Forgotten Wallet Buys a BG of 25
Perhaps you saw the picture that I posted yesterday of Arden making a play during her weekend long softball tournament? It was accompanied by a caption that read, "Tournament champions! Five games in two days, not one low BG. OmniPod & DexCom perfect together. #diabetes #softball #undefeated".
Tournament champions! Five games in two days, not one low BG. OmniPod & DexCom... perfect together.#diabetes #softball #undefeated
I probably could have written a blog post about the experience but I was still plenty exhausted from the weekend - so I went with a simple photo to not only celebrate, but to let you all know that it can be done. Long hot days, travel, little sleep and a lot of exertion can be managed with a few diabetes tools and a little extra focus.
Do you know what a CGM and insulin pump can't help you with? They are not designed to remind a person that they put their wallet into the glove compartment of their wife's car - if they did, yesterday would have gone much better.
This is the story of a blood glucose reading of 25, that happened in a restaurant - it was an old school low, no working CGM and enough rookie mistakes to fill sharps container. Ready?
As previously mentioned, Arden had a softball tournament that lasted all weekend and required us to stay in a hotel on both Friday and Saturday night. In the fine tradition of baseball/softball lunacy, we scampered from the field Sunday afternoon moments after Arden received her championship trophy, to make the ninety minute drive home... so our son Cole could pitch in a 4:30 pm game (Five innings, no runs btw). Anyway, during that drive I put my wallet into the glove compartment of my wife's car and never removed it. This was no big deal, until I found myself in the parking lot of a restaurant the next day - with no money.
I guess that I felt pretty silly having driven ten minutes to the restaurant with my kids and one of Arden's friends in the car only to find that I didn't have any money. I couldn't believe that I forgot my wallet. Then I recalled that it wasn't just abandoned at home, but was in Kelly's car. I thought for a second, asked my son if he had some cash that I could borrow and we drove home to get it from his room.
Ten minutes to the restaurant, a few minutes sitting in the parking lot figuring out what to do, ten minutes home, a few minutes to gather the cash and ten minutes back - then we got our seats, read the menu and ordered.
Lots of confusion, lots of running around - lots of opportunity to forget that I pre-bolused Arden for the meal, when we initially left to go out to eat, you know - almost an hour ago!
My brain snapped back into diabetes mode when Arden said, "Dad, I feel dizzy". I asked her to test. It took a few moments then suddenly the math came to me, Ten minutes + five + ten + five + ten + ten x I bloused for a meal / the CGM is still calibrating = JUST DRINK A JUICE!
I stayed calm not only because we were in a restaurant but because one of Arden's friends and teammates was sitting in the booth right next to her. I prioritized; stop seizure, try not to panic, juice, test, stay focused. Arden's BG was 50 when we tested but I could tell, even without her CGM that she was dropping fast. Not because I knew how long it had been since we bloused, not because a could see it in her face - I could tell because of what she said when I asked her to keep drinking.
Arden took a few sips and then put her head on the table. In my opinion, one of the most frightening and nauseating side-effects of low blood sugar is the inability to care about your own life. "Arden keep drinking, I really need you to keep drinking". She didn't move, I knew she heard me but she could make herself care. Arden understands what will happen if she doesn't drink the juice and she couldn't, because her blood didn't contain enough glucose, make herself care about her own life.
I instructed my son to stand up and then I picked up Arden and moved her to my side of the booth. "Cole, go get apple juice from the waitress, walk right up to her - be fast". I got Arden to finish the juice that we carried and tested again, her BG was now twenty-five. With no CGM arrows to rely on, I just wanted her to keep drinking. Cole returned with the apple juice (Arden doesn't like apple juice) and I had to beg her to drink it - I whispered in her ear, "Arden, please drink this, I think you're about to have a seizure", she responded without hesitation, "I don't care".
Before I knew about diabetes, if you would have told me that a reduction in the amount of sugar in a person's blood would make them cease to care about preserving their own life, I would not have believed you. Continuing to exist is perhaps our most basic and natural instinct, it has kept humans alive and thriving for untold millennia and yet, too much insulin can make you lay down and die without a fight - even when the fight is something as simple as drinking a juice.
I kept talking until she would drink, soon the waitress brought bread and other foods, Arden began to eat and a few minutes later her BG was above fifty. She took a few more minutes to pull herself together and then asked to go back to her original seat, with her friend.
My heart wanted to race but I stopped it from doing so, my eyes wanted to cry but I did not let them. I couldn't breath and I couldn't stop thinking about all of the avenues that I should be considering. Where is more sugar if I need it, when do I let others know how close we are to a real medical emergency, "don't you dare panic", and how the hell did you leave your wallet in Kelly's car? A swirl of thoughts and emotions but they were no longer needed, it was over as fast as it had begun. Now all I had to do was try to put my thoughts all back where they belong. Then the waitress put Arden's meal in front of her and I had to, and this almost seems unthinkable, had to count the carbs that I used to stop the low because I was going to have to bolus again for the meal. Only brave blousing can stop a rebound high. Time to be brave.
I must have looked terrible by this time because my son asked me if I was alright. I only responded, "It sucks being an adult sometimes" - and then we ate lunch.
From Friday night until Monday at noon, I made hundreds of decisions about Arden's diabetes. Some how I was able to manage her through five softball games, swimming, at times - less than healthy food choices, exposure to the hot sun and then I left my wallet in my wife's car - a simple mistake made on Sunday night that took us up to the brink of Arden having a seizure on Monday afternoon. Had Arden not felt dizzy, I don't know what would have happened.
UPDATE: I probably should have included in the original writing that Arden's BG, at the time of the pre-bolus, was 230. It was a restaurant that we frequent, knew what she was going to order and how many carbs it contained.
Arden's Day of Diabetes: #DayofDiabetes
Around a year ago the JDRF did this cool thing where people could sign up for text alerts that were meant to simulate having diabetes - so people could understand better the relentless nature of living with type I. I loved that idea, but how could I not? That's exactly how I started Arden's Day.
Six months ago some wonderful folks did it again on Twitter using the hashtag, #DayofDiabetes and I loved the idea even more (Twitter is perfect for this) and participated in the event. Those same people brought up doing it again today - I'm in.
I'll be tweeting, Facebooking and refreshing this blog post all day whenever diabetes requires interaction. I wonder what kind of day with diabetes this Day of Diabetes will be?
Midnight: My day with diabetes began around midnight when a late evening bolus just would stop. Managed temp basal rates to get Arden's BG to 110.
4 AM: Up again to set more decreased temp basals. Finally gave up around 5 AM and gave Arden some juice (1/4 of a box) . Ended up staying awake because the juice wasn't working. Of course, the juice I added at 6 AM ended up being too much - figures.
7 AM: Up for school and now blousing to stop the BG rise from the second juice sips. CGM now 160, arrow straight up. Juice sips worked too well!
7:50 AM: Replaced juice box in Arden's bag (Used it last night for a low during softball pitching practice), set a timer for 45 minutes on her phone. Going to try and eliminate high BG (190 CGM) before school snack at 9:30 am.
8:28 AM: Blogged about diabetes
9:07 AM: Just texted with Arden, need her to test her BG. She told me to "wait five minutes" apparently they are in the middle of a contest. #DayofDiabetes
9:30 AM: Arden and I texted for her school snack. BG was 190, stubborn this morning. We boluses for 30 carbs. I asked her to test, she wanted to bolus from CGM. She said, "Fine I will but if they match I will poop on you" - I hope she meant the emoticon. They matched BTW.
11:00 AM: Lunch time text.
1:48 PM: Post Gym #CGMnow is 97. Temp basal off for 30 min and a few carbs should hold it there. We’ll see. #DayofDiabetes
2:30 PM: Arden will be home soon. Time to pack a bag with supplies so we can go watch her brother play baseball for the school team. I don't remember what it feels like to run out the door with just my wallet and keys. #DayofDiabetes
3:16 PM: So the one day I try to outsmart an after school drop in BG... diabetes does the opposite. 185 and creeping up. Damn
5:07 PM: Some mini muffins will stop the bg fall. Only bolusing for half. #DayOfDiabetes
6:30 PM: Made a wild guess about dinner carbs on the way to a restaurant. Needed the pre-bolus time to work on a slightly elevated BG. I won't know hoe well I guessed for about 90 minutes.
Pitstop fail!
Allow me set the scene
Arden's school has a half-day scheduled and one of her friends has organized an outing for a few of the girls after school. The group is being picked-up by one of the mothers for lunch and a manicure, I am not attending. We will manage BGs as we do while Arden is at school, a sleepover or other out of the home events.
What could go wrong? How about, literally everything...
We were battling a stubborn blood glucose number all morning, it was one of those 180ish numbers that just won't budge. Arden's pump was due to be changed later in the day but I thought it could make it just a little longer - I was wrong.
Arden's morning snack sent her BG into the 300s but we didn't know immediately because her DexCom sensor gave out just after we bloused for the snack. Are you following so far? Pump site going bad, just ate, CGM not reporting.
When Arden texted that she was getting ready to leave school, I asked for her CGM number and she replied, "It says ???". Okay, no problem, "we can just test a little more while you're out", I said. Knowing that they would be at the restaurant in under ten minutes, I asked her to test so that we could bolus for lunch... Arden tested and was over 340.
It was then that I decided to go to the restaurant and perform a 'diabetes pitstop' in our car. Seemed easy, and I had a plan. I wanted to changed her pod, swap her CGM and inject insulin for her high BG and the food she was about to eat. I didn't want all of this to ruin her outing so I didn't think twice about letting her eat with the high BG, normally we'd wait.
In my imagination, I saw Arden hop into my car; we'd switch her pod and pop off the old one, inject some insulin, swap her DexCom receiver, and she'd be back inside before anyone realized that she had left. Smooth, like a pitstop.
Arden got into my car and I told her my plan, she looked at me like I had two heads. She was not thrilled about trying all of this in a car.
Putting on the new pod went smoothly, but she wasn't terribly comfortable getting an injection in the cramped car. After a bit of drama, we injected and moved on to the DexCom receiver and that's where, to use a topic specific metaphor, the wheels came off.
Arden has been wearing a DexCom CGM for years and years and we have never, I want to reiterate - NEVER hit a vein upon insertion - until we tried to do it in my car, outside of a restaurant... while her friends were waiting for her. The blood would not stop, it was gushing out from under the sensor and going in every direction possible.
Arden freaked out just a little and I began to feel defeated and then she said something that broke my heart, "Let's just go home".
I removed the sensor, stopped the bleeding with some glove compartment napkins (Huge thanks to my wife for suggesting that I keep napkins in my glove compartment) and worked to help Arden find a little calm. When she relaxed I told her this...
There are going to be times when diabetes is difficult but we can't let it beat us, we can't give in to the feeling that is telling us to go home. We live our life no matter what. This isn't how you hoped today would go and I am sorry that my plan didn't workout very well but you are going to pull yourself together, go back inside and eat with your friends. Then I want you to get your nails done and forget about all of this, it's over - you're fine.
I felt like crap when I dropped her off at the door to the restaurant, I couldn't believe that so much went so wrong, all at once. Moments before, Arden asked me why we were having so many problems and I responded, "It's just bad luck - randomness that seems like it's not". She laughed when I told her I was sure that we had used up our allotted 'bad luck' for the month in the last five minutes.
Arden went on to eat and laugh with her friends, she got her nails painted purple and had a wonderful afternoon. I'm grateful that I didn't give-in to the pressure that diabetes put on us, I think that it would have been a serious personal setback for Arden and perhaps me, if I would have taken her home.
Proud to say that this blog entry is a Best of the 'Betes Blog winner. Thank you for nominating me!
There is a ton of value in persevering through moments like these because you can't replace or recreate the tough situations that teach us the most. I know that none of us want these challenges, but there is so much that you can take from them... sometimes they are worth the hassle.
Weekend Roundup
Happy Blue Friday, I hope you enjoy the weekend and a few of these initiatives, stories and a giveaway.
You take the quiz and a diabetes charity that we all love gets money - nice!
When you take this two minute quiz Novo Nordisk will make a donation to the Diabetes Hands Foundation.
Help Strip Safely to effect real change in the FDA's meter rules.
from strip safely: "FDA has two draft guidance documents about blood glucose meters that are open for comment until April 7, 2014. A “draft guidance” is basically a preview of what standards the FDA is considering requiring in order for blood glucose meters to be cleared — the law requires that FDA open its draft guidance documents up for comment before publishing a final version. FDA welcomes comments from the public, and so we highly encourage everyone affected by diabetes to submit their considered thoughts." - I did it last night, it's easy and important. Go take a look.
This week on Arden's Day
We are giving away a pair of diabetes circles shoelaces - easy to enter
This simple pancake recipe is easy on Arden's BGs
Does your DexCom make you sing?
I wrote a piece for Disney about spousal engagement and your child's diabetes management
Name that Tune: Diabetes Edition
You know how hearing a certain sound or word can make music begin to play in your head, sometimes you are even prompted to sing out loud? That happens around here more than you would expect and almost always because of diabetes.
You know how hearing a certain sound or word can make music begin to play in your head, sometimes you are even prompted to sing out loud? That happens around here more than you would expect and almost always because of diabetes.
Available on iTunes
This first one always gets me and most times I can't stop myself from singing out loud. When Arden's BG gets low, her DexCom G4 'beeps' three times... BEEP, BEEP, BEEP...
As soon as the tones stop, I sing, "Everybody get up...".
Check out the music, see if you hear it too.
Available on iTunes
Arden has said in the past that she can "feel the fall". What she means is that when a high BG is beginning to come down, before her meter or CGM can even tell what's going on; she can sense that it's happening.
She'll look at me very seriously as she tries to make sense of the sensation. Then she looks right into my eyes and says, "I think I'm falling...". There is something about Arden's phrasing that makes us all sing-along with Ms. Alicia Keys.
Also on iTunes
It's a simple question that gets asked about thirty minutes after we bolus for an elevated blood glucose,
"Arden, is that insulin working... check your CGM" - When everything is going as planned Arden answers, "It's going down" and the entire house sings...
"I'm yelling timber!"
On iTunes
More music courtesy of the DexCom G4. Two beeps can indicate a high or rising BG. In this house they are also an excuse to sing the theme from Rocky 3.
Rising up!
We listen to all kinds of different music but I there is just something about diabetes that makes catchy pop songs jump into our heads. I'd love to know if this happens in your homes, I think if it did... I may feel less weird the next time I belt out, "Everybody get up!". I can't wait for the next wave of summertime radio to arrive so we can replace a few of these songs, I need a new diabetes playlist - this one is so 2013. Don't worry, I'm keeping 'Eye of the Tiger'
