Tuesday 3 September 2013

Rookie Mistake (365:11)

So this past weekend we went up to Nicola Lake to camp for a few days. As we're packing up extra infusion sets, reservoirs, dex, and a couple of glucagon shots, Dylan says to me, as a joke, "Don't forget the insulin, Mom."

"No way," I reply, chuckling. After all, I had just picked up a fresh vial from the pharmacy the night before so that we'd have more than enough for the trip, and for the site change we'd need to do while away.

Two hours later, we're in the car, entering Chilliwack (about an hour from home), when Dyl's pump beeps low reservoir. And then it dawns on me. I packed all the d-supplies from the cupboard but left the fresh and the old vials of insulin in the butter compartment of the fridge. Holy crap!!

Option 1? We could go back, but it's at least an hour home, and we're smack in the middle of rush hour traffic. Then the four hour drive to the lake. That would mean we'd arrive at the campground around 10:00pm to assemble tents and make dinner in the dark. Not fun.

Option 2? Stop at the nearest pharmacy and beg them to give me a vial of insulin. There are two immediate problems with this option. First, I have no prescription on me, and while my local pharmacy (who knows me, and is very familiar with Dylan's prescriptions) would do it no questions asked, other pharmacies may not. Second, all drugs in BC, including insulin, are monitored and patients are only permitted to draw them at a pre-set frequency, depending on established use. Meaning that the government computer system knows Dylan's regular insulin use, so if we suddenly try to get twice as much as normal, red flags go up. I picked up a vial the night before, plus another vial a few weeks ago, plus whatever Dylan's father might have recently ordered for his place. Would we be at our cap? There was only one way to find out.

I dragged Dylan in with me so he could show them his pump if there were any problems with the lack of prescription. Luckily the pharmacist was super understanding and immediately gave us a new vial. Yes, we were over the insurance company's drug limit, so we had to pay for the vial, but within 15 minutes we had insulin in hand and were back on our way to the campground.

A rookie mistake that I'll definitely never be making again.

Monday 26 August 2013

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?

Friday 23 August 2013

Week in Review, Diabetes Day Camp (365:9)

What a week Dylan had at diabetes day camp at West Van Community Centre. He attended Monday-Thursday and experienced four days loaded with fun activities, great friends, and lots of diabetes education.

Day 1, Dylan arrived, thrilled to discover that he knew a bunch of the kids already from Camp Kakhamela! The group headed to Lighthouse Park for a hike and geocaching lesson, then back to the rec centre for lunch, board games and some diabetes ed.

Lighthouse Park, Day 1
Day 2 they went pitch & putt golfing, where Dylan experienced one of his lowest blood sugars ever. 1.7 mmol/l (30.6 mg/dl)! A full 10-pack of dex later and he was back into normal range, but then a few hours later, at snack, he had dropped to 3.0 mmol/l (54 mg/dl). Honestly, I never would have thought to temp basal for golf, and neither did he. Lesson learned.

Day 3 the group went up Cypress Mountain for an exploratory nature hike and to pick wild blueberries. This time Dylan set a 50% temp basal and ran a little high for the rest of the day, but not too bad. After picking, they returned to the rec centre and made blueberry pancakes with their pickings, practicing carb counting and how to count carbs for an entire recipe, then adjust it to a per serving amount.

Thursday was a food day. They spent the morning at Lonsdale Quay market, exploring the food vendors and talking about healthy food choices. For lunch they selected a food stall for their meal (making sure it was a healthy, balanced lunch) and estimated the carbs in their meal.

Dylan missed today to go camping for the weekend with his dad, but the group ferried to Bowen Island to go kayaking and visit a working bee farm!

Throughout the week, they created a video for newly diagnosed kids, too. Touching on ideas including injection fear, navigating the quarterly clinic and A1c test, and when to start pumping, the video will be shown to newly diagnosed kids to show them they are not alone. Very cool idea.

Wednesday 14 August 2013

Diabetes Day Camp at WVCC is Back! (365:8)

Last summer, the North Shore Chronic Disease Services and West Van Community Centre partnered up and ran a 5-day diabetes day camp for 11-15 year old kids with type 1 diabetes in Vancouver. Dylan attended and loved it, and is super excited to be returning again next week for another round!

Funded by Lions Gate Hospital, Medtronic, and Animas, the kids get a fully supervised all-day camp Aug 19-23 (10:00am-5:30pm), all meals and snacks, a daily out-trip, and even some diabetes education. And the cost? Only $100 for the week!

Check out the flyer below for full info, or call NSCDS at 604-984-5752!

Tuesday 13 August 2013

Swimmer's High (365:7)

Swimming is one of Dylan's favorite activities, and he's a great swimmer to boot. But for someone with type 1 diabetes who wears a non-waterproof insulin pump, managing blood sugar while in the water can be a challenge.

We've been lucky in the past and the carb-burning exercise of swimming has always balanced out the lack of insulin. So much so, that on vacations in past years, we've let Dyl disconnect from his pump for 3 to 4 hours at a time, without an increase in bg afterwards. No pre or post swim bolus required - the swimming simply replaced the pump. Easy peasy...

But diabetes, being like Murphy's Law, throws a curve ball when we least expect it. When we think we have it all figured out. When we try to use almost 8 years experience to base a decision today. It shows us that even after something has worked time and time again, it won't necessarily work today.

Between increased insulin needs, the early onset of puberty, a higher body weight, and possibly dozens of other factors, swimming no longer burns enough carbs for Dylan to be disconnected for any length of time. We learned this the hard way yesterday when he hit the pool with friends for an afternoon swim. 

After 3 hours in the pool diving, flipping, swimming, and playing in deep water, he came home with a blood glucose level higher than I've seen in a long time. A whopping 20.6 mmol/l (370 mg/dl)! A big bolus (6.25 units) and a 30 minute wait later, we faced a 24.8 mmol/l bg (446 mg/dl) and a pump telling us Dylan had too much active insulin to bolus further. A manual override of another unit bolused, and another 45 minute wait, and bg was down to 9.6mol/l (173 mg/dl) and still dropping. 2 hours post-swimming we were down to 6.4mmol/l (115 mg/dl) and I finally started breathing normally again.

On days like this, being a d-mom is extra difficult. It's so easy to focus on the negative and worry about the damage that's being done to his heart, kidneys, nerves, or eyes when his blood sugar is high. It's easy to feel like a failure as a parent and a caregiver, for not keeping my son away from harm. It's easy to let diabetes win.

But this 365 project is about staying positive and not allowing diabetes to be all bad all the time. Because like it or not, he will have type 1 diabetes for his entire life, and I don't want him to think of it as a death sentence, a disability, or a hindrance in any way. I don't want him to mope around focusing on how diabetes gets in the way.

I want him to understand that living with type 1 diabetes can be a challenge, but there is absolutely nothing he cannot do. I want him to accept it, to own it, and to know that when bad s*#t happens, we pick ourselves up, brush ourselves off, and we get ready to take on the next challenge.

Thursday 8 August 2013

Dead Glucagon, or Each One, Teach One? (365:6)

After Dylan returned from camp, I put away his unused diabetes supplies back in the d-cupboard and discovered a box of glucagon tucked behind some infusion sets. My initial reaction of "score!" was quickly subdued when I looked at the bottom of the box and saw an expiry date of November 2012.

In Canada, a box of glucagon costs about $110 without private insurance coverage (luckily we have a very generous insurance provider who covers the cost of virtually all diabetes supplies). Knowing this, it makes me sad to see it expire. Seems like a waste to simply throw it away, especially when there are families who cannot afford to have multiple boxes of this magical reconstitution lying around the house "just in case." It gives me that same kind of guilty feeling I get when have to throw away uneaten food; I wish there was someway I could make it useful.

Moments later I remembered what the diabetes educator had told us in training: never throw away a box of unused glucagon. Use it for practice, or donate it to the hospital and they will use it to teach someone recently diagnosed. In neither case would it be injected for real, but the act of drawing out the water, injecting it into the vial, mixing, and redrawing the solution into a syringe is good practice, and might help avoid the foamy mess I created the first time I ever had to use glucagon in an emergency situation.

Which led to to remember the numerous and horribly frightening times in which we've needed to give Dylan glucagon. Times when it made the difference between life and death; bringing up a dangerously low blood sugar in a matter of minutes. Part of me feels gratitude towards this little box and its capabilities. Another part of me is relieved that glucagon does, in fact, expire in our house now, because it means we didn't need to use it. I can only hope there are many more unused expires boxes in the future.

What do you do with expired glucagon?

Wednesday 7 August 2013

The Go-to Low Treatment (365:5)

Yes, it's chalky, tastes horrible, and leaves a powdery mess on everything it touches, but nothing is more effective at treating Dylan's lows than good ole' Dex. So when Dylan woke up feeling low, after sleeping out in the backyard in a tent with his sister and the neighbors' kids, he did a quick test and self-treated with Dex. That's my rock star!

Um, yeah that's a blood smear on the tester's plastic cover...