Surprise! A Ketone All-Nighter

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Evie came home yesterday from school with a headache and an upset stomach. She gets headaches pretty frequently and for a variety of reasons, diabetes being one of them. Sometimes with nausea, sometimes not.

Her blood sugar had been pretty high at bedtime the night before, over 500, but she came back down with two overnight corrections, so I figured she had just missed a bolus, as opposed to having pump problems. Her blood sugar had not been especially high yesterday at school, or at home in the afternoon….200’s, not great, but not that unusual for her.

She had the headache all day, and had a mediocre appetite at dinner. When I checked her at bedtime her blood sugar was over 500 again, and…..surprise! her blood ketone level was 2.3 mmol/L (red light zone!). I had her test with a urine ketone strip for comparison, and she tested out with Large ketones.

(Neither Evie nor Luke have been especially prone to developing ketones in the past, and we’ve gotten out of the habit of checking regularly. In fact, we check so rarely that I had to open a new bottle of urine ketone strips for Evie to test. Time to get back in the habit.) 

So I changed out her infusion set and insulin reservoir and did a correction bolus, had her drink a huge glass of water, and pushed her basal insulin rate to 175%. And then checked her blood sugar and ketone levels about a million times throughout the night.

By about 3:00 am she had negative blood ketones and her BG was below 100. I checked her again an hour or so later and she was 75, so she drank 4 oz of juice and went back to sleep. She woke up this morning at 65.

I figured she was in the clear until she texted me her blood sugar number from school this morning: 451 at 10: 30 am. Way too high for 2.5 hours after a carefully carb-counted breakfast. Sigh. Her dad brought some freshly opened insulin to school and changed out her pump reservoir again, and she bottomed out at 43 two-hours after lunch.

So the front-runners for probable causes are: bad infusion site, degraded insulin, stealthy illness, or maybe even hormonal insulin resistance?  I wish it was more clear, but, frustratingly, nothing about diabetes is ever cut and dry. Sometimes it just sucks.

Baseball Night Buffet

The orange slice smile….classic!

Feeding us all on baseball game nights has been a challenge! We leave the house at 4:30 in the afternoon, not to return until at least 8:30 at night (hello, bedtime!). Eating dinner at home would mean either an absurdly early meal, or a really late night for everyone. Eating dinner at the ballpark means nachos and hot dogs all around. Neither scenario is ideal.

Tonight I packed us a picnic: cantaloupe, snow peas/carrot sticks/cucumber slices, avocado, whole wheat pita, hummus, pb&j’s, and dried pineapple and graham cookies for a treat. Will had his own dinner packed in his baseball bag, including his favorite dugout snack–orange slices!

Everyone ate, everyone ate well, and I can throw them into bed for a good night’s sleep the moment we walk in the front door. Success!

Diabetes….Run With It!

I’ve had such fun running with my kids this spring!

Will and Luke both surprised and humbled me by finishing a 5K fun run with me a few weeks ago, the longest distance either of them has run before outside of soccer practice. They enjoyed the attention they got by being the two youngest runners, and I was insanely proud of them!

I knew beforehand that Will could run the distance, but I wasn’t sure about Luke. In fact, I hadn’t even planned to have him run, but he stepped up for his bib number without a second thought. I tucked the business parts of his blood sugar meter into his SPIbelt (which is how he wears his insulin pump), along with some glucose gel and meter strips, and we took off! 

Both boys ran about a mile before we had to slow to a walk for a bit. We all stopped again after the second mile for a quick blood sugar check (a little elevated but not worrisome), but Will took off on his own after that. Luke started to struggle a little in the third mile, but always managed to turn on the heat when someone was cheering him on or there was a photographer taking his picture!

Will finished his run in just over 30 minutes; Luke and I crossed the finish line after about 45 minutes. We checked his blood sugar one more time and then bolused for his post-run snack. There’s always a worry during exercise that Luke’s body will chew through his blood glucose too fast and he’ll have a low. Having the tools with us to check for and treat a low blood sugar is non-negotiable!

It was not only amazing to see my two small boys run a distance race, but to witness the pride and accomplishment that they felt within themselves at the finish line! And as icing on the cake, they won 1st and 2nd place in their age group (which I’m pretty sure was created on the spot).

It’s so important to me that all three of my kids feel confidence in their physicality, whether they happen to have diabetes (Evie and Luke) or they don’t (Will). Running a distance race was a perfect way for them to safely feel what it’s like to push themselves towards a physical goal, and to learn that they can do more than they can imagine! This is a lesson that I learned late in life, and it pleases me to no end to see them learning how to enjoy being active now, when it can become a lifelong habit.

A Hypo Mystery

I'm going to need to restock the juice box supply.

So many juice boxes this week….

If Luke is coming up on a site change and it’s close to bedtime, he usually asks me to wait until he’s asleep. No problem. I can pull off his old infusion set and place his new one and he doesn’t even bat an eye.

So last Wednesday night that’s what I did. I also took the liberty to place his new set on a little used place on his body, his upper thigh, for the sake of good rotation.

His BG the next morning was 48, which sometimes happens after a site change, so he downed a juice box to start his day. Pre-lunch BG was 270, he ate about a cup of ziti noodles with red sauce, we bolused for a small BG correction and 45 grams of carbohydrate, and I sent him off to school. An hour later he was 47.

What the….what?

The next day he had nearly the same scenario at school, plus a couple more low-40’s hypos at home. So I pulled his thigh site that night and placed a new one on the back of his arm, the old tried-and-true standby.

Incidentally, both days he was uncharacteristically irritable and aggressive at school and found himself in time out several times. He typically gets spacey and whiny when he’s low, but he doesn’t usually have so much trouble controlling his behavior.

My (loose) theory is that the thigh site was too close to the muscle (this skinny little boy is pretty short on adipose tissue) which caused a too-rapid uptake of his meal boluses. And then the resulting quick drop in his blood glucose caused extra irritability and crazy-boy behavior.

Either that or his pancreas has rebooted.

(Kidding, kidding….)

It’s Race Season….Run! Run! Run!

After several months of holidays, busy schedules, and the resultant relaxation (no, the complete neglect) of my exercise habits, I’m feeling a little sluggish. In the past few years I have maintained a healthy level of fitness and activity through yoga, hiking, running, and whatever else I can grab time for. Physical activity, more than anything else in my life, keeps my mind clear and focused, my emotions steady, and my body strong and healthy. Which all make me a better mom, better partner, better friend….a better woman in general!

So we’ve rolled over into a new year, and are rounding the corner on winter. I’m craving some exercise and the pick-me-up that comes with it. Spring will bring sunnier days and warmer temperatures and….race season!

I just started running a couple of years ago with the encouragement of my sister, Kate, a marathoner. She’s inspirational in her own running and I’ve had so much fun racing with her! And she’s not afraid to yell “Tie that shoe Angie!!!” in the middle of a course.

Downloads

Left: June 2011 Solstice Run, Vancouver WA. Right: June 2012 Pacific Crest Sports Festival, Sunriver OR

Just like Kate has passed her love of running on to me, I aspire to instill the same feeling of excitement about fitness in my kids. Evie has participated in three seasons of Girls On The Run, a great program that builds confidence and love of fitness in grade-school girls. She and I have run three 5K races together as part of that program! I’ve been delighted to run together and encourage her, and to see the pride on her face when she completes a race and improves her time.

Left: Evie and one of her Girls On The Run pals after their Spring 5K. Right: Evie’s very first GOTR 5K. Will and Luke provided moral support and comic relief.

We participated in the weekend-long Pacific Crest Sports Festival last summer in Sunriver, Oregon, and Evie, Will, and Luke got a taste of the triathalon world. They each rocked the Kids’ Splash, Pedal, and Dash, and Will finished with an impressive 6:49 (that’s minutes).

We hung around transition areas and cheered. We watched athletes claw their way to the finish of a challenging triathalon course and then break out in laughter and smiles at the accomplishment! And in our downtime we rode miles and miles of paved and unpaved bike trails through the gorgeous Deschutes National Forest (Bonus!).

Kids' Dash

Left: Luke, Evie, Will (and cousin Ella) at the mini-tri bike transition. Right: Post-race smiles, and medals all around.

The very, very best thing about this particular festival is that it serves to generate excitement for fitness in the whole family. Kids run, moms run, dads run, friends run, strangers run (and bike and swim!), and everybody has a great time!

Emphasis is on personal best and finishing, not winning, and everyone’s efforts are recognized. Our group had racers in both triathalon events, the half-marathon, 10K, and kids’ races, and everybody’s finishes were celebrated wholeheartedly. I honestly can’t think of a better way to make fitness fun and to model that health is important and valuable.

1-mile Dash finishers

Left: Luke, Evie, and Will after their 1-Mile Dash finish. Right: Luke was especially proud of his race medal, and has since permanently affixed it to his school backpack.

So I’ve set a goal for 2013: I will run a 10K race in under an hour. I only have one 10K time under my belt for reference, but I think it’s doable. I have one race lined up for April, and I’m anticipating a second chance in June.

In the meantime, I’ve got to get running!

What activities excite you and make you want to get moving? Please share!

This looks like it could be a great tool! I wonder if I can take a peek at the code book before buying?

See Jen Dance

My CDE noticed my new appreciation for making things from scratch. (Or more often than not, having my husband make things from scratch for me because I hate cooking.) She also noticed that my blood sugars are being poorly affected from miscalculating carb counts in fresh foods.

The quinoa bake was a really good example of the mistakes one can make during insulin dosing. (Seriously… why do pasta and grain packages only give you nutrition information for dry portions?) Since I was getting frustrated not knowing exactly what I was eating when making things from scratch, she suggested I get a scale. But not just any scale – one that measures carbs and other nutrition facts for a multitude of other foods.

I bought one this weekend. Here is my Perfect Portions Nutrition Scale.

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Don’t get me wrong. This is a small investment. My little $5 scale pales in comparison…

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Life Lessons….I Have Those!

My friend Rachel Vidoni, who also happens to be a blogger, recently passed my name on to Rene Syler of Good Enough Mother, a blog about parenting in real life, to participate in a feature called Life Lessons.

Life lessons….I have those!

Some of the questions are easy for me to answer (What keeps you grounded? What do you want to achieve in the next 12 months?), but other more self-reflective questions are proving more difficult (What is your biggest regret? What bad habit would you most like to change about yourself? Aside from motherhood/fatherhood and marriage what are you most proud of in your life? and, When were you happiest?)

But one of my goals for 2013 is to continue to be mindful and present: in my relationships, with my kids and family, professionally, and personally. And that means recognizing that it’s difficult to articulate answers to these questions and forging on anyway. Knowing the answers is important.

So look for my addition to Rene’s Life Lessons soon! What are some of yours?