Dawn Phenomenon and Pump News

Alyssa has experienced high blood sugars in the morning for the last two weeks or so.  High for her morning level is anything over 150.  As I have mentioned before, Alyssa's blood sugar usually drops about 100 over night.  So my goal is to have her sugar somewhere around 200 at bedtime.  If her glucose level is below 200, she'll have a bedtime snack and if it is close to 200 she will not.  What was odd, I was seeing high blood sugars in the mornings and even after the nights she didn't have a bedtime snack.  Could this be the 'dawn phenomenon' I've been hearing about?

Dawn phenomenon is the term used to describe early morning (usually between 2a-8a) high blood sugars in diabetics.  It is thought that the body releases hormones over night, like the growth hormone and cortisol, that cause insulin resistance.  Alyssa takes Lantus in addition to Novolog, which is a slow release insulin that normally works for 24 hours.  I've heard though it can often be unpredictable with schedule changes.  Of course other reasons can be incorrect dosing of insulin or eating too many grams of carbs before bed.  In my opinion, I think it is tied to activity level as well. 

What this means?  I will again be waking at 2 in the morning checking blood sugars to see if there is a rise in the middle of the night for a few days and see if adjustments need to be made to her diabetes plan.

Pump news: We looked at 4 insulin pumps the other night.  It was really cool because Alyssa got to touch them and see how they worked.  After the pump class, I read all the information and narrowed down to either the Omnipod or the Ping.  We have chosen to go with the One Touch Ping.  I really thought Lu was going to push for the Omnipod because it is tubeless and stays on, but she liked the Ping best.  The cool thing is that it is 100% waterproof and Alyssa also liked their infusion sets the best, which are easily inserted and come in different colors :).  So yesterday, I faxed all my insurance info over the the rep and we have started the process.  Next step will be to see how much they will cover!

http://www.animas.com/

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!

Type 1 Diabetes...need more snack ideas

Choosing snacks for Alyssa is an ever evolving task. Being a child with type 1 diabetes, high energy, high metabolism, and one who could previously eat anything she wanted....means mom had to become very creative. Her snacks need to be around 15g of carbohydrates to keep her blood sugars level.  I always keep sugar free jello, sugar free popsicles and cheese sticks on hand, as they are low carb alternatives when Alyssa’s hungry between snacks or meals. She loves vanilla flavored yogurt and a serving of the light is 14g of carbs. All the little 100 calorie snack packs have somewhere between 14-17g of carbohydrates and there are tons of varieties and great when you're on the go. It also gives her a chance to have chocolate chip cookies in mini size :). Sugar free jello pudding, ritz bits peanut butter snack packs, gold fish snack packs and 4 to a pack of peanut butter or cheese crackers are all 15g of carbs or less too. If she experiences a low blood sugar, I usually give her a 4oz. juice box followed by a protein/carb snack of cheese and crackers or cheese and a few grapes or apple slices. She has 3 snacks a day and who would want the same thing over and over? Therefore, I am always on the lookout for new snack ideas.




(An updated version of a early post).

What is A1C??

I have had several readers ask, "What is A1C?"

Of course, prior to Alyssa's diagnosis, I didn't know either.

Basically, A1C is a blood test that reflects patients blood glucose levels for the past 2-3 months.  Specifically, the A1C test measures the percentage of hemoglobin (the protein in red blood cells that carries oxygen) that is covered with sugar.  The higher the level, the higher average of blood sugars and the higher the risk of complications.

A normal A1C is between 4.5-6%, which means an average of 80-135 mg/dl (blood sugar levels).  An A1C 6.5 or higher indicates diabetes.  There is also pre-diabetes which is an A1C of 5.7-6.4%.  For most adults with diabetes, the ideal target is an A1C of 7% or lower (average bg's 170 or lower).  With children, the target is 8 % or lower (average bg's 205 or lower).

Counting Carbs

Counting carbohydrates can be quite difficult when your type 1 child eats something that doesn't have a label.  This week, Alyssa has been going to vacation bible school and the first thing they do is eat dinner.  The first day was pizza, applesauce, Oreos, and a Capri Sun (I brought a Capri Sun Roarin' Water because it only has 8g of carbs compared to the 22 in regular Capri Sun).  I knew a regular applesauce cup has about 22g of carbs, at least the brand I buy does.  I knew a regular slice of pizza has about 45g of carbs.  The Oreos were 25 g of carbs for a 3 cookie serving, but she only ate 1 of them.  Adding it all up in my head....this was a total of about 83 grams of carbs which would normally mean a basal rate of 4.15 units of insulin.  However, I knew she was going to be running around like crazy for the next few hours and burn up a lot of those carbs, so I decided to give her 3 units of Novolog.

At the end of VBS, blood glucose check read 212 (honestly, I thought it would be lower, but not too bad).