Tag Archives: T1D

Hypoglycemia Unawareness

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“Actually, I’m feeling a little low…..”

This was Luke’s response when I asked if his blood sugar was high, a question brought on by some mildly squirrely behavior. (Although in hindsight, the alligator tears over a minor disagreement with his brother should have clued me into to the hypo-in-progress.)

I could not have been more surprised to see this number on the meter.

If, at 31, he just started to be aware enough of a low blood sugar to tell me, and I just started to see symptoms that would make me ask the question, what was going on in his body in between 30 and 80? Or is the meter/strip just too inaccurate at those low numbers, and he wasn’t truly that low?

He gobbled down 4 glucose tabs and a 16-gram yogurt, and when we rechecked a few minutes later he was up to 96. Phew.

This is the second time this week that he’s crashed into the low 30’s, with no symptoms or awareness, after a breakfast site change. Next time I change out his infusion set I’m going to do hourly checks until I’m sure his numbers are staying up!

The Perils of a Hotel Mini-Fridge

Two Bottles of Frozen Insulin

We took a road-trip North to Great Wolf Lodge (aka, Kid Paradise) yesterday to celebrate the end of the school year. The boys were in charge of packing the cooler at home before we left, and unpacking it into the hotel room’s mini-fridge when we arrived.

What I neglected to do is double-check their work.

What I found when I went to pull out yogurts for breakfast this morning is that my efficiency-minded little boys had packed all the smallest things into the smallest part inside the fridge. We grown-ups know this part as The Freezer.

Another small thing from the cooler? The little container that held the insulin bottles I brought with us for Luke’s site change he’s going to need this morning. *stomach drops*

Yes, my friends, this is what frozen insulin looks like. And consequently, now completely useless insulin. Dead insulin on vacation? Awesome. Let the trouble-shooting begin….

DBlog Week 2013, Day Two: We, The Undersigned

Click for the We, The Undersigned – Tuesday 5/14 Link List

“Recently various petitions have been circulating the Diabetes Online Community, so today let’s pretend to write our own. Tell us who you would write the petition to – a person, an organization, even an object (animate or inanimate) – get creative!! What are you trying to change and what have you experienced that makes you want this change?”

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To: Medtronic

Re: The MiniMed Paradigm® Revel™ Insulin Pump

Petition: We, the undersigned (me), feel that the MiniMed Paradigm® Revel™ Insulin Pump should be programmed to, at the very least, flash brilliantly and emit a siren sound when the pump reservoir completely runs out of insulin.

Yes, I know there is an alarm that tells me when the reservoir is low, and I know I have control over at what remaining volume the alarm sounds.

But I have lots going on. And two insulin pumps to keep track of. And one child who rarely even tells me when her pump alarms. And while the regular “boop beep boop” sound is fine to remind me that the reservoir is running low, there really should be a different kind of alarm for when the insulin level finally reaches “–.–” (empty).

Because there’s not a different alarm, there’s no way to know when the pump runs dry, and then its a guessing game to determine how much insulin they’ve actually received. (“How long has your pump been alarming like this??? It’s completely empty!!!“)

I need something that will get my attention.

Like flashing LED lights and a horn sound. Which would also serve as a deterrent for my forgetful daughter. Can you imagine having that happen in the lunchroom at school? She’d never forget again!

I love my kids’ pumps. They are fabulous and I have no other issues with them besides this. So please, Medtronic, help out a busy mom and build this flashing-light-loud-and-insistent-can’t-miss-it-alarm feature into your future models. Is that too much to ask?

DBlog Week 2013, Day One: Share And Don’t Share

Click for the Share And Don’t Share-Monday 5/13/13 List of DBlog Post Links

DBlog Week is an entire week in which diabetes bloggers will be posting daily using pre-determined writing prompts. I’ve never written every day for a week before, so this is going to stretch my brain in a new (and hopefully interesting) way. I can’t promise that the chaos of my life won’t interfere….some posts may happen in the wee hours of the night….but I’ll do my best to write on every topic!

So here goes….

“Often our health care team only sees us for about 15 minutes several times a year, and they might not have a sense of what our lives are really like. Today, let’s pretend our medical team is reading our blogs. What do you wish they could see about your and/or your loved one’s daily life with diabetes? On the other hand, what do you hope they don’t see?”

First off, our endo provider is also a parent of type-1 diabetic kids, so I know he already “gets it” in the visceral sort of way that providers without type 1 kids can’t. All of the anxiety, stress, worry, chaos, uncertainty, and fatigue that I feel is something I know he understands. That’s a blessing when it’s time to come in for those dreaded check-in appointments.

So for all the other providers out there who don’t have such a personal connection to Type 1, I wish they could see that I eat, sleep, and breathe diabetes. It’s ever-present in my mind; sometimes at the forefront, when I’m in the middle of carb counting or a set-change for instance, and sometimes just as a low-level anxiety, like a mosquito buzzing in my ear.

I download insulin pumps every two weeks to search for patterns and make pump adjustments. I memorize food labels and ingredient lists. I organize and keep inventory of our myriad diabetes supplies. I skip sleep to make sure I get middle of the night blood sugar checks and corrections done. I read about diabetes. I research available technology. I troubleshoot, and I problem-solve, and I teach, and I teach some more. I haggle with our insurance and mail-order pharmacy for hours. I worry about exerting too much control over their food choices. I worry about exerting too little control over their food choices. I worry about everything, and yet I know that I’m doing the best I can.

I take that on as a mom so that my kids don’t have to feel that, and so it doesn’t dictate our family life. I keep a straight face even as I’m stressing about their upcoming A1C results, so they don’t ever feel like they’re burdening me. I talk with them about their diabetes in an age-appropriate way, all the while thinking about the very real and life threatening implications of the disease.

It’s a lot, and sometimes it’s overwhelming. What I never want my providers to see (but which I have to cop to), is that we sometimes go 4-5 days on an infusion set because I don’t have a great system for remembering to change them. My kids eat more treats than I’d like and is good for them. A lot of the time we’re rushing around and I do things like forget their diabetes kit, or that they needed more strips. Lancet-changing….doesn’t happen.

An although I know I’m doing the best I can, there’s always room to do better. I’m going to be so happy when I’m doing enough to finally see some good Hemoglobin A1C numbers. More on that another time….

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.

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….)