Treating Lows

When I ask Alyssa what it feels like when her blood sugar is low, she says that she feels like she's shaking and her heart feels like its going to beat out of it's chest.  What I notice when she's low is that her face pales and although she's cool to the touch, she breaks into a sweat.  Also, her pupils dilate and her speech is affected.....it appears as though she's drunk.  Last night, just before bed she came to me and said she was low.  She was already treating herself with a juice box, as she had checked her sugar and it was 34!!  I sat her down and retrieved the Smarties from our supply cabinet and gave her a few of those after she finished the juice box.  This is always a touchy time because there is always the chance she'll lose consciousness.  The 15 minutes before re-check seems to last forever.  Then just as quick as the low came on, the color starts to return to her cheeks, her words become clearer and she says she feels better.  Re-check 92.  I gave her 4 peanut butter crackers.  At about 2:30 a.m., I checked again.....bg of 187. 

She had an 1 1/2 hour cheer practice earlier that evening, but her bg's were good before and after.  And what was crazy, was that at this time she was just playing on the laptop, nothing physical. She had a normal bg before dinner and ate really well.  Ughh....unpredictable!!

The D-O-C

When your child is first diagnosed with diabetes your world is set into a spin, especially if you have no previous exposure to the disease.  In my case, my step dad was diagnosed when I was in my early teens and I had gestational diabetes when I was pregnant with one of my children.  So, I had a little understanding of the physiological aspect of type 1 diabetes.  However, when my daughter was diagnosed I still felt like a steam roller had flattened me.  My new job was going to be her artificial pancreas.  I was going to have to measure and calculate what she ate.  I was going to need to determine the amount of insulin she needed based on her blood sugar levels and consumption of food; all while being sure to account for her physical activity.  I wasn't sure if I was the best person for this job.  What if I messed up?  What if I made a mistake?  And then there was the fact that our entire lives were flipped upside down.  This disease affects the entire family.

We were and are very fortunate to have a supportive "village" that immediately jumped in to help us make sense of this situation.  But what we needed too were other families who lived with this disease, who had been where we were.  I began to search the Internet for more information about living with this disease and stumbled across a mother's blog, D-Mom, The Sweet Life with a Diabetic Child.  I read her current and older posts.  Her blog led me to another d-mom's blog, and so and and so on.  Their blogs also led me to Facebook groups and Twitter events.  This is the Diabetes Online Community (#DOC).

Connecting with the DOC helped me know what to expect when my daughter returned to school after her diagnosis, helped me figure out what a 504 plan was, and led me to volunteering and advocating...they led me to start this blog.  From the DOC I've gotten advice, support, and understanding from other parents who live similar lives.  From the DOC, Alyssa has built relationships with other children who are like her....who have to prick their fingers and take injections and who feel bad when there sugar levels aren't just right.  (And they've helped us choose what pump we will get)

If you or your child is newly diagnosed, my advice to you is to connect through blogs and social media with others who have been where you are.  I'm sure glad I did!

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/

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).

I thought I had it together.....ugh

So, today was our quarterly visit with the pediatric endocrinologist.  Interesting morning, to say the least.  To start things off, I didn't sleep well last night, so when the alarm rang this morning, I didn't want to get up.  Thinking maybe I shouldn't have....  We did Alyssa's normal morning regimen and she asked if she could have a little coffee this morning. So, since she was up earlier than she had been in a few weeks I thought a little 'children's coffee' might help her get going.  I measured the milk, sugar free creamer and mixed them with a little coffee.  I accounted for that with her Novolog dose and we hit the road to drop her brother off at his first day of driver's ed and then on the see the doctor.

When the nurse called us back, she wanted to check Alyssa's blood glucose levels and I thought for sure it was going to be within range.  At this time it had been 2 hours since she had eaten....but a reading of 405.  I was floored!  She hasn't had a reading like that is such a long time.  Re-check...305...better, but what the heck??  I felt terrible.... I mean, I carefully measured her food, counted the carbohydrates, and calculated the insulin dose.... all of a sudden I felt like the worst mom in the world.  I mean, I know realistically that things like this happen and diabetes is a very tricky disease.  Sometimes bg's fluctuate for reasons out of our control like stress or excitement.  I know Alyssa and I both were excited to discuss the insulin pump with the endo.  Another blow, her A1C was 8.2, up from the last visit.  Ideally, they would like to see it 8 or less.  Ugh!

Well, on a happier note we did discuss the pump.  We are scheduled for an insulin pump class on Tuesday evening.  After we pick out the pump we want, the next step will be to contact the insulin pump company to start the purchasing process and see what pump and how much our insurance company will pay for.  I'll go into more detail in another post about the process of getting Alyssa started on the pump and the steps we'll take in the near future.

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.

Mother of the Year

I do not know what has been wrong with me this week.  Maybe my brain fog has been caused by the leftovers of my sinus infection last week or from my new diet I started this week??  Or maybe its because I've been scrambling around getting everything in before the deadline for my new school that I will be attending in the fall.  It's been an interesting week for sure.... I hit my oldest son's truck pulling out of my driveway, I got stung by a bee, I did something to my hand....and then the winner this morning....

My son Jamon rides to school with a friend, so I drop him off on the way to Lu's school.  As I pull out of their driveway, it hits me, Alyssa didn't get her insulin!  Really?  Like she hasn't been getting insulin every morning for the past year and a half? The injections were made, it just totally slipped my mind.... I whipped the car around and headed back towards the house....arguing with my self.  How could you forget?  Remember, you are human.  Alyssa gets two injections in the morning, Lantus (a slow release insulin) and her quick-acting insulin, Novolog.  Normally, she checks her BG and I go ahead and give her the injections before she eats.  This morning though, her bg was 86, and because the Novolog usually drops her sugar pretty quickly,  I decided I would wait until she had eaten her breakfast to give her the injections.  I'm apparently not good with a change in protocol.  Ahh the anxiety...  

Anyway, we rushed home and I quickly gave her injections and we were back on the road to school.  And, we made it on time!  Hopefully there are not too many more mornings like this...not good for my inner control freak!