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.

Oh Canada... It's DexCom time!

The DexCom G4 continuous glucose monitor is now available in the true north! I'm not exactly sure how DexCom got their device ready for sale in Canada. Perhaps the transmitter will be wearing a tiny little hockey sweater? Who knows...

Getting started looks pretty straightforward. Go to dexcom.com/en-ca and then click "Contact Distributor". The link takes you to www.animas.ca, the company that is handling the distribution for Canada. The Animas page doesn't have any DexCom specific links. I would use the "Contact Us" tab at the top right of the Animas page and ask how to get started.

I found this contact information for Animas Canada at the bottom of the Canadian DexCom page linked above.

Local Dexcom Distributor

Animas Canada

200 Whitehall Drive

Markham, Ontario

L3R0T5

General inquiries: 1-855-293-5083 or 

CustomerCare@Animas.ca

Product support: 1-866-406-4844

I'm so excited for my Canadian friends, you are going to love having a CGM!

Three Days without DexCom

I felt quite like Linus the other day, when time took our diabetes security blanket away.

It was meant to be, the DexCom transmitter is designed with an internal battery that is warranted to last for six months but when our transmitter turned a year old a few weeks ago, I thought maybe we had the one that would never lose it's charge. 

Then, of course, it did.

Only a few days past it's birthday our G4 transmitter let out a death knell in the form of the image that you see above. "Low Battery: Order New Transmitter" - and so I did. Today's blog post isn't about a fight with an insurance company or a medical supply firm filled with inept employees. All of that actually went smooth as silk. I made the call and the new transmitter showed up three days later. But those days taught me a lesson.

The lesson? I lean so hard on that continuous glucose monitor that I was initially lost without it. Now, today's blog post isn't about how great diabetes technology can be, and I'm not going to sing the praises of DexCom (Though I could) - Today is about shining a light on the true meaning of what the CGM brings into a life lived with type I diabetes. 

Continuous Glucose Monitoring brings a sense of calm and peace while it removes uncertainty and blindness.

I can see the insulin go in but where does it go, what will it do, when will it do it and how long will it be before it has completed it's task? I can see the food go in, but how, when and with what intensity will it impact Arden's blood glucose level?

I stand in a dark room, it's walls built with uncertain nervousness, waiting for the room to catch fire. I think that's what injecting insulin felt like before we had a CGM. It felt like the five seconds before the knife wielding lunatic jumps from the shadows in your favorite horror movie. But it feels like that all day, at least it did in the past and it did again for these three days, well, it tried to feel like that but I was able to stop it with the knowledge that I've gained living with a CGM in our life.

My first reaction when the battery in Arden's transmitter failed the day after it's first warning that it would, was fear. I thought about how positively Arden's A1c was effected when we added glucose monitoring to our life and worried that our success was solely based on the information that our devices report. I was actually concerned that I wouldn't remember how to handle things without the technology that I've rightfully grown to trust. The first night I gave in to the pressure and I stayed up half the night testing. Do you know what those tests showed me? They showed that even though diabetes is unpredictable, I have a pretty good feeling for when it's going to be unpredictable. I know when a miscalculated bolus will become an issue, and low BGs aren't as elusive as they felt before I was able to watch twenty-four hours of blood sugars on the DexCom screen. There's no doubt that I can't predict everything and I certainly don't know when an unexpected change in Arden's BG will happen, but I can guess with some reasonable certainty. My educated guesses are now more educated than they once were, and I think that there are times when I lean too hard on the information coming from the Dex. I think that sometimes I know what the correct action to take is, and I use the DexCom data to convince me that I'm correct. 

So I found my bravery and went back to managing Arden's diabetes the way I did in the past... By closing my eyes, trusting myself and hoping for the best (And I tested more often).

I'll tell you what though, I put all that high-mindedness aside the second that the FedEx driver handed me the package that contained Arden's new transmitter. I tore the box open, grabbed the transmitter and drove directly to her school to pop it in. I trust myself, I do, but this diabetes dance is much easier when you have someone or something to lean on.

Update on Wednesday, November 20, 2013 at 1:28PM by Scott Benner

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Health Canada Approves DexCom G4

DexCom announced yesterday at their May 1, 2013 Earnings Conference Call that...

"On the international front, we are pleased to report that we have received approval from Health Canada to begin marketing the G4 system in Canada. Our initial approval is for adults only. However, we expect to file supplements seeking pediatric approval later this quarter. Our distributor in Canada expects to commence a limited launch at the beginning of Q3 with the full launch commencing before the end of Q3"

Congratulations to my Canadian friends who have been patiently waiting to use DexCom's G4 system!

The Not So Great but VERY Powerful Bolus

Arden's CGM vibrated on my leg. Earlier during the previews I asked Arden to give me her G4 so that I could monitor her BGs while we watched 'Oz The Great and Powerful'. The vibrations that her CGM sent through me were too intense to ignore and moments later I was greeted rudely by the message on it's small glowing screen.

Arden's CGM indicated that her BG was 94 and the number's accompanying arrow was pointing straight down. You can see on the chart below that's not good news.

From the DexCom G4 Users Guide

Prior to the movie we stopped for a light meal, Arden had a salad and one baked potato skin. I pre-bolsed for twenty carbs, ten minutes prior to the waiter arriving with our food, she ate as I expected. A little over an hour later we settled into our theater seats (about thirty minutes before the movie was scheduled to begin). Arden was holding a box of Bunch-a-Crunch, a small popcorn and she was talking about sharing a few gummy candies with her friend who was joining us. I pre-bolused for forty carbs at this time. We donned our 3-D glassed and the movie began.

95, one arrow straight down

A CGM reading of 95 doesn't phase me, and one arrow down doesn't really cause me to become alarmed anymore, "Just missed with the bolus", I thought. Then I looked at the time on the OmniPod PDM and became a bit more concerned. This was all happening only one hour into the movie, I had more than "just missed" - I significantly over estimated how much Arden was going to eat. I shook the candy box, reached into the popcorn bag and discovered that she really hadn't eaten any of the treats that we initially believed she would. I reached into the gummy candies, put five in her hand and whispered, "Eat these please, your CGM says 95, one arrow down - I think I gave you too much insulin".

Arden ate the candy quickly but three more alarms were already shaking my leg

Now her CGM was reporting a BG of 84 with one arrow down, seconds later it was 76 and then the arrows doubled. 76, two arrows down. Arden's BG was running away from me. I had already opened the juice box by the time the double arrows hit, Arden knocked it back like a shot as I tested to autenticate the numbers on her CGM. Her BG was 56 on the meter and the arrows were staring back at me as if they were awaiting an answer to the question, "What are you going to do Scott?".

I recounted the carbs in my head based on what I now knew she had eaten and then added the new carbs that she just wolfed down to that total. I was okay, I knew that the numbers matched. I told myself, "Just wait, don't over treat" but no sooner than I was able to talk myself into that response...

BEEP, BEEP, BEEP, BEEP - "LOW, two arrows down"

I could feel my adrenaline surge when the beeps angrily blared out. I started looking around to see which way out of the aisle was less blocked, thought about where the snack stands were located and considered sending our son Cole for a cup of regular Coke. Then I looked at Arden, she was sitting next to her friend who came along with us for the movie and I just didn't want her to have to rush around like the world was coming to an end in front of her pal. So I quietly slipped Arden a glucose tab (We never use glucose tabs), I asked her to chew it up quickly and swish the powder around in her mouth.

She did so dutifully, then leaned over to me and whispered in my ear, "am I going to be okay?"

Those words broke my heart and brought a tear to my eye but I answered without hesitation, "absolutely, Daddy has it all under control, go back to watching the movie", but I wasn't sure. The CGM still said "Low", though now it was reporting only one arrow down - so I tested again and this time Arden was 68. I could breath again, she was going to be fine.

I asked Arden how she felt and she responded, "A little dizzy but I'm okay". I told her that we caught the fall and that she should go back to watching the movie. Her friend never saw a thing, I did however miss the flying baboons... I heard they were fierce though, Arden told me later in the car. She knew because she never had to take her eyes off of the screen, mission accomplished.

The DexCom CGM is an indispensable tool in our day with type I diabetes. I genuinely never imagined that Arden wouldn't eat the amount of food that we bolused for. This was a complete anomaly, movie theater food always needs a strong bolus, this never happens - until it did. CGM technology is the best. Who knows how this all goes with out the Dex, maybe Arden would have gotten dizzy and told me that she didn't feel well, maybe the movie would have held her attention to the point that she didn't notice. I'm thankful that we didn't have to find out.

I gave her way too much insulin, that happens. The DexCom CGM makes that eventuality feel less scary.

Update on Wednesday, March 20, 2013 at 11:25AM by Scott Benner

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