BSC Book Club ~ January 2012

I am an avid reader, time permitting. Lately my schedule has been so crazy that I've had very little time for reading, but I have set a goal to read 50 books in 2012.

1. Not Dead Yet; My Race Against Disease From Diagnosis to Dominance by Phil Southerland and John Hanc

This book was reviewed individually earlier this month. To read the review, click here

2. The Guernsey Literary and Potato Peel Pie Society by Mary Ann Shaffer and Annie Barrows

Synopsis: January 1946: writer Juliet Ashton receives a letter from a stranger, a founding member of the Guernsey Literary and Potato Peel Pie Society. And so begins a remarkable tale of the island of Guernsey during the German occupation, and of a society as extraordinary as its name.

When I first picked up this book from my local library, I was hesitant because of its letter format. I thought the idea of telling a story in the form of letters would cause the plot to be disjointed, but I was far from wrong. I quickly adapted to the style and found the main character, Juliet, an absolute delight. Her sense of humor is richly developed and her witty personality is immediately lovable.

Poised in the aftermath of World War I, the novel follows the lives of the inhabitants of the island of Guernsey after German occupation is over. And whilst they should be broken and bitter after years of horror under German forces, they manage to find beauty, simplicity, and hope through their bonds with each other.

I would highly recommend this book; it is a treasure.

January Report Card

At the beginning of this month, I outlined one major health goal that I have for this year: balance. My life is messy; it's crazy-busy; and at the end of 2011 I was wiped out. So I made myself a promise: to do whatever it takes to restore balance to my life. And I decided to essentially give myself a monthly "report card" assessing my progress. With one month gone, the question is: did I deliver on my promise?

Physical Health
This area was my strongest going into 2012, and still might be, though there is definitely still lots of room for improvement. My sleep patterns have improved a bit; I still stay up later than I'd like, making me tired during the day, or needing a nap mid-afternoon (which causes the cycle to repeat over and over). My diet is better; I've virtually eliminated take-out from my diet, with the exception of sushi, and am eating regular meals more often, but still battling too many low blood sugars. Again, there is ample room for improvement. Sadly, exercise was basically non-existent in January. I went for a few runs, snowshoed once, and snowboarded once. Pretty sad, considering I usually get in a good workout at least 5 days a week. However, I have set some nice big race goals this year, including a couple of half-marathons, a full marathon, at least 2 long distance bike races, a triathlon, and the Tough Mudder (stay tuned for a post this week about upcoming races/events). The events will motivate me to get moving, and fast. Assessment: C

Mental Health
As a teacher I get a bit of a mental workout every day, and I love to read. I set a goal to read 50 books in 2012, or just under 1 per week, but I only read 2 books this month. I'll have to step it up for February. January's BSC Book Club post will also appear this week. Assessment: C+

Emotional Health
Overall I did pretty good in this area. I was much less stressed this month than usual. I feel calm, grounded, and more connected with my family than I was in late 2011. Always room for improvement here, but increased exercise directly correlates to a decreased stress level for me, so even more reason to step up the cardio. Assessment: B

Spiritual Health
Whoa. No progress in this area this month. Assessment: D

"Sense" of Relief

Today we got some news we've been anxiously awaiting for the past few weeks. Private health insurance is going to cover the cost of sensors, so Dylan can go on a CGMs! They will not cover the actual cost of the transmitter itself, but will cover 80% of the ongoing sensor cost, with no annual limit.

In BC, Canada, the provincial government covers the cost of insulin pumps and supplies for most kids (less an annual deductible based on family income), but they do not cover any part of Continuous Glucose Monitoring Systems because they are considered "luxury," or non-mandatory equipment. Most private insurance companies also cover the pump cost and supplies, but very few cover CGMs, so we were thrilled to hear that ours will cover the sensors. The sensors for Dylan's Minimed VEO are approximately $50 each, and last for about a week, so we would be looking at about $2600 a year without insurance coverage. We'll only be paying about $500 of that cost. Not bad!

I am super excited to get Dylan wearing a CGM because he just got the new VEO in December (after 4 years with the Minimed 522) and it is the only pump in the world with the "Low Glucose Suspend" feature, meaning the pump will automatically shut off for 2 hours when Dylan's blood sugar goes below a preset range. For a child who is prone to hypoglycemic seizures at night, this is an incredibly helpful feature.

More news to come, once we get the CGM and start using it!

Full information on the Minimed VEO can be found here.

In the Blink of An Eye

And just like that, they're all grown up. It seems like only yesterday that my eldest was an infant and I was cherishing being a new mom. And yet my babies are babies no more. With a 15, 11, and 8 year old, now I race to slow down the clock and enjoy every single little moment.

This week has been tough on me. Dylan has been away at "Outdoor School" with his class for 4 days now. That's 4 full days and 3 nights of him monitoring his diabetes entirely on his own. He's testing, SWAG'ing, bolusing, carb counting, treating his own lows, and even setting up his own temp basals. My little guy is growing up, and is taking ownership of his disease in a way he has never done before. And he's doing it well!

Today I drove up to the site to change his infusion set. Technically, he can do it himself, and has before, but he really doesn't like inserting the new needle by himself. I can't say I blame him, those things are HUGE. I arrived at ten to 1:00pm, quickly found him in the auditorium, and we headed over to the first aid cabin where all of his D-supplies are being kept. The entire time we were in there (all of 6 minutes) he was looking at the clock, antsy to get it done so that he could get back to his buddies in time for the next field study at 1:00pm. That's my guy - never letting D get in the way.

So how he has done this week? Monday's numbers can be found here. As for Tuesday, Wednesday, and today, check these out...

Tuesday, Jan 24th
8:30 am: 7.1 mmol/l (127.8 mg/dl)
12:13 pm: 5.2 mmol/l (93.6 mg/dl)
3:10 pm: 7.4 mmol/l (133.2 mg/dl)
5:49 pm: 3.6 mmol/l (64.8 mg/dl
9:20 pm: 4.6 mmol/l (82.8 mg/dl)
9:58 pm: 4.7 mmol/l (84.6 mg/dl)

Wednesday, Jan 25th
8:29 am: 10.1 mmol/l (181.8 mg/dl)
12:09 pm: 5.3 mmol/ (95.4 mg/dl)
3:06 pm: 5.1 mmol/l (91.8 mg/dl)
5:51 pm: 6.2 mmol/l (111.6 mg/dl)
9:05 pm: 4.8 mmol/l (86.4 mg/dl)
9:55 pm: 4.1 mmol/l (73.8 mg/dl)

Thursday, Jan 26th
8:20 pm: 10.4 mmol/l (187.2 mg/dl)
12:09 pm: 9.2 mmol/l (165.6 mg/dl)
3:10 pm: he forgot to test and input to pump, but did have a snack
5:52 pm: 12.6 mmol/l (226.8 mg/dl, not surprising after no afternoon test)
9:02 pm: 5.1 mmol/l (91.8 mg/dl)
10:00 pm: unknown

Pretty darn good if you ask me. I am so proud of Dylan!

Wordless Wednesday - One Small Step

In keeping with this week's theme of Dylan's small steps towards independence...

Neil Armstrong leaves his mark on history

Independence - 24 hour update

Well, the first 24 hours of Dylan's trip to Outdoor School have been relatively uneventful. They arrived at the 200 acre site around 10:30am yesterday morning, and quickly met their counsellors and claimed their bunks, before jumping head first into a full afternoon of activities. As mentioned in yesterday's post, One Small Step for Dylan, One Giant Leap for Mom, Outdoor School is a high activity week involving a lot of exercise and outdoor learning. Exciting, but rough on the blood sugar.

A lunch time test indicated a 4.2 mmol/l (75.6mg/dl) blood glucose level. At afternoon snack he was 4.1 mmol/l (73.8 mg/dl) and at dinner he was down to 3.3 mmol/l (59.4 mg/dl). All 3 numbers are too low for my liking, so I was very worried when I spoke to Dylan at 7:15pm last night.

Dylan has had nighttime hypoglycemic seizures in the past. He hasn't had one in a few years now, but all of the ones in the past were after days in which his sugar levels ran low for at least a few hours of the day. I didn't want to risk him having a seizure (or worse, an undetected low) in a cabin with his friends, not to mention without me there to treat it, so together we decided we would err on the side of caution and program a temp basal overnight. 12 hours at 75% was the final decision, in part because that's what he did at diabetes camp the past 3 years. We also agreed that if his bedtime snack reading was under 5.0 mmol/l (90 mg/dl) he would call me again. As a final precaution, I told him to test one last time right before going to bed and if the reading was under 8.0 mmol/l (144mg/dl), he was to have a juice box.

Though my experience with diabetes was telling me these precautions should be enough, I was still frantic most of the night and barely slept. I finally dozen off around 1:30am, with both the house phone and my cell phone right beside me. I woke up frequently through the night, but never due to a ringing telephone. At 7:30am when my alarm went off, I was happy to discover that there had been no calls, and therefore no problems.

Only 3 more nights to go...

One Small Step for Dylan, One Giant Leap for Mom

This week marks perhaps the single biggest step towards independence that we have taken since Dylan was diagnosed with diabetes over 6 years ago. And while it's not a huge deal for him, it is a colossal step for me, as I am trusting him explicitly to monitor his own diabetes care for 5 full days!

We are very fortunate to live in and attend a school district that owns a 200 acre outdoor learning facility, known as "Outdoor School." All students in the district visit Outdoor School twice in their elementary years: for 3 days/2 nights in grade 3 and for 5 days/4 nights in grade 6. Classroom teachers accompany the students, and are assisted by high school students who volunteer as camp counsellors.

The experience itself is incredible. Students sleep in cabins and eat all meals in a common room, and then go out on "field studies" twice each day; once in the morning and once in the afternoon. Field study topics include a working farm, a pond study, salmon hatchery, and forest study, among others, and students also play cooperative games, sing campfire songs, and perform skits. It is an experience that stays with them for years, not only because it is such an amazing learning opportunity, but because of the bonds it strengthens between friends and the memories it creates.

For most parents it is an opportunity for children to grow and gain some independence. But for the parent of a child with type 1 diabetes, it is much more complicated than that. It means 5 days and 4 nights of Dylan being responsible for his own testing and bolusing. The first aid attendant will remind him to test at every meal and snack, and help him with carb counting, but otherwise he's pretty much on his own. Outdoor School involves a LOT of activity and excitement, so the pockets of his coat are loaded with a tester, a juice box, a 50 bottle of dex tabs, and a granola bar. He then has another 1/2 dozen juice boxes and granola bars in his suitcase to refill his pockets as needed, and treat nighttime lows and the first aid attendant had a big bag of extra supplies.

Dylan has been pumping for over 4 years now and is very confident and capable with bolusing. He's also become quite good at recognizing lows as they first start, and treating them accordingly. He has his 2 closest friends with him all the time for extra help, too, as they know what his low symptoms are and can tell the nearest adult if necessary. There is a first aid attendant there during the day and evening and another one on call at night. They are trained in administering glucagon and have my cell number handy should they need to speak with me. Finally, there is a clinic 10 minutes from the site and a hospital 20 minutes away.

Each night after his evening snack, Dylan will call me and read me all the day's data from his pump. Then depending on the numbers we will adjust basals for night time. If the day's blood sugar numbers are good, we will leave his overnight basals as usual; if he has been running low through the day, we will do a temp basal overnight. Then on Wednesday I will drive up to the site (about 90 minutes from my house) and change his infusion set.

All in all, this is a big step for us. Not only does it allow Dylan to demonstrate his maturity and independence, but it forces me to step back and let go of the reigns a little bit.

Whether I make it through the week without going crazy with worry is another story...

Apple Puffed Pancake

We made this today for brunch and it was delicious. With about 10 minutes of prep time and 20 minutes baking, you can't get any easier.

Ingredients

2 Cup peeled and thinly sliced Granny Smith apples

1 Tablespoon fresh lemon juice

6 Tablespoon granulated sugar

4 eggs

1 Cup all-purpose flour

1 Cup milk

Pinch salt

3 Tablespoon brown sugar

2 Teaspoons cinnamon

3 Tablespoon unsalted butter

Maple syrup, optional

Procedure

Preheat oven to 425ºF. In a bowl, combine apples with lemon and 3 tablespoons granulated sugar, set aside. In another bowl, combine eggs, flour, milk and salt; whisk until smooth. In a third bowl, combine remaining sugar with cinnamon, set aside. In an ovenproof dish (I used a 9" glass pie dish), add butter, then place into oven until butter begins to sizzle. Remove from oven and pour batter into dish. Arrange apple slices on top and sprinkle with cinnamon-sugar mixture. Bake 20 minutes or until golden and puffed. Serve with maple syrup. Serves 8.

Nutritional Information (per serving, without syrup)

Calories 216, Fat 8g, Protein 6g, Carbohydrates 30g, Fiber 1g.

Winter Sweatbetes

The DMSA discussion on Wednesday, January 11th included ideas on winter exercise, and various people shared their favorite cold weather workouts. I am passionate about exercise, so the topic got me thinking about all of the different things our family does in the winter to maintain fitness and enjoy the outdoors.

We try to get outside as much as possible, and our fortunate to live within 15 minutes of 3 ski resorts, so snow activities are a big part of our winter fun. Personally, I love to snowshoe, and try to get out at least once per week, and Dylan plays ice hockey from September to June, though as a family, our favorite activity is definitely skiing.

My oldest is a snowboarder, and Dylan his sister both ski. My husband is a skier and I can do both, though since learning to snowboard 4 years ago, I haven't skied once. 

This afternoon we went up to Grouse Mountain and enjoyed a terrific day on the slopes!

Skiing can be quite the workout, too, so it certainly affects blood sugar levels. Dylan's bg was 10.9 mmol/l (196.2 mg/dl) pre-ski and 3.6 mmol/l (64.8 mg/dl) after 3 hours of skiing. We did not change anything on his pump, so he was running at his regular basal rate. I know now, that a temp basal of around 80% is probably a good idea.

Extreme Wake-up Call

"Complacency": My new scariest word in the "diabetes dictionary". Worse than "low" or "ketone" or "A1c" or possibly even "hypoglycemia" or "complication." Complacency almost cost us last night. BIG TIME.

According to dictionary.com, complacency is a noun, meaning a feeling of quiet pleasure or security, often while unaware of some potential danger, defect, or the like; self-satisfaction or smug satisfaction with an existing situation, condition, etc.

I'm not suggesting that I suddenly became unaware of the dangers of diabetes after 6+ years of my son living with the disease. Rather, I think, for a little while, I stopped worrying so much about the possibility of danger to him specifically because his numbers have been so good for so long. I got so used to the good numbers that I temporarily forgot that diabetes is anything BUT predictable. 

I do nighttime checks almost every night, and for the past few weeks, Dylan's nighttime numbers have been pretty close to perfect. Usually 5.0-9.0 mmol/l, (90-162 mg/dl) with the odd 4.0 mmol/l (72 mg/dl) or 10.0 mmol/l (180 g/dl). Nothing too outside of ideal range. 

Last night I was going to bed just before 11:30pm and I knew I had a very long day coming up today, working 11 hours straight (I have since taken 1/2 the day off). Plus, I was sick earlier in the week and still wasn't feeling 100%. I was exhausted. And yet for some reason it suddenly occurred to me that I should test Dylan. Not at 2:00am, but right then, at 11:30pm. I grabbed his tester and went in to room, to discover him lying in bed, awake. He had thrown off his covers and was lying in his boxers only. An alarm went off in my head. Because Dylan has had nighttime hypoglycemic seizures in the past (see Dear Seizure), my first thought was that he had had a seizure and I had somehow missed it. After a brief check for evidence of seizure, and talking to Dylan, I realized that was not the case, he was just really warm. Another alarm went off in my head. A quick finger poke revealed a blood glucose reading of 1.6 mmol/l (28 mg/dl). I shook my head in disbelief, thinking I must be really tired and the meter is really reading 11.6 mmol/l. No, it was 1.6 mmol/l! A retest with a finger from the other hand came back with a 2.0 mmol/l (36 mg/dl). Holy crap! 1.6 mmol/l is the lowest Dylan has ever been in the 2251 days he has lived with type 1 diabetes.

7 minutes later, after 25 grams of fast acting carbs and a temp basal set at 75% for 4 hours, and he was up to 2.2 mmol/l (39 mg/dl). Another 8 minutes and he was 2.5 mmol/l (45 mg/dl). 30 minutes after the first test he was up to 4.3 mmol/l (77.4 mg/dl) and I finally exhaled. At 1:30am he was 5.1 mmol/l (92 mg/dl), but at 4:30am he was back down to 3.7 mmol/l (66.6 mg//dl). Another 25 grams of sugar and another temp basal of 75% for 4 hours. By 5:30am he was 7.4 mmol/l (133 mg/dl) and at 7:30am he was 10.4 mmol/l (187 mg/dl).

Fast forward to now, where we sit with blood glucose levels stable, but on the low side all morning. Dylan has a full blown cold, complete with sore throat, stuff nose, and low grade fever. The exact same cold my daughter had last weekend, and I had earlier this week (see Immunity Breakdown). I know the illness is responsible for the low readings, and his numbers are always wacky when he's sick, but when Dylan went to bed last night he felt fine. As so I was complacent. 

I honestly have no idea what caused me to test him at 11:30pm last night. Call it intuition, motherly instinct, gut feeling, whatever. All I know is that one test very well might have saved his life. And though I know it will drive my crazy, I keep asking myself, what if I hadn't checked?

Immunity Breakdown

One of my biggest day-to-day fears with Dylan is that he'll get sick. So much so that we take extra precautions to minimize his chances of his contracting any type of virus. We wash hands often, we use hand sanitizer, we shower regularly, I disinfect doorknobs and other commonly touched household surfaces probably more often than I need to, and we avoid close contact with anyone who is sick, even if it's just the tiniest of tiny colds.

Why do I do this? Because Dylan doesn't get sick often (less than his brother and sister actually), but when he does, he usually gets VERY sick. His last simple "stomach flu" resulted in lethargy, a fever than ranged from 102 degrees to 107.1 degrees, multiple days of vomiting in which he was unable to keep anything down, including even water, and dangerously low blood sugar for days on end (because of the lack of carbohydrate intake). He was admitted to hospital for intravenous fluids, where he remained for a few days, until they figured out that he had also developed a secondary infection that required antibiotics. This virus-gone-hospital-stay has happened more times than I care to recall.

So it frustrates me hugely when we have had virus after virus rampaging through our house lately and the majority of them have been brought in by me! I have had at least 4 colds since September and to say it's starting to bug me would be putting it mildly. Just last week I had a brutal sinus cold for about 3 days. By Thursday I started to feel better. Then Saturday my daughter complained of a sore throat and runny nose and was sick all day Sunday and part of Monday. Monday night around 2:30 am (well, technically Tuesday morning), I awoke to discover I had the same symptoms, and here I am nursing my second cold in just over a week.

Sadly at this time of year, I have to blame my job. I am a substitute teacher and specialize in primary education, so mostly Kindergarten to grade 3 (though I teach anything from K-7). While I adore young children and love my job, 5-8 year old are not exactly the most hygiene conscious group. They are sticky, runny, oozing messes in winter, and their classrooms are loaded with germs, not to mention that I'm usually called in to cover for a teacher who is at home sick, so the germs are recent. Part of the job I suppose, and I know my immune system will strengthen with time, but for now, it sucks.

Not Dead Yet ~ Phil Southerland Turns 30!

Synopsis: Part memoir, part sports adventure, Not Dead Yet tells the inspirational story of Phil Southerland’s battle with Type 1 diabetes and how from diagnosis to sheer determination, Phil Southerland beat all odds and turned his diagnosis and his passion for cycling into a platform.  From leading a Race Across America to now managing a world-class cycling program, his journey on and off the bike is changing the way the world views diabetes.


When Phil Southerland was seven-months-old, he lost ten pounds in a week, his body was limp and his breathing slowed to what his mother called a “death rattle.” Rushing him to the ER, she was informed that tiny Phil displayed the youngest case of diabetes on record in the world at that time.


Blindness, kidney failure and death were all predicted for him by age twenty-five. Twenty-nine years later, not only is Phil alive and well but as the founder of Team Type 1, he and his team of championship cyclists — many of them diabetics—have become health and fitness role models for people the world over.

Together, they have taken on some of the most challenging endurance events in the world, including winning the Race Across America—a grueling 3,000-mile endurance competition—twice. Today, Phil continues to lead Team Type 1 as its professional cycling team, among one of the top 30 teams in the world, races toward an invite to the world’s top cycling event, the Tour de France in 2012.  Leading the pack is a serious challenge for any athlete, but for Phil and his teammates, it presents two daily battles: one to stay in razor-sharp race-fit condition, the other, to stay alive. 

Not Dead Yet is Phil’s powerful story: his account of his relationship with his mother, and how she struggled to keep him alive; growing up quickly in the New-Old South of the 1990s, learning at the tender age of 6 years old how to check his glucose and give himself injections; of how he fulfilled his dream of becoming a professional athlete using his team and the bike as a platform, inspiring thousands of individuals and families around the world who are battling diabetes to not just chase, but catch, their dreams.


As an avid road cyclist and the mom of a type 1 child, I absolutely adored reading this book. I found that once I started reading, I had a hard time putting it down. It was fascinating to learn about Phil's rise to professional road racing, and to discover how he has owned his diabetes care since the age of 6 years old. Diagnosed with type 1 diabetes at only 7 months old, Phil's mother Joanna was told that Phil would not likely survive past the age of 25, and that if did somehow survive, it would with complications, such as blindness or kidney failure. This past Sunday, January 15th, Phil turned 30 years old.

Phil's insights into living with diabetes are remarkable. His discipline and determination to maintain control of his disease, and be the "CEO" of his body, as he puts it, are outstanding. From the tender age of 6, Phil has been giving himself insulin shots multiple times per day. He has learned how to maintain the delicate balance between insulin, carbohydrate intake, and exercise, in order to maximize his health and athletic success.

As a cyclist, Phil started where many start: at the bottom. As a teenager he hung out in bike shops, tagging along for mountain bike group rides whenever possible. As his strength and endurance improved, so did his success. He switched from mountain biking to road racing and slowly climbed up the categories, winning many races, until finally reaching the professional level.

Team Type 1 is Phil Southerland's baby. He not only created it, but races as part of the team, while also being the CEO and handling much of the management duties. Team Type 1 has grown exponentially and is made up of both men's and women's teams, as well a running team and a triathlon team! Their current goal is to get the men's elite team into the Tour de France for 2012! I certainly hope they are successful!

Similar to Lance Armstrong's "It's Not About the Bike," "Not Dead Yet" documents Phil's life from childhood to adulthood, and from amateur to professional cyclist, through all of which he has type 1 diabetes. An inspiring and admirable story, I would highly recommend "Not Dead Yet"to cyclists, to anyone who is affected by type 1 diabetes, and to those who simply love a good hero story.

Happy birthday Phil. And thanks for teaching me that when I put my mind to something, truly anything is possible.

Beef Noodle Soup

I haven't posted a recipe in a few weeks, and this one is too good to skip. I made this soup last weekend, with some leftover roast beef from dinner the night before. It was absolutely delicious. The asian-inspired ingredients provide a unique flavor, while the veggies and rice noodles add important nutrients. Relatively low carb, this soup makes a great meal. It's also low fat, gluten free, and contains over 20% of daily iron and folate needs!

Ingredients

8 oz beef top sirloin grilling steaks, thinly sliced across the grain (I used leftover sirloin tip roast)

2 tbsp cornstarch

2 tbsp sodium-reduced soy sauce

2 tbsp sherry (optional)

1 tsp sesame oil

3/4 tsp five-spice powder

3/4 tsp granulated sugar

6 oz wide (1/2 inch/1 cm) rice noodles

2 carrots

4 heads baby bok choy

4 cups sodium-reduced beef stock

1 egg, beaten

2 green onions, thinly sliced

Procedure

In bowl, combine steak, half each of the cornstarch, soy sauce, and sherry (if using), the oil, five-spice powder and sugar. Let marinate for 15 minutes.

Meanwhile, cook noodles according to package directions; drain and divide among 4 bowls. Peel carrots; cut into thin 2-inch long strips. Separate bok choy into leaves. Set aside.

In large Dutch oven, bring stock, remaining soy sauce and sherry and 2 cups (500 mL) water to boil. Stir in steak mixture, separating with spoon; reduce heat and simmer
for 3 minutes. Add carrots and bok choy; cook until wilted, about 2 minutes.

In small bowl, whisk remaining cornstarch with 1 tbsp water; stir into soup and simmer until glossy and slightly thickened, about 2 minutes. Return soup to boil. With fork, stir in egg in slow thin stream, pulling into strands. Pour over noodles; sprinkle with green onions. Makes 4 servings.

Nutritional Information (per serving) Cal 315, Protein 20g, Total Fat 5g, Carbohydrates 47g, Fiber 4g, Cholesterol 76mg, Sodium 67mg, 

Source Canadian Living Magazine, March 2007

Unsolicited Advice

I cannot even begin to count how many times I have been given unsolicited advice about diabetes. "Eat this," "drink that," "take this," "do that." There are so many supposed quick fixes and "cures" for diabetes, ranging from dietary choices, to supplements, to activities, etc. and yet none of them actually work. 

As a parent of a child with type 1 diabetes, I wish and hope for the day there IS a cure, but until then, it both frustrates and saddens me to receive unsolicited advice about a cure.

Today I stumbled upon this cartoon about a cure for the common cold (which I am suffering from myself at the moment) and was immediately struck by how easily it could also be applied to diabetes...

The Revolving Door

Some days life with diabetes seems so busy. And I'm not just talking regular busy, I'm talking insanely, over the edge, almost too much too handle busy. This has been the case for us lately.

Years ago I worked in the marketing industry. I was in my mid-twenties, with a communications degree and some very ambitious career goals. My oldest was 4 and Dylan was born 3 months into what I thought at the time was my dream job. I worked 70 hour weeks and traveled 1 week out of every 6. It was a crazy job; so much so that one of my coworkers at the time said that working for that company made him feel like "he was standing in a revolving door during a hurricane." At the time I thought it was quite a clever simile, but then again, I thought my life was busy then. I had no idea how prolific his words truly were.

I had no idea what busy was.

Last night I watched "I Don't Know How She Does It" with Sarah Jessica Parker. A semi-entertaining movie about how a working mom with 2 small kids balances everything in her life. And yet all I kept thinking while watching it was, seriously? She thinks that's busy?

She has no idea what busy is.

Busy is being a parent of a child with diabetes. Between the day to day care, the worry, the nighttime sugar checks, the highs, the lows, the carb counting, and the juggling of basal rates and exercise, it can be pretty onerous at times, but it's manageable. Then throw in a teenager who seems to have given up on school altogether and is at risk of failing the year, and a d-mama who has been completely blindsided and slapped across the face with the wicked head cold, and what do you get? Busy like it's never been before. And as if that's not enough, the child with diabetes is sent home from school mid-morning with what appears to be a fever and a sore throat; possibly the beginnings of a flu.

It's gone from simply busy to diabolically bananas.

All in a typical week of a d-mama.

Dreaming of Diabetes; Sibling Prevalence

As if thoughts about diabetes do not occupy enough of my waking time, last night I dreamt about diabetes. In my dream, one of my biggest fears materialized: my daughter was diagnosed with type 1 diabetes. The level of detail in my dream, right down to her blood sugar number at diagnosis, was so vivid that when I awoke there was a brief moment in which I was so confused by the dream that I couldn't figure out if it was a dream or reality. As sleep faded away and I became more alert, I knew I had been dreaming, but the fear in my heart is pertinacious.

According to the Joslin Diabetes Center, the prevalence of diabetes amongst siblings in significantly higher than that of the general population. I fact, it is 10 times higher, meaning that, "If one child in a family has type 1 diabetes, their siblings have about a 1 in 10 risk of developing it by age 50" (Joslin). Now, in addition to the previous statistic, there are a number of different factors that COULD affect my daughter's actual likelihood of diagnosis. First, her and Dylan are half siblings (different fathers) and I honestly have no idea if that makes a difference or not. Did Dylan inherit some kind of "diabetes gene" that led him to develop type 1? And if so, did he get it from his father or from me, or both? Second, my daughter has a slightly different racial background than Dylan. While I am caucasian, my husband is Hispanic, so our daughter is a combination of both. Climate clusters are prevalent is type 1 diabetes diagnoses, and "caucasians (whites) have a higher risk of type 1 diabetes than any other race. Whether this is due to differences in environment or genes is unclear" (Joslin).

Based on all of the above, is my 15 year old son more likely to develop type 1 because he and Dylan share genes from both parents? Who knows. I try not to think about it, in order to prevent myself from going completely crazy, but clearly it has permeated my dreams...

Just Keep Swimming

Yesterday afternoon Dylan and his younger sister were invited to go swimming with our next door neighbors, who have children of similar ages. The 4 kids spend a lot of time together, and they all get along really well. The majority of their play time, however, is usually spent in one of the two backyards, so diabetes has never really been an issue. Sure there has been the odd time here and there that they all go to a movie, or go bowling (they went two days ago), but because Dylan has been pretty on-the-ball with his diabetes care lately, I try not to worry too much, and I force myself to give him some independence. Plus, now that he has a cell phone, he simply texts me if he has a question or concern.

The neighbors know he has diabetes, and I know they know some basic info about it, but I've never sat down with them and had "the talk" (you know the one I mean, about what diabetes is, how to recognize highs and lows, counting carbs, bg testing, all that fun stuff we load onto the parents of our kid's friends before leaving our child in their care...). I know Dylan has talked to them a bit about it, and his sister would certainly notice right away if he was showing signs of low blood sugar, so I decided to let him go to the pool.

But swimming and diabetes don't always mix well. We use the new Minimed VEO pump, which is NOT waterproof, and unless I'm at the pool with Dyl to hold on to the pump, I'm not comfortable with him leaving a $7000 unit in the changing room. So right before leaving, he did a quick test and was 4.8 mmol/l (86.4 mg/dl). He felt great and took off his pump. As an added bonus, yesterday was infusion set change day, so he also took off his 3-day old infusion set, and headed out the door completely pump free. It's not too often that he gets to go commando, but when he does, he loves it.

In the past, we've found that swimming is intense enough exercise for Dylan that he is okay to go pump-free. His blood glucose level holds pretty steady while he's in the pool and we rarely have to bolus post-swim. But he usually only swims for an hour or so. Yesterday they were in the pool for over an hour and a half, so by the time he got changed and arrived back home his pump has been suspended for just over 2 hours. Another blood test revealed he was 13.0 mmol/l (234 mg/dl), which is high, but not as high as I was expecting considering he had gone over 2 hours without basal insulin. A quick bolus and he was back within range by dinner time.

Did it go exactly as I expected? No.

Does it ever with diabetes? No.

Would I do anything differently next time? Probably not.

It's so rare that Dylan gets to go pump-free and just be a regular kid for an hour that I don't want to deny him this simple pleasure. I spend so much of my days worrying and fretting about diabetes that every so often I need to force myself to step back, let Dylan be a kid, and say, "just keep swimming."

"Low" Awareness

Hypoglycemia is every diabetes parent's worst nightmare, so when a child with diabetes starts to recognize his or her personal symptoms of low blood sugar (no, not everyone experiences hypoglycemia the same), it is a big deal. And while every low is not the same, and some may have no symptoms at all, recognizing common symptoms can be lifesaving.

It wasn't too long ago that Dylan had very little awareness of lows, and he still has a limited awareness of highs, but over the past year or so he has become acutely aware of when his blood sugar is low, even when it is barely low. This awareness has been extremely helpful in treating his frequent hypoglycemic episodes, but it has also left him a little bit cocky, hence this conversation after school this past Friday.

We came in the house and Dylan immediately grabbed the bg tester that was on the kitchen counter.

Me: You ok?

Dylan: Yeah, just feeling a bit low. Proceeding to insert strip, prick finger, etc.

Me: You look a bit low. Dylan has very distinctive signs of low blood sugar. His face gets quite pale and the area under his eyes goes a deep purple color.

Dylan: That's what I thought. I'm getting too good for this.

Me: Sorry? Too good for what?

Dylan: Diabetes. I used to get false lows, but not anymore.

Me: What do you mean "false lows"?

Dylan: When I would feel low, but then test and I would be fine. It usually happened when I was tired. But now I know when I'm low because of the weak knees. Dylan's strongest personal symptom of low blood sugar is what he has nicknamed "weak knees". He says his knees feel like they can't support his legs, so they want to bend. This is his first indication of low blood sugar and it appears early.

Me: Hmmm.

Dylan: reaching for a juice box in the fridge...

Me: So, what are you?

Dylan: 3.6 That's in mmol/l, and is equivalent to 64.8 mg/dl.

Me: Good catch honey.

If only they could all be this easy...

Late Night Strip Party

Dylan has this habit with his strips that after he tests his blood, he tucks the strip into the little pocket behind the lancet pocket in the meter pouch. I guess after my constant nagging about finding strips all over the house, he figured this is easier. And it is. I simply dump the pocket of its used strips whenever I notice they are accumulating, usually every few days.

Last night he was 4.8 mmol/l (86.4 mg/dl) at bedtime, which is a little low for my liking, so he ate a quick mandarin orange and went to bed. I tested him at midnight and he was 4.9 mmol/l (88.2 mg/dl). Not much of an improvement, but I was hesitant to give him any sugar at this point because he's been waking up slightly high for the past few weeks. So I asked my husband, who was going to be awake for a while yet, to retest him before coming to bed, and let me know the result. If there was no change, I would treat the near-low, but if it had come up a bit, I'd leave it. A test two hours later revealed a blood sugar of 5.7 mmol/l (102.9 mg/dl), perfect for my comfort zone. But I guess my hubby forgot about Dylan's used strip collection in the back of the pouch, because we awoke to this on the floor beside Dyl's bed...

That's actually not bad! I've accidentally dumped the used strips when there are significantly more than that...

Oh, and it looks like it's time to shampoo the carpets...lol.

What Happens in Vegas...A Diabetes Tale

December 31st, 2011, marked the 9th anniversary of the day my husband and I started dating. It's not our wedding anniversary (which will be 5 years this coming April), but we celebrate both dates each year. Strangely enough my husband always remembers the New Year's Eve date before I do, yet I always remember the wedding anniversary. Or maybe that isn't so strange? A girl and her wedding share a pretty big memory after all.

Over the course of New Year's Eve last weekend I started thinking about the wedding day itself and as I thought about the events of the day, I suddenly remembered a diabetes story I had completely forgotten about.

My hubby and I got married in Vegas (an hour north of Vegas to be exact), at what used to be an old horse ranch, but is now strictly used for weddings. It was not a spur of the moment, typical Vegas wedding like you see in the movies. We planned it well in advance and chose Vegas for a number of reasons: we wanted a destination wedding, we wanted to keep the guest list small (had we gotten married at home our guest list would have had about 250 people on it because we both come from HUGE families), we could count on the weather, and I loved that Vegas offered these incredible wedding packages that take care of ALL of the planning. All we had to do was show up, dressed, with guests, rings, and a marriage license, and they took care of the rest - flowers (including bouquets and boutonnieres) video, photos, minister, location, decorations, limo, a private bus for guests, even champagne.

Dylan had been diagnosed with diabetes almost a year and a half before the wedding and was still on MDIs (multiple daily injections). It was the first time we had ever traveled more than a couple of hours from home, not to mention internationally, since his diagnosis. I thought I was prepared. I had all of the necessary paperwork to get his supplies through customs, and I had snacks and dex to treat low blood sugars on the plane, if needed. I also left extra fast-acting sugar with my mother and with my maid of honor, to ensure that no matter who he was with, we would be covered. And my immediate family had all been trained on how to test his blood, give him injections if needed, and recognize signs of low blood sugar. After all, he was only 6 at this point and wasn't nearly as independent with his d-care as he is now. Plus, he wouldn't be with me every minute of the trip. 

All three of my children were involved in the wedding itself. They got ready with me, rode in the limo to the site with me, and stood with me during the vows. The wedding itself was beautiful, but for the purposes of this post, it was what happened after the wedding that I remembered a few days ago. Once the on-site photos were done, my hubby and I, along with his best man (and his spouse), and my maid of honor (and her spouse), rode in the limo back to Vegas to take more pictures at the Bellagio. The remaining 40 guests, including my kids, rode together in the tour bus for the hour or so trip back into the city. About halfway back, Dylan got very pale and started to sweat (his typical signs of a low). My mom, who was sitting with him, reached for his tester, only to realize that it was in the limo with me, as was the dex. She could tell from lookig at him that he was low, and he said he felt low, but he thought he'd ok for a bit longer. Did I mention it was about 4:30pm on a Friday afternoon at this point. Traffic crawled along the highway, slowly inching towards the city, as Dylan's low became more and more apparent. My mom asked around the bus - did anyone have any candies in their purse, or anything that might have a few carbs? No one did. It was 99 degrees outside and everyone had brought the absolute minimum to the outdoor ceremony. 

My uncle, who was also to be the wedding MC at the reception later that evening, asked the bus driver to get off the highway at the next exit. But because it was a prearranged pick up and drop off, the driver refused, saying he was on a strict schedule. My uncle Earl, bless his heart, refused to take no for an answer. And luckily for Dylan, Earl has a special way with people. He has a big powerful voice, and is scared of nothing or no one, and as a former professional football player, he's not exactly a small man. So he explained that Dylan had diabetes and needed fast-acting sugar immediately, that Dylan's life, in fact, depended on it, and asked the driver again, to please pull of the highway and stop at the nearest convenience store. Again the driver refused. At this point, Earl stood up, towering over the driver, and told him that either he pull of the highway immediately, or Earl would "make him pull over." Thankfully, for everyone involved, the driver complied, they found a 7-11 at the next exit and Dylan quickly downed a bottle of orange juice. Within minutes, he felt fine and by the time I saw them an hour later at the restaurant downtown, Dylan was laughing about the event. Can't say I was, but we learned a number of valuable lessons that day, one of which being that diabetes never sleeps. And it never takes a vacation. Even when mommy gets married.

My 3 children, then aged 10, 3 and 6. Dylan is on the right

My hubby and I, with the stunning Vegas desert scenery behind

10 Diabetes Goals for 2012

Yesterday I posted about some personal goals I have for 2012, and today I want to highlight some of our d-goals for this year. After all, this a diabetes blog.10 goals in a nutshell...

1. Test more often.

2. Get Dylan's A1c to below 7.5, or at least closer to it.

3. Start using a continuous glucose monitoring system (CGMS).

4. Become more knowledgeable about the glycemic index and post-prandial blood sugar.

5. Connect with more d-moms and d-dads, and hopefully meet up with some!

6. Continue to spread awareness by participating in the Cyclebetes National Relay, this time going coast to coast!

7. Test more often.

8. Know that while diabetes is a part of our life, it does not define us.

9. Do my best and know that is enough. Dwelling on the bad numbers will only drive me crazy.

10. Test more often...did I mention that one already? 

Finding Balance in 2012

The 4 quadrants of health (clockwise from top left): physical, mental, emotional, spiritual

Life is messy. There is no doubt about that. But in the midst of the craziness we all need to find at least some semblance of balance in order to keep from feeling completely disconnected and lost. In 2011, I let that balance elude me, and by the end of the year I was feeling utterly and totally drained, overwhelmed, and exhausted. So my goal for 2012 is to bring balance back to my life by examining each aspect of my health (physical, mental, emotional, and spiritual), and making any changes or adjustments necessary to restore equilibrium.

Is it a "New Year's Resolution?" Call it what you will: a goal, a resolution, a plan, whatever, the term is irrelevant. I need to make some changes in my life, period, and I think the beginning of a new year is just as good a time as any to do that. Besides, there is something therapeutic about a new year and the sense of a fresh start that comes with it.

Over the year, I'll be blogging periodically about my progress, both overall and in each of the 4 specific areas, but for now, these are the basic goals:

Physical

Overall, my physical health is pretty good, but there are a few inconsistencies that I'd like to address. Sleep: I usually get enough sleep, but it rarely follows any predictable pattern. Working on call makes it difficult to get into a routine, but I am hoping to at least start going to bed and getting up at the same times every day, especially on weekends. Night time blood checks will continue as always. Diet: Towards the end of last year my diet got really bad. Too much take-out and fast food, skipping meals, and late night snacking left me feeling tired and my blood sugar going low way too often. I need to eat 3 meals a day at somewhat similar times every day, have regular snacks, and make sure I get protein at every meal to help stabilize my blood sugar. Exercise: My exercise routine almost exactly mirrors my my sleep and diet patterns, so when 1 suffers, all 3 suffer. This year I have some pretty lofty exercise goals (including running my first full marathon), to help keep me on track.

Mental

Last year I rediscovered my love for reading, and I want to build on that in 2012. Once per month I'll be posting about the "Blood, Sweat and Carbs Book Club" and discussing any books I've read that month. This will include diabetes related books and fiction. I am aiming to read 50 books in 2012, or about 1 per week.

Emotional

Stress is my biggest culprit, slowly invading every other aspect of my life. I can learn how to deal with my stress better, let things go, and relinquish some of my need for control. I can be a better wife and better mother. The overlap between this area and the other 3 is huge.

Spiritual

In terms of spiritual heath, I am not entirely sure yet what my exact goals are, but I do know this: I need to be more present and more aware. My life is busy and I tend to get caught up in the day to day details and lose track of what matters most. I would like to find a little bit of time every day just for me, to meditate and clear my head. I am also thinking of returning to church. I haven't been in far too long and I feel like I'm in a good place right now to return.

So those are the basics for now. More specific details and progress reports will appear throughout the year.

Happy New Year!