Is It Good News, Really?

While it definitely doesn't feel like it's been a few months already, last Friday marked Dylan's latest quarterly endo appt. With mixed emotions, we headed into the clinic, me wondering whether today's meeting would bring news good enough to reassure my worried brain before Dylan heads off for a week in the Mexican Riviera with his dad and brother.

At our previous appt in early January, Dylan's A1c had been 8.8. Not good, but better than the 9.0 he had had two months prior, and his endo actually congratulated him for bringing it down 0.2 in two months, considering one quarter of that time was Christmas break. With puberty right around the corner, his A1c is expected to be a bit higher, but 8's are still out of my comfort zone. Something in the 6's would be ideal, but I'd be happy in the 7's.

This appointment was a quickie. No nurse or dietitian today, we were only meeting the endocrinologist. A quick evaluation of his pump data showed his testing is getting much more consistent, though he's STILL struggling to maintain the lunch time tests at school. There were more highs than I expected (though most are mid-afternoon reactions to his missed lunch tests), but overall it looked pretty good. We moved on to measurements (he had grown 0.5" and gained 2 lbs since Jan, bp was normal, as always), and then the dreaded A1c. After seeing the scattered highs in the pump data, I was starting to worry even more about the A1c. Yes, I know it's just a number, and one we shouldn't take personally, but damn it's hard not to. As independent as Dylan is for his diabetes care, at the end of day, I am responsible for his well being and when his A1c is high, I feel like I've failed to fulfill my responsibility to care for his and keep him safe. Dylan, on the other hand, wasn't worried at all. He was convinced it would be a much better number than last time.

So what was the outcome? Drumroll please..........8.1! Still a ways to go from where we'd like it to be, but down 0.7 in 2.5 months (and 0.9 in 5 months)? We are heading in the right direction, and quickly. I'll take it!!

Paleo Chicken Satay with Fiery "Noodle" Salad

I record cooking shows like they're going out of style. Individual shows, series', anything and everything that looks interesting. Some I watch right away, others may sit on the PVR for months, or even years. Such was the case with a show that inspired Friday night's dinner. Recorded in the summer of 2011, I watched Jamie's "Chicken Satay with Fiery Noodle Salad" episode of "30 Minute Meals" and with only a few minor adjustments, made it fully paleo, without losing any of the incredible flavour or adding to the cooking time. I omitted the dessert altogether and we had some cut up fresh fruit instead.

As Jamie points out in the episode, in order to keep the timing down, you really need to get everything organized first. Read through the recipe in its entirely, and get out all of the ingredients and equipment needed.

Ingredients

Satay

1/2 a small bunch of fresh cilantro

1 fresh red hot chili

1/2 clove of garlic

3 heaped tablespoons good-quality crunchy almond butter

dash gluten-free tahini

2cm piece of fresh ginger

2 limes

Chicken

4 180 gram skinless chicken breasts

Noodle Salad

2 cups cooked spaghetti squash (1/2 cup per person)

100 grams unsalted cashews

1/2 medium-sized red onion

1 fresh red chili

1 small bunch of fresh cilantro

1–2 tablespoons gluten-free tahini

1 lime

1 teaspoon sesame oil

1 teaspoon fish sauce

1 teaspoon honey

Garnish

2 little gem lettuces (I used a spring mix)

1/2 handful of fresh coriander

1 fresh red chili (optional)

dash gluten-free tahini

1 lime

Procedure
Start with the satay sauce. Add the coriander (stalks and all), chili (stalk removed), peeled garlic, 3 heaped tablespoons of almond butter and a lug of soy sauce, to a food processor. Peel and roughly chop the ginger and add. Finely grate in the zest of both limes, then squeeze in the juice from 1 of them. Add a couple of splashes of water and process to a sauce. Season to taste. Spoon half into a nice bowl and drizzle with extra virgin olive oil, put the rest aside.

On plastic cutting board, cut the chicken breast into 1"-1 1/2" cubes and thread onto wooden (or metal) skewers. Scoop the rest of the satay mix from the processor into a roasting tray, add the chicken skewers and toss with your hands to coat, rubbing the flavour into the meat. Remove cutting board and knife and wash hands. the chicken with olive oil and season with salt. Put on the top shelf of the oven, under the broiler, for about 8 to 10 minutes on each side, or until golden and cooked through.

Bake 1 medium spaghetti squash and scoop out the flesh with a fork to make "noodles." Put the squash in a medium sized bowl. Bash up the cashew nuts and add to the pan to toast. Peel the onion and place in a processor with the chili and cilantro. Pulse. Place in a large bowl with 1-2 tbsp tahini sauce and a little olive oil. Add the juice of 1 lemon, the sesame oil and fish sauce. Season and add to the cooked spaghetti squash. Toss the cashews in the pan with some sesame seeds and 1 tsp honey. Once golden, add to the bowl with some more cilantro leaves.

Serve with extra cilantro, fresh red chili, tahini and lime wedges.

Nutritional Information (per serving)

Calories 404.2, Fat 25.6g, Saturated Fat 4.1g, Cholesterol 44mg, Sodium 158mg, Potassium 482.1mg, Carbohydrates 22.0g, Fiber 5.4g, Protein 25.1g.

Skating Along

The ice surface has been so smooth and sheen, free of cracks or dents, that we didn't even notice the big open hole ahead. Blindly we skated forward, bearing down, picking up speed, hurtling towards the gaping pit of freezing cold water. Before we knew it, we were submerged; soaking wet, struggling to get out before falling below the surface forever.

No, we didn't really fall under the ice, but this metaphor seems perfect to describe our family life with diabetes lately. Diabetes here has been uneventful, routine, common even; each day predictable and manageable. No lows, no highs, just a whole lot of 6's and 7's.

We were enjoying the skate, getting comfortable, and even temporarily forgetting that ice couldn't be perfect forever. Inevitably D would rear it's ugly head and we would fall. And that we did last night when Dylan's pump ran out of insulin in the middle of the night.

My own fault really, I should have refilled the reservoir earlier. I should have understood that with the stomach bug Dyl's has had the past couple of days, his insulin needs would have been higher. I should have been on top of it. But I wasn't.

Around 3:30am his pump alarm went off, signifying the end of the insulin and in his half-asleep state he heard it, but ignored it. By the time he woke up this morning his bg was 22.4 mmol/l. A quick site change, refill, and bolus, and we waited for the new insulin to do its job. We waited, and waited, and waited some more. Half an hour later we tested to discover a bg of 24.1 mmol/l. Crap. Another bolus, another wait, another test, and finally it started to come down.

A sudden and effective reminder for us to never get too comfortable with D because it has always been, and always will be, anything BUT predictable.

Wordless Wednesday ~ Overcoming Obstacles

At times, living with type 1 diabetes may seem like an insurmountable mountain, but it IS manageable when taken one step at a time.

Sleeping Over with Diabetes

The dreaded sleepover; it can be a d-parent's biggest fear. Putting your trust in another parent, let alone one who doesn't know your child as well as you do, can be scary. Terrifying in fact. At the same time, Dylan having as normal a life as possible is critically important to me. I have always made it a rule to never let diabetes get in the way of his doing anything and this has forced me to relinquish a bit of control and trust him to take responsibility for his diabetes when I am not with him.

Sleepovers were one of the last things I allowed. For years, I would permit friends to sleep at our house, but the idea of Dylan staying somewhere else was simply not an option for me. Even his dad's house and grandparents' houses frightened me. Over time, however, as he has become more and more responsible with his own diabetes care, my trust in him has increased accordingly.

His first few sleepovers at friends' houses were with his best friend, who lives a block away from us, and whose parents are very familiar with diabetes and Dylan's care. They know to remind him to test frequently, they know how to treat his lows, and they recognize his low symptoms. And when they're not sure about something, they call or text me. In short, I am comfortable when Dylan is at their house.

Last Friday night, on the other hand, marked the first time I've allowed him to sleepover at the house of a friend whose parents (in this case a single mom) I don't know well. Dylan desperately wanted to stay there, and though every part of my being wanted to say no out of fear, I really had no rational reason for denying him this privilege, so we came up with a plan. Dyl was to text me every few hours with bg readings, especially before eating anything, and if anything was out of the ordinary, we would address it, and bring him home if necessary.

I dropped him off at 4:30pm, with a blood glucose level of 6.2 mmol/l. His pre-dinner text revealed that he was 5.1 mmol/l, and another text before bed showed he was 7.8 mmol/l/. At home, we would bolus for 7.8 mmol/l, if it was at any time other than before bed, as that's a tiny bit high for my liking. But we've always kept a marginally higher "acceptable" range for bg readings immediately before bed because Dylan has had nighttime hypoglycemic seizures in the past, though not in years. His nighttime bg levels have been very steady as of late, and he wakes up if his sugar nears 4.0 mmol/l, so I let him skip the middle of the night test for the sleepover. Yes, I really other parents would think I'm crazy for skipping a 2:00 am check, but with no variation in activity for the day, and bg readings steady for the previous few days, I felt confident that he would be fine. An early morning text showed a bg of 9.0 mmol/l, which he followed with a breakfast bolus for the french toast he was about to eat, and an insulin correction for the 9.0 mmol/l, all on his own. That's my guy; a true rock star when it comes to managing his diabetes.

So am I more comfy with sleepovers now? Not a chance. Yet baby steps are getting us there slowly but surely.

Paleo Mexican Beef Soup

I've been eating paleo for two months now, and while my kids will gobble up the occasional paleo meal, they're not ready to jump on board full-time, so I tend to nab whatever chance I get to cook paleo food that my kids will enjoy. This morning I lucked out when I was hit with a wave of creativity while cruising through old facebook posts. I saw pic of a beef stew/soup posted by a friend on mine and fellow blogger mom over at momontherun.ca and decided to use the pic as inspiration for lunch!!

A quick look in the fridge revealed we had lots of fresh veggies, as well the end of a roast beef from the the previous night's dinner. I literally started cutting things up and tossing them into a big pot. Once it was all in, I brought the pot to a boil, then simmered, covered, for 1/2 an hour. I ladled the soup into bowls and topped it with sliced avocado. and a dollop of organic greek yogurt (my one paleo exception). So delicious, and a great warmer on a cold rainy day. Makes 8 bowls.

Finished product before serving

Ingredients

28 ounce tin diced tomatoes

tin tomato paste

6 cups reduced sodium beef stock

2 cups water

3 cloves garlic, minced

1 medium yellow onion, diced

3 cups cubed cooked roast beef

1 tsp sea salt

1/2 tsp fresh ground pepper

2 tsp oregano

1 small green pepper, diced

2 carrots, peeled and sliced

1/2 cup celery, diced

3 cups fresh baby spinach leaves

1/2 cups cilantro, chopped

Topped with avocado and greek yogurt

Nutritional Information (per bowl, without toppings)

Calories 234, Fat 3.6 g, Saturated fat 1.1 g, Sodium 1220 mg, Potassium 717 mg, Carbohydrates 27.6 g, Fiber 4.6 g, Protein 23.8 g

Full Circle

What do 23 months, blood and urine tests, an echo-cardiogram, full allergy testing, a pediatric urologist, cardiologist, and 2 allergists give you? In our case...nothing. Since Spring 2011 we, with the help of Dylan's endo, have been trying to determine what is causing him edema in his face, hands, feet, and sometimes stomach and we are no closer to figuring it out now, than we were 23 months ago, except for knowing what it's NOT.

A round of blood and urine testing revealed it's not his thyroid, nor is it a simple hormonal or nutritional issue. The kidney ultrasound and additional urine testing told us that Dylan's kidneys are in perfect condition. Great news considering we're now 7+ years living with diabetes, but not getting us closer to an answer. The echo-cardiogram revealed Dyl's heart is functioning properly, so it's not a matter if poor circulation. And the 2 allergists agree that Dylan has NO allergies, even minor. He was tested for everything, including foods, and no reaction whatsoever. And it's not celiac or angioedema. For more details on the tests we've endured so far, click here.

His endocrinologist is now out of ideas; she's eliminated everything that can cause edema. Could it be hormones due to the possible onset of puberty? Dylan is almost 13 after all, but he's had this edema for almost 2 years...

The second allergist that we saw, just last week, said that some of us carry a higher than normal amount of protein in our blood and that it can cause edema in the extremities. It's not an indication of a kidney problem, it's just something unexplainable that some people have. She was not overly concerned about it, and gave us yet another lab requisition to have Dylan's protein levels measured at various times over the course of a day. So that's next, and hopefully it will give us some answers.