boost" him up at the beginning of the "adventure"....

Me, and yes, I need to lay-off the P90X...I look like I am going to beat the shit outta someone with those biceps - UGH. Note my handy companion "WoodChuck #2". He is attached to me like a 3rd arm.

The scenery - oh so beautiful...what I am NOT showing you is that there was a woman giving a guy covered with tattoos a massage on the lawn that the kids and I were standing on. There was music (and oil) involved... and let's just leave it at that and keep on going.

I always thought these leaf-less, well OK branch-less trees...I guess that makes them "tree trunks" were cool...FINALLY got a picture of them. Note: Massage Lady and Tattoo Man are now out of sight...big SIGH of relief.

The path ... to "adventure" as Bridget likes to call it.

Joe
UH...OH...going LOW? We do a blood check and YEPPERS, Joe's blood sugar is 60...another 2 Starbursts (now we are out of the candy) and move onto Orange flavored Glucose Tablets...so 2 Starbursts and one Glucose Tab it is. Joe is then sitting in the middle of the path refusing to move btw. So I "disengage" and wait for the LOW to come up. Diabetes is a TURD.

A stop for a little "dip" of the feet in one of many streams encountered on the way... Still waiting for the LOW to come up...at least we are not in the middle of the PATH any longer.

Bridget...Joe's biggest fan (and,at times, nemesis).

Perking-UP from the LOW. 88 and one arrow UP.

Dear god who uses this for shelter?...mind you it is by the...

UNDERPASS...WTF? Only in VT.

Joe and Bridget played under the freeway... trying to catch frogs, throwing rocks, throwing re-bar (until I realized what they were doing) and then it was back to just throwing rocks and not the re-bar for awhile...

The "ZEUS" signage here...maybe it was painted there as an offering to the "God of the Sky" or maybe some teenage male is having a surge of testosterone and wanted to paint the word "ZEUS" in honor of the "Father to Gods and MEN"? I don't know. Funny how the end of the hike ends-up here at the freeway underpass with GRAFFITI...not very "VERMONT-y".

Some fun with a MILD LOW in the day-in-the-life with Type 1.

HEEELLLLLLOOOO N.U.R.S.E.!!!

For as crazy and outlandish as many of my posts are, I think you guys may be figuring out after all these "school postings" that I am a little "anal". I was a Surgical and Pediatric ICU nurse for 14 years For The Love of God...so YES, I like things clear and concise.

This is something I wrote up for Joe's nurse when he started K-garten. Our 504 plan is more "general" than what this document covers. (Wendy from candyheartsblog.com has an awesome 504 Plan here). This is more of the "nuts and bolts" of Joe's daily care needs and "how to's". As with all the documents, please feel free to use/tweak/etc. You can access this document by either "copying and pasting" OR clicking here to access it on Scribd. OR you can access all documents I have uploaded to date by clicking the tab on the upper right corner of my blog.

Side Note: Please make sure to give a copy of glucometer manual and pump manual..etc to the Health Office. Also, many product manuals can be accessed on-line.

Onto the DOCUMENT....

DAILY CARE FOR JOE 2009/2010

I will send in “Daily Care Log” (for "Daily Care Log" click here) each day. This will have Joe’s morning blood sugar on it. It will also have a list of foods that we packed for Joe for that day with carb counts. The nurse or designated persons will write down blood sugars and amounts of insulin given throughout the day. Please tuck the “Daily Care Log” in the pack where Joe’s glucometer is kept at the end of each day and place the pack in Joe’s backpack.

BLOOD SUGAR CHECKING ROUTINE

Joe’s blood sugar may be checked by the School Nurse or designated persons.

1. Check daily prior to morning snack.
2. Check daily prior to lunch.
3. Check prior to P.E.
4. Check daily @ 1:45 – 2:00.

*Joe’s blood sugar must be checked promptly when he appears LOW.

TREATMENT FOR LOW BLOOD SUGAR

If blood sugar level is less than 70, Joe will need sugar. He usually takes glucose tablets to treat a low (each tablet contains 4 grams of carbohydrate).

***If Joe’s blood sugar is less than 70 - Give 3 glucose tablets OR a juice box

After giving Joe sugar, wait 10-15 minutes to recheck blood sugar level. It is important that Joe not eat anything during the 10-15 minutes, as other food components can slow down the absorption of the sugar given to treat the low. If the repeat number is less than 70, treat again using the directions above.

If Joe is UNCONSCIOUS OR HAVING A SEIZURE:

1. Have someone call 911 and then parents
2. Give Glucagon (in the red container - needs to be "reconstituted) 1mg into the front of Joe's thigh
3. Roll Joe onto his side
4. Once he regains consciousness...have him take sips of juice if he is able
   

WHEN TO GIVE INSULIN

1. Daily with morning snack.
2. Daily with lunch.
3. Daily with any extra food
4. To correct a high blood sugar

*Extra insulin will be needed when there are ketones present…call parents for instructions/or Joe may need to go home for large ketones.

HOW TO GIVE INSULIN (note this is for the Animas Ping Pump - I also give a copy of the Ping Manual to the Nurse for her office - this is a "cheat sheet").

For Carbs with Blood Sugar Check:

1. Unlock pump by pressing up and down arrows at the same time (sometimes I have to do it twice)…the pump will make a beep and the home screen will appear.
2. Select menu on the pump and press “OK”
3. Select “Bolus” and press “OK”
4. When having food with carbs select “eZCarb” and press “OK”
5. Enter in carbs (using arrows) and select “OK”
6. Enter in blood sugar (using arrows…it will start you at 80) and then press “OK”
7. The pump will say “show result” select “OK”
8. The pump will then show Carb…/BG…/IOB (insulin on board) with numbers by them…then, there will be a row that says “Total”…use the number of units stated by total for dosing. Use the up arrow to get to the number listed by “Total” then press “OK”. You then need to press “OK” again for the pump to deliver the insulin.
9. Press the up and down arrows at the same time to lock pump.
   

For Blood Sugar Correction Only: (correct blood sugars > 200)

1. Follow steps 1-3 above
2. When correcting for blood sugar only select “eZBG” and press “OK”
3. Using arrows, scroll up to the number that corresponds to Joe’s blood sugar and press “OK”
4. Select “show result” and select “OK”
5. Next to the word “total” there will be the number of units of insulin you should give Joe
6. Use the arrows and scroll up to the number displayed by the word “total” and then press “OK”
7. Then press “OK” again for the pump to deliver the insulin
8. Press the up and down arrows together to lock the pump.

WHEN TO CHECK KETONES

Ketones must be checked if Joe has two consecutive readings greater than 250 and/or if he complains of abdominal pain or vomits. Please call parents if he has moderate to large ketones (a blood ketone reading > 0.6 or moderate to large urine ketones). He may need his pump site changed (parents will change) and extra insulin and/or he may need to go home for closer monitoring. Please have him drink water and have liberal access to the bathroom.

WHAT TO DO FOR P.E.

Please check Joe’s blood sugar prior to P.E. If his blood sugar is less than 70 (treat the LOW, as outlined). If his blood sugar is 70-140, please give him 2 crackers from his cracker pack (8grams). If his blood sugar is 140-220, do nothing. If his blood sugar is greater than 240 (do ½ a correction).

WHEN TO CALL PARENTS

1. Blood sugar less than 70
2. Blood sugar greater than 250
3. Moderate to large ketones
4. If Joe’s pump becomes disconnected
5. If Joe’s pump is alarming
6. If Joe becomes sick or vomits
7. For questions on carb counting
8. For ANY questions or concerns

PHONE NUMBERS (I list my phone #, my husband's phone #, our email address, and the Endocrinology phone # here).

And that-is-that...HOPING to make your "day-in-the-life" a little easier FRIENDS.

THE LOWDOWN ON LOCKDOWNs

Preface: The following post, like all material contained in this blog, is not intended as medical advice. In addition, I would like to THANK Joe's school for all that they have done in making school a safe environment for children with type 1 diabetes.


So, a lot of us D-Moms are talking about 504 Plans, educating school personnel...etc. This is Joe's 3rd school year with the public school system. When he started kindergarten 3 years ago there was a "weak" substitute school nurse system in place at his school and the district refused to delegate nursing tasks (which included EVERYTHING diabetes related...even checking a blood sugar and giving "life saving" sugar to treat a low). I told them that this was unacceptable. If the school nurse was gone, no one was in the building that could help my FIVE year old son check his blood sugar and/or treat a low by simply giving him sugar tablets. After graciously, but firmly presenting my case, the district provided incentives to "bump up" their pool of substitute nurses and this has been a non-issue since.

This, however, caused me to take pause....


and think.....

What would happen to Joe in a Lockdown Situation? If no other personnel are allowed to be trained on even simply giving him sugar...what if he was low and locked in a classroom due to an unsafe situation going down in the school. Is it acceptable to rely on a FIVE year old to take care of "D" on his own? Well I am 38 and I can barely handle it - so NO. This was not a safe situation. I realize we cannot ensure our children's' safety 100% of the time. We cannot forsee all the dangers that they will encounter. I could not, however, sit by and be "OK" with something that I could improve upon. I am not one to "panic" or "freak-out" over every last detail. Yes, there is only like a 0.001% chance that a Lockdown could happen here in Vermont at Joe's elementary school of all places. But hey...guess what? It did happen a few years ago. A school one town over had to Lockdown do to a gunman in the school. So it can happen even here in Vermont...and from what I have heard it happens much more frequently in schools throughout the country. I wasn't comfortable with Joe's situation.

So I changed it.

I have done all the education of the non-licensed medical personnel in Joe's school. They are allowed to perform blood glucose checks, treat lows, and administer Glucagon in Lockdown situations ONLY. They are not allowed to administer insulin and so you will notice if he is high, they are instructed to give non-carbohydrate fluids, but not insulin. I will have to sign a waiver stating that Joe is "independent" with his care in order for him to administer insulin, which I may consider doing this year. I wasn't ready to do that when he was five for obvious reasons.

Here is a procedure that I came up with:

First let me start by saying all of Joe's diabetes care is done in the Health Office. So this is why this plan is important to someone in his situation. It may be different for those of you that have the care being done in the classroom (we are moving to more "classroom-care" this year).

Emergency Preparedness Plan for J.M.'s

Diabetes Management

When will the Trained Non-Medical Personnel help J.M. with his diabetes management?
During times of In-Shelter Lockdown, Trained Diabetes Personnel will help the child with his/her diabetes care. Routine diabetes care (ie insulin administration/carb counting/etc) will be managed by the School Nurse or a parent. Parents must be notified if the School Nurse is not available for routine diabetes care.

What Tasks are to be performed: 1) Help/remind the child to check his/her blood sugar. 2) Help the child treat a low blood sugar. 3) Call parents or contact School Nurse for a blood sugar less than 70 or greater than 250. 4) Give Glucagon if the child is unconscious or having a seizure.

PROCEDURE:

In-Shelter Lockdown:


1) Check or remind the child to check his/her blood sugar at the beginning of an In-Shelter Lockdown, if the child complains of or is showing signs of being low, and every 2 hours for the duration of the Lockdown.

• If the child's blood sugar is less than 70 - see the "Treatment of Low Blood Sugar" procedure.


• If the child's blood sugar is between 70 and 90, please give the child 1/2 of the granola bar provided.


• If the child's blood sugar is greater than 250 - please notify the School Nurse and call parents immediately once the situation permits. Encourage the child to drink sugar-free fluids.

2) Please do not give the child food or fluids that contain carbohydrates during an In-Shelter Lockdown ... as he would need insulin to cover the food. (He may have the sugar/granola bar for the treatment of a low as outlined above).


3) If the child is unconscious or having a seizure - give the child Glucagon - see the "Glucagon Administration Instructions".




The above document is all well and fine you think...but how is it executed?

The 504 Plan: In Joe's 504 it states that he will have access to diabetes supplies and trained personnel during an In-Shelter Lockdown.

The Actual Mechanics of the Plan: There is a bag with a back-up glucometer, strips, batteries, sugar, granola bars, Glucagon, and one bottled water that "travels" with Joe's class. He always has access to the supplies and the classroom aid is trained to use the contents in the bag. I have a folder in the bag with short and simple instructions on everything I have taught. Treating a low and Glucagon Administration are laminated and placed on the front and the back of the folder and any additional information is placed in the folder. People feel more at ease knowing the information is there.

The "tattered folder" - the quick and dirty on treating a low with phone numbers (mine, my husband's and the Endocrinology Group)

Glucagon administration instructions on the other side of the folder

And there you have it...another "day-in-the-life"...what those of us with young type 1s need to do to ensure our children's safety.

SIDE NOTE: Please see other documents made for school in the side bar... general "d" info for the school, daily logs that travel back and forth between home and school, blood sugar check procedure etc. Please use any and all documents and tweak to your needs. I am soooo tired of us all having to "re-invent" the wheel. xoxo

DO NOT PITY THE PORTUGUESE PRINCESS NOR HER SON... WOMAN!

About the title: (I am 1/2 Portuguese...and liked the way all the "P's" flowed together).

So I saw HER.

I saw HER tonight once we arrived at soccer. Who? Saw who? You are most likely questioning.

The lady who PITIES Joe and I.

I haven't talked about it too much, but boy have I given it some thought. It has weighed heavily on my mind intermittently over the past few weeks. This incident needed some "processing" before I could put finger tips to keyboard.

In the (almost) four years since Joe has had type 1, I have not experienced an event like this:

• Three weeks ago this woman witnessed me checking Joe's blood sugar after his game/before the "DREADED" team snack. She then commented (within earshot of Joe and I) to another woman standing next to her..."THAT is so SAD...". Even worse, was then her son (Joe's team mate) was asking her "what is so sad mom?" (she was avoiding answering him) he again asks while raising his voice and tugging on her shirt-tail "what, what...what is so sad?" She then whispers to him to 'be quiet' and that she will tell him in the car.
  

WOW...

Speechless...(which for me is RARE)

... and again WoWie, WoW, WoW... (thanks Junie B. Jones)... REALLY?

OK, so after I was stunned from the above verbage from this lady...that Joe's and my situation was "SAD". I began to really think about it. What do I want people to think? say? do? I mean REALLY???... Is there anything that people can say, feel, and/or do that will be "OK" or "acceptable" to me? Prior to this I haven't given it much thought. Well I can start off by saying I certainly DO NOT want pity. On the other hand, I don't want people to "blow off" the enormity of the disease.

In watching Joe day-in and day-out deal with the rigors of his routine with grace (most of the time). Here is what I WANT...Here is what I HOPE... people think (if they even give it a second thought) when they see my son, Joe, dealing with the likes of "D".

I want them to see his BRAVERY (this kid took a needle to his "A"-double-"S" for a site change while flying on an AIRPLANE mind you). I want them to understand that he is a HERO. I want them to "get" a 400 point blood sugar drop during hockey practice must feel like shit, but he still manages to skate well and have a good attitude. I want them to understand that he is AMAZING; the kid can add up 17g+17g+6g+10g+3grams of carbohydrate (for his Fluffernutter and milk for lunch), in his 7year old brain. I want them to know that he lives each day to the FULLEST...with GUSTO. I want them to know that he is a kid with HEART. I want them to take notice that HE DOESN'T FEEL SORRY FOR HIMSELF. He takes each day in STRIDE inspite of having a "Woodchuck #2 toting, carb calculating, needle wielding, insulin dispensing, lunatic pancreas on legs" following him around asking him if "his number feels OK." How he hasn't become "neurotic" after that last mouthful of a sentence I do not know, but he hasn't. He is SIMPLY JOE.

I WANT people to be in AWE of him. I WANT people to ADMIRE the courage and tenacity that he displays daily...heck HOURLY. I WANT that for Joe... I want that for me.

I DO NOT WANT TO BE PITIED ... I want to INSPIRE. Anyone who knows me knows that. There you have it... some more crazy-ass ramblings from a mom who hopes to do right by her AMAZING HERO of a son, JOE...who lives each day to the MAX hand-in-hand with "D".

Post Edit: I am not a confrontational person. Joe only has one more soccer game with his current team. I am hoping that I can show this woman what a day-in-the-life is like with finesse and tact.

The MANY, MANY....MANY, MANY REASONS for a LOW JOE

I don't want to SCARE you guys...but I think I may do a post of mostly pictures and few words. Yes, I am feeling OK. Nope, I don't have a fever. My fingers are lively and dancing across the keyboard. I was just thinking after viewing all the pictures I have of Joe...MAN this kid IS "BALLS TO THE WALL" all the time. For you "non-D folks"...I want you to take in how these photos look like Joe is just a "KID BEING A KID". What you don't know is that all of the below activities require special monitoring, planning, and care... I know, welcome to CRAZY TOWN (in "let me take you to Funky Town" - like music playing in the recesses of my twisted brain)!!!

Now, without further delay...

The many ACTIVE reasons that make for a LOW JOE (mind you this is only "active reasons"...not sickness... poor carb counting ... wrong insulin dosing... stars and moons being out of alignment reasons...that too can make Joe GO LOW)...

(Hula-Hooping Joe... look at the "determination" in that face)

(Up-To-No-Good Joe...this is in the remenants of our backyard ice rink)

(Biker Joe)

(Jumping Joe)

(Dirt Pit Joe ... yes, this is in our backyard... and yes, Joe and his pump become a filthy dust spattered mess... I have to use a baby tooth brush to clean all the cracks and crevices of our Animas Ping Insulin Pump)

(Hockey Joe)

(Baseball Joe)

(Soccer Joe)

(Diving Joe)

(Jousting Joe? Not sure what the heck this is called...but it too can make him go LOW while he is pummeling his opponent)

(Another Maher Family Classic - Surfboarding Joe down the Slip-and-Slide - GOOD TIMES)

(Skateboarding Joe...and yes, I asked him to change shoes and put on pads)

(Don't ask, b/c not even I know...prior to this pic he was skateboarding with the cones on his hands and feet)

For more information on Low Blood sugar click here.

The planning for all of the above activities includes frequent blood sugar monitoring and extra food/carb sources. Blood sugar checks are done every 30 minutes with hockey and soccer...otherwise we check Joe's blood sugar every hour while he is active. "Dexter" has lightened the load on this front. If his CGM numbers are running "right on" with blood sugar numbers, I will skip a blood sugar check and take a peak at "Dexter" (click here to read about one of my favorite posts about "Dexter" our CGM) and "boost" Joe's blood sugar accordingly. Woodchuck #2 is always on my person ready for ACTION stocked with the glucometer, Glucagon, Ketone Meter, syringes, and glucose tablets and Starbursts. The hardest part for Joe is taking a "break" from his activity of choice to care for his diabetes...for the most part he handles it with GRACE.

Again...A day-in-the-life... it never ends... balancing blood sugars, activities, food, and insulin day-in and day-out... This is where the "details of the mundane can drive you INSANE."