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.

"Failed Batt Test"

That pesky warning that pops up when we change batteries in Dylan's insulin pump, and perhaps one of my most hated diabetes phrases. Why, you ask? Shouldn't changing a pump battery be a simple, straightforward task? One would think so, but in our case it seems to always be anything BUT simple.

I honestly have no idea how often the pump batteries should be changed, or how long they're "supposed" to last. I guess it depends on what kind of batteries are used, and maybe how frequently the pump is accessed. Alarms, night lights, bolus reminders, do they use extra battery life? Probably. Regardless, it doesn't matter in our house, where batteries, especially AAAs and AAs, have always been more sought after than toilet paper.

With the amount of battery-requiring electronics, one would think that we had a surplus of spare batteries lying around, but that is far from the case. One would also think that as a parent of a child with an insulin pump, I'd have extra batteries reserved exclusively for pump use. That would certainly make sense, but, again, would be incorrect. Well, kind of. I buy batteries for pump use, but no matter how explicit I am about their purpose, they get snagged up by kids and used in other devices - toys, remote controls, video game controllers, etc.

Case in point: about 6 weeks ago, Dylan's pump was nearly out of batteries, so we took out the old one and went to pop in a new one, but couldn't find one. The next step was to take a partially used AAA our of an electronic device in the house, yet every one we tried failed the pump's battery test. We literally lined up batteries on the kitchen counter, testing one after the other. We'd put it in, tighten the cap, and wait. "Failed Batt Test" would appear on the screen, over and over. Finally, after over a dozen attempts, we found one with enough life to pass the battery test and power the pump.

It was mayhem; an absurd and unnecessary amount of panic and stress, after which we swore we would NOT got through again. So we hid a battery where only my hubby or I could find, so that we would have a spare no matter what.

Last night, while we were changing Dyl's infusion set, I noticed that the battery bars were empty, so I took out the old one and went to my "hiding spot" to grab the spare. Only it wasn't there. WTF??? I asked my husband, "do you know what happened to that spare battery we set aside for Dyl's pump?" "Oh, yeah, I think it's in the clicker for the Blu-Ray player," he responded. Hmmm. After a few muttered expletives, I grabbed the clicker and took out the two batteries, placing one after the other in the pump. "Failed Batt Test" on both. Are you friggin' kidding me?? I didn't even bother testing any others, as I know from last month that a AAA can have enough power to operate a remote control, but not enough to power an insulin pump.

At 10:00pm I drove to the store, bought an 8-pack of AAAs, took one out for the pump, and locked the rest in the glove compartment of my car. No, not really, but lets hope the next time we do a pump battery change there are some left!

Skating Along

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

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

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

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

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

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

Tweak, tweak

Last week I wrote about the problem we were having with Dyl constantly running slightly high (Trends Don't Lie). As a result, we upped a couple of basal rates in the hopes that it would at least curb the 2 daily spikes he was experiencing. And we were right, it did combat the spikes. However, it still left him elevated throughout the day, all day.

Fast forward to today, when we were back at the diabetes education center for a check-up. In addition to doing Dyl's quarterly A1c, weighing and measuring him, and talking about changes and updates in diet and exercise routine, the endocrinologist took a really hard look at Dyl's pump data and decided to make some pretty substantial changes. In fact, she increased every single basal rate. Background note: Dylan has six different basal rates which vary considerably at different times of day. For example, because he is prone to hypoglycemic seizures in his sleep, he takes less insulin at night. For some reason, which we really have no idea, he requires more than twice the amount of insulin between 2:30pm and 6:00pm than he does at any other time of day. The other 4 rates fall somewhere in between. (This ability to vary insulin delivery over a 24 hour period is one of the MANY reasons I love pumping over MDI.)

I've said this before, and I'll say it again and again: I love our endo and I trust her explicitly. So when she says increase all the basal rates, I do it. And I did, but not without fear. This is, by far, the most drastically we have ever altered Dylan's settings, and a couple of the settings were increased by as much as 0.2 units per hour. In an MDI user that injects insulin two or three times a day, 0.2 units may not seem like much, but in an 11 year old pumper, who boluses additional insulin for food, it's a lot. Fingers crossed that these changes get his bg levels back into ideal range, at least most of the time.

Trends Don't Lie

Up and down, up and down. Just when I think I have pump rates set so that "in range" is a reasonable goal for the immediate future, diabetes goes and changes everything again. Call it Murphy's Law, call it karma, call it whatever you want, I call it living with diabetes. At it's best, it's manageable; at it's worst, it's a roller coaster, but it's always uncontrollable. And the more we try to control it, the more elusive that control becomes.

After some pretty decent bg readings for most of September, we have seen some consistent highs for the first half of October. And not "high" highs, which are so much easier to correct, in my opinion, with a nice, big, well-measured bolus. No, we've been dealing with what we call "low" highs in our house - those pesky high blood sugar levels that don't appear to be have an obvious cause. The ones that hover just a little above the "ideal" range; too low to continually correct, to high to ignore. The 11's were our battle for Thanksgiving. Not just one, not two, not even three, but a solid 48 hours of blood glucose readings ranging from 11.0 mmol/l (198 mg/dl) to 11.5 mmol/l (207 mg/dl). Furthermore, Dylan felt fine. He didn't feel high and wasn't showing any symptoms of hyperglycemia. It didn't seem to matter what he ate, or how many times we corrected the highs, the next reading was another 11. We changed infusion sets, tried a new vial of insulin, double checked against multiple meters and the result was still the same...11s. It became a bit of joke with Dyl after a while, as he'd test and then say to himself, while waiting for the number to appear on the meter screen, "anything but 11."

What does one do in that situation? Personally, I am always hesitant to adjust basal rates because so many things can cause a temporary increase in blood glucose levels. Maybe Dylan was under a bit of stress, or fighting the early stages of a virus. Perhaps he had a decreased amount of exercise for that 48 hour period. Or maybe it's the beginning of puberty - something I've been dreading, from a diabetes standpoint, for a while now. The point is, it's so hard to determine what causes a rise in bg, that basal adjustments are not always the best answer.

So I did what I usually do in this situation, after I've tried the obvious solutions (bolus, increased water, bout of exercise, infusion set change, new insulin, different meter) and haven't seen success - I look to the numbers to tell me. After all, numbers don't lie. And while a single number, or even a day's worth of data, can't always provide a clear picture, trends over time can reveal a lot. So I sat down at the computer, uploaded the last two weeks of pump data, and stared long and hard at the information, looking for trends, patterns, or anything that would shed light on the situation. Sure enough, I quickly discovered a number of problems. Twice during the day, for the past 2 weeks, Dylan's bg levels had been quite elevated (prior to the 2 days of 11's). It was always at the same time each day, and always a similar level of elevation. So I increased the basal rates for the few hours prior to those 2 times, in the hopes that it would help to curb the spike.

I then texted the endocrinologist to let her know that I had uploaded new data, and increased two of Dylan's six basal rates. I also asked if could she please let me know if any other changes were required. Yup, after almost 7 years of parenting a child with diabetes, I still ask the endo about every change to pump settings. And I probably always will.

Just Keep Swimming

Diabetes and exercise don't always mix well. While yes, exercise does wonders for the body and can provide significant help in managing blood sugar levels, the unpredictability when the two are mixed is enough to drive anyone crazy. 

Just this morning, Dylan started a week of intensive swimming lessons. 45 minutes of near non-stop lengths, practicing all strokes. The only breaks to the lengths are to tread water. I literally has no idea how his blood sugar was going to react but I (perhaps stupidly) tried to base my estimate of previous experience. Ya - anyone with type 1 diabetes or who cares for someone with type 1 knows very well that what works one day does NOT necessarily work the next. But you have to start somewhere, right?

A year and a half when we took Dylan to Mexico for 10 days, we balanced exercise (swimming) with insulin pretty well. Awesomely well, in fact. Turns out with Dyl at that time, that the glucose he was using, via energy he was exerting in the pool, almost perfectly balanced the increase in his blood sugar levels while being disconnected from his pump. Basically, this means he went pumpless for most of the day, every day, and the effects on his blood sugar were minimal. He'd wake up in the morning, test, bolus and eat breakfast, and remove his pump. He'd swim from 9:00 to about noon, test, put the pump back on to bolus for lunch, remove it again, and swim from 12:30 to 4:30 or so. Then he'd resume wearing his pump until the next morning. Seems crazy, yes, but it worked for him because he was so active in the water.

So fast forward 20 months, and add about 25 pounds in body weight. Pre-pool test revealed a bg of 8.1 mmol/l (145.8mg/dl). He wore his pump right up until the climbed into the pool. We didn't run any temp basal rates in the hour or two prior to the lessons, and he didn't have any extra carbs. Did I expect the same results as in Mexico? No. I expected a low, and I was worried because Dylan's telltale warning sign of a low is what he has termed "weak-knees," meaning that his legs feel like they're going to give out at the knees. Of course, in the water he wouldn't feel that because he wasn't standing. I stayed in the viewing area the whole time, armed with dex tabs in the off chance he started to feel low. 

Post-swimming test result? 12.9 mmol/l (232.2 mg/dl). Go figure...

Evaluating the Numbers

Diabetes is a numbers game. We are forever chasing the elusive bliss of bg perfection, a better A1c, or day of spot on carb counting. Some days the planets align and all seems okay; other days we chase highs and lows via the diabetes roller coaster. But how do we evaluate success? And failure, for that matter? For many the quarterly A1c test is the ultimate report card, for others reporting is a daily process.

I fall somewhere in the middle. I look forward to (or dread) the quarterly A1c because I like the overall picture it presents. It gives us a "big picture" idea of how Dylan is doing, and while I try not to take it as a reflection on my ability as a d parent, let's face it, it's pretty hard not to. My problem with the A1c is that it doesn't take into account what is going on in Dylan's body each and every day. It's doesn't identify areas in which pump settings need to be adjusted, or carb ratios altered.

For this information I turn to the pump data itself, and while I have heard from countless people that they hate the Medtronic CareLink reports, I quite like them. I upload pump data every 2 weeks (or that is the goal anyway) and I go through the numbers with a fine toothed comb, looking for patterns, problems, or anything out of the ordinary. Without fail, I always learn something new; no 2 uploads are ever the same. In fact, that seems to be the rule with diabetes - as soon as things start to make sense, they change.

Over the past few months, one trend emerged over and over in the reports - Dylan was not testing enough. This has been an ongoing problem for us, and the one things we are continuously working on. Dylan is amazing about testing when he's at home, but regular testing at school has always been an issue, more so as he's gotten older.

The most recent upload, however, showed quite an improvement in testing, and more tests means a more accurate picture of what is really happening inside his body. So what did I learn this time? I learned that we need to up his basal setting almost across the board. In the 2 weeks of data, only 3 days did his average bg fall into the ideal range. The remaining 11 days it was just above normal. Was I surprised? At first, but then I took into account a number of things. First, it's been a couple of months since we made any pump adjustments. Second, he's growing, and has been eating a lot more lately. Third, hockey season is over, so his activity level has decreased a bit. Each of these factors, or all three, could be causing his bg to rise.

Without the reports, or a log of some kind, I would have to wait until our next quarterly A1c test and endo visit to find out this info and to make pump adjustments. But our next appointment isn't until the end of July, so that's a full month in which Dylan's bg could be running higher than it should, wreaking havoc on his body and making him feeling like crap unnecessarily.

So now what? We tweak. We increase basal rates a bit here and a bit there, and maybe increase carb ratios a tad. And we fire the data over to the endo for any additional changes. Then in 2 weeks we repeat the process. And we do it again, and again, and again, every couple of weeks, to ensure that Dylan's pump is giving the ideal amount of insulin to his body throughout every day.

Diabetes Time Capsule ~ HAWMC, Day 1

Today is the first day of WEGO Health's 2012 Health Activist Writer's Month Challenge. Yup, 30 posts in 30 days, so let's get this party started.

Today's prompt asks bloggers to pretend they are making a time capsule of their health focus that won't be opened until 2112. What's in it? What might people think of it when the find it?

Seeing as we keep all of our household diabetes supplies in a rubbermaid box, I think it's fitting that my time capsule be in the same. Its contents would be:

-insulin pump with instruction manual

-vial of insulin

-sample infusion set and reservoir

-blood glucose kit

-bottle of strips

-handful of lancets

-bottle of dextrose tablets

-couple of syringes

My guess would be that people opening my time capsule would be shocked that we even used such things. Hopefully that would be because diabetes had either long since been cured, or because the technology to control it was so far advanced that our pumps looked to them as the first insulin pump looks to us now. 

Technological development moves exponentially fast, so I find it unfathomable to even imagine where we might be in 100 years. After all, 100 years prior to now, there was NO treatment for diabetes whatsoever. Insulin has only been available for 90 years, and the first insulin pump wasn't invented until just over 30 years ago, at which time it was the size of a large backpack and looked like this

Can you imagine wearing one of these bad boys around?

**Don't forget to enter the Blood, Sweat & Carbs giveaway for your chance to win a $200 prepaid credit card. For full info, click here.**

Oddity

I don't know how many infusion sets I have changed over the years. A lot. Once every three days, for four and a half years (Dylan was on MDIs for his first two years with diabetes), would mean somewhere around three hundred and fifty site changes. It's basically always the same thing - disconnect tubing from Dyl, peel off old set, rewind pump, dispose of old reservoir, fill new reservoir, attach new tubing, insert in pump, prime, insert new cannula in Dylan, attach pump, fixed prime. Good for another three days, assuming nothing plugs, falls off, gets kinked, infected, or runs out batteries. It's become routine. So routine, in fact, that I rarely need to think about it; I move in an almost robotic state, much like when tying my shoes or brushing my teeth.

But today, for some bizarre reason, something was different. As I popped the new reservoir onto the top of the insulin vial and pulled back the plunger to fill the reservoir with insulin, I found myself struck by the oddity of it. I watched as the life saving serum slowly filled the tube-shaped reservoir, the liquid creeping up the marked plastic: 50 units, 100 units, 150 units. As it neared the 180 unit mark (Dylan will only use about 120 units over 3 days, but I always add a little extra), I released the plunger and removed the reservoir from the insulin vial.

I found myself overwhelmed in a way I cannot even explain. How can something so small be responsible for so much? This tiny amount of simple, watery-looking substance gives my son life for three days. Without it, he would die. I am well aware of this fact, and I am eternally grateful to Frederick Banting for his miraculous discovery over ninety years ago. I am in awe of the advances in the field of medicine, that enable my son to wear an insulin pump, essentially a mini-computer, that continually injects him with one of six different preset amounts of basal insulin, specific to his body weight, activity level, and the time of day.

And yet today, for the first time, I was genuinely struck with a feeling of surprise at how readily we accept and embrace this blend of nature and technology. Pumpers are not alone in their use of health technology; the addition of man-made materials to the human body is widely used, ranging from braces to pacemakers, to prosthetic limbs, to breast implants, to wheelchairs, among other things. Each device serves a purpose, and many are brilliant inventions that not only enhance lives, but save them, each and every day.

With the exception of insulin itself, an insulin pump is the greatest advancement in diabetes care to date. It has changed diabetes itself, enabling it to become an easily manageable disease with fewer side effects and a longer life expectancy than ever before. I love Dylan's insulin pump and I am so thrilled the technology is available. Yet it is still a machine, and for today I found that odd, that's all.

"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?

2 Week Pumping Update

Well, we have officially been using the new VEO pump for 2 full weeks and even though it is essentially only a newer version of the old pump, we used the upgrade timing as an opportunity to fine tune our pumping skills, adjust basal and carb ratio settings, and establish a more consistent testing schedule. So has there been any improvement to Dyl's blood sugar levels?

Here are Dylan's average blood sugar levels for the past 14 days:

breakfast: 10.9 mmol/L (196.2 mg/dl)

morning snack: 10.6 mmol/L (190.8 mg/dl)

lunch: 8.3 mmol/L (149.4 mg/dl)

afternoon snack: 4.4 mmol/L (79.2 mg/dl)

dinner: 8.9 mmol/L (160.2mg/dl)

bedtime snack: 9.2 mmol/L (165.6 mg/dl)

night: 9.8 mmol/L (176.4 mg/dl)

Overall average: 8.6 mmol/L (154.8 mg/dl). 

Based on the overall average above, Dylan's A1c reading for the past 2 weeks, if it were calculated on a 2 week period, would be 6.5. Considering his last A1c was 8.7, we are certainly on the right track, but still have room for improvement. Now in that same 2 week time period, he also had 15 low blood sugar readings, with the lowest being a mid-afternoon reading of 2.0 mmol/L (36mg/dl). His highest result was an evening snack reading of 21.4 mmol/L (385.2 mg/dl).

Can you say diabetes roller coaster??

The VEO Has Landed!

The VEO and some of the other supplies we got

And we're off!

Our new Minimed VEO arrived last week, in a massive box, full of other goodies. Not only did it contain the pump itself, but two Contour Link meters (that wirelessly communicate with the pump), six months worth of infusion sets and reservoirs, a remote control for the pump, a new USB to upload data from the pump to the Carelink website, and extra batteries and belt clips. 

After reading through the pump manual and getting my head around the few minor differences between the Paradigm 522 (old pump) and the VEO, we are ready to start using it. Today we retired the old pump and Dylan started wearing the new one, and then in a few weeks, we'll add the CGMS too.

Seeing the old pump looking so lonely perched atop my microwave got me thinking. What do people usually do with their old pumps? Ours is 4 years old, so the warranty has expired, but the pump works perfectly and we've never had a problem with it. Is there anywhere I can donate it, or someone who needs one? Any ideas would be much appreciated!

I Still Remember...

Free Write a Post that starts with the line "I still remember..."

I still remember the day we switched from syringes to an insulin pump as if it were yesterday, and yet it's been 4 years. Late November 2007 Dylan started on the Minimed Paradigm 522 insulin pump and we never looked back. Now, 4 years and an expired warranty later, we are about to embark on a new pumping journey with the Paradigm VEO.

It's hard to explain all of the phenomenal ways in which pumping has enhanced Dylan's life. But here are the top five pump highlights (in no particular order) that Dylan is most crazy about:

1) It allows him the flexibility to basically eat what he wants when he wants. Before pumping, Dylan had a very specific meal plan. He had 3 meals per day, consisting of 45 grams of carbohydrate each, interspersed with 3 snacks of 15 grams per day. They were timed to meet the peaks of the insulin injections he was receiving, so he had to eat at pre-set times or risk low blood sugar.

2) It eliminates multiple daily injections. HUGE bonus!! Dylan was getting 4 injections per day - 2 in the morning (1 injection of rapid insulin and 1 of long acting insulin), 1 injection of rapid at dinner, and an injection of a different long acting insulin at night. It was messy, a nuisance to measure all the time, and the needles were big and painful for a 5 year old.

3) It helps to stabilize his blood sugar levels. Sure, it's far from perfect, but we certainly have less severe high and low swings with the pump. The continuous basal insulin, coupled with the ease of tweaking carb and bolus amounts has vastly reduced the massive high and low swings he used to get.

4) Better A1c numbers. For the most part Dyl's A1c numbers have been better with the pump. There is still room for improvement, but we're moving in the right direction.

5) Finally, and this is the number one advantage to pumping, it gives Dylan so much independence. Before pumping I was with him all of the time, hovering and monitoring his every move. Now, he can go to friend's houses to play, and even sleepover, he can be a "regular kid" at birthday parties, and he can play sports just as hard as his peers. He is responsible for all of his blood sugar testing, carb counting, and bolusing. He can tell you the carb count of virtually any food right off the top of his head, and if it happens to be one he doesn't know, he has an awesome app on his iPod to help him (CarbFinder) figure it out. I oversee everything and do his site changes, but he likes to be responsible for the day to day pumping.

I couldn't imagine going to back to MDI's (Multiple Daily Injections) and neither could Dyl. We are so excited to usher in another 4 years of pumping with the new pump!

Automatic Low Glucose Suspend Pump

I am going to deviate from the #NHBPM prompt for today and write about something new and exciting that's happening in our family!

Until recently, the phrase Low Glucose Suspend, or LGS, would have been a thing of the future; a feature I'd love to have on Dylan's pump, but didn't. Well, that is about to change. Today I started the process of upgrading Dylan's pump, as the 4 year warranty on his current pump has just expired. 

Dylan currently wears the Minimed Paradigm 522 and he loves it. It's super easy for him to use on his own and it fits with his lifestyle. Don't get me wrong, I'm not suggesting that Minimed is a superior pump or anything. We have simply never tried anything else and considering Dylan does most of his diabetes care himself, it's easier to stay with what works for us, rather than switch to something different. I have looked at other options, but the new Minimed VEO just can't be topped for me. This new pump, available in Canada and Great Britain, but not yet in the United States, has a feature unlike any other pump: it has a low glucose suspend option. And when you have a type 1 child who is prone to hypoglycemic nighttime seizures, this feature is music to my ears.

So how does it work? Basically, you program your target zone and if your blood sugar level falls to the bottom of this zone (or below the target zone), the pump automatically suspends insulin delivery for 2 hours. Now clearly there are few things wrong with this. First, 2 hours may be more time than needed, but if that's the case, you can manually restart insulin delivery. Second, blood sugar may continue to fall after insulin suspension because of the amount of active insulin already in the body. Third, it is definitely not a replacement for nighttime blood sugar testing; I will continue to test at night no matter what. Albeit the system is not perfect, it sure is a heck of a lot better and more advanced than anything else on the market today. And if it can help to prevent Dylan's nighttime seizures, then I'm a very happy mama.

Stay tuned as I report back in a few weeks once we have the new pump and have been using it for a while!

And for more information on the Minimed Paradigm VEO, visit their website.

To Fund or Not to Fund; the Shenanigans of the Alberta Diabetes Debate

Tuesday night I was watching my local 11:00pm news, reading a book while watching, paying limited attention to the stories until my ears perked up at the mention of the words "diabetes" and "insulin pump." I quickly found myself getting quite upset at the content of the story, so much so that I rewound the article twice to ensure that I had heard everything correctly. I then even hit record on the PVR so that I could re-watch the story in the morning with fresh eyes.

A bit of factual background presented at the offset of the article:
1) "Every 7 seconds somebody around the world dies of diabetes and that number is rising, even though the disease is largely preventable"
2) by the year 2030 there will be an estimated 5 million diabetes diagnoses
3) Diabetes is expected to rise 3% within the current decade
Now the story did not differentiate between Type 1 and Type 2 diabetes, but I am assuming (hoping) that point 1's reference to "preventable" was meant to describe Type 2 only, and that points 2 and 3 refers to all forms of diabetes, be it Type 1, Type 2, LADA, etc.

So here's the deal. In Canada, most provinces provide funding, at least in part, to help offset the outrageous cost of purchasing an insulin pump. They also help with the cost of maintaining the pump (including covering the cost of infusion sets and reservoirs. Sensor/CGM costs are not covered). In BC, where I live, this funding is a recent change, but a much needed one. The current issue involves the province of Alberta (next door to BC, and directly north of Montana) where the government has been debating whether or not they should join the majority of the other provincial and begin to cover insulin pump costs.

It all came to light Tuesday when the CDA (Canadian Diabetes Association) released a report stating that the Alberta gov't will not be providing any funding for insulin pumps, even though they have one of the highest rates of diabetes in the country. The reason stated by the government is that they would prefer to focus on "preventing diabetes" in the first place and that because type 2 makes up 90% of the diagnoses in Alberta, the government feels it's in their best interest to focus on prevention rather than treatment. The CDA has argued, and rightfully so, that over the next 20 years, an insulin pump program could save the province up to $10.8 million. 

The outcome: The Alberta health minister agrees that the statistics presented by the CDA are convincing and the government will continue to keep the issue "on its radar."

My questions for readers are twofold: What type of funding/subsidy options are there for insulin pumps where you live? And do you believe that the government should be responsible for helping families with the costs of an insulin pump and its supplies/maintenance?

Both the footage of the television segment, as well as the print article, can be found here: Alberta has high diabetes rate but won't fund insulin pumps.

Spring Cleaning Diabetes Style

Have you ever gone to change an infusion set or give an injection only to discover you are completely out of insulin? And I don't mean that the current vial is empty, I mean totally out - every blood glucose kit, emergency bag, even the extra stash in the produce drawer in the fridge. All of it. Gone.

I usually pride myself on being very organized. It is one of my strengths, though at 8:30pm last night, when I went to change Dylan's infusion set, I suddenly realized that I didn't have even a drop of insulin anywhere in the house. "How much is left in your pump reservoir?" I asked him, thinking maybe we could buy ourselves another night with that, and I could pick up more insulin from the pharmacy in the morning. "3.1 units," he says. Crap, I think to myself, that will last all of what, a few hours? He currently takes about 30 units per day, so 3.1 units right before bed, is simply not an option.

An emergency late-night trip to the pharmacy and we're back in business. Sure it was a little past bedtime at this point, but the alternative is unthinkable.

"How did I let that happen?" I kept asking myself. But I already knew the answer. I've simply been too busy lately and I've let things slide, even something as simple and necessary as reordering prescriptions. So I decided then and there that I would do a complete overhaul on my "diabetes cupboard." You know what cupboard I mean, we all have one, the place in your house that you keep all the supplies - the extra glucose meters, the strips, the pump supplies, the fast-acting sugar. But I highly doubt that most are as disastrous as mine was today!

I started by taking everything out and laying it on the kitchen counter. Wow, it was like a medical supply store threw up in my kitchen; there was stuff everywhere, some of which I didn't even know I had, some of which I had been keeping for far too long. Slowly and surely I went through it all, throwing away 2 expired glucagon shots, 2 expired bottles of ketone strips, and 1 glucose meter that I don't remember ever seeing before, and that we have never had any strips for. There were cans of Glucerna (Dylan drinks them when he's sick) that expired in 2007 (wtf?) and lollipops from Halloweens of years gone by. All in to the trash.

Next I got down to the nitty gritty - the glucose meters, or "kits" as we call them in our house. "How many kits do you think we have in the house right now, Dyl?" I asked him. "I don't know, 6?" he responds." "Ten!" I tell him. Ten! Plus the one in his classroom at school, the one in my car, the one at Grandma's, and probably another half a dozen at his dad's house. How can there be many, and yet sometimes we are hard-pressed to find one? The answer lies not in the number of kits, but in the number of WORKING kits. I opened every one and made sure each had a pricker, extra lancets, and a full bottle of strips. They all did. Then I checked power; only two had battery life, the other eight had dead batteries. Wow.

Finally, I reorganized all the other diabetes related paraphernalia, made a list of all the items I need to reorder, admired my neat orderly cupboard, and wrote a reminder in my calendar to inventory the diabetes supplies on a regular basis, so running out of insulin NEVER happens again.