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.

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 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!!

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)

 

Tumble

Just an update on Alyssa's bg's.... This was her first tumble practice in 12 days. Before practice, her bg was 200.... She had a 15g carb snack prior to practice and drank a low sugar Gatorade throughout. At the end of 30 minutes of tumbling, blood glucose level was 83. Good bye high sugars from last week!! Still on summer schedule for cheer practice, so she's resting up for 3 hrs tomorrow. Happy that competitive cheer is year round :)

Summer Vacation

Alyssa has been experiencing post breakfast highs every morning this week except for today. Also, normally her bg's drop nearly 100 during the night and this week she's only been dropping about 50. (ie. before bed bg's were 200 and this morning 150)

The difference in this week and the others since schools been out for summer is that her cheer gym has been closed this week for the 4th. She normally practices cheer 3 hours a week and also has separate tumble lessons. So I'm sure the decrease in physical activity is affecting her levels. Back to it come Monday though :)

Life with T1 is definitely a balancing act.....

Alyssa's Birthday!!

Alyssa celebrated her 9th birthday this past Friday on June 15th.  The first thing she said that morning was that she wished she didn't have to have diabetes on her birthday.  So, it became my goal to keep diabetes from the forefront.  We had a fun day hanging at the pool with friends.  I knew she would be swimming and running, so I let her eat anything she wanted.  (Of course I kept the meter close by :)).  But she had mini cupcakes, Doritos, chocolate pudding; and, crackers, ham, and cheese.  When we left the pool, bg was 112!  So we stopped at McDonalds for a happy meal where she had a burger and fries and an injection.  That evening she had a few friends sleep over so, we went out for pizza.  Bedtime bg was 200 even!  What a great day!

Now, her party was the following day and her bg's were a different story.  They started off well in the morning, but by the time of her party at 3 pm, she was around 80 ( a little low for her in the afternoon).  She had several friends over and I'm sure her low was because she was so active.  They played on the slip 'n slide and in the jacuzzi.  When it was time for cake, Alyssa went in to change out of her swim suite and it seemed to be taking her a long time.  I went in to check on her, and she was incoherent.  She was trying to put her dry clothes on top of her bathing suite and when I asked her if she was ok, she said she was very tired.  She was very pale and her eyes seemed to be in a daze.  After she answered me,  she immediately started crying.  I knew she was low.  I grabbed a juice box, a container of frosting, and her meter.  Luckily when I stuck the straw in her mouth she began to drink the juice and I checked her bg..... 30!!  That's the lowest I've seen it.  She quickly finished the juice and I started taking finger fulls of icing and putting in her mouth.  In just a few minutes I could see the color coming back into her face.  I helped her get dressed and held her....she continued to cry...she was scared and so was I.  Ten minutes later, bg's back up to 90!!  Relief!!


(We had 2 cakes, this one Alyssa and her friend decorated)

We went back out on the porch where our family and friends were waiting for us and I said, "take 2!"

Packing for Grandma's

Since Alyssa's diagnosis, the only people she has been left with are her two older brothers and her grandmothers.  On Thursday, my hubby and I will be leaving for the Florida Keys to celebrate our 18th wedding anniversary.  Ahhhh.....4 sun-filled days in paradise!!

Before Lu's DX, all I had to pack were her clothes when she'd spend the night away from home.  Now, packing takes much more preparation.

Alyssa's Packing List

*Diabetes supplies (meter, strips, lancets, alcohol swabs, syringes, & insulin)
*Emergency Kit for lows (Glucagon, smartie candies, and juice boxes)
*4 Breakfasts, 4 lunches, 4 dinners, and 24 snacks
 (I pack snacks and meals that I prepare ahead of time that have the exact amount of carbs that she needs for each meal)
*sugar free drinks & water bottles to mix sugar free Kool Aid in
*Schedule
(I type up her schedule and instructions for what to do in the event of highs or lows and add the emergency endocrinologist's number)
*clothes
*favorite pillow & stuffed animal
*games
*movies
*toiletries

Our car will be loaded down on the way to the airport until we drop her off.  What's funny is that everything that I am taking can fit into 1 rolling carry on bag!

Cheer Camp

Alyssa is on a competitive cheer team and this weekend she took part in her first cheer skills camp. Alyssa’s diabetes is very sensitive to extra physical activity, so this requires careful planning and monitoring as well as timing meals and insulin. This is because muscles use up glucose at almost 20 times the normal rate during intense exercise and can result in low blood sugar levels.

During her normal practices in order to avoid drops in blood glucose levels, we check her bg’s before class starts and if she is below 200 she has a carb/protein snack and she has a low sugar Gatorade on hand that has about 15 g of carbs. This snack and drink will replace the glucose slowly as she burns the glucose she has on board and holds her over through the 1 ½ hour practice. In the case of cheer camp, I knew the activity would be more intense and last longer. We checked her sugar when we arrived on day 1 and it was 212, she had a snack and about an hour in her bg was 200. At the water break re-check, her level was at 147, so she had a few grapes and more low sugar Gatorade. By the end of day 1 practice, her level was at 150. Day 2 started at 12:30p, so she ate lunch at 11:30a. When we got to the gym her bg was 300, but she had just eaten and had a lower level of insulin about 30 minutes prior. At the water break, we checked and her level was down to 200. She ate a few grapes and 2 peanut butter crackers. At the end of camp, her bg was 116. I knew her bg’s would continue to drop after the exercise stopped because her team had worked so much harder on day 2, so I let her have a little of the high carb snacks that were offered like cheese puffs, chips, grapes, and even a donut! I chose not to give her insulin and rechecked her bgs about an hour later…99...perfect... her body was still burning that glucose.  If she hadn't had that snack, she would have went low.

Alyssa is such a trooper. She didn’t complain about having her finger pricked 4 times extra because she was having such a good time… We have a longer choreography camp in a couple of weeks and I'm feeling a little bit better about it.

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!

Math skills needed....

After dinner last night, Alyssa went in her room to work on a puzzle.  About an hour later, I went into check on her because she was too quiet and she was fast asleep in her bed....7:30p and way early for her?  I pricked her finger (she doesn't wake anymore) and the meter read 434...wth!!  recheck....413!  I calculated the carbs, she had eaten something she had eaten many times before and had gotten her insulin.  I woke her up and had her get in the shower while I made another injection.  Here is where math skills come in handy....

Oddly, Alyssa usually drops about 100 pts during the night...I'm not sure what crazy girl does in her sleep....but normally I try to make sure her levels are between 180-200 when she goes to bed.  Alyssa's correction rate is .5 units for every 50 over 150, but since her bedtime goal is around 200 and I wanted her to drop about 200 pts., I gave her 2.0 units.  Another problem, sometimes the insulin brings her down too quickly and she feels the affects of a low even if she is not (and if she doesn't eat as well).  So, I also gave her a 15 g carb snack.  I estimated with the insulin and the snack that she would wake up with a bg of about 150.  This morning....the meter read 136... pretty darn close!!

I'm not sure where this spike came from (I searched for evidence of a secret snack, but didn't find any??) I think its instinct to want to find the culprit, although there may not be a tangible one.  I mean really, there is no known cause for this disease so it's understandable that there is no known cause for occasional spikes or lows.   I try not to stress too much when situations like this happen, but its hard not to when your a control freak like me :-/

3rd Annual Diabetes Blog Week: What its like to have Type 1 Diabetes

What it’s like to have Type 1 Diabetes

Managing type 1 diabetes is a balancing act. This daily stabilization of blood sugar levels depends on the four injections of insulin in which the amount is based on food consumed and physical activity through out the day and night. Blood sugar levels have to be checked 6-8 times a day and there is constant worry about highs and lows, which can both be dangerous. Type 1 does not go away, it doesn’t take a break. Type 1 is on your mind constantly and you can never forget about it. It’s a 24 hour a day, 365 days a year job.

A day in the life of Alyssa:

6:15a Wake up, prick finger to check blood sugar

6:30a 2 insulin injections

Eat breakfast

9:30a snack

11:50a prick finger to check blood sugar

1 insulin injection

3:00 p snack

4:30p prick finger to check blood sugar

Cheer/tumble from 4:30-6p

5:45p prick finger to check blood sugar ½ way through practice

If low (usually) treat with juice

6:30p prick finger to check blood sugar

1 insulin injection

Eat dinner

9:30p prick finger to check blood sugar

Eat bedtime snack to avoid lows during the night

*Depending on how her bg’s have been there may be a blood sugar check in the middle of the night. Also, if she is more active than usual, there may be other blood checks during the day.

Mom Going Back to Work: Afterschool and Diabetes

So we are in the 3^rd week of school.  Alyssa has adjusted well to her school schedule.  I recently started working part time in the afternoons, so she has also started going to after school care for the first time in her life.  The great thing is that one of the diabetes care managers at her school is also the director of the after school program.   

Alyssa also started cheer & tumble.  I’ve made sure I check her sugar and give her a snack before the class so that her levels stay balanced.  We’ve have 2 classes and she hasn’t gone low either time.  When she was first diagnosed, she was in the middle of basketball season and even with snacks beforehand, she still ended up going low.  We ended up giving her 2-3 snack during 1 practice.   I think it was the honeymoon period, so now she’s a little more leveled off.

I had a project this week that had to be on a medical specialty.  Of course I chose Pediatric Diabetes.  I am not one that enjoys talking in front of a class, but it was a little easier because it was a topic that was so important to me.

We are just 22 days away from our first JDRF walk.  If you have donated I want to thank you from the bottom of my heart.  More than 13,000 children are diagnosed with Type 1 every year and it is important that we find a cure!  We’ve risen just over $400 through the internet in Alyssa honor.  We feel so blessed that so many people love our baby girl!  We also have more than 20 walkers signed up to walk with us!  It’s very emotional for me to think about our friends and family that are willing to take a stand against this disease and support the research that will lead to a cure.  I love you guys!!

I’m working on T-shirts for Alyssa’s Angels!  I’ll post pictures once I get the final draft!  So, my life’s a bit crazy right now, but I am excited about everything that is going on!

Summer vacay & Getting ready for August 25th....ughhhh

Last Wednesday Alyssa got her cast off!  Yay!  We left for the beach Thursday morning and spent 4 fun filled days there.  The diabetes behaved for the most part while we were there.  She was extremely active, as you can imagine after having to wear a cast for 7 weeks and now finally able to jump in a pool.  Alyssa's glucose levels are very sensitive to activitiy, so we did have a couple of low's, but all in all it was a great time for her! 

I am a full-time student and classes start for me on August 15th.  So, this week I am trying to get all my ducks in a row as the following week the kids will be going back as well.  Today I opened up the care plan packet that I need to fill out for Alyssa's school.  When she was diagnosed we were half way through the year and the nurse walked me through the paperwork in her office, so I really do not recall all of this.  Plus I was a little overwhelmed at the time..... This whole "504 plan" is quite confusing.  I do understand that it means that no one with a disability can be excluded from participating in school and that accomodations have to be made for children with illnesses, handicaps, asthma, allegies and diabetes.  However I do not understand why I have to go in for a meeting with the "504 Board" so they can decide if she falls under the act!?!  She clearly is diabetic, and clearly needs to be able to check her glucose levels and have her insulin injections during school.

Walk to a cure and weekend stuff

Wow!! So excited about everything going on in my life right now! Just registered our team “Alyssa’s Angels” for our first JDRF Walk to a Cure that will be held at Elon University in Burlington on October 8th. The response has been outstanding!! http://www2.jdrf.org/goto/alyssasteamangels

My oldest son, Phillip is touring his first college today with one of my best girlfriends. I can hardly believe that he is a high school junior! I’m still struggling with the fact he just got his license!  My other son, Jamon will be starting the 8th grade at a new school this year!
I have 2 weeks left of my summer break and then I’ll be back to school for my 3rd semester!

We had a great weekend full of celebrations for family and friends~ diabetes showed its ugly head Friday night while we were at a pool party. Alyssa’s levels were perfect all day long, she ate a great dinner, had a lower dose of insulin because I knew she would be swimming (1 armed swimming because she’s still wearing a cast until Wednesday) and then came the dreaded words “I feel shaky.” Her glucose had dropped to 43, the lowest it has ever been. 4 oz of juice, checked in 15 minutes, up to 63, still shaky and now nauseous. Juice usually does the trick, so I think it was lower than the meter read. I gave her about 2-3 oz of Pepsi, checked blood in 10 minutes and back up in the 90’s…whew. Gave her 2 peanut butter crackers, nausea gone and back to the pool she went. Back home, checked again before bed, 300 :-/! What a roller coaster….I know it was the Pepsi, but I felt I had to get that sugar up quick! Glucose tabs tend to take too long; the juice brought it up, but not enough. Saturday was a good day and so was yesterday, I just have to get a handle on what amount of insulin she should get if I know she’s going to be over active. It’s just so difficult to judge?? Tonight she is going to vacation bible school and I am debating whether or not I will give her insulin with dinner, because I know my girl will be chasing all the boys around!

It takes a villiage

It takes a village….

I am so grateful that we have so many family and friends who support, care and love our children. It honestly takes a village to raise a child; this is even more important when you have a child with juvenile diabetes. Fortunately in our situation, family and friends want to be educated and want to be informed about Alyssa’s care.

The first people that need to be educated are the other children that live in the home. I have 2 amazing sons who have always looked out for their baby sister, well when she’s not getting on their nerves. But in all honesty, since she was diagnosed, they are on her like white on rice. We’ve trained them in a sense by letting them check her glucose levels, giving her injections, educating them on what she can eat and what to look for. They have also dealt really well with the changes that have had to be made around here; Splenda instead of sugar, diet drinks, no candy….and if they buy their own candy, they don’t eat it in front of her. And it’s not that she can never have candy, it just has to be monitored.

My mother and mother-in-law have also been a great help. It was about 5 months after her diagnosis before Alyssa spent the night away from home, which was a long time for her because she loved spending weekends with her grandmothers. It’s a huge responsibility and they have made it possible for me and my husband to get away, take a break, and know that our little girl is being well taken care of.

Our friends are the best! I’m hearing about research they’ve read about, food ideas and substitutes. They continuously ask about Alyssa and when we are all together they are genuinely curious about her care and want to take part in it.

Outside of the home, more than likely the first people that need to be educated are teachers and school staff as they are with your child several hours a day. We are very fortunate that Alyssa’s school has a wonderful, caring staff. I’ll have a post about diabetes and school soon as I prepare for Alyssa’s return to school next month.

All in all, the most important thing is for Alyssa to know that she is loved and that diabetes does not define who she is. She is still that smart, silly, busy little girl who just so happens to have a disease. Our family and friends have been a tremendous part in helping her recognize that.

Snack time

Choosing snacks for Alyssa is an ever evolving task. Being a child with high energy, high metabolism, and who could previously eat anything she wanted-I had to become very creative. Her snacks need to be around 15g of carbohydrates, which does not include regular chocolate chip cookies (her favorite).

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 carbs and there are tons of varieties. It also gives her a chance to have those chocolate chip cookies in mini size. Sugar free jello pudding, ritz bits snack packs, gold fish snack packs and 4 to a pack of peanut butter crackers are all 15g of carbs or less to. 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. ). 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.

Counting Carbs...highs and lows

Juvenile Diabetes is a condition where the pancreas produces very little or no insulin which is the hormone needed for glucose to enter the cells and produce energy. If there is not enough insulin, glucose remains in the blood stream and can result in heart damage, kidney damage, vision problems, and skin problems--just to name a few of the major complications.

Alyssa's diabetes requires her to have 4 injections of insulin a day. With her 3 main meals, she has Novolog which is based on the amount of carbs she will eat with her meal and her current blood sugar. In the morning she also has an injection of Lantis, which is a long lasting insulin. Her 3 main meals consist of 45-60 grams of carbs and then she has 3 snacks (mid morning, mid afternoon, and before bed) that consist of 15 grams of carbs each. Her glucose levels are checked 4-6 times a day, poor little fingers; including in the middle of the night. The purpose of this diet plan is to keep her glucose levels between 100-180 (as she feels symptoms when she gets below 100).

I have found that her activity level majorly affects her levels. Alyssa is a very active little girl and it did take some time to get her adjusted. When she was first diagnosed, I thought our biggest ploblem would be to keep her sugar levels down, but in her case, with the insulin and her activity level, we stuggle with lows. Since she was diagnosed, working with her physician, we have had to adjust her insulin several times. Just when you think you're getting balanced, she starts having highs or lows...sometimes both in the same day.