Are You High? (365:10)

Until recently, Dylan didn't experience distinguishable or telltale "signs" when his blood sugar was high. His low blood sugars have always been apparent to him and to me, but highs not so much. Even today, there is really only 1 symptom that accompanies every high.

Walking to the local library recently, we noticed something wasn't quite right with Dyl. He was a bit quieter than usual, and not his lighthearted, cheerful self.

He was focused and deep in concentration; so much so, that he didn't see this sign and proceeded to walk right into it, bonking his head on the bottom. Normally, he would laugh something like this off, and we would laugh along with him. Side-note: I realize it may seem mean to make fun of someone who has just potentially hurt themselves, but Dylan has a very particular sense of humor, plus I knew he wasn't hurt, just caught off guard because he literally didn't see the sign coming.

No, no joking around today. Today he got defensive and bitter, snapping at his sister and I for giggling, accusing us of making fun of him. Totally out of character for him.

I didn't think too much of it at the time. Maybe he was tired, or a little warm (we've had a hot summer and he reacts easily to the heat and humidity). But then on the way home, we crossed a street together, his sister and I turned left to continue down the next street and Dylan kept walking straight. He was headed in a direction that would have taken us further from our destination, and he normally would know this. 

After about 10 yards or so we realized he wasn't with us anymore and called out to him, again chuckling a little. This time he got really mad at us and then it dawned on me.

"Are you high?" I asked him - a legitimate question to a child with type 1, but also a bit of an inside joke between him and I because he's entering high school next week and is very anti teen drug use (again, his sense of humor...).

"I was 10.4 (mmol/l (187 mg/dl)) when we left the house." 

We had been walking for about 15 minutes. Ahhhh, that explains it.

Anyone else experience big mood swings with elevated blood glucose levels?

What is Type 1 Diabetes?

Day 2 Prompt: Introduce your condition(s) to other Health Activists. What are 5 things you want them to know about your condition/your activism? 

When people learn that my 12 year old son has type 1 diabetes, the usually make certain assumptions about that the disease is, or where he "got it" from. Sadly, misconceptions are rampant when it comes to type 1 and the volume of incorrect information floating around is abundant. Sometimes it seems easier to tell people what type diabetes IS NOT, rather than what it is. 

It is NOT:

• caused by eating too much sugar, either as a child or adult, or by sugar at all
• caused by any lack of care or neglect on the part of a parent or caregiver 
• a casual disease that comes and goes. It is 24/7/365.
• a result of being obese or overweight, nor does it have anything to do with weight at all
• contagious, meaning you can't "catch" it from someone else
• a disease with diet restrictions. My son can eat chocolate, sweets, starchy foods, and sugar, just like your child (though when eaten in excess it WILL cause cavities, and lead to obesity and other health issues, just like in your child). We just need to balance his carbohydrate intake with insulin.
• curable.

Type 1 Diabetes is an autoimmune disease in which the insulin-producing beta cells in the pancreas are destroyed, causing the body to stop producing insulin, and blood glucose levels to rise. Without insulin, the body cannot survive, so type 1 diabetes IS fatal if untreated. Fortunately, it is treatable with insulin, which can be delivered either via syringes or subcutaneously using an insulin pump. While insulin therapy is far from a cure for type 1 diabetes, it provides patients with a tool with which they can live a long and healthy life.

It is a disease that never sleeps. It IS manageable, but with vigilance and constant care. Blood glucose levels must be checked throughout the day and night, and insulin must be given multiple times per day to keep blood glucose levels within an ideal range. Variations in blood glucose levels throughout the day are to be expected, but readings outside of the target range (highs and lows) should be treated immediately. Food intake must be closely monitored (carbohydrate intake causes a rise in blood glucose), as do activities that burn carbohydrates, such as exercise. Other factors that can, and do, affect blood glucose, include temperature, stress, illness, and hormones.

There is no cure for type 1 diabetes, so utmost attention to diabetes management is critical and lifelong.

Ok, so that's a few more than 5 things. It is what it is.

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.

The First Time I... ~ HAWMC, Day 28

The First Time I... Write a post about the first time you did something. What is it? What was it like? What did you learn from it?

The first glucagon shot I ever administered to Dylan was one of the scariest moments of my life. Dylan was having his second hypoglycemic seizure (though his first with me; he was with his father the first time he had a seizure). I had been trained on administering glucagon way back when Dylan was first diagnosed with type 1 diabetes, but had never actually needed to use the shot.

The rest of this post is an excerpt from the previous post Dear Seizure. It has been adapted slightly.
"I rolled Dylan onto his side as best I could, while trying to console my daughter, who was 4 at the time, and sobbing, while my husband raced downstairs to the kitchen to get the glucagon shot (in hindsight, I now keep one in my bedside table). He couldn't find it. "What does it look like?" he called from the bottom of the stairs. "Hurry," I screamed, "It's in a long, thin white box."

OMG, in that brief time, I thought I was going to lose my son. I have never been so frightened. I sat there helplessly watching my baby seize, unable to do anything to help him. Suddenly my husband reappeared in the doorway and I felt the hugest sense of relief seeing him standing there with the diabetes supplies, while I thought, "We weren't too late." He had been unable to locate the shot itself, so he brought upstairs the entire rubbermaid container, in which we keep ALL of the diabetes supplies, and dumped it out on the carpet. I grabbed the glucagon and began to prep it, desperately trying to remember my diabetes training from almost 2 years prior, when the nurse had shown us how to prepare the shot.

My hands were shaking so badly and everything around me seemed to be spinning. I was crying. The only thing I could think of was "please don't die, Dylan, please don't die." I tried to stick the needle into the vial and hit the metal rim instead of the rubber dam. The needle bent to a ninety degree angle, but it didn't break off. I pulled it back straight and tried again. It went in. I shot all of the water in and shook the concoction, way too quickly, and it was all bubbly and foamy. I didn't care, I was desperate and my baby was still seizing. I drew at much as I could into the syringe and when I saw that the syringe was half full, I rammed the needle into Dylan's thigh so hard that if he could have screamed, he certainly would have. I injected what fluid I had in the syringe and then repeated the process, drawing up the last bit of glucagon in the vial and injecting it into his thigh again.

Finally, after what seemed like an eternity, the seizing slowed and then stopped. Dylan was still unresponsive, but after a few minutes his eyes started to focus and he looked at me. In that moment I knew the seizure was finally over. It would still be a long night ahead, as I monitored Dylan and checked his blood every 15 minutes for the remainder of the night, though within 30 minutes of the glucagon shot, he was up to 16.9 mmol/dl (304 mg/dl)."

Take that Diabetes!

The search for a cause of Dylan's headaches has now brought us full circle. We have gone from blaming diabetes, to questioning his eye sight, and back to diabetes as a cause again. When I first thought diabetes was the culprit, I assumed it was high blood sugars that were giving Dylan headaches, but when we tracked the headaches, there was absolutely no correlation with elevated blood sugar so we eliminated D as a cause.

Then this past Friday, Dylan had his quarterly checkup at the Diabetes Education Center of our local hospital. After speaking with his endocrinologist about the headaches, she thinks that they may, in fact, be a result of D. Her belief is that they are an after effect of low blood sugar. When I heard this, it sounded vaguely familiar. I remember reading some comments from type 1 adults that compared the feeling of over-treating a low to a hangover. Does treating, or perhaps over-treating, a low result in a headache? And if so, is there any way to avoid this?

On a separate note, Dylan did a victory dance for his endo at the appointment Friday. His last A1c was in early December of last year and we were both very upset to see a result of 8.7. It was the highest he had even been and I felt like a complete failure as a d-mom to let his A1c get that high. The 8.7 was the direct result of Dylan being very nonchalant about his testing. He was great testing at home, but was neglecting to test at school, resulting in too many highs. His endo wanted to see a reduction of a full point, bringing his A1c into the upper 7's by the next appointment. A tough task indeed. We both vowed then and there to be more vigilant about testing, determined to bring that 8.7 down to a healthier level.

So were we successful? Not only did Dyl get his A1c into the 7's, he got it down to 7.1!! Personally, I would still like to see it lower, but we are celebrating this victory nonetheless. Take that diabetes!

"See"king Answers

Headaches can be quite a nuisance, and trying to identify their cause can be equally annoying. As I posted yesterday in Blame Diabetes, Dylan has been getting frequent headaches for the past few months and we have been unable to figure out why.

Originally I assumed they were blood sugar related, but after some simple tracking I quickly ruled out diabetes as a source. My next thought was that they were an allergic reaction to something. We saw our family doctor and he gave us some suggestions on how to check for a food allergy, but so far we've come up empty-handed. Dylan is currently on a waiting list to see a pediatric allergist, but the wait is almost a year, so it will likely be autumn before we get in.

Then Dylan came home from school a few weeks ago complaining that he was having difficulty seeing the overhead projector screen from his desk, leading me to think he was straining his eyes and needed glasses. He was due for his annual eye exam anyway, so we went in yesterday to see the optometrist. Another strike-out. Dylan's eyes are close to perfect, and while he has a -.25 in each eye, it is not enough to warrant glasses or to cause headaches. The optometrist was not at all concerned, and informed us that vision can fluctuate a little bit during growth spurts, and with diabetes. He expects it will stay the same or return to normal by next year's appointment.

I'm happy for Dylan that he doesn't need glasses (he really didn't want them), but I'm frustrated that we still have no idea what is causing his headaches. He has his quarterly DEC appointment (A1c test and visit with the diabetes team) tomorrow morning, so maybe his endo will have some answers.

And for the record, the results of his pupil dilation test (to check to any signs of diabetic retinopathy) were perfect. His eyes show no signs of any problems whatsoever.

Blame Diabetes

Suffice it to say I do this far too often. Diabetes is on my mind for such a large proportion of each and every day that I tend to hold it accountable for any problem in Dylan's life. Sure, a lot of the time it's warranted because diabetes is the culprit, but from time to time there are other factors at play. After all, he is an 11 year old boy. He CAN and WILL get sick, scraped, scratched, bruised, banged up, and heartbroken as he grows up, and many of those times it will have nothing to do with diabetes.

On and off for the past few months, Dylan has been battling headaches. Some are minor, some more intense, and some even causing nausea they are so powerful. At first, I wrote them off as normal, stress related aches and pains, but their persistence has me concerned.

My immediate reaction was that they were blood sugar related; that he was getting headaches when his blood glucose level was high. In fact, I was positive this was the cause (always quick to blame diabetes). So we started tracking patterns. Every time he had a headache we'd test his blood sugar, but we quickly learned that there was absolutely no correlation between his sugar levels and headaches.

Back to the drawing board we went, unable to figure out the cause of his discomfort. Fast forward to a couple of weeks ago when Dylan came home from school and told me he had been having trouble seeing the overhead projector screen from his desk in his classroom. As the metaphorical lightbulb flashed in my brain, I wondered, "Could it be that simple? Does he need glasses?"

He is due for his annual eye exam (the one with the pupil dilation) anyway, so I called the optometrist and made an appointment for Dylan to have a full eye exam. We see the doctor this afternoon, so hopefully I'll have some answers soon.

Symptoms of Hyperglycemia

For those of us who have children with diabetes, we are all too familiar with the extreme symptoms of hyperglycemia, as they were the triggers that led our child to be diagnosed with type 1 diabetes. But hyperglycemia can occur daily, even with mild symptoms, so it is important to know the signs and treat it accordingly. Last week I posted about hypoglycemia symptoms and included a little picture that helps kids identify the signs. Here is its hyperglycemia equivalent:

Hyperglycemia can be defined as a level of sugar in the blood that exceeds the target range. Ideal blood sugar range can vary by individual, but as the level increases, symptoms of hyperglycemia appear.

The most common symptoms include:

• dry mouth
• extreme thirst
• frequent urge to urinate
• drowsiness
• frequent bed wetting (in children)
• blurry vision
• increased appetite

If untreated, hyperglycemia can lead to:

• rapid weight loss
• dizziness
• difficulty breathing
• unconsciousness or coma
• ketoacidosis

Over the long term, extended or frequent periods of hyperglycemia can lead to diabetes side effects such as blindness, kidney failure, foot or leg amputation., and even brain damage. 

So what causes hyperglycemia? A number of factors can be responsible, but the more common contributors include:

• too much carbohydrate
• less activity than normal
• emotional stress
• illness
• growth spurts
• forgetting insulin
• faulty insulin/old infusion sets/equipment failure, etc

Symptoms of Hypoglycemia

Dylan describes his lows as getting "weak knees," meaning that his legs feel like they're going to give out. He also gets shaky, and very pale, with pronounced dark circles under his eyes. Very different from how I feel. (See Exercise Induced Hypoglycemia from earlier this week) In fact, the symptoms of hypoglycemia can vary considerably from one person to the next, so it's critically important to be aware of all of the various possibilities.

When Dyl was first diagnosed, his endo gave us this awesome sheet with pictures of what hypoglycemia can look like, and a similar picture is on the wall in Dylan's classroom, so that his classmates are familiar with how he may appear with low blood sugar.

Any or all of these symptoms are possible, as are others not on this sheet. In fact, symptoms of hypoglycemia can be mild, moderate, or severe, and may include any or all of the following:

Mild Symptoms...

• sweating
• shaking
• hunger
• pallor
• dizziness
• headache
• mood changes

Moderate Symptoms...

• irritability
• blurred/double vision
• confusion
• poor coordination
• headache
• fatigue/sleepiness
• nightmares (if sleeping)

Severe Symptoms...

• unconsciousness
• convulsions/seizures
• coma
• (and if not treated quickly, death)

Know the signs.

Exercise Induced Hypoglycemia

One of my biggest fears is exercise induced low blood sugar. Dylan is so active, playing hockey 3-4 times per week, playing with friends, trampolining, walking, skiing, and wrestling with his stepdad, that I often worry about the effects on his blood sugar. Fortunately, he is on an insulin pump, so it's easy to program varying basal rates for different times of day and run temporary basal rates during exercise.

But what if we do all that and he still runs low? It's happened, that's for sure. Our first treatment is always fast acting sugar, either juice or dextrose tablets, and when in doubt we usually disconnect or suspend the pump to prevent any more insulin delivery while he's low. Then we retest every 10-15 minutes until his blood sugar is back in range.

This is perhaps the only aspect of Dylan's diabetes that I can truly relate to because I get exercise induced hypoglycemia myself. A LOT. In fact, it has become so common that I am now hesitant to venture far from home during exercise, unless I have a decent supply of fast acting sugar with me. The onset is sudden, and often unforeseen; literally one minute I'll feel fine, and the next I'll be struggling to stay upright. The feeling is odd, but very specific. And it's always the same, just to varying degrees of intensity, depending on how low I get. Shakiness comes first, followed by an acute awareness of my surroundings, but an inability to respond to them. Everything becomes more pronounced; sounds get louder, colors brighter, and I feel lighter, almost weightless. Yet every movement requires concentrated and deliberate effort. And the longer I go without sugar, the weaker I feel.

I don't have diabetes, so I don't usually carry a blood glucose tester on me during exercise (unless Dylan is with me, or I have my purse, which has an extra kit for him at all times). This means I don't usually know how low I am. If at home, I use Dyl's meter to check (and for the record the lowest I've even been is 1.8mmol/l, which is equivalent to 32mg/dl for my friends south of the border). I I usually start to feel anything under 4.0mmol/l, or 72mg/dl), but since I don't have to worry about over-treating the low, I usually just continue to treat until I feel better.

I know that if I eat slow-release complex carbs, combined with a little protein, about 20 minutes before exercise, that I'm much less likely to get low, but, as with diabetes, there are no guarantees. Some of the most effective pre-workout foods for me are a bowl of homemade oatmeal topped with flax seeds and fresh berries, or a whole grain bagel with peanut butter and banana, or a fruit smoothie with 1/4 cup of protein powder. I also know that if haven't slept well the night before, or have had ANY alcohol in the previous 24hrs, I am way more likely to get low half an hour into my workout.

Overall, it's not a huge deal, except that I started my half-marathon training this week, and as I was headed out the door for a run this morning, I suddenly became paralyzed with fear because I knew I hadn't had any protein with breakfast. I wasn't planning on running far enough to need a fuel or water belt, so I had 3 choices: chance it and see what happens (ah...no); stay close to home by literally just running around my neighborhood (too boring); or get on the mill. I chose the latter and spent 40 minutes running on the treadmill in my bedroom, while watching a bit of "Eat, Pray, Love." Good thing too, because about 10 minutes in I needed sugar. A big handful of Sharkies and a glass of juice later, and I was good to continue.

Live and learn, right?

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.

"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...

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

"Best of" Post: Dear Seizure

Grab a post from your archives and repost it! Add a few sentences at the beginning to frame it. Why you chose it. Why you liked it. And why it should be shared again.

"Dear Seizure" is a post I originally wrote last May, during Diabetes Blog Week. It was perhaps the most difficult post I have ever written because it forced me to remember and relive some of the scariest moments I have experienced since Dylan was diagnosed with diabetes in 2005. It's also one of my most popular posts, so in case you missed it in May, here it is again...

Dear Seizure,

To a Type 1 parent you are one of the most terrifying words, and experiences, imaginable. Luckily for most parents, you are something they will hear or read about but you will never visit them. I wish you had never been to my home, but you have, too many times. So let me tell you what I remember of your last visit, and tell you what I think of you.

You do not know me directly, but you know my son, Dylan. He is 10 and was diagnosed with Type 1 diabetes five and a half years ago, when he was 4. Sometimes, I think of diabetes as a roller coaster ride. Up and and down, up and down, it is our personal roller coaster, and while lately the ride seems to have slowed down and and stayed pretty level, there was a period of time when the lows seemed leave the coaster track, transcend logical space, and settle in a vortex somewhere beneath the earth's crust. That is when you would visit us.

It's been so long since we've seen each other, I had almost forgotten you, or had at least buried you in a part of my brain that I could access at my will. And then I stumbled upon a poignant and emotional blog post written by Hallie, author of The Princess and the Pump, and my memories of you came rushing back. I felt as if you had just visited.

It is your first visit I remember the most,  perhaps because first impressions are so very powerful. It was August 3rd, 2007. A quiet summer evening no different than any other. And our family had no idea that we were about to experience the most terrifying event of our lives to date. The details of that specific day are a bit fuzzy, up until your visit. We'd never had problems with major highs or lows since Dylan was diagnosed, and at this time, we were still using syringes, though it would be your first visit that led us to get Dylan an insulin pump. I remember that Dylan's sugar was a bit low a few times during the day, but nothing too worrisome. Then at bedtime we tested and he was 3.0 mg/dl (54 mmol/l), so we gave him an extra snack, retested, and everything seemed ok.

Dylan went to sleep, and my husband and I went to bed a few hours later. At 2:28am, I awoke, thinking I heard one of my 3 children calling me. It was my eldest, Josh, who was 10 at the time, and shared a bedroom with Dylan. They slept on bunk beds and Dylan was on the bottom bunk. "Mom," Josh called, "Dylan is having a..." and before he could even finish his sentence, we were out of bed, racing down the hall. I ran to the boys bedroom, and sure enough, you were there in full form. Dylan was at the beginning of a full tonic-clonic seizure. He was convulsing on his back, foaming at the mouth, and his eyes were partly rolled back and glossy. I called his name over and over, but no response. You were in complete control of his body.

I rolled Dylan onto his side as best I could, while trying to console my daughter, who was 4 at the time, and sobbing, while my husband raced downstairs to the kitchen to get the glucagon shot (in hindsight, I now keep one in my bedside table). He couldn't find it. "What does it look like?" he called from the bottom of the stairs. "Hurry," I screamed, "It's in a long, thin white box."

OMG, in that brief time, I thought you were going to take him. I have never been so frightened. I sat there helplessly watching my baby seize, unable to do anything to help him. Suddenly my husband reappeared in the doorway and I felt the hugest sense of relief seeing him standing there with the diabetes supplies, while I thought, "We weren't too late." He had been unable to locate the shot itself, so he brought the entire rubbermaid container, in which we keep ALL of the diabetes supplies, upstairs, and dumped it out on the carpet. I grabbed the glucagon and began to prep it, desperately trying to remember my diabetes training from almost 2 years prior, when the nurse had shown us how to prepare the shot.

My hands were shaking so badly and everything around me seemed to be spinning. I was crying. The only thing I could think of was "please don't die, Dylan, please don't die." I tried to stick the needle into the vial and hit the metal rim instead of the rubber dam. The needle bent to a ninety degree angle, but it didn't break off. I pulled it back straight and tired again. It went in. I shot all of the water in and shook the concoction, way too quickly, and it was all bubbly and foamy. I didn't care, I was desperate and my baby was still seizing. I drew at much as I could into the syringe and when I saw that the syringe was half full, I rammed the needle into Dylan's thigh so hard that if he could have screamed, he certainly would have. I injected what fluid I had in the syringe and then repeated the process, drawing up the last bit of glucagon in the vial and injecting it into his thigh again.

Finally, after what seemed like an eternity, the seizing slowed and then stopped. Dylan was still unresponsive, but after a few minutes his eyes started to focus and he looked at me. In that moment I knew it was finally over and you were gone. It would still be a long night ahead, as I monitored Dylan and checked his blood every 15 minutes for the remainder of the night, though within 30 minutes of the glucagon shot, he was up to 16.9 (304 in the US). Your visit left him exhausted and he vomited several times later that night.

My husband had tested Dylan while I administered the glucagon and his sugar was 3.7 (or 66 for those in the US), which is low, but not that low. He had been lower before without any problem. We later learned a number of things from your first visit. First, upon the beginning of a seizure the liver releases a shot of stored glucose into the bloodstream, so our reading of 3.7 told us what Dylan's sugar level was AFTER this liver glucose shot, not before. Second, always keep a glucagon shot within reach. Third, Dylan has, what his endo calls, a low seizure threshold while sleeping. This means that he is prone to nighttime seizures and that a low blood sugar that is easily treatable during the daytime, is much more dangerous for him at night.

You have visited us twice since that summer night in 2007, with your last visit being in the summer of 2009.As much as I dread the possibility of you ever visiting again, I am grateful to you for one reason. That you do visit. Some children do not receive your visits. Dylan is lucky, in a way, because your visits save his life. For some unknown reason, you are his body's last resort; it's way of alerting us that something is terribly wrong. Without you, his blood sugar would slip lower and lower and he would fall into a coma, or worse, and we would not know anything was wrong until it was too late.

I am a D-Mom. I am strong and determined, and unwavering. I will never give up fighting for my son, and you will never beat me. But I will also be eternally grateful for your help in saving my son's life not once, not twice, but three times.

Thank you,

Jen

Dear Seizure ~ Diabetes Blog Week, Day 2

Dear Seizure,

To a Type 1 parent you are one of the most terrifying words, and experiences, imaginable. Luckily for most parents, you are something they will hear or read about but you will never visit them. I wish you had never been to my home, but you have, too many times. So let me tell you what I remember of your last visit, and tell you what I think of you.

You do not know me directly, but you know my son, Dylan. He is 10 and was diagnosed with Type 1 diabetes five and a half years ago, when he was 4. Sometimes, I think of diabetes as a roller coaster ride. Up and and down, up and down, it is our personal roller coaster, and while lately the ride seems to have slowed down and and stayed pretty level, there was a period of time when the lows seemed leave the coaster track, transcend logical space, and settle in a vortex somewhere beneath the earth's crust. That is when you would visit us.

It's been so long since we've seen each other, I had almost forgotten you, or had at least buried you in a part of my brain that I could access at my will. And then I stumbled upon a poignant and emotional blog post written by Hallie, author of The Princess and the Pump, and my memories of you came rushing back. I felt as if you had just visited.

It is your first visit I remember the most,  perhaps because first impressions are so very powerful. It was August 3rd, 2007. A quiet summer evening no different than any other. And our family had no idea that we were about to experience the most terrifying event of our lives to date. The details of that specific day are a bit fuzzy, up until your visit. We'd never had problems with major highs or lows since Dylan was diagnosed, and at this time, we were still using syringes, though it would be your first visit that led us get Dylan an insulin pump. I remember that Dylan's sugar was a bit low a few times during the day, but nothing too worrisome. Then at bedtime we tested and he was 3.0 mg/dl (54 mmol/l), so we gave him an extra snack, retested, and everything seemed ok.

Dylan went to sleep, and my husband and I went to bed a few hours later. At 2:28am, I awoke, thinking I heard one of my 3 children calling me. It was my eldest, Josh, who was 10 at the time, and shared a bedroom with Dylan. They slept on bunk beds and Dylan was on the bottom bunk. "Mom," Josh called, "Dylan is having a..." and before he could even finish his sentence, we were out of bed, racing down the hall. I ran to the boys bedroom, and sure enough, you were there in full form. Dylan was at the beginning of a full tonic-clonic seizure. He was convulsing on his back, foaming at the mouth, and his eyes were partly rolled back and glossy. I called his name over and over, but no response. You were in complete control of his body.

I rolled Dylan onto his side as best I could, while trying to console my daughter, who was 4 at the time, and sobbing, while my husband raced downstairs to the kitchen to get the glucagon shot (in hindsight, I now keep one in my bedside table). He couldn't find it. "What does it look like?" he called from the bottom of the stairs. "Hurry," I screamed, "It's in a long, thin white box."

OMG, in that brief time, I thought you were going to take him. I have never been so frightened. I sat there helplessly watching my baby seize, unable to do anything to help him. Suddenly my husband reappeared in the doorway and I felt the hugest sense of relief seeing him standing there with the diabetes supplies, while I thought, "We weren't too late." He had been unable to locate the shot itself, so he brought the entire rubbermaid container, in which we keep ALL of the diabetes supplies, upstairs, and dumped it out on the carpet. I grabbed the glucagon and began to prep it, desperately trying to remember my diabetes training from almost 2 years prior, when the nurse had shown us how to prepare the shot.

My hands were shaking so badly and everything around me seemed to be spinning. I was crying. The only thing I could think of was "please don't die, Dylan, please don't die." I tried to stick the needle into the vial and hit the metal rim instead of the rubber dam. The needle bent to a ninety degree angle, but it didn't break off. I pulled it back straight and tired again. It went in. I shot all of the water in and shook the concoction, way too quickly, and it was all bubbly and foamy. I didn't care, I was desperate and my baby was still seizing. I drew at much as I could into the syringe and when I saw that the syringe was half full, I rammed the needle into Dylan's thigh so hard that if he could have screamed, he certainly would have. I injected what fluid I had in the syringe and then repeated the process, drawing up the last bit of glucagon in the vial and injecting it into his thigh again.

Finally, after what seemed like an eternity, the seizing slowed and then stopped. Dylan was still unresponsive, but after a few minutes his eyes started to focus and he looked at me. In that moment I knew it was finally over and you were gone. It would still be a long night ahead, as I monitored Dylan and checked his blood every 15 minutes for the remainder of the night, though within 30 minutes of the glucagon shot, he was up to 16.9 (304 in the US). Your visit left him exhausted and he vomited several times later that night.

My husband had tested Dylan while I administered the glucagon and his sugar was 3.7 (or 66 for those in the US), which is low, but not that low. He had been lower before without any problem. We later learned a number of things from your first visit. First, upon the beginning of a seizure the liver releases a shot of stored glucose into the bloodstream, so our reading of 3.7 told us what Dylan's sugar level was AFTER this liver glucose shot, not before. Second, always keep a glucagon shot within reach. Third, Dylan has, what his endo calls, a low seizure threshold while sleeping. This means that he is prone to nighttime seizures and that a low blood sugar that is easily treatable during the daytime, is much more dangerous for him at night.

You have visited us twice since that summer night in 2007, with your last visit being in the summer of 2009.As much as I dread the possibility of you ever visiting again, I am grateful to you for one reason. That you do visit. Some children do not receive your visits. Dylan is lucky, in a way, because your visits save his life. For some unknown reason, you are his body's last resort; it's way of alerting us that something is terribly wrong. Without you, his blood sugar would slip lower and lower and he would fall into a coma, or worse, and we would not know anything was wrong until the morning.

I am a D-Mom. I am strong and determined, and unwavering. I will never give up fighting for my son, and you will never beat me. But I will also be eternally grateful for your help in saving my son's life not once, not twice, but three times.

Thank you,

Jen

Dental Problems and Type-1 Diabetes; Is There a Link?

Monday afternoon I took my type 1 son to have 2 cavities fixed and we're back there again tomorrow to have another 2 cavities dealt with. 4 cavities at the last cleaning, and 2 at the cleaning before that. It seems that every time we go to the dentist, my 10 year old has new cavities, and yet his brother and sister do not. So it got me thinking, is there a connection between type-1 diabetes and increased dental problems?

We all know that type-1 diabetes can lead to a number of pretty scary side effects, especially if not controlled well, but in all my D reading over the years, I can't recall ever seeing a direct connection between type-1 diabetes and cavities. So I decided to do a bit of research on the web, and found that while there are countless articles on increased risk of gum disease in diabetics, there doesn't appear to be a definitive connection with diabetes and cavities. 

All 3 of my kids have basically the same dental care routine. None of them are perfect, but they're good enough for the most part, and yet only my type-1 child is prone to cavities. Perhaps he doesn't brush as thoroughly, or maybe he's simply just got "bad" teeth, if there is such a thing. But it's really got me thinking now, is there a direct connection between type-1 diabetes and increased cavities?