#DAM Fall Back

#theoneeye 👁️

Many nights, that's all it requires; one eye. There's an internal 2-ish a.m. alarm in me. I wake. Eyes closed, I fumble for the phone on my nightstand. My right eye reluctantly opens. It scans the Dexcom app to make sure he is at an ok number.

The app will alarm if he goes below 70 or above 300. I don't have it on for other deviances, like if it loses signal or rapid drops and climbs...if I did, it would alarm all.the.time.

Last night was a good night to sleep. #thankful
#makediabetesvisible #t1d #needtotweakbasalrate

T1d people change time on your pumps! 🕑🔄

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They Don't Train You About This Stuff

#theydonottrainyouforthisatdiagnosis
#nightchecksdothematyourownrisk

There was no time for a thought to flicker in my thought feed, as I dropped to the floor like a 140 pound sack of potatoes.

Last week...

It was 2-ish a.m.  I had just checked Joe's blood sugar and turned off his bedside lamp and was traversing my way around and through what looked like laundry fields, hills, and mountains.  The laundry - some piles clean, some dirty, and some were possibly unknown (clean or dirty or both) is a typical scene in Joe's room these days.  He does his own laundry.  I think he has a system?

Back to me...

I was maneuvering myself through the laundry landscape and came upon a crumpled up large blanket.  I decided to walk on the blanket pile.  The pile was large; it looked soft; it looked safe.  One step onto the blanket and my right toes hooked into a metal laundry basket catapulting it up on end to impact my right shin, tripping me.   The laundry basket then falls to the ground in time for the top metal edge to absorb the impact of my anterior thigh.

Do not underestimate the impact of our day-in-the-life.

Night Shift

At least he piled up the juice boxes neatly.

The above is the scene that greeted me, as I went in to wake him a few weeks ago.

'Joe, the juices are not for snacking on.'

'I was low in the middle of the night.'

'Three times?!'

'Yes.'

Over the years, people have asked me ... 'When will Joe start taking care of his diabetes during the night?'  These people are well intentioned.  I've been pretty adamant that Joe sleep when he can.  Diabetes keeps him up enough.  He wakes, at times, when he is poked.  He wakes, at times, when I am cramming a juice straw into his mouth.  He wakes, at times, to the beeps from a pump failure.

He is a growing teenager.   His energies should be focused on school, sports, friends, video games....and other teenager-y things.  He needs his sleep for typical growth and development.  I have slept with the CGM by my bedside, nightly, for years.  It alarms, I wake, I take care of what needs taking care of.

On the three-juice-low-night, Dave checked Joe prior to bed ... and accidentally left the CGM in Joe's room.  While I found it reassuring that the alarm woke the sleeps-like-the-dead-Joe, I will still cover the night shift.  I know, one day ... soon enough, he will need to manage that, as well.  For now, it will continue to be me.

More on on our day-in-the-life of nights.

1:37 am

In the fog of my blissful sleep, I hear something.  It's important.  I recognize that as I slumber.  I try to remain asleep, but my mind searches for the implications of the sound.

It's 1:37 am.

My subconscious knows to to be on "high alert".  Joe just participated in a power skating camp this evening...with a failed site...which resulted in a HIGH blood sugar... which required a new pump site...and a correction dose of insulin.  This may, or may not, end up with unstable blood glucose readings.

Unfortunately for me and more importantly Joe, this will be a rough diabetes night.

It's 1:37 am.  My mind and my body wake from the alarm.  Joe is low.  It's the "MEMMMP...MEMMP...MEMMP!! - Your kid is super friggen low...low alarm".  I'm still a little dazed from my slumber.  I catalogue the day.  The power skating, the site change, the correction are recollected.  This could be bad. 

I stumble into his room.  I'm tired.

I ready his glucometer with the test strip.  I lance his finger, as he sleeps.  The blood is wicked up the test strip.  He is 40.

I turn off his insulin pump for 2 hours.  Four glucose tablets are grabbed from the supply kept in his room for exactly this; our nights.  I didn't even need to coax him to chew the tablets.  In his sleep, he chomps on each tablet.  They are each consumed in short order.  His body knows ... it needs them to survive.

I plod back to my bed.  I lay down.  I know I won't sleep; he is too low for that.  I'll need to know he is OK.  40 is nowhere near "OK" when he sleeps.

I start on my left, turned away from my night stand where the CGM resides.  Eventually, I turn to the right.  I take a peek.  He's only 45, smooth.  I wait.  I turn.  It's about 2 am.  I turn.  50 smooth.  Still, I wait.  I know it will turn around.  I just need to wait a bit longer.  Just a little longer until I'll feel OK.  Just a little longer until I'll feel he'll be OK.  Just a little longer until I can go back to sleep again.  Back and forth I go, peeking at his number.  At 2:17, or so, 63...diagonal up.  The next time I check he's 115 ...diagonal up.

But, is he truly alright?

I need to check on him to be able to sleep.  I prop myself out of my bed.  I plod back into his room.  I want to check his pulse.  Weird, I know.  If it's his carotid (on his neck) it may wake him.  I take his wrist in my hand.  I feel a strong, steady radial pulse.

Finally, I can go back to sleep.

A glimpse of a rough night in the day-in-the-life of parenting my child who has t1d.

The Toe Is A No Go

Perhaps I shoulda warned him before doing it.

Maybe a little heads-up woulda been the appropriate thing to do?

I'm not sure what good toe poking etiquette entails.  In hind sight, initializing a toe-poking-protocol on a sleeping subject is probably not the proper procedure.

Yesterday morning around 6:57-ish, the house was still sleeping; well everyone, but me.  I was headed out for my morning run.  Joe's Dexcom was showing a 67 and diagonal-downing.  A check was warranted on the sleeping Joe.

I entered his room and readied the glucometer with the test strip.  While wielding the lancing device, I assessed the target situation.  Joe was dead asleep with both hands tucked under his head, making his finger tips unavailable.  I noted his toes, peeking out from under his blanket, were easily accessible.

Pry fingers from under his head...wake him up?

Poke toe...maybe he sleeps?

Fingers?

Toes?

Welp, I haven't tried to poke his toes since he was like 4.  Let's just say I tried to yesterday morning...and... he did not sleep through it and as his leg briskly recoiled, he might have said something like "for the love of all that is good and holy..!" (but with different nouns and verbs).

I wanted him to sleep in.  He's growing.  He's tired.  He was up late the previous night.  He's up, due to diabetes nonsense, more often than not these days.  Note to self:  poking his toes will not help him sleep in.

I then poked the kinda-awake-and-kinda-annoyed-Joe's finger. A 99 was obtained.  The basal rate was decreased by 40% x 1 hour.  I ran.  Once I arrived home, a smooth 122 graced the Dexcom screen.

Waking Joe, via the toe, while simply trying to manage the day-in-the-life.

Sleep Drinking Talking

Last night...Or shall I say this morning at 1:37am-ish...

I'm doing the one-eye, half asleep, orange-juice-dispensing-via-a-straw-maneuver to a sleeping Joe.  He sleeps during night sugar dispensing.  He chews and drinks in his sleep.  Frankly, I kinda sleep through it too.  Sure, I wake up to the donging off of the Dexcom's alerts, and yes I plod to his room in the darkness of the night, and yup I lance and squeeze his fingers for some blood to test, and of course I then grab some sort of sugar to "boost"  him up. 

I do it all with one-eye partially open; the effect is a sense of doing it all while I'm sleeping, but I'm not...but...I am...but, I'm not. 

Back to last night.

I was holding the straw to his lips.  He sleep drank (like sleep walking, but drinking) and I was nodding off as I balanced the juice and the straw.  All of a sudden, a sleepily, soft "Happy New Year, Mom." startled me from my slumber.  Joe continued to sip and talk with the straw positioned at the side of his mouth.

"Happy New Year, Bud."

"Mom..."  (still sleepily drinking juice, as I'm still sleepily dispensing it) "when does the President take office?"

Juice is gone.  I'm not gonna talk politics with him at 1:40am-ish in the morning.

"Goodnight, Joe."

Our day-in-the life, even on New Years!  Happy 2016.

Patient Portuguese Pancreas Princess

There may be a little spittle on your screen if ya try to say the title out loud.  Truth, I am Portuguese (half, from my father's side).  Truth, Joe's misguided T-cells forced me into performing as an exogenous pancreas.  False, I am not patient.  And I am actually a "queen" not a "princess"...well, my name means "queen" in Spanish.

Sorry for the jibber-jabber.

This morning at 6:30ish...

"Is Joe up..."  (my less~than~subtle way of knowing he is alive)

"They are both still asleep." 

"Check Joe's number, the basal increase .. he was 127." (@ the 2am check)

Yesterday morning, I had logged Joe's numbers and noticed he had a consistent climb of about 50 points from the 2am check to the 7am check.  I think he is growing.  He is constantly eating bacon (don't ask).  I tweaked his basal from 2:30am to 6am.  I had to do the every-other-hour-thingy with the Omnipod.  I was not just gonna crank him up by 0.05 units for that length of time, because 0.05 is like 1/7 of 0.35 (what is that? like a 14% increase) ... with the Ping, I would have just cranked that bad boy up by 0.025u/hr, oh well.

Last night was my night to do the night check.  Dave and I usually rotate night checks.  He does the 2am check for two nights.  I do the 2am check for two nights...and so-on and so-forth.  We have been doing this system for a good year now.  Alternating every other night did not seem to let us fall back into the "habit" of sleeping through the night.  I have thought of a three night alternating schedule, but I fear the overwhelmingness of the the thought of three nights in a row of 2am alarms is psychologically detrimental and destructive to the checker-person. 

Anyways...

When I do the night checks, I wake-up early.  I set my alarm for 2am, but many times I wake-up at like 12:03 or 12:49 or 12:55.  And.  I just check Joe then.  And.  Yes, technically this is cheating my system that I so braggity McBragger-pantsed on my blog just a couple of days ago.

Last night...

I did it again.  I woke up at midnight.  I knew that I needed to wait til 2am.  I needed to get a good glimpse of Joe's numbers at appropriate intervals surrounding the basal changes.  So, back to bed I went til the 2am alarm.

What was he at 6:30am you may or may not be asking???  128.

A horizontal Portuguese Pancreas Princess raised her arm from her bed for a zestful celebratory pump, when Dave relayed the number.

A day~in~the~life of night time basal tweakage.

Night.Strip.Trash

There was a time that I was a neat night pancreas...



See how the used test strips are/were housed in a dish?

 

**********

"Oh...yea...If ya get some sort of error message when checking Joe ... just grab another strip and re-test....and if that one errors-out...just grab another strip...and so-on...til you get a number." ~ Me to Dave

You see...

A few nights ago...and btw, I am surprised this hasn't happened to me before during my 7 years as an exogenous pancreas.

During the 2am check, while trying to coax out a strip from a fresh (fresh - meaning full and hard to manipulate out a strip) freestyle vial~vesicle~container~thingy, I dumped out all 47 or so strips onto Joe's chest of drawers.  Unfortunately, they spewed out all willy-nilly-like all over the place and there were some old used test strips spritzled into the mix.  I'm a slob night time pancreas, so it seems.

So, our test strip vial now has "old-dirtys" mixed in with "new-cleans".  Nice.

 

 

A day~in~the~life of needing to clean up my night-time act.  I'm sure you are better about throwing away your used night strips.

One Third (It's a BIG "Hunk")

In response to "Overkill or Good Diabetes Parenting?"

Store hours?  I wish.

I wish that diabetes management had like store hours or something.  Like maybe Joe's beta cells could "magically" come back to life from 9pm to like 8am.  Ya know?  Like every night Joe's glucometer and insulin pump and CGM could put up a "CLOSED" sign.

Yea...right...

What is 8/24?

I believe it is one third.

I believe it is one third of our 24 hour day.

If it is one third of our day~in~the~life of living with diabetes, guess what?  It is one third of our A1C.  I guess I shouldn't say "our"...it is one third of my child's A1C.  One third is a big hunk of my child's well being.

I am not going to be wishy-washy here.  I am not going to say do what works for you and your family.  I am not going to.   I am going to say that I think night checks are part of managing diabetes.  I don't do night checks solely out of fear of lows and out of fear of the dreadfully named "Dead In Bed Syndrome".  I also do them for trending blood sugars and adjusting basals accordingly.  And.  I do them for correcting highs as well.

It is a third of one's A1C  during a chunk of time that would normally have "predictable activity" (sleeping), with "predictable carbohydrate intake" (not eating, because sleeping), and with, for the most part, a "predictable amount of insulin" (no carb intake, because not eating, because sleeping) on board.

Our nightly routine here is:

Dave checks Joe's blood sugar @ 11pm (the following assumes no IOB and no CGM):

• If Joe's blood sugar is less than 70, we treat by using the rule of 15s.
• If Joe's blood sugar is 71-100, we give 8 grams of CHO
• If Joe's blood sugar is 100-250, we do nothing.
• If Joe's blood sugar is greater than 250, we correct and then set an alarm to check Joe's blood sugar in 2 hours.

Dave or I checks Joe's blood sugar between 2am and 3am:  We use the same actions as written above.

A day~in~the~life of managing my son, Joe's, blood sugar at night.

Glad To Do The 4am POD Change?

We are currently having a Schnauzer Party.

You see we have Oscar (salt and pepper) and Henry (the black one) and we are dog sitting Cooper (the party mix).

A couple of nights ago... on Cooper's first night at our house...

I woke.  It was 4am.  It was my night off from the blood sugar check.  Dave was standing at the foot of our bed saying something about us having a "situation"; I think he said we had a "couple of situations" actually. 

"Joe's POD is alarming that it has failed and Henry has *expelled fecal matter* (not in those words mind you) all over his crate ... *then something was mentioned about the stench ... Henry's crate housing Henry resides in our room*"

This is where I was somewhat glad and not resentful that I know more about the PODs and insertions than Dave.  Dave had not done a POD insertion yet.  He had only watched Joe and I do one. 

I volunteered for the POD change and left the soiled crate and canine to Dave.

A day~in~the~life of our nights with diabetes and dogs.

"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.

Fickle D'

"What was he?" ~ Dave to me at 3am...

"144"

My "one-eye" started to close and then I thought perhaps maybe I should ask why he was asking. 

My "one-eye" reopened ~ "Why?"

Dave's sleepy voice yammered off something about 9 glucose tabs and something about the 40s.

Me ~  "oh, I forgot to tell you that I never bolus for all of S'mores ... just half ... he always goes low after eating them."

Joe had a rough diabetes day yesterday.

6:54 am 337
9:06 am 306
10:05 am 319 (ketones 3.9)
11:18 am 248 (ketones 2.4)
12:14 pm 319  (ketones 1.4)
1:46 pm 448
2:14 pm 422
2:53 pm 406
4:01 pm 255 (ketones 0.0)
5:35 pm 56
6:56 pm 46
7:15 pm 110
8:15 pm 77
9:00 pm 80
10:49 pm 52
11:09 pm 41
11:29 pm 65
2:30 am 44
3:16 am 144


He handled it with grace.

A day-in-the-life of fickle d'

The "One-Eye"

I think I was pulling the "one-eye"... you know...the middle of the night check "one-eye"?  It is where I only open one eye so that I can traverse the walk to Joe's room and sift through his d' supplies to grab a blood sugar check, while tricking myself that I am still sleeping b/c one eye is closed.  I think I was pullin' the "one-eye" at 6:07am this morning as I stumbled back into my room...from Joe's.

Dave to me:  "What are ya doin'?"

Me:  "Just checkin' to make sure Joe was still alive...he is not in his room...so he must be good."

Yes.  I am serious.  This is what I said.  This is what goes on in our d' home.

Here is what happened...here is what went down.

1:47am - I woke.  On my own.  I usually do in anticipation of the alarm.  I set my alarm for  3am,  but usually wake an hour or so prior; my internal clock so-to-speak.  The "one-eye" was employed per usual.  Joe's blood sugar was 280.  I went to bolus...I cannot remember how much the pump called for.  I think it was like 1.8 units.  I scrolled up the insulin dose, pressed OK.  Then that "dunh..nah..nuh...nah...nuh...nah...NUH" alarm went off.  You know (Animas users) that alarm that means something is up.  I looked at Joe's pump.  It said something to the effect of "there is not enough insulin left in the cartridge in this pump to give that dose you just scrolled up to".  There was 1 unit left in the cartridge.

You and I both know what I should have immediately begun to do.  You know.  Like open the other eye...traipse down the stairs...get out a new cartridge, a new set, an alcohol pad,  Site Prep,  IV 3000, and oh yea...the insulin.  You and I both know that I needed to be putting in a new site.

Now, please don't get judge-y here.  But, you wanna know what I initially did.  Yes, it is embarrassing.  It is embarrassing for a few reasons:  1) I am a nurse 2) I have been a d' rent for a pretty long time and know better and 3) this is my child and I should be taking decent care of him.

Ok...

Here goes...I stumbled, "one-eyed" back to my room and into my bed dividing 1 unit by his basal rate of 0.3 units/hr.  Hmmmm...I figured out that should get him to about 5am...with the non-corrected 280....knowing that I was hoping to sleep into 7am.  Then I actually was wondering how long it would take the ketones to climb...and finally I thought of the ICBCs (kinda going all "Princess Bride" here...you remember the ROUSs ~ Rodents Of Unusual Size).  ICBCs translates to Inevitable Cartridge Bubble Clingers.  So, technically Joe may only have about 0.5 units left in that pump.

Eyes (both of 'em) were opened.

Bed was exited.

Stairs were traipsed down.

Supplies were collected.

Site was changed.

280 was corrected.

The CARNAGE..  Note:  No Glucose Tabs were used in this scenario...They were toppled over from a previous night...left them in photo for "drama factor"



Technically, I should have set an alarm for 4-ish or 5am.  Too tired to set the alarm, I was relying on my internal clock to just kinda jostle me awake around then.  It didn't happen, hence the check for life at 6:07am.

A blood sugar was finally checked at 8am.  A 107 graced the glucometer screen.

A night-in-the-life of managing type 1 diabetes for my son Joe. 

The In-Between Place

11:58pm last night...on the heels of the news of another child lost, at the age of 13, to Type 1 Diabetes...

I hear it.  Is it part of my dream?  As I lay there in some sort of state between wake and sleep, I try to figure it out.  The sound.  What is it?  Then it stops.  My mind rests.  I slip back into sleep.

It starts again.  I hear it.  My body and mind struggle with the sound; having a difficult time placing it.

Some nights it seems that Joe's Dexcom can alarm for a good hour before I wake enough to identify it.  There are hours of my nights that are spent in that "middle" place...not awake...not sleeping...in a cloudy haze.  Too tired to wake.  Too awake to sleep.  If that makes any sense what-so-ever.

Finally, I placed the sound.  Shit.  It is Dexter.

"LOW" is on the screen.  The "Under 55 Low" alarm.

I kinda lay beside Joe, as I ready the glucometer...eyes half-focused...so tired...cannot really tell if he is breathing...he is not really moving...or responding to my touch as I handle his finger for lancing.  Good.  The blood comes quick after the poke.  A sign of life. 

The blood is wicked up the test strip.  The glucometer counts down 5~4~3~2~1.  A 105 graces the screen.

I shutdown Dexter.  His accuracy has been off with this sensor.

I leave my 3:00am alarm set.  The 105 bears watching.

A day-in-the-life of my nights watching over Joe. 

Our Parenting Conversations Are Different

Six years almost.  Six years since Joe has been diagnosed.  It is strange how a certain acceptance has developed.  As I send him out on his bike, on in-line skates, on foot into our community, as I tuck him into bed at night, as I drop him off at school ... a teeny-tiny part of my heart and my brain is always aware and somewhat prepared for the possibility that I may not see him again. 

The kids were out in the 'hood playing with their friends.  Joe was squirting a hose into a gaggle of girls squealing their protests.  I was prepping dinner by laying out the leftovers on the kitchen island.  Dave walked in from his day of work.

This was last evening.

Me:  "Good day?"

Dave: "Yeah..."

*Or I think he said "yeah".  I was only half listening.*

Me:  "Kids had a good first day of school...Bridget loves middle school ... Joe said his day was boring...blah...blah...blah."

*pause*

Me: "A child died last night.  Seven year old.  Diagnosed at two.  Low or Dead In Bed.  Parents slept through a night check alarm. Found him in the morning."

Dave: "Can you imagine?"

Then, we went there.  We went to a place we haven't gone.  Actually, it is something I had not thought about; one of us blaming the other for a missed night check and a gone Joe.  We are human.  We need sleep.  This family is facing our worst fear; the death of their child.  The night check ... done or not ... may or may not have prevented this death.  The thought of struggling with "the blame" and "the guilt" while dealing with "the grief" is overwhelming.

Me:  "We would not blame one another... would we?"

Dave:  "How could you not 'go there' ?"

Me:  "I guess you are right ..."

A day-in-the-life conversation between my husband and I, as we parent a child with Type 1 Diabetes.

The "Double Low"

"I feeel soooooooo terrrrrrrrrrrible."

I could tell he was low by the way the "e's", the "o's", and the "r's" were drawn out and by the tone and pitch of his voice. It was 1:28am. Joe was stumbling into my room and climbing on top of me as I woke to his entrance. I released myself from the heap of Joe and hurried to his room to grab the glucometer.

He was moaning, saying it was a "bad one".

He was 50. The low was treated. Afterwards, Joe did not want to leave my bed. "My body won't work". I offered to carry him back to his bed, but the thought of that made him just groan and roll-over. He was on my side of the bed. I retreated to the guest room. Another alarm was set for 2am. Another alarm was set to ensure his blood sugar was in a safe range.

When he woke the following morning...

"That was a bad one mom; not a normal low. I don't get them often. But when I do ... I feel like I am a 20-something. That was what I call a double low."

I questioned, "A double low?"

"Yep, that is what I call those. I have only had a couple, but they are the really terrible, awful ones."

A day-in-the-life of understanding diabetes through my son's perspective.

How Long Has This Been Going On For?

Last night...

At 3:32 am....

I am awakened by the the bright glow of the hallway light flooding my room from the doorway, as Joe enters.

"Mom, can you cover me with a blanket? ... I just had a really bad dream..."

"Sure Buddy."

I got up. I followed Joe back to his room. I grabbed a blanket from his closet shelf and spread it over his lean little 8 year old body. I kissed his cherubic, dimpled cheek. I grabbed the glucometer and readied it for a blood sugar check. I lanced Joe's finger. The blood wicked up the test strip. 5-4-3-2-1. A 97 graced the screen. Dexter was showing a smooth trend-line. I picked up the Dex 4 container. Shook it a bit. Nothing. No sound. It was empty.

Joe then chimed in, "Oh, I just took the last glucose tab right when I woke up Mom ... Dexter was 71 with a diagonal down."

Too tired to process the information, I said goodnight and headed back to sleep.

This morning I addressed it. Apparently, Joe has been taking glucose tabs when he feels low in the middle of the night. He is not waking us up when he feels low. He reads Dexter and "boosts" accordingly. While I am encouraged by his independence and his diligence in avoiding lows, I am a bit concerned that he has not been letting me know that he is feeling low. And. His pump settings may be off a bit due to the fact that I have not been aware of his "nocturnal boosting". Great. I am livin' the dream folks...livin' the dream.

A day-in-the-life of reigning in Joe's evolving independence.