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?!

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.

When things go wrong, they go wrong.

Yesterday was a busy day around here. Arden was leaving straight from school to attend a gathering of her friends at one of their homes. I also had a speaking gig at a local Barnes & Noble in the early evening. Remote management of Arden's BG extended past the school day and into the play date as I prepared for the event.

Everything was going great even though the food choices at the get-together were carb heavy, pizza, brownies and the like. Arden's BG was steady at 145 for most of the afternoon, we had seemingly defeated the pizza and the brownie didn't seem to be gaining any ground on the last bolus. Good stuff.

Arden arrived home just a few minutes before we had to leave for the bookstore (Kelly is away for work, so the kids came along), her BG was still holding steady so we jumped into my car and headed out. It was on that short ride that things began to go wrong. First Arden's CGM indicated that her BG was rising slowly so we bolused, it seemed strange because she was now over ninety minutes past the the time that she ate the brownie and there was no spike after she ate it. The pizza by this time had been ingested over four hours prior. I thought it (BG rise) could be the pizza but more likely we were fighting with the combo of pizza and brownies. Still the rise was slow and I had no concern that the bolus wouldn't handle it.

Forty-five minutes into the book talk Arden's CGM was going nuts. Her BG was now rising quickly and the last bolus didn't look like it was going to hold. She tested and we were very aggressive with the next dose, very aggressive. So there we were in a Barnes & Noble, I'm chit chatting with the crowd about Life Is Short, can't leave for an hour and trying to decide if Arden's blood sugar rise is food related or if her pump site suddenly went bad... I didn't know and only time was going to tell. A short while later we boulsed again because subsequent testing indicated that the last bolus only served to stop the rise in her BG and wasn't enough to bring it down. By the time we got home her BG had fallen just enough to create more confusion. Do you know what I mean? I was in that spot where it seemed like everything was going to be alright if I just gave things a little more time.

But you know that wasn't the case.

Arden climbed into bed with me to watch television (Far after her bedtime), she was drinking water, I was setting increased temp basal rates and staring at the DexCom screen - the evening had devolved into a good ole' fashion cluster fuck.

I gave up after one in the morning and changed her pod. I felt comfortable that her BG was in a safe place for me to sleep a little after four thirty in the morning. Good news is, my TiVo is empty now...

Bad news? I never heard my alarm and we didn't wake up until eight in the morning, school begins at five after. I woke the children and told them to get ready, "Don't rush, I just want you to arrive in time for second period". Cole jumped into the shower, Arden went to her room to get dressed - CGMnow was 80.

I brushed my teeth, got Cole to the first floor and called for Arden, she didn't answer, I called again... nothing. When I tried the knob on her bedroom door and it was locked, I knocked, no answer. So I raised my voice, "Arden!, Arden, open the door".

"I can't, I'm on my bed and I can't get up - I'm low".

When I unlocked the door to Arden's room she was sitting on her bed, her face lacked muscle tone and she looked pale. I immediately handed her a juice and asked why she didn't call me or drink a juice. She responded, "I can't move, I have a bad headache and I'm dizzy". We treated, tested and she ate a piece of toast. When her BG finally came to a balance I asked her to get ready for school but she said that she felt like she didn't sleep at all last night, she thought she was getting sick. I explained that I've heard from many PWD that they experience a hangover like sensation after a significant overnight low and that it comes with a feeling that you didn't sleep. Then she said something that dropped my heart into my stomach.

"That never happens to me..."

I had to explain that each day with diabetes wasn't going to be the same and that different issues are going to arise as she gets older. I think she was sad to hear that, but too out of it to care. It's almost noon and Arden is still sleeping in her bed. Her BG is all good now but I'm a little worse for wear. I'm sharing this today because I promised to try and be even more open during Diabetes Awareness Month. But also because I was reminded recently that my blog reaches a lot of parents and I never want any of you to think that the shitty stuff that sometimes happens to you... isn't happening to us. It is, it's happening to all of us.

You are not alone and I hope knowing that helps in some small way.

Recall: FreeStyle and FreeStyle Lite Test Strips

From Abbott Diabetes Website:

November 20, 2013

Dear Valued Customer,

Recently, it has come to our attention that certain lots of FreeStyle® and FreeStyle Lite® Blood Glucose Test Strips produce erroneously low blood glucose results when using FreeStyle® Blood Glucose Meters, FreeStyle Flash® Blood Glucose Meters and the FreeStyle® blood glucose meter built into the OmniPod® system. Erroneously low results that are not recognized may pose significant risks to your health.

If you do not use the meters in the photographs below, your blood glucose test results are not affected and you do not need to read any further.

FreeStyle Flash® 
Blood Glucose Meter
 FreeStyle®
Blood Glucose Meter
OmniPod®

Please click here for Abbott's complete announcement that lists affected lot numbers and information about what to do next if you have strips that are part of the recall.