Sports Induced Adrenaline

It that time of year, basketball and other indoor running sports are in full swing. Diabetes common sense dictates that an hour of running could and likely would cause a drop in your child's blood glucose level. Some of you, heck - most of you, probably have that exact situation going on. Basketball, soccer and other running based sports probably have you checking BGs, whipping out juice boxes and worrying during early morning games in gymnasiums all over the world. 

But if you have a very competitive child... you may be experiencing rising BGs that are impossible to trace. This is the case for Arden. During basketball practice last week her starting BG of 130, never moved throughout the almost ninety minute practice. Arden ran drills, shot the ball and played defense at practice speed (Slower than in a game) without experiencing a change in her BG. As it turns out, when the scoreboard lights up, Arden wants to win, and she wants to win enough for her fight or flight response to kick in. 

I've devised a plan in which we bolus at the beginning of her basketball games in the amount equivalent to what a juice box would require. Most games, I can keep her BG around 180, but last week it jumped up to over 200 and caused me to have to bolus again during the game. The problem we run into with covering adrenaline is this... As soon as the game is over, the adrenaline disappears, and Arden's BG quickly begins do drop.

That's when the adrenaline bolus needs to be feed, luckily Arden is particularly hungry after she plays. This week she fed the bolus a waffle.

You can really see what I'm talking about in the DexCom image above. Arden woke up at 8 AM and I gave her a small correction that didn't do much by the time the game started at 9 am. By the end of the first quarter though, I had to give Arden a huge correction bolus (Big for her, 1 unit) to combat the significant rise (Her DexCom arrow was straight up). By the time the game ended and we sat down in a diner, Arden's CGM was reading 140 with an arrow straight down, I still bolused for half of the waffle, and as you can see Arden's BG was 101 and steady as we left the restaurant. Be aware that these mornings need to be tracked closely in the hours that follow, because after all of the insulin and food finishes, you never know which way BGs are going to go.

Please also keep in mind that the amount and severity of the adrenaline fueled rise will vary from person to person or it may not happen at all. It really does depend on the individual's level of competitiveness, for some children, basketball may react like other exercise. Arden's team lost on Saturday, but she scored all eight of her team's points. You should see her go, she definitely plays with adrenaline! 

Tech Note: Don't forget that the DexCom G4 signal seems to become amplified in some gymnasiums. You may be able to keep the receiver with you as your child runs up and down the floor without losing connectivity. It works for us. I even gave Arden a bolus with her OmniPod PDM this week while she was playing in the game.

Surfing Santa

So we ventured out into the snow late Sunday afternoon to check out a huge Christmas light display about thirty minutes from our house. On the way we stopped to have a quick bite, Arden tested her blood glucose and just as we were about to bolus... the batteries in her PDM went dead. I immediately looked around the restaurant for a fix, my wife told me that she saw a convenience store as we drove up, but that I would need to get back into the car to get there. Truth be told, I didn't want to go back out into the snow, but moreover, I didn't want Arden to miss her food because she was waiting for me to return with batteries. I began looking around for an answer when it hit me, the restaurant had televisions covering almost every inch of it's walls, "I bet they have a drawer full of TV remotes", I thought.

A few minutes later the bartender was pulling two triple A batteries from one of his many remotes, and Arden was back in business. The very kind bartender wouldn't even take the batteries back before we left...

The Christmas lights were a blast! I mean, were else are you going to see a giant Santa on a surf board?!

Nelson Mandela: July 18, 1918 - December 5, 2013

Receiving the Nobel Peace Prize

“No one is born hating another person because of the color of his skin, or his background, or his religion. People must learn to hate, and if they can learn to hate, they can be taught to love, for love comes more naturally to the human heart than its opposite.”

- Nelson Mandela

Please feel free to leave your favorite Mandela qoutes in the comments section. 

Diabetes Sucks

We swapped Arden's OmniPod last night after basketball practice, it was a little later in the evening then I would have liked as being tired combined with jabbing a hole into yourself, seldom goes well - but then, what does go well with piercing your skin with a needle?

After we finished, Arden asked me if I would "cuddle" with her for "ten minutes" when she went to bed, great offer, I of course said, "Yes!". 

As we climbed into bed Arden had to reposition herself a few times, she told me that it takes a little while to become accustomed to having a pod in a new site and that she was going to sleep on her side because of the placement of this pod. Even though I am aware that she uses different sleep positions based on pod placement, the look on her face as she tried to get comfortable, mixed with the mature way that she explained the annoyance, brought me a moment of melancholy. 

When we finally got comfy Arden kept talking, and she told me that she wished we didn't have to change her infusion site so often. My mind immediatly raced back to before we began using an insulin pump and those long sad days of giving my baby ten needles.

"I know it hurts", I began. Arden stopped me and made it clear that I didn't know what it felt like to have type I diabetes and then she added this exclamation to her sentence saying, "Diabetes sucks!". "You're right", I replied, "I don't know what it's like". I rephrased, "I imagine that it hurts to get stuck with a needle and I know that having it happen every three days must suck.

Do you remember when you received insulin with needles?". She did not.

I told Arden how I would give her two needles every morning when she woke up. I explained how we'd test and shoot insulin later in the morning for breakfast, how sometimes a couple of hours after a meal she would need more. Breakfast, lunch dinner and "You would eat a snack everyday around three in the afternoon and one before bed". "Did I get a needle at snack time too?", she asked. By the time I finished explaining how we managed her BGs with needles, we counted ten injection. Two in the morning (BG maintenance and slow acting), at times two for meals (Carbs and BG maintenance), an afternoon snack, evening snack and two before bed (BG maintenance and slow acting). We decided that most days she experienced about ten shots and then we did some math. When Arden realized that with injections she would get stuck about a hundred and forty times in two weeks, she looked relived. More math told us that two weeks of needle sticks was the equivalent to one year of site changes. With that news, she proclaimed that changing her pods wasn't "too bad" but, "it still sucks".

A car accident that results in a broken arm is certainly not a cancer diagnosis, but it may well be the worst thing happening in your life. Perspective is certainly very important to have, but not at the expense of your own feelings. I am elated that Arden knows that her insulin pump has made her life better without forgetting that needing to wear it, to stay alive, sucks.

I left her room feeling proud, the melancholy had left me. Diabetes may suck, but she owns it.

diaTribe Petition: Please help

from the diaTribe petition at change.org

At a recent meeting of Oregon’s Health Evidence Review Commission (HERC), the state panel recommended reducing access to test strips for people with type 2 diabetes on the Medicaid-funded Oregon Health Plan (OHP). A new plan would severely restrict access to strips for type 2 patients unless they are newly diagnosed, take insulin, or meet a few other special requirements. For people not taking insulin – which covers the vast majority, about 70% of all type 2 patients – those with an A1c above 8.0% would be entitled to one test strip per week, while those with an A1c below 8.0% would not be provided with any test strips at all. 

This recommendation would severly limit test strips and set a dangerous precedent for other states looking to cut overall health care costs. It's difficult to understand how the HERC imagines people with an A1c below 8.0% will manage their diabetes without test strips, and a test strip every week is hardly meaningful for patients or providers. Furthermore, any cost reductions will likely be more than canceled out in the long-term due to increased complications, hospital visits, and operations that inevitably folow poor control. The decision is currently scheduled for December 5. If you are a person with diabetes or a caregiver, we encourage you to sign this petition and write to Oregon Health Authority’s Director Dr. Bruce Goldberg and the members of the HERC about the importance of having access to test strips and self-monitoring blood glucose.

Read more about the issue and what you can do at diaTribe.org 

Add your name to the petition

Update on Wednesday, December 11, 2013 at 9:40AM by Scott Benner

Your participation made a difference! Read the update from diaTribe.