Diabetes Awareness: But she's too skinny to have diabetes......

We have been extremely busy the last few months and I have gotten behind on my bloggin'.....A lot has happened in the Dean house since my last post so I have plans for several posts over the next few weeks!

However, with this post I want to discuss type 1 diabetes misconceptions.  I've touched on this topic in the past, but this issue has been coming up a lot more lately.  I used to get defensive when people would make these types of comments, but then I realized its because they don't know any better.

There are many misconceptions about this disease, but I've put together the ones I feel strongly about.  Here is my top 5 list of type 1 diabetes misconceptions:

1. "But she's too skinny to have diabetes." Although diet and weight are factors for type 2 diabetes, it is not the cause of type 1 diabetes.
2. "She can't eat that cupcake." As is should be for us all, moderation is key.  Also, there are times when sugar levels can drop too low and sugar is needed to raise it.
3. "She can't play sports because her sugar will drop." Exercise is important for everyone including those with diabetes.  Precautionary measures like eating snacks and frequent bg checks can help avoid hypoglycemia.
4. "She'll never be able to have children."  Diabetic pregnancy require closer monitoring, but there is no reason,  with excellent blood sugar control and diabetes management, that mother and baby will remain healthy throughout the pregnancy and birth.
5. "Taking insulin will cure diabetes." Insulin is not a cure, it is their life support.  Unfortunately there currently is no cure for diabetes.

Enjoying the summer!!

What's been going on.....

Whew....well things are going well with Alyssa!  She is healthy and active and enjoying the summer!  Life is busy and hectic for our whole family and I haven't had the time to catch up our blog!

Before school got out Alyssa's elementary school held a Kid's Walk to Cure Diabetes (JDRF) and Alyssa raised the most money out of the entire school!  She was gifted a huge care package from Chick Fil-A as well as many other prizes from JDRF!

On June 15th Alyssa celebrated her 10th birthday with a party with her friends at the park!

Now we are preppy for walk season and looking forward to taking part in all the activities!  In the meantime Alyssa is working hard at the thing she loves the most, competitive cheer and enjoying the summer!!

Our insulin pump is the best!

We are approaching our six month mark since starting on the pump.  I have to tell you that getting used to the pump did take some time, but I honestly feel it was the best decision we could have made.  Alyssa has adjusted nicely and honestly knows how to work it better than I do.  Site changes have become much easier and we have had little problems.  I still get up and check her blood sugar between 2 and 3 am, depending on what time she went to bed.  She sleeps right through this check and this makes me sleep much better.  This has helped me catch a couple of lows as well as make corrections for any night time highs. 

In our case the pump has also helped with lows that are the result of exercise.  We disconnect during cheer practice and performances and have had only 2 or 3 lows.  This is because with the pump, Alyssa no longer needs her long lasting insulin that's peak can be unpredictable.  We check blood sugar levels before and after and correct accordingly.

Fall happenings and pump update

Well, Alyssa has been using the pump for a little over a month now.  We've had some ups and down, highs and lows; and tears and laughs....I would be lieing if I didn't tell you there have been times I thought I had made a mistake by pushing for Alyssa to get on the pump....I'd be lieing if I said I had not thought about disconnecting it and going back to shots.  But I keep reminding myself why this will be best for her in the long run. 

The hardest part....the first several site changes were a nightmare.  Alyssa's anxiety about them got her so upset leading up to it that it took at least an hour to calm her down to put in the new site. Fortunately that has gotten better.  The problem now is that she'll only let me put the sites on her bottom....we are alternating cheeks.  We have done the stomach once but she hated it.  Alyssa is so petite, her bottom is the only place she has any extra meat. 

We have also had a few scary high and low bgs that seem to have come out of no where.  There were also a few night time lows, but I think we've worked out those kinks with basal rate changes.  In the beginning I was checking her bgs every 3 hours while she slept, now I'm only checking once in the middle of the night.

I do finally feel we are getting the hang of things.  There definitely are many pros of using the pump.  Alyssa has much more freedom with when and what she eats....if she wants something to eat at any time, we just bolus for the carbs.   Its so nice to enter her carbs and the pump figures the amout of insulin...all of this without another injection.  This made Halloween and Thanksgiving a lot less stressful!  One site change every 3-4 days versus 12-16 injections over 3-4 days.

 Also, besides a few spikes and lows, her average blood sugars have been really good.  During cheer and tumble, we disconnect and honestly have had fewer lows during exercise because she's no longer on the long lasting insulin, Lantus. Since she's given little amounts of fast acting insulin every hour through the pump she no longer needs the long lasting.

Overall, even though I've had some moments of doubt, I believe the pump will afford Alyssa more freedom and as she gets older, more independence.  As with any change, adjustments should be expected.

P-day

I don't know who was more excited this morning... Me or Alyssa? We've both been anxious for this day, especially since we received her pump over a week ago. The huge Animas Ping Box and the slew of pump supplies are hard to miss when they are taking up 1/2 my kitchen table.

Since we've received the pump, Alyssa and I have played with it. I read 'the book' and watched the video, and when we sat down with the pump trainer things ran smoothly. Alyssa demonstrated most of the functions. After we set up the pump, filled it with insulin and checked blood sugar, it was time to insert the infusion set. The infusion set is a spring loaded device that punctures the skin with a needled and as it withdraws leaves a cannula. The tubing from the cannula connects to the pump and this is how insulin is infused.

Because Alyssa was scared, I asked her if she wanted to put the infusion set on me first. Of course she did... I'm still wearing it :)

She was a little scared but was very brave. As a reward we went out for a chocolate sundae :). So great to bolus for 50g of carbs by remote!!

The next few days are going to require close observation and I'm expecting some changes. In the beginning we'll be checking bg's before meals, 2 hours after meals, before bed, at midnight and at 3 am. The goal here is to eventually improve Alyssa's life and I feel the pump will after we all get used to it.

Another cool thing, we never noticed our endo wore a pump or even that she had T1D... Alyssa saw hers today and its the same pump we use :)

It's walk season.... Fundraising ideas

We have so many fundraising events that will benefit this year's walk. Of course we have the online donating through JDRF's walk page. We had a fundraising yard sale a couple weeks ago that was successful. Currently, we have 2 catalog/online shows going with Pampered Chef and 31. Next weekend some friends of ours are hosting a pig pick in' fundraiser. We asked one of our company's suppliers and they agreed to sell JDRF sneakers and another hairstylist friend is donating a portion from each client for the month of September. Our church also has been extremely generous with love offerings and donations for our yard sale.

With a little less then two weeks to go, I do not see how we can not reach our team goal of $3500!!

First day of school

With the first day of school came a new diabetes schedule. Left behind were the late nights and sleep in mornings. We started the new schedule a few days before school started, but I still knew the lazy days of summer that fit her current diabetes protocol was sure to change with the active life of a new 4th grader. I knew she would be more active so the morning of the first day I reduced her fast acting insulin. Mid morning she had her provided snack, but at lunch time a bg of 70. 2nd day of school, reduced insulin even more, usual snack and a lunch bg of 63. On the plus side, bg's have been normal at dinner which means her dose is good at lunch as well as the carbs in her afternoon snack. Tomorrow I'll make another reduction to see if that helps with the low blood sugar at lunch.

Going back to school

School starts 1 week from today, so I broke out Alyssa's most recent diabetes plan and starting filling out the paperwork for my meeting with the school nurse on Thursday. I will also give a brief training to her teacher on what to look for with Alyssa. The teacher will be attending a diabetes class provided by the school that usually happens sometime during the first week of school as well. So, this little training session is just so she knows what to expect the first few days of school.

I purchased enough snacks to last a month for the teacher to keep in her room as well as several juice box packs to treat lows. I've started getting her diabetes bag ready that stays in the office that will contain her meter, strips, syringes, glucose tablets, alcohol swabs and insulin. Ideally I would have liked for Alyssa to be on the pump before school started, but at least we have the ball rolling.... hopefully final approval in the next couple of weeks!!

Beaching it....

Vacation to Key West was great and the trip through airport security on the way back was much better than on the way there. Blood sugars behaved for the most part. We did have a few lows at the beach, but we were well prepared since we expected it.

Getting ready for vacation

We are nearly packed for vacation. This is Alyssa's first time flying since her diagnosis. I got a letter from her endocrinologist and packed double the supplies we will need for the week long trip. I'll let you all know how it goes on Wednesday :) This afternoon, we even had time to hit the nail shop... Key West here we come!

Carb Counting Basics

I know I have written several posts about carb counting, but because diet is probably the most important aspect of managing diabetes, I don't think it can be covered too much.  Understanding carbohydrates helps determine which foods affect blood sugar and how much insulin should be given for the food eaten.

The 3 main nutrients in food: proteins, fats, and carbohydrates all affect blood sugar levels; however carbohydrates is the main effector.  After carbs are eaten and digested, they become glucose and enter the bloodstream.  This causes blood sugars to rise and insulin is required to move the sugar into the cells for energy.  Some might think that carbs are bad; but in reality, they are the body's main source of fuel.

Foods that contain carbs are: starches (Breads, starchy veggies), fruits, milk products, and sweets.

Estimating carbohydrates can be done based on serving sizes (some call carb choices).  On average 1 serving size will have about 15 grams of carbohydrate.  This method is best used when there are not any food labels or when eating at a restaurant.  Examples of carb choices are: 1 slice of bread, 1/2 cup of corn, 4 ounces of juice, small apple, 8 ounces of milk.  Each of these would be considered 15 grams of carbohydrate.

Counting grams of carbohydrate is much more precise.  Reading food labels and meal planning books are the best way to count grams of carbs.  I recommend the book, Calorie King.  When using this method, food is measured and then the carbohydrates are calculated.  When reading food labels, its important to determine how many servings you are going to eat and then multiply that by the grams of carbs per serving. 

*Watch out for products that say they are "Sugar-Free" or "No Sugar Added".  Just because a product is sugar-free doesn't mean its carb-free.  So always check the grams of carbohydrate.

Pump Class

Looking forward to going to play with the different insulin pumps this afternoon with Alyssa. Look for a post about the experience as well as the next step, insurance :D

A Great Weekend

Riding 4 wheelers through trails and mud and puddles was not something I thought I would ever do. I wouldn't say I'm a girly girl, but I never really saw the need to play in the mud. Alyssa on the other hand is very versatile. She likes being a girl, playing with makeup, painting her nails; but she also likes playing with toy cars and out in the dirt.

So, yesterday, I agreed Lu and I would go with the boys to Busco Beach, an ATV park a couple hours from home. Alyssa love it and I have to say I had a lot of fun too! She rode a lot on her own and has gotten really good. My sons Phil and J are fearless and they got a kick out of mom's screams as we went over ramps and through the mud.

For the most part diabetes behaved. We had one low towards the end of the day and honestly four wheeling is a lot of work, so we checked periodically and stopped for extra snacks.

All in all, it was a great day with the family filled with some great memories!

Changes

The endocrinologist made a few changes to Lu's regimen because her hemoglobin A1C had gone up .2 since our last quarter visit.  Yesterday was the first day of the dose change and also her 3 hour cheer practice.  I was a little nervous to give her the higher doses with breakfast, but didn't want her to spike before the 10:30 practice time.  Her Lantus was increased from 9 units, to 10 units and her Novolog rate was increased from 1 unit for every 20 grams of carbohydrates, to 1 unit for every 15 grams of carbohydrates.  I gave her the updated dose with breakfast at 7:30 and on the way to practice, checked her blood glucose levels.  258 at 10:15.....we are back to those post breakfast spikes where the insulin is taking a little longer to kick in.  Practice immediately started with warm-up and practicing jumps.  After about 20 minutes of that, they started tumbling and that lasted about 30 minutes.  At 11:30, we did a recheck of her bg's and she was at 115.  She had a snack, apple slices, peanut butter crackers and low-calorie Gatorade.  They practiced their competition routine and around 1:00, she gave me 'the look', which I knew meant that she didn't feel good.  Re-check, bg's 62.  Quick juice and a snack and the timing was good because the team decided to take a break.  10 minutes later,she perked right back up and finished practice with energy left over.

Dum Dum

On my last visit to the pharmacy to pick up Alyssa's diabetes supplies, I decided to go through the drive thru. I told the lady behind the glass that I need to pick up my daughters prescriptions, gave her date of birth and confirmed our address. Alyssa was in the seat next to me and the pharmacy tech waved at her. We chatted for a few minutes about the heat (over 100 degrees that day) while she rang everything up. It takes a few trips through the pass through because of the boxes of syringes. On the last pass, I opened the door to the pass through and beside Alyssa's bag of insulin was a Dum Dum lolly pop. I just smiled. And yes, Alyssa ate the sucker later!

Pump talk

As I've mentioned before, I've been hoping to talk Alyssa into getting the pump. I know it seems to be an easy decision because she would go from 4 injections of insulin a day to changing the pump site every couple of days. However, I also know the idea can be quite scary and she already has to deal with so much. That is why I've never really pushed it, I just hoped she would show me when she was ready. This morning we went out for breakfast and the topic of getting a pump came up again. She showed a little more interest in the pump this time and said she would try it :). Fortunately, tomorrow is our appointment with the endocrinologist; so, we'll see how it goes!! There are several steps before we can start using the pump, but I'm excited we are on the way!!

Summer Schedule

I remember when I was a kid, the thing I looked forward to most during summer vacation was staying up late and not having to get up early in the morning. But when you have diabetes, its important to stay on a schedule. I have to admit, over the past several weeks we have slept a little later each morning so that now we get up between 7:30-8 as apposed to the 6:00 am alarm when school was in. And Alyssa is going to bed around 10:30-11 pm, when her school year bed time is 8:30-9... well she usually falls asleep somewhere around that time and we put her in her bed :)

I knew last night Alyssa had stayed up later than usual watching a movie. I woke up at 7:40 this morning, pricked her finger (she slept through it) blood glucose level was 147. I made her breakfast (3 little pancakes, sugar free syrup & a cup of milk is exactly 60 grams of carbohydrates), walked her sleepily into the kitchen and she started eating as I made her injections. I gave her her Lantus and Novolog and then proceeded with making coffee and cleaning up the kitchen. When I turned around, I noticed that Alyssa wasn't at the breakfast bar, so I went looking for her and this is where I found her.......

Sneaky Sneaky

Having diabetes stinks and I think it does even more so for a kid.  For the most part Alyssa manages her diabetes very well, knowing that she needs to check if she can have something before she puts it in her mouth.  I try not to keep the joys of sweets from her, my theory is anything in moderation.  She knows that even if she can't have a sweet at the moment she asks, she can save it for later when she can.  This decision is based on her glucose level, how soon it is to a mealtime, her activity level, and the amount of time before she goes to bed.

Yesterday with dinner she asked if she could have a low-sugar Klondike ice cream bar.  The dessert has 25 grams of carbohydrates and so I said that she could have it for desert after she ate her dinner.  With the ice cream, her dinner total came to 75 grams of carbohydrates (Normally 60).  Before dinner her blood glucose level was 144 (good).  Her insulin ratio is 1 unit for every 20 grams of carbohydrates, and because her bg's were good, no correction was needed.  So I gave her 3 1/2 units of Novolog.  All was good. 

At her bedtime glucose check her level was 166 and if they are under 200, she has a night time snack that is 15 grams of carbohydrates to balance her blood sugar level through the night.  She normally handles this on her own, and I'll call out to her, "What's your sugar?" she usually tells me what it is and I tell her if she needs a snack or not.  Well, I told her to get herself a snack (she has her own cabinet full of snacks all that are 15 grams of carbs or less)  However, miss flossy decided that she wanted to have another ice cream bar.  So, I'm in my room on my laptop and I hear my husband ask Alyssa if mom said she could have this ice cream?  "Alyssa!!" She had taken one bite.  Anyway, I had her wrap it up, promising she could have it the next day.  Diabetes is tricky and nights can produce dangerous lows or highs depending on her level of activity and pattern of bg's for the day.  That is why I choose to give her 15 grams of complex carbohydrate snacks that include protein before bedtime instead of sugary treats that can cause spikes and morning highs.  

I know it's tough to not be able to eat what she wants anytime she wants, and trust me, she didn't forget what I told her as she had her ice cream bar with her lunch this afternoon.

What is insulin?

Insulin is a hormone produced by the beta cells of the pancreatic inlets of Langerhans.  Insulin is secreted into the blood in response to the elevation of blood sugar levels.  Insulin then causes an individuals cells to absorb glucose from the blood and store it in the liver and muscles of the body so that it can be used as energy.

More than diabetes....

Alyssa is a beautiful, active, silly, sassy 9 year old girl who just so happens to have type 1 diabetes. She is so much more than a diabetic....Alyssa loves to cheer, tumble, dance, swim, sing, read, give make-overs to her girlfriends, paint nails, and play with her cat, Cookie, and Chihuahua, Poppy. She would rather be outside than in... loves riding her bike and her brother's four-wheeler. If she must stay in, she loves watching music videos on YouTube and playing on Stardoll.com. Her favorite color is green and she loves all things that glitter.....

"Hey I'm a wildflower, growin' in the sunshine
Soakin' up the way of life I was raised in
Runnin' barefoot bloomin' in a summer shower
Ponytail dancin' I can't help it, I'm a wildflower"
(Jane Dear Girls)