A-low-n

As I pulled up, he was sitting on his friend's driveway.  His shoes were off.  He was alone.  He looked pale.

There are times I'm not sure what to expect.  Sure, experience has given me some ideas.  He may be pasty white and shaking.  He may be curled up in a ball, moaning and mumbling, as he deals with the low.  Or...he may be sprawled out like a 5'6" over-cooked, linguini.  These thoughts went through my thought feed yesterday, after I read the text.  The text stated he was not doing well.  

 

I knew before I left for my run, he did not have his supplies; his sugar. Sometimes, I like to give him a break from the reminding; the nagging. 

Luckily, his friend stuffed him with Fruit Gushers and Short Bread cookies.  Joe then went out to the driveway to sit and wait for my arrival. Alone.

"Joe, why didn't you stay with your friends?"

"I just wanted to wait.."  I think he wanted to wait out the low; perhaps in private.

"You should have stayed with people."

"I knew if I passed out you'd come soon .. and find me."

He was 39.

Alone in his day-in-the-life.

Going Well!

I promise I did not "wear" the headlamp as I dropped off Joe to his friend's house for the sleepover last evening.  However, for your viewing pleasure I did ....

I thought the "head lamp" was a thoughtful token for night-check-ease.  Salami and pickles were brought for Joe's snacking pleasure to veer him away from heavy carb snacking into the night.  In general, Joe does not eat carbs after dinner.

So far so good.  I have not heard from Joe or Joe's-friend's-mom since 10:30pm last night.

Up to that point Joe had consumed pizza (2 slices), ice cream (1/2 a cup, which he thought was a cup and we bolused for a cup, and he then called me back to say it was 1/2 a cup and we then made up the difference with Starbursts, which I believe ultimately lead to a low...but whatever), salami, salami wraps (cream cheese spread on salami that is then rolled up into little cigar-shapes), and pickles. 

His numbers have ranged from 55 to 270. 

I'll take it.

A day-in-the-life of support pancreating remotely.

Freak Show

"If he is unconscious or has a seizure - Glucagon is in his camo bag OR call me and I'll run over and give it..  AND call 911". ~  Yeah, so writing that part seems a little over-the-top..but what am I to do?  It could happen.  I like how I added in the part of just calling me so I could "run over" and whack him with the Glucagon.  It is so very difficult to not appear like a freak show.  To top it off I am sending Joe over with a jar of pickles and salami-wraps for "free" snacking into the evening hours.  Freak Show...

 

My Head On Village Person Body...Don't Ask...

 

10:56pm last evening, Joe's blood sugar was 25.  Haven't seen a number that low since he was 3 years old.

 

Tonight is the sleepover.  I am a little nervous, due to Joe's low trend through the night over the past week.  I cannot back out of this though.  I know it.  Joe is thrilled and I need to make this happen AND keep my composure to give the illusion of "normalcy".  So,  I analyzed his numbers this morning and backed off his basal rates. 

 

I then proceeded to type out "instructions" to accompany my 10 year old child. 

 

Here is what I came up with (I added the red just for my readers here on Beta Buddies.  No red was added to the actual document for "normalcy-appearing-purposes"):

 

Joe should check his blood sugar: every 2-3 hours and/or before he eats and/or if he feels "LOW".

 *Joe is going to call me with blood sugar numbers and carb counts and he/I will bolus over the phone.

 * I did talk to him about not "over-carbing".  I told him a couple of pieces of pizza were OK, but no more.  One carb snack in the evening would be OK, but he should not graze (unless he is running low, then it is OK).  It is OK for him to snack on the non-carb foods (the pickles and salami-wraps that I sent are for this purpose).

 LOWS - A low blood sugar for Joe is a number less than 70:  If Joe's number is less than 70 he needs sugar.  Sugar is in his camo-bag.  He needs either 3 Starbursts OR 3 Glucose Tablets.  He then needs to wait 15 minutes and then he should do a re-check of his blood sugar to make sure the number has come up to 70 or higher.

 If he is unconscious or has a seizure - Glucagon is in his camo bag OR call me and I'll run over AND call 911.

 NIGHT TIME CHECKS - Please check Joe before you go to bed and call me with the number.  Then at 2 am (sorry...ugh).  For the 2 am number, if Joe is < 70 please give him 3 Glucose Tablets (he will chew them while he sleeps) and then re-check his blood sugar in 15 minutes to make sure his number came up (double sorry).  If Joe is 70 - 100, please give him 2 Glucose Tabs.  If Joe's blood sugar is 100-249, do nothing.  If Joe's blood sugar is 250 or greater, then he needs a "correction" dose of insulin.

 Using the Glucometer/PUMP remote for "correction": (NOTE: You should be within 5 feet or so of Joe to deliver the insulin from the remote) Once the blood glucose number appears on the glucometer screen, you can select "bolus" (at bottom of screen) by using the down arrow to highlight "bolus" and then pressing the "OK" button.  The glucometer will then give you a menu of "types of boluses" , you will select "EZBG" using the arrows to highlight "EZBG" and then pushing the OK button.  The screen will then display the current BG/where we want his BG "120"/and a correction factor...the math so-to-speak.  Push "OK" (Joe's current BG will be highlighted).  The cursor will then be highlighting "show result", press the OK button.  There will then be a screen suggesting how much insulin to give (the amount will be next to the word "TOTAL=").  You will need to push the up arrow until the suggested amount is reached.  Once the amount entered is the same as what the Total suggested you will press the "OK" button.  The cursor then moves to "Go".  You will press the OK button again to deliver the insulin.

A day-in-the-life of authoring an "Instruction Manual" (of sorts) for Joe, my ten year old son who has type 1 diabetes.

"HHH...e.l.p."

Literally thinking of "Cutting The Cord" ... more on that soon...

 "Ahh . ... he (a.k.a. Joe) told me that we might need to leave a door unlocked for you... ah, so you could come in and check him in the middle of the night." ~ Joe's-friend's-mom  to me.

I paused to see what her reaction was going to be so that I could, in turn, mirror it.  She started laughing.  So, I then started laughing.  Little did she know, I would do that "PLAN" if it seemed "normal" and "OK" to her.  Little did she know that Dave has indeed climbed through muddy ravines...in the dark... at 2 am ... to access Joe's blood, while he attended an overnight Hockey Camp.

You see..

Yesterday, after school, as I was wrapping-up from work ...

Joe phoned:  "Mom! I was invited to a sleepover...for Memorial Day Weekend! ... on this Friday! ... can I go?!"

My eyes filled:  "Sure bud.  We'll have to figure out the diabetes." (sErIoUsLy, why did I even need to mention the "diabetes part"?  I hate that I did that.)

Joe has never spent the night at a friend's house.  He is now ten years old.  Seven of his ten years have been lived with diabetes.  We have had friends over to our home for the night, but never vice-versa.  When he was younger, it seemed too daunting, to complicated.  Then the issue just seemed to slip off the radar.  For me it did anyway.  Not sure if Joe has given it much thought over the past few years.  I am ashamed to admit that I did not make this happen for Joe earlier.  I simply could have just asked a friend to have him over; friends that know diabetes fairly well after hanging with Joe and I over the years.  I simply just needed to ask;  to ask for "hhh...e.l.p".

As I was pre-discussing the "pre-slumber party diabetes plan" with Joe's-friend's-mom, I was apologetic when mentioning the 2 am check. Asking for "hhh..e.l.p." is difficult for me; to a fault.  I struggle to do it even for the wellbeing of my child.

"Help" (transitive verb) ~ 1) to give assistance or support; 2) to make more pleasant or bearable.

A day-in-the-life of accepting assistance and support, in order to make Joe's life with type 1 diabetes more pleasant and bearable.

Thank You Phone Caller Friend. Community.

You can thank the letters "W" and "M" for the following post.  I have been up.  I have been up at 1:40 correcting a 300.  I have been up at 4:15 making sure the correction worked or that it didn't induce coma.  And I am now...just up..because who can sleep with all these ups and downs.  I wonder how Joe's body feels while it is "W"-ing and "M"-ing?  And I swear that right before the "W" there is like a finger pointing at me...like I did something wrong.

**********

Phone call the other day after school.

Me: "Hello?" (newish phone, didn't have friend in my contacts yet, hence the "?")

Phone Caller Friend:  "Hey...we just saw Joe pushing his bike up Brickyard (a street)...he looked a little .. tired.  Does he have a phone or something?  ... Just thought you would want a heads-up..."  Now I am pretty sure she was calling to give me a diabetes "heads-up", but maybe it was a normal "heads-up" call.  My mind almost always goes to "diabetes" where Joe is concerned.

Me:  "Thank you so much.  I just checked his number at school.  It was in a good range for him to ride home.  He is walking because ... bike is a BMX bike ... no gears (by the way, let me insert here ... a total blood sugar buster).  Please always feel free to call if something looks off.  There may be times Joe could use some help."

A village.  Did I ever tell you that I actually do live in a village.  Essex Junction is a village.  A village, by definition is a community smaller than a town.  I think the term "It takes a village"  really hinges on the "community" part of the "village" definition.  Community:  A group or society helping one another. 

**********

This year, after school is going to be a bit different.  Joe will bike home and go to after school activities.  I reflected this on his daily log; the piece of paper with carb counts and instructions that accompanies Joe to school daily via Woodchuck.  I have added a "sugar sliding scale" of sorts to boost him according to his 2:45pm number. 

Presenting the 2012 "LOG"

Here is the blown up part of the "sugar sliding scale" instructions.  I also like to use it for P.E. Days.

Community in our day-in-the-life of looking out for Joe.

Confidence

The following happened yesterday afternoon, after school. The interaction took place between Joe and one of his oldest and dearest friends. Children, and adults for that matter, can say things out of anger and frustration.


The snow was falling, heavy and wet. Joe was playing with a group of friends in the distance. I approached with Woodchuck. After school lows have been a frequent companion lately. A quick check confirmed it. 68. A juice was spiked and dispensed. Joe knocked it back.

I then gently probed him about a disagreement that he had just had with his friend.

"He was being mean to me mom. I told him that if he kept acting like that he would not have any friends. THEN. He said to me that if I still had diabetes when I was an adult I would not have any friends."

I wasn't really interested in the "he said-he said" business of the incident. There was only one thing I wanted to be sure of...

Before I walked off to leave him with his pals, I casually asked ... not wanting to make a big deal of the situation ... "Joe, you know that is not true?... right? ... diabetes will not make people not like you."

In an authentic, upbeat voice, Joe said "Of course not mom. Diabetes makes me even cooler. I'll always have friends."

I walked away. My heart was light.

A day-in-the-life of confidence despite diabetes, perhaps ... dare I say it? ... enhanced by it.

That Is NOT On My Playdate Cheat Sheet...

What sending Type 1 on a Play Date looks like:

A few days ago...

The water mushroom and the blaring music were a concern.

I lounged on my chair by the pool. The cell phone was poised on the arm of the chair. My eyes scanned it regularly for any sign of a call, a message, a notification. I was with Bridget and her friend. Joe was at his friend Adie's house. The phone is a constant companion during Joe's absence. I have trust and faith in Joe and in Nikki, Adie's mother. They may need me though.

The green notification light started blinking.

My right hand refreshed the phone. Damn. I missed the call. It was them.

I call them. The peripheral background noise makes the call difficult to interpret. Nikki let's me know that Joe was 63. I think that is what she said. I repeat into the phone staccato-like "six" "three". She confirmed. Something about sugar or Starbursts was mentioned. I ask in a loud cave-woman-y voice "He.took.sugar!?" Again, at least I can hear the "yes" that is delivered in response. Nikki goes onto say something about Joe wanting a snack and he was mumbling something at her like "combo bolus". Well.... Ok then. This isn't on my Play Date Cheat Sheet.

Joe gets on the phone.

The lisp-y, the nasal-y, and the soft spoken-y really isn't working for me here. The noise of the water 'shroom splashing and the Pop Rock spewing from the speakers is too much. I heard "snack" and "combo". I interpreted the issue as "Joe, are you wanting to eat now? ... are you calling because you don't want to wait the 15 minutes to recheck your blood sugar? ... and you want to do a combo bolus to cover the snack?"

I heard a "yes", with the emphasis on the slightly drawn out "s" that we all know and love in the lisp.

Fine.

I understood.

I tell him to do a 0%:100% extended over 30 minutes (this is NOT intended as medical advice). I tell him not to enter in his BG, assuming he will correct with the 12 grams of carbs he just consumed for the low. I can pick out an "OK" from his end. Then, abruptly, the call is ended. He hung up, ready to man his pump with the instruction given I assume.

Bridget comes at me from the snack bar. She is shaking two Tootsie Pops like they are maracas to the beat of the music with confidence and sass. I continue to scan my phone.

A text came in... "Don't worry... we r all good!"

I responded with ..."I know he is in good hands!"

A couple of hours later, when Joe is back with me, he checks his number. A 108 graces the glucometer screen.

A day-in-the-life of critical thinking as he expands his independence.

Click here for my original post on "Play Dates".

OUT OF THE MOUTHS OF BABES

I was dropping off Joe's diabetes kit to the school nurse today and she witnessed a funny and cute interaction between Joe and one of his classmates yesterday...

Joe had brought in a friend for his blood sugar check...and he was poking his finger (a few times...he has a few callouses...so sometimes it takes a few pokes to find a spot that will bleed). Anyways, the friend asked him if it hurts...and he responded "no...I do it like 15 times a day".

Surprised, his friend then turned to him and asked "Does your mother know about this?!"

Too cute...I wonder what his friend would think if she knew that his mother also sticks needles into his "tush" for pump site changes?...

ADIE ("Like the Number 80")

Seriously, does it get better than having a "best bud?"...I don't think so, especially in the eyes of a 6 year old boy...and that is just what Adie is, Joe's best bud. He comes over at least 2 times a week after school and he and Joe (and often Bridget) play Lego's, reenact Star Wars, ice skate, play soccer, rake leaves, play video games, etc. These two bring out great qualities in each other...Adie brings out Joe's empathetic side. I love watching Joe care for a friend so deeply... and I think Joe encourages Adie to try new things...both boys have heart...and this makes me love them all the more. They giggle when they push Bridget's buttons enough to get a rise out of her. They are your typical bratty little brothers...but when push comes to shove, Bridget fiercely protects them on the playground and vice-versa. The three of them are thick as thieves.

Few people know this, but I used to dread play dates...what if the other children are hungry...and it isn't quite a good time for Joe to eat. I could offer everyone cheese and meat (carb-free foods), but that doesn't always go over well with young kids in this carb-laden, processed-food flooded world. Joe didn't usually mind...if another child stated they were hungry and I fed them a snack, but it bothered me. Fortunately, Joe is usually pretty easy going with his food and the schedule...don't get me wrong...the kid is not deprived in any way. He has carbs (I just try to feed him a consistent amount at the same time daily and he has treats in moderation). The one thing Diabetes likes is consistency...that generally means meals around the same time daily, with roughly the same amount of carbs at the same time daily...with roughly the same activity schedule daily. So I am finding my stride in juggling play dates and best buds and diabetes and making it work...like all things it requires BALANCE...and our lives have been enriched by Joe's best bud Adie...