Pooh. Gilly. Bear.

Arden has been fighting off a cold for the last week and her BGs have been low overnight as a consequence. We've used up more juice boxes this week then in a literal year of overnights prior. I'm beginning to drag a little bit from the experience but Arden, despite her distaste for drinking juice when she isn't thirsty, is taking it all in stride.

I can't seem to avoid these lows, I've tried everything. By the time this story happened I had resolved myself to the fact that we would be dealing with low overnight BGs until her cold passes.

But anyway... last Friday we went to the movies and saw Monsters, Inc. Many hours after the movie ended in the wee hours of the morning, Arden's CGM alarmed and woke me. I checked her DexCom receiver and saw that her BG had fallen well below the low threshold, so I tested. Arden needed to drink a juice.

I was able to wake Arden with very little issue and she began to drink. I held my left hand behind her back at one point because she was having trouble holding herself up. When she finished the juice she handed me the empty box and said, "Thanks poohgully bear". Her words seemed without meaning, I was startled by her jumbled communication. Perhaps her low blood glucose was more severe then the Dex and meter indicated. I was worried that she was becoming incoherent. I asked her, "what did you just say?" and without missing a beat, she smiled and said again, "Thanks poohgully bear". I responded this time, "Arden, I'm sorry but I don't know what poohgully bear means. It sounds to me like you are saying, Pooh Gilly Bear".

"No, not poohgully bear", she said. Then she spoke the words again only slower saying, "Poohgully bear". In this instant Arden and I had slipped into an Abbot and Costello routine. I was sitting on her bedside saying, "pooh gilly bear" and she was responding with words that sounded, to me, exactly like what I was saying. Finally I realized that everything else about our conversation, sans poohgully bear, was very coherent so I stopped worrying that her BG was much lower then indicated. We agreed that I wasn't going to understand her message and we said goodnight. I told ther that she could go to sleep, adding, "I'll be back to check on you in about fifeteen minutes".

Before I walked out, I couldn't help it, I asked one last time "poohgully bear?". Her little voice answered back in the darkness, this time very, very slowly, "pooh gully bear". I laughed and said, "Arden I'm hearing pooh and bear but I just can't make out the middle word... are you saying gilly?" She answered only, "Never mind" and then giggled. I left the room expecting to never know.

Her BG leveled out some time around 3 am...

The next morning Arden and I were making breakfast together while Cole and Kelly slept in. I brought up our conversation because I wanted to know, even though I imagined that she wouldn't remember. "Any idea what 'thanks poohgully bear' means" I asked.

Then Arden said this, "Remember last night we saw Monsters, Inc., it's what Celia calls Mike... poohgully bear".

I laughed so hard that I thought I was going to break a rib and then replied, "do you mean Googley Bear?".

"Oh, is that what she calls him... sounded like Poohgully Bear to me".

We smiled at each other and then I couldn't help but to walk over and gave her a big hug.

Most low BG stories aren't any fun, but this one, this one needed to be shared.

Click the image to hear Celia

Update on Monday, March 18, 2013 at 9:45PM by Scott Benner

My new book, "Life Is Short, Laundry Is Eternal' is available now - Amazon/Kindle - Barnes&Noble/Nook 

Update on Monday, March 18, 2013 at 9:45PM by Scott Benner

My new book, "Life Is Short, Laundry Is Eternal' is available now - Amazon/Kindle - Barnes&Noble/Nook 

I'm the Cornerback

I found myself yesterday explaining to a friend some things about diabetes. During the conversation I mentioned that Arden's BGs have been all over the place for the last few days. They were high yesterday morning and I couldn't get them to budge. Then, as if someone flipped a switch, they were suddenly perfect for the remainder of the day. Early the next morning after some late night Christmas wrapping, I was heading to bed and I checked on Arden for what I thought would be one last time. Arden's CGM told me that her BG had begun to fall fifteen minutes before I arrived in her room. I tried to stop it with a temp basal but I was concerned that I was too late, so I settled in and waited to see where the bottom of this drop was going to be. Maybe, I hoped, maybe I won't have to wake her but I knew in the back of my mind that I was going to be chasing this BG all night.

The next day as I was explaining to my friend that managing diabetes is a lot like playing cornerback in the NFL, I realized that I was correct in more then a just a few ways. When you play football as a defensive player there is one truth, no matter what you do, or how much you practice, the guy you are defending is always one step ahead. In this example, the wide receiver (diabetes) has a head start. You may be just as fast and even more nimble but he always has the unfair advantage of knowing the route he plans to run while you are left to try and keep up. There are two ways to cover a wide receiver, you can be smart or you can be flashy. A smart corner keeps up with his opponent, always staying within reach. He reads tells in the receiver's body language, looks for clues in the alignment of the offense and then he let's his skill and talent guide him to a place on the field were the final act of their battle takes place. It's in that spot where, with luck, he'll be able to react in time to stop the receiver from catching the ball. 

All the receiver wants in the world is to get away from his defender so he can make a catch, score and beat the defender. The cornerback, being a defensively minded participant in the game, he just wants to stop the receiver from advancing more then anything else. When a corner fails at his job pundits says he was burned, because that is exactly what it feels like. It's a terrible feeling to make your move and miss the ball. Your momentum takes your body out of position, you are no longer in a place to effect the play. You give chase, but you know just as everyone else looking on does, that you'll never catch back up to the man with the ball. The man you were charged with stopping. I've stood on a football field and watched my man, the guy I know I can beat, run away. He's outsmarted me, out performed me, he's beaten me. I know it, everyone else knows it, but what hurts the most is that he knows.

That's were the similarities between football and diabetes stop. Diabetes doesn't know it just beat me, but I still feel burned. Eventually I gave up that night and woke Arden so she could drink some juice. Then I chased her BG until the early hours of the morning.

Some times when I'm able to keep up with diabetes and my skills take over, I make an awesome play on the ball. I've knocked a few passes, that were going for touchdowns, out of the air. Once and a while, when unleash my flashy, I pick one off and take it back for six.

Each morning when Arden wakes up, I'm renewed by the look on her face and ready to run with diabetes again. We stand across from one another, look deep into each other's souls and wait in the intense silence for the ball to be snapped. I hope that one day, someone will walk on the field, take their ball and go home. Until then, I scrap with the guy that lines up across from me, doesn't matter what number is on his chest - 56, 347, doesn't matter. I know what he wants, but I have a surprise for my opponent... I want it more.

Arden's Big Blue Test

The walk begins, CGM says 183

We decided to do the Big Blue Test during Arden's 7th Jdrf Walk. Arden woke up in the morning after being a little low overnight, she ate a banana as we were packing for the walk and then bolused appropriately. Normally I wouldn't treat a morning low with such a carbtastic food choice, but we were in a hurry and needed to get Arden's BG up so we could get out the door for the walk. With no pre-bolus to help battle the banana I expected a BG rise to happen in a short time, and as you can see on the DexCom graph (above), that's exactly what happened.

The next BG hurdle came as we waited for the rest of our walk team, and the soft pretzel table beckoned our son Cole. We Cole returned, I watched as Arden's eyes became fixed on the doughy confection. "Dad, can I get a pretzel?". Arden returned with a giant, carb infused, pretzel. I didn't even bother trying to pre-bolus because Arden couldn't decide how much she may eat. I told her to just go at it, and I'd figure it out when she was finished. At 10 AM, just as the walk was beginning, Arden announced that she had eaten as much as she could, which was well over half of the pretzel. I took my best guess at how many carbs she had, closed my eyes, and bolused away. Then we walked...

One hour and fifteen minutes later we stopped on the last leg of the walk to play by the water... Arden's CGM read 189 (image below). I know you are seeing a ton of people holding up their CGMs and meters before and after their Big Blue Test work outs. I know most show a decrease in their BG from just 15 minutes of activity, but this is even more amazing then that, and I'll show you why. I can almost guarantee that without the exercise that Arden did her BG would have been in the mid 300's, if we were lucky. Look again at the few hours prior to the end of the walk. A banana with no pre-bolus, a soft pretzel only 30-45 minutes later, again with no pre-bolus. These two food choices should not only have driven up Arden's BG, but decimated her BGs for the rest of the day. But look what happened...

 CGM says 189 after 75 minutes of walking, even with all of those carbs

The rest of the day and night followed suit.

Before lunch, 2 hours since walk start.

12.5 hours since walk began and after Chinese food at 7PM!

Check out the overnight graph that goes from Chinese food to waking. I made no overnight basal adjustments and gave no bolus.

Arden took The Big Blue Test to help The Diabetes Hands Foundation in their effort to send $100,000 in diabetes relief to places in need. In the process we learned that not only does moderate exercise help to control Arden's blood glucose, but it can provide a full day and night of BG stability. The experience also gave me a lot to think about regarding my own activity level.

I hope you take the Big Blue Test right now, you don't have to be a person living with diabetes to benifit from the activity or help the effort, just click the link. I'm very glad that I did!

New plan for school and a sweet daddy daughter moment

Arden was on the longest play date of her life yesterday. She went to her friend's house around four in the afternoon to swim and ended up staying until ten that night. I've never left her alone before this date but I wanted to use this opportunity as a practice run for our new school day management plan.

Arden was originally just going to swim and come home but our results were so good that she was able to expand the plan into dinner and playtime afterward. She and I co-managed her diabetes by text and phone with no help from adults on her end. Interestingly, her tone while we spoke on the phone was more confident and mature then normal. Almost like she put her big girl pants on when she was thinking about type I - which was very inspirational!

For the first three years of school Arden has visited the nurse every time that her diabetes needed tending to; before and after meals, activity, for highs and lows and so on. Those visits, while necessary and also very helpful to her maintaining a steady blood glucose level, took quite a lot of time away from her school day. 

Thanks to a law that was passed a few years ago in New Jersey, children are allowed to test their blood glucose in the classroom where we live. I have been waiting for the time in Arden's maturation where I felt comfortable that she and I could co-manage her type I over text/phone without an adult present to double-check her steps. I decided at our last 504 meeting that third grade was the time to give this idea a try. Since then we've been adjusting our at home management routine to mimic this reality and last nights play-date was our first official test run. Arden doesn't of course think of all of this in the same way. That is, she was just on a play-date and not aware that I was testing my theories. 

I was so happy with how smooth the evening went that I had no trouble extending the date twice as the evening progressed. When Arden returned home at the end of the evening she was pretty hungry and so she had a late-night snack that I covered with insulin, perhaps too completely considering the amount of swimming she did. Around four thirty in the morning all of her activity from the day caught up to her and she experienced a low BG. 

When I checked her DexCom CGM it said 'low' and the graph indicated that she had been dropping slowly but steadily for the last two hours. When I tested her with a finger stick she was 42. I set a temp basal for an hour that eliminated her basal insulin and brought her a juice box. 

I spoke softly to her to let her know that someone was in the room and when I saw a bit of life on her face I began to repeat, "your blood sugar is pretty low Arden, let's drink some juice". After the third or fourth time I spoke she waved her arm at me in a sleepy but annoyed fashion and then sat up, she looked at her clock and then in the sweetest voice you can imagine said, "good morning". I handed her the juice box and she began to drink, in between each long sip she would open her eyes just enough so that she could see me in the glow that my iPhone created. She smirked each time in a loving, not joking way and then bumped the tip of her straw into my nose. After a number of sips (and bumps) she tried to hand the juice back to me but I needed her to take one more drink. After that last sip she said, "okay daddy I'm done, going back to sleep now... thank you".

I told her that I would sit up for a while to make sure that her BG leveled out and she replied, "sounds good, I love you". I told her that I loved her too and adjourned to my room with a great big smile on my face. Then I busied myself on Twitter and read some emails to stay awake.

I am going to be blogging extensively about Arden's new management process at school over the first few months of the school year, I hope that you find those posts helpful as we move towards a more independent lifestyle for Arden. It should be interesting to say the least. Arden will be permitted to keep a cell phone with her in class and she will be contacting me directly when she tests, eats, feels dizzy and more. We are going to try and eliminate as many visits to the nurses office as possible. I'm very thankful for the open-minded way that Arden's school, teachers and nurses are approaching this change. I am sure that it is difficult for them to try something that is so outside of everyone's norm. It's very exciting to be stretching these boundaries for Arden and the other children that live with type I.

Exercise and type I diabetes blood glucose control

Arden followed in her brother's footsteps last week when she tried out and was selected to play on our town's all star softball team. Yea Arden! The girls have been practicing each night since and I am learning more about blood glucose control before, after and during exercise then could have imagined.

Her second at bat.

First thing I learned is that all of Arden's activities from the past don't put nearly the strain on her system that an intensive two hour practice/game brings to her. Arden experienced a latent low in the early hours of the morning that followed her first practice. It was nearly eight hours since that practice began when her BG suddenly dropped. I couldn't cut off the fall by suspending her basal so I woke her up to drink a juice box. Normally I can fend off lows at night with a temp basal, this was different, a more powerful drop. I was awake and ready for it because I expected it but if I hadn't been, there is no telling how low she may have gotten.

So the next night I was ready! I kept her BG a little high before bed and didn't cover a small snack after practice. This turned out to be a winning combination. Night two went well.

On the third night I tried to mimic the success from the evening before but it turned out that a new site on her leg wasn't working the way I expected. When I combined keeping her BG a little high with a small snack and a site that wasn't up to snuff, I got a high BG that wouldn't come down easily. Hindsight has me wondering if the leg site was perhaps less effective because of the large amounts of running that she has been doing, as they normally work very well.

After I moved the OmniPod to her abdomen the next few nights went as planned, however I had to put quite a lot of effort into keeping things balanced. These last few weeks haven't just proved to me that strenuous activity can cause a low but that high BGs effect athletic performance. I noticed that if Arden's BG gets too high that her speed seems to diminish (I hope that you can share your experiences with me in the comments about this). Normally a very fast runner, Arden couldn't perform as she usually does if her BG began to rise above 220. I think that I also saw a decrease in her hand-eye coordination during this elevated period.

Last night before her first game I tried very hard to keep her BG around 100 before game time. I added carbs as the game was about to begin, a few slow acting and about 15 grams of juice. I was hoping to keep her steady without going too high during the game. I was able to do this with a lot of help from her DexCom CGM and she never went above 190 but wow was it a lot of work... though totally worth it to see her have such a good time.

This first game didn't just teach us more about type I diabetes, it also gave us our first look at Arden's competitive nature in a sporting moment that she regards as very important. Arden took this game seriously, she had fun but playing well was definitely high on her list of priorities. It goes without saying but we are very proud of Arden and the extra effort that is required for her to participate makes that pride shine just a little brighter.

Your child can definitely play sports at a competitive level with type I diabetes, that fact was never in question. All you have to do is give the moment the forethought and preparation that it requires, it'll be tough at first and you may spend a night or two battling lows but once you have a system in place it's not unlike the rest of your days with diabetes. You can do this.

Have fun out there!

One of the two outs Arden recorded in her first game.