The Mirror

As we walked side-by-side through the parking garage into the hospital yesterday, his 6' frame towering over me...he said 'I don't really even think about having diabetes except on Endo days and sometimes when I have to check a number.'

'Really?'

'Yeah'

He then went onto say something that briefly caused my eyes to sting.  He said, 'it's weird, but when I look in the mirror...I don't see my POD anymore.  I don't see the CGM.  I just see me.' 

When Joe thinks of himself, he says diabetes doesn't even enter his definition of who he is.

The Endo appointment went well.  Joe continues to do the majority of his care.  He is an active high school freshman and manages to juggle school, being an athlete, and managing diabetes successfully.  His A1C was 7.  A fine number considering his growth and his independence.

He turns 15 at the end of April.  We discussed his drivers permit with his endocrinologist.  You see, driving with diabetes adds another element of risk to just the act of driving.  People with t1d need Medical Clearance Paperwork, in order to get their driver's permit or license.  When Joe starts to drive, he should check a blood glucose prior to driving and every hour if he is driving for more than an hour's time.  He should not drive unless his blood glucose is 90mg/dL, or higher.  Driving low is more dangerous than driving inebriated.

I'm not sure how I am doing with all of this.  Actually, that's a lie.  I do know how I've been doing.  I've been fairly anxious.  High school has been more of an adjustment for me...than for him; I think.  I have had to back off as a hands-on pancreas and trust that I have taught him well.  I have.  Can I just say, at this age, sometimes having that damn Dexcom is a blessing and a curse all in one.  Watching his blood sugar remotely can cause my mascara-fringed eyeballs to bulge outta their orbits when his number is tanking to the 40's, while he is at school or at a hockey practice.  There isn't a darn thing I can do to help him.  I watch.  I wait.  I worry, then I hope and I trust things will be OK.

A day-in-the-life update.

Take That Growth Hormone

Growth Hormone is released from the pituitary, which is a part of the brain. Growth hormone counterbalances the effect of insulin on muscle and fat cells. High levels of growth hormone cause resistance to the action of insulin.  Basically, this means blood sugar levels will run high during periods of growth.


A week...or so, ago.. we visited Joe's endocrinologist...

Measurements were taken, values were obtained, a physical exam was conducted, mental well being was noted. 

Another 1.7 inches in height was reached; he is now taller than me.  A few more pounds of weight were gained.

His A1C was 7; down 0.3 from his last visit.

I'd say we are holding our own.

A day in the life of  growing UP with t1d.

Hopefully Never

Studies have shown depression symptoms in children and adolescents with type 1 diabetes are nearly double that of the highest estimate of depression in youth in general.

So...

Today we were at our quarterly Endocrine appointment.  This one started off a bit differently.  We, Joe and I, were each given a folder with a depression-y/anxiety self assessment to complete.  Mine was a couple of pages long with a bunch of statements followed by "yes" and "no" check boxes to check.  I had checked most of the "no" boxes; I had not experienced negative feelings about certain aspects of caring for Joe in the past week.  Furthermore, the questions addressed obtaining supplies, insurance coverage, etc...things we don't currently struggle with.

Joe's questionnaire looked fairly simple.  It was a single page.  He had to rate his feelings from something like "never"....all the way to...something like "frequently; all the time".  I took a quick glimpse at his sheet and he checked the "never" box for each statement or question.  One statement was in essence "I feel bad about myself."  Joe's answer was"never"... this was the gist of the questioning and Joe's answers were consistently positive.

At Endo Today

I handed in our completed forms and then entered the exam room and plopped down next to Joe.  Joe gave me the side eye.  His voice was hushed when he said "I feel bad for those people."

It was my turn to give him the side eye and then a whispered ... "For who?"

"The people that feel bad about themselves or their lives."

"Joe, you know why they had us complete that form...right?"

Joe's expression was blank.

"Joe, people with diabetes tend to be a little more depressed than other people."

"Oh.."

Not depressed by the day-in-the-life...yet.

Changing

The intake questions were directed to Joe.

Do you use Apidra in your pump?'

'Yes'

'Are you on any other medications?'

'No'

'Have you been to the hospital for diabetes since your last appointment?'

'Yes'

'Were you admitted?'

'No.'

'Have you had your flu shot'

'No, not yet.'

'When was your last dilated eye exam?'

Joe's eyes darted to me.  I answered.

A couple of days ago, we visited the Endocrinologist.  Joe's A1C was 7.1.  The usual things were discussed and assessed.  The unusual part of the visit was Joe was now an integral participant in the visit. 

More questions were directed to Joe, by the endocrinologist.

'How's the carbohydrate counting, the blood sugar checking, and the bolusing going?'

'I'm asking you these things, not because you are going to get in trouble, but because these are the things you  are in control of ...I don't want to recommend changes to your settings if you are missing boluses or if your carb counting is off.'

My mouth twitched.  I wanted to talk.  I didn't.  It's Joe's turn now.  He's 12. 

Joe responded, confirming he was good with the carb counting.  He is.  Joe responded, confirming he checks his blood sugar regularly.  He does.  Joe responded, admitting he forgets to bolus for afternoon snacks.  He has a few times over the past few months.

Overall, Joe is doing well.  The basal rates need adjusting.  Apparently I've kept him on little boy settings and need to boost them up to more "teenager-y" settings.

He's changed so much.

He's grown over 3 inches in the last several months.

His toes frequently grow out the front of his sneakers.

His face has thinned.

His legs have thickened.

His total daily insulin dose is now over 40 units; it used to be in the low teens.


As we drove away from the hospital, Joe asked if he could start to help me with adjusting his pump settings.  'I need to start being a part of that Mom... someday I'll need to do it on my own.'

A changing day-in-the-life.

I Let The Dirt Bike Comment Go...

A couple of days ago...in the car, on our way to school...

"OK Joe, so I'll bring your LEGO Ninjago Space Ship~Thingy and Catching Fire for the Endo visit." No comments on the Catching Fire. Bridget read it. Yes, violence. Yes, it, the violence, isn't as "depersonalized" as Star Wars with it's Lightsabers, or as Harry Potter with it's "STUPIFY", etc. I know ... kids killing kids with spears, arrows, and hand-to-hand combat that is organized and sensationalized by the government to instill fear in the "governed" seems to be a bit inappropriate for an eight (almost nine) year old. After typing that I realize that... indeed ... yes, I suck.

Back to the story at hand...

"Oh... and... Joe, please try not to laugh when the doctor examines you. He is a diabetes expert and he needs to look you over to see how your body is doing with diabetes."

In the rear view mirror, I see Joe's eyes widen. "You mean he is the best at diabetes in the world."

"Ahh. No. Well, I don't know exactly Joe. Let's just say he is the best at diabetes in children in our region. How's that?"

"mmmm" Joe seemed satisfied with my shifty response.

I dropped Joe off at school. I had a couple of hours before I needed to return to grab him for the Endo appointment. Now, usually I am not too thrilled to be going to Endocrine appointments. It seems that they coincide with a bad batch of blood sugar trends. I have felt that I was going in to "face the music". I have had "defensive manifestos" prepared for my actions with the pump, with boosting, with letting the settings ride. This time, however, I felt confident. Joe's numbers have been steady. Diabetes has been in the periphery of our day-in-the-life. Joe's last A1C was 7.3%; his highest, since pumping. I was hoping for a 6.6 to a 6.9%.

With Lego Ninjago thingy and Catching Fire in hand, I collected Joe from his school and off to Endo we went. While entering the parking garage, I saw a stretcher with a covered body being loaded into a hearse. I scope out Joe's focus. He saw it too; the body. He thought it was being loaded onto an "ambulance" and he did not understand why the persons head was "under a maroon colored sheet". I explained that the person was dead and that the body was being taken for burial. Joe chimed in "so the doctors did everything they could to save that person and they just couldn't". So... do I just go with it? Or, do I let him know that "life" isn't always the "best outcome" for the patient. I let him know ... the truth. This upset him a bit. The part that a person would choose death over treatment options. He wanted to know that I would always choose to treat anything that comes my way in the "medical condition" department. I reassured him that I would at this stage of my life... that I would do everything possible to ensure that I would be here for he and Bridget. A simple "good", was his response.

After the "body" sighting and deep discussion we headed into our appointment.

The Endo visit was uneventful. Joe's A1C was 6.9%, with a fairly tight standard deviation.

We checked out. On the elevator to the parking garage, an elderly man in a wheel chair joined Joe and I for the ride. I looked down at the gentleman's feet. He was missing one. His prosthetic was visible. I notice Joe's eyes were taking it in (face palm... I don't think I can handle another deep convo with this kid today). We departed from the elevator; from the one-legged man. Joe said nothing for a few moments. Then... "I think he lost his foot racing dirt bikes Ma."

A day-in-the-life of trying to parent a kid through doctors visits at the hospital.