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.

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?

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...

Memories; The First Low

Diabetes Blog Week Prompt, Day 3: Today we’re going to share our most memorable diabetes day. You can take this anywhere.... your or your loved one's diagnosis, a bad low, a bad high, a big success, any day that you’d like to share. 

I love that these topics are really getting me thinking...there have been so many diabetes memories, both good and bad. I could post about Dylan's diagnosis. Or about Cyclebetes, the cross-Canada cycling event I was lucky enough to participate in not once, but twice. I could write about one of the many amazing JDRF events we have partaken in, or about the day we started pumping. All worthwhile choices.

But no. Today, the memory that keeps flashing to the forefront of my brain, is of Dylan's one, and only, REALLY bad daytime low. Sure, he's had hundreds of lows, in fact, lately he gets them daily. But this low...this bad boy was different. It had attitude. It was the type of low that keep a d-parent living in fear. The type of low that makes you want to hold on to your child and not let him or her out of your sight. EVER. 

One day, within the first year after Dyl was diagnosed (he was 4 years old at diagnosis), he was spending the day with grandma at her house, which is about a 10 minute drive from our house. (For the record, she is and always has been knowledgeable about Dyl's diabetes, and is one of the few people I've always been comfortable leaving Dylan alone with.) After spending the afternoon together, she was driving him home when she decided to make a quick stop at the library to drop off a few books. She pulled up in front of the building and noticed Dylan had fallen asleep in the back seat of the car. Side-note: this was a very common occurrence, and still is now. Dylan frequently falls asleep within the first minute or so of travel time. Knowing this, she left him in the car and ran the 10 or so feet to put the books in the outdoor return slot. She hopped back in the car and drove to my house. When they pulled in our driveway I could see her, from the kitchen window, struggling to get him out of the car. Again, this wasn't uncommon. He would sleep so soundly for short drives, that we would often have difficulty rousing him once we reached our destination. I saw her pulling him out of the booster seat and trying to get him to walk up the flight of stairs to the back door. And that was when I knew something was very wrong.

Normally Dylan would be disoriented after snoozing in the car, but he would still semi-wake up and stumble into the house. This time he wasn't. My mom was literally dragging him; she had both arms hooked around his chest in a sort of sideways embrace, and was attempting to pull him up the stairs, his legs and feet dragging behind. As I opened the door to help her, she apologized, explaining that he had fallen asleep in the backseat and she couldn't rouse him. 

I immediately knew the truth. He wasn't sleepy, he was hypoglycemic. Between the two of us, we brought him inside and sat him on the couch. I tried, unsuccessfully, to give him dex, but he wasn't responsive enough to chew the tablets. I grabbed a juice box, rammed the straw through the metal hole, and squeezed the juice up through the straw so that it dribbled slowly into Dylan's mouth. For the first few seconds, he didn't swallow, the juice running out of his mouth and down his chin, spilling onto his t-shirt. Then suddenly, as I was about to prep the glucagon for my first real use, he swallowed a few sips of juice. Then a few more. And slowly, as if by magic, the life returned; the color slowly returned to his cheeks, the clarity to his eyes, and the control to his limbs. He was back. 

Nothing, I repeat, nothing, can prepare a parent for that experience. I thought I was ready - I had done all the training, been through the procedures, I knew what to do in an emergency. But nothing I had read or studied could have prepared me for the real deal. That afternoon was the first time I TRULY understood just how unpredictable, powerful, and terrifying, diabetes could be. 

Round 2

January, and now into early February, will go down as the sickest month for Dylan since diagnosis. For years, he has been the child that rarely got sick. He had a near-perfect attendance record at school, and got colds and flues much less often than his brother or sister. It was something I was constantly thankful for, because those rare times he did sick, he'd get VERY sick, usually requiring hospitalization with intravenous fluids to keep bg levels from plummeting. So the less illnesses, the better.

Well, we've gone full circle this season. After a week long achy feverish-coughing flu in mid-January, he returned to school for a few days, only to leave at recess last Tuesday vomiting. The stomach flu had arrived.  More vomiting that day, followed by no appetite, and moderate stomach pain for 2 days. By Friday, he felt up to returning to school, and then (remember, hindsight is 20/20) proceeded to have a very active weekend. Friday night he attended the Vancouver Canucks game with his dad (eating stadium chicken fingers and mini-donuts for dinner), then Saturday he played in a 70 minute soccer game, followed by a 90 minute performance class (singing). Immediately after the class we raced home so that he could don his snow gear and go tubing with a dozen of his classmates (followed by hot chocolate and popcorn). Sunday morning he lounged around the house, and walked up to a friend's house, before they went swimming for 2 1/2 hours in the afternoon.

I tried to balance out the day with a healthy Paleo dinner consisting of wild salmon pan-fried and served over an avocado remoulade, along with mashed sweet potatoes, and steamed vegetables, but I think the damage was done. He simply did too much too soon. When I woke up at 7:00 am this morning I had the nagging feeling that something wasn't right with him, and went to wake him up.

"How are you feeling this morning Dyl," I asked, expecting a response related to his stomach.

"Low," he replied.

Surprised, because he never wakes up low in the morning, I grabbed the kit and did a quick check while he was still in bed. 2.7 mmol/l (48.6 mg/dl)!! After 4 dex tabs and a 15 minute wait, he was up to 6.0 mmol/l (108 mg/dl) and complaining about how much his stomach hurt. So here we are again, home from school nursing a persistent stomach ache.

Running & Low Blood Sugar

Currently I am training to run a half marathon in early May; well, that is the goal anyway. Over the past few days I have started to accept the fact that it just might not happen because I may not be ready in time. I HATE HATE HATE the idea of putting it off, but I ran a half last year totally unprepared, and promised myself I would never do that again.

Why is there a chance I won't be ready by May? It's not for lack of trying, or because of missing motivation. It's not even due to fact that I've been super busy lately. It's in part because of injury (I strained my lower back about 2 weeks ago and it has been a slow recovery), but mostly because of crappy blood sugar.

Running has become scary for me lately. It seems that on almost every run, my blood sugar bonks about 20-30 minutes in. I've tried adjusting my pre-run meal, but have seen little improvement. I've tried downing masses of juice immediately before going out, and while I'm sure my blood glucose rises pretty quick, it plummets even faster. The result? Shorter runs, and too many runs on the treadmill, where I can keep a bottle of dex tabs beside me at all times. Too bad that all the 30 minute treadmill runs in the world aren't going to help me run 21.2 kilometers on the road.

Frustration is mounting. I love running, but these lows come from out of nowhere. One minute I feel great, and the next I am shaking, dizzy, and unable to put one foot in front of the other. It sucks. So I am testing out a new (to me, not new to the market) nutritional supplement/protein powder that claims to do wonders for balancing blood sugar levels. It's low calorie, high protein, and is loaded with vitamins and minerals. I officially start taking it next week, when I get back from my mini spring break vacation, and will take it every day prior to training. But out of curiosity, I took some this afternoon and jumped onto the treadmill for 30 minutes. 15 minutes came and went, no low symptoms. 20 minutes, 25, and 30. Not only did I not feel even slightly low, I felt fabulous. I ran 0.2 miles per hour faster than I have been lately (not much, but hey, it's something) and I finished the half hour knowing I could have run another one. This supplement is looking good so far. The real test will start next week when I begin taking it daily.

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!

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?

"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.

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?

"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