Number Thirty Seven

Have you ever heard that if you ask a person to name a number between one and one-hundred, the most common answer that people give is thirty-seven?

I don't know if that's something that can be proven mathematically but I have noticed it a lot over the years, that number just pops up all of the time.

Arden's All-Star softball team competed in their All-Star tournament last week. They played their first game on Thursday night and lost. Friday was rained out so they were scheduled to play two games on Saturday but they couldn't lose again or they would be out of the tournament - you can only lose two.

Thursday's game required a large bolus to battle Arden's adrenaline and the same was needed for the first game on Saturday. They won that first game Saturday and after a thirty minute break to recharge, they played again. During that second game her BG held steady until about the fourth inning. Arden's DexCom CGM was hung on the fence of the dugout during the games and I would check it every inning or so depending on how her BGs were acting. Arden ran out on the field when the forth inning began, as she did I walked into the dugout and looked at her CGM. Her BG was 120 with two arrows pointed down, she was falling fast but I knew that a juice box would handle it. I was actually waiting for this fall. Arden ran in to the dugout, drank a juice box in about ten seconds and ran right back to third base. Her BG balanced out as I expected and the girls won the game about an hour later. When Saturday ended, the team was 1 and 2, and scheduled to play again the next day at 1pm.

Arden's BGs were on the low side overnight, as I expected they may be and I handled them with a little juice and some temp basals. Nothing out of the ordinary after a day of activity.

Sunday brought high temperatures and a clear sunny sky, it was very hot. The girls warmed up at twelve-thirty, the game began at one and the adrenaline hit her about 45 minutes later. I bolused when her BG began to climb but I was too late, Arden's BG was on the move. I tried desperately to get it to come back down without going to low. Arden has trouble running when her BG gets above about 200 - she is normally very fast but above 200, her speed and dexterity become average, so my goal is always to keep her under that number when she plays. They won the first game and the next game was going to start in a half an hour. Arden's BG wasn't moving but I still only gave her a slight bolus (.20) for all of the food that she ate after game one. I thought that the .20 was a conservative approach to her game break snack as I was still leary of a fall from the earlier adrenaline bolus. 

We were now into the second game and my plan was to check her CGM after the third inning. The last time I looked at it was before the second inning began, it read 192 with an arrow diagonal down. Before I could get up after Arden made the last out of the third inning, she ran through the gate toward me holding her hands over her head and gesturing for me to come to her...

"I feel really dizzy!"

I didn't bother to test before I handed her a juice. She sucked it down as I tested her free hand...she was 37.

I said to Kelly, "Give her another one" as I ran to get the CGM from the fence. Arden's BG was dropping so fast that the CGM hadn't caught up yet, it read 101 but now both of it's arrows were pointed down. Arden's BG was falling way too fast, she drank two juices, ate a fast acting tablet and was now chewing on a handful of Mike and Ike's. I tested again, BG was 49 and she was still very dizzy.

Arden and I went into the dugout to get out of the sun, she alternated between sipping cool water and fuetly holding her head to try and stop the dizziness - seeing her press her hands into the side of her head broke my heart. I hugged her as she laid into me, I quietly told her that it would stop soon. We tested again, 69 but the arrows on the CGM were still pointed straight down. I decided to follow what the meter was indicating, I believed that her BG was climbing and stoped considering more carbs. It was then that Arden's place in the lineup came up... it was her turn to hit. "They can skip you for one inning", I told her.

"I can hit", Arden stood up squeezed her head between her hands one last time and put her helmet on, we tested again and her BG was 131 but she was still feeling the low. What came next was Arden's only strikeout of the tournament. She fouled off two pitches, running them both out before swinging and missing the last pitch of her at bat. I sat in the dugout staring at her, I was sure that I shouldn't have let her hit but I just couldn't find the parental wisdom in telling her that diabetes was going to make her miss that at bat. Secretly, I was so happy that she didn't get on base because I didn't want her to run but you can't imagine how proud I was of her for trying. She sat out the next half inning, opting to lay on the bench with her head on my lap so she could try to get her bearings. She only said two things to me during that time... "It's getting better" and " I can't believe two balls went to my position". She was annoyed that she missed the opportunity to make two plays.

When her team made the last out, she sat up, looked at me and said, "I'm okay, go back with mom".

Arden and her team went on to win that game and then they won the next one too. They never lost after losing the first game on Thursday and they won three in a row on that hot Sunday afternoon. I'm still not positive that I should have let her hit but, well, check this out...

 

That's Arden holding her trophy. Her team won the 2013 eight year old All-Star tournament last weekend! She played all but three outs in the field and never missed an at bat. Arden beat all comers, including diabetes - I think that if I was any prouder of her... my heart would burst.

Super Bolus, I Fear You No More

I just couldn't take it anymore. I'd count the carbs perfectly, pre-bolus at exactly the right time and still there are certain foods that require another bolus an hour later. On the surface you would think that I wasn't administering enough insulin but that couldn't be because every once and a while the bolus would work - but not usually.

Example: Movie theater

Arden is a nacho and popcorn lover at a movie, and we see our fair share of movies. Most times, I measure, count carbs and bolus only to watch her DexCom G4 point it's arrows to the sky before the second act is over. Then I spend the rest of the afternoon dropping random measurements of insulin on the number in an effort to get things back to a desired level without going too low. Sounds like a bad Price Is Right game, doesn't it?

Then it just hit me a few weeks ago, we have a CGM, why am I erring on the side of caution and chasing highs when I could be living on the edge of glory with Arden's DexCom G4. Suddenly, I felt stupid. All of this time I was playing scared when I know that's how you get hurt. Time to put my head down and run through a few wood be tacklers. (Sorry, my metaphors are all over the place today)

So I looked at that food on Arden's lap, counted carbs and then added every drop of extra insulin that I ended up given her at the last movie. My new thought, "What's the worst that could happen... she starts to get low, the DexCom catches it and we throw back a fast juice box and catch the fall".

That's exactly what happened

We watched Star Trek, Arden munched on her snacks and about an hour into the movie Arden's DexCom line had never wavered, her BG was 118 and steady. This was either going to be the perfect amount of insulin or too much. About fifteen minutes later, "Beep, Beep, Beep", 92 one arrow straight down. No big deal I thought - then I leaned over and said, "Here Arden, drink this juice". Twenty minutes later the CGM line was steady at 88, Arden was able to graze her remaining popcorn without worrying about bolusing and her BG never fluctuated, even hours after the movie had ended.

All of these fancy diabetes gadgets and I was using them to chase numbers instead of staving them off. I know that this sounds scary to many of you and I know that it takes time to find your comfort level, but please believe that on the day that you gain that level of comfort... this is all going to seem so much easier. Sadly, you can't rush that day to come, but it's so worth getting to and it makes me incredibly happy to know that you will all be there one day with me - kicking type I diabetes in it's annoying ass.

Tears of Insulin

images courtesy of Lilly Diabetes

Recently, I attended the 2013 Lilly Diabetes Blogger Summit in Indianapolis, Indiana. One part of the visit allowed us to witness insulin being manufactured and I'm here to tell you that the experience brought me to tears.

Maybe it was the overwhelming feeling that Arden couldn't live without the concoction or perhaps it was when I realized how many dedicated people it takes to make the insulin that Arden needs so desperately. I'm still not completely sure why the sight of insulin production was so moving to me. All I can tell you is that as those little glass vials were zooming past me and as I watched the mechanical arm fill them, I cried. There I was in a viewing room with my fellow D-Bloggers, all of us clad in hairnets, masks and gowns, when tears suddenly began to roll down my cheeks.

Arden doesn't even use Lilly's insulin and still the thought of this place existing was too powerful for me to ignore. So many people that I love, and so many of you that I call friends depend on places like this. I never really thought about it before, never considered the scope and effort that went into the production of insulin. It was amazing and overwhelming to behold. "Arden wouldn't be here today without out companies like Lilly", I thought as I watched the vials fly by... Then I looked around the room and saw so many friends and fellow D-bloggers who all could make similar statements about loved ones and themselves.

I found the hours that we spent on the production floor to be altering, they filled me with gratitude and humility. Diabetes did it again, just when I thought that my perspective on life was as clear as it could possibly get, diabetes brought things into even tighter focus.

This visit was as close to spiritual for me as anything that I've ever experienced. I went to the place that makes the very substance that my daughter needs to stay alive. What an amazing day, what an honor!

Lilly Diabetes invited and paid for me to attend the 2013 summit. Airfare, lodging, food and transportation was all covered by Lilly. I did buy a jammin' lemon pound cake slice for myself at the airport. They never asked me to write about my experience or in any way tried to sway my opinions.

Pictures from 2013 Lilly Diabetes Blogger Summit

I have so much coming up for you over the next two weeks, let's see.

I'll be telling you about my trip to Indiana to visit Lilly Diabetes where we:

Saw how insulin was manufactured

Met Kris Freeman

Recorded a group DSMA PodCast

Learned about the man who drives Lilly's direction

and more...

___

My book, 'Life Is Short, Laundry Is Eternal' won a gold Mom's Choice Award - more about that later.

___

While Iron Man was kicking super villain butt, I kicked the ass of a crazy combination of nachos, popcorn and candy. I'll be writing about the unorthodox way that I beat that BG back to where it came from.

___

For today, let's get started with some pictures from the Lilly Diabetes 2013 Blogger summit

Lilly Diabetes invited and paid for me to attend the 2013 summit. Airfare, lodging, food and transportation was all covered by Lilly. I did buy a jammin' lemon pound cake slice for myself at the airport. They never asked me to write about my experience or in any way tried to sway my opinions. 

Pre-Bolus

Original art by Mike Lawson - Check out Mike's YouTube page by clicking on the image

This story begins in 2006 just moments after I asked Arden's nurse practitioner if she was "nuts".

NP: <blank stare>

Me: <incredulous gaze>

Only moments before our staring contest began Arden's NP became the first person to suggest that I give Arden her mealtime insulin before she started to eat. I can't be sure if she referred to the practice as pre-bolusing, probably not as we were MDI, but she definitely wanted me to inject before Arden ate.

"Are you nuts?"

I responded emphatically that I could never give Arden insulin before she ate. Arden was two years old and there was no way to be certain of how much food that she would finish. The NP repeated her very reasonable request but I could not wrap my head around this new idea. Pre-Bolusing, bah, Arden would be safer if I left her alone at the mall with money pinned to her shirt.

I was 100% correct on that day. There was absolutely no way to be sure of Arden's appetite. However the inability to guess how much she would eat wasn't the only reason I didn't want to inject before meals. Arden weighed maybe nineteen pounds at the time and Novolog had a way of peaking intensely in her body. She had already experienced a seizure from an insulin miscalculation that I made. That mistakes lesson was still very fresh in my mind and with that bad memory still looming over me, I just couldn't bring myself to administer insulin that wasn't already covered by food or a high BG.

Of course everything that the NP said made total sense. I wanted to give Arden's insulin a head start, I dreamt of a moment when her food would begin to expel it's carbohydrates just as the insulin was pulling her BG lower. I could picture that perfect image in my mind, a tug-of-war with food on one side and insulin on the other. Both combatants pulling furiously without once moving the rope that is Arden's blood glucose value - the dream of a steady mealtime BG. I wanted very much for that to be our reality and so I promised myself that I would make the adjustment when the time was right.

Fear and poor timing stopped me from taking the NP's advice all those years ago. Eventually the day came when I found my footing with the idea and gave up on being scared... that's the day Arden's A1c began to decrease.

We haven't looked back.

The beginning of our trip down the road to pre-bolus freedom was littered with pot holes. The first bump took some time to traverse, we first had to wait until Arden was old enough to give thoughtful consideration to her hunger. After that hurdle was cleared we took the first step, bolusing ten minutes before a meal. Those next ten minutes were the most tense of my day, I would test and worry so much after the bolus that I barely had time to finish cooking. Initial results were less than stunning so I moved the pre-bolus to fifteen minutes before a meal. The extra five minutes increased the impact of the insulin and lessened Arden's post meal spikes, but I still wasn't seeing a huge return on our efforts. I wanted to take the process to another level but I couldn't, in good conscience, give Arden insulin farther from the beginning of her meal. If only I could see the insulin work, I needed a crystal ball...

... or a DexCom CGM

Arden's CGM turned pre-bolusing into the most valuable weapon in our arsenal. It's one thing to have a good idea of how long it takes insulin to begin working in the body. But when you are able to not only witness the movement of the BG, but also the speed with which your glucose level is rising or falling... it's the difference between rumor and fact... between guessing and knowing with reasonable certainty. The day that my eyes were opened to the benefits of wearing a CGM, that was the day that everything changed.

Arden was 149 before dinner last week. I bolused for the elevated BG and pre-bolused for 50 carbs, it was a significant amount of insulin for her. Before DexCom I would have panicked and served the food in less then ten minutes. Now I take my time finishing dinner while Arden and Cole do their homework and leisurely prepare their plates as I wait for the CGM to tell me when to serve.

I put dinner on the table when the arrow on Arden's DexCom G4 turned south, waiting until her BG was below 110. The amount of time between Arden's bolus and her BG decline can vary most days depending on a number of factors. Glucose monitoring grants the flexibility to wait, providing a level playing field for the insulin and those scrappy carbs to wage their battle on.

At least now it's a fair fight.

Don't forget what the bottom of the site says... Always consult your doctor before making changes to your health care. I am not a doctor.

More about the art: The art work displayed at the top of this post is an original piece from Mr. Mike Lawson. Mike is a tireless advocate for people with diabetes, a friend and extremely talented artist. You can find him working at TUdiabetes, on Twitter and through his fantastic YouTube channel.