MicroCell to the rescue

Lately the cell coverage has been spotty in Arden's classroom. The school does have WiFi and Arden's phone is connected to it but we still seem to be having interment signal issues. The other day Arden sent me a text that said...

"58 one arrow down", but none of my return texts made it back to her phone. I quickly called the office and they put me through to the room, but I don't want that to ever happen again so I called AT&T to inquire about the poor signal quality and find an answer to our problem.

The CSR thought (and I agreed) that a good fix would be to install a MicroCell in Arden's classroom. A MicroCell creates a cell signal with the a wired Internet connect, Arden's class has ethernet. We have one in our house and get good results so I thought it was worth a try. A few minutes later the CSR explained that he thought he could help with the price (It's $200) because of the medical need. Later that afternoon I went to my local AT&T store, purchased the MicroCell and by the time I dropped it off at Arden's school, AT&T had credited the purchase price back to my cell phone bill.

As I was saying goodbye to the gentleman on the , I expressed my gratitude one more time and he responded, "Think nothing of it, my dad has diabetes... I understand."

A huge thank you to the kind CSR and another to AT&T for hiring great people who take the time to listen.

Sure, you can go to the Selena Gomez concert

If you read Arden's Day with any frequency you know that we manage Arden's Bgs with text messages while she is in school, at a friend's house and every other time that she isn't in our physical space. I've written how the process has eliminated so many issues, lowered her A1c and making us all to feel more independent are but two. I am genuinely excited to tell you that we have recently added, "Go to a concert" to that list! Now you may be thinking that there is a world of difference between managing type I from across town and being an hour away in a stadium singing along with the former Wizard of Waverly Place, but you know what - not so much. It turns out that the biggest hurdle when considering the difference between the two situations is realizing that there aren't any.

I have two main concerns when Arden isn't with me. Loss of communication and An unexpected low BG. All that remains is manageable with pre planning. Supplies, food, and juice is no issue to pack and have at the ready. A well thought out testing schedule eliminates most surprise BGs and Arden's DexCom G4 finds the ones that slip through the cracks. Of course no one can plan for a significant BG drop that defies logic, that possibility is the diabetes equivalent of having a car accident - you wear your seatbelt, drive safely and hope for the best.

I received a call asking if Arden could go to the Selena Gomez concert with one of her best friends, I didn't hesitate to say, "Yes!". One year ago the mom on the other end of the phone wouldn't have been able to finish her sentence before I said, "Thank you but no". But so much has changed in the last year. Now when a person that I trust calls and asks for Arden to accompany them for an evening, I can say yes with less trepidation and that makes me very happy for Arden.

Here's how I handled Arden going to the concert...

First, the mother and I had a nice lunch together the week before the event. Even though Arden goes to their house for play dates, we still manage through texts while she is there so the mom doesn't have a lot of interaction with diabetes. She understood the basics and knows how to react in an emergency but the concert was going to require me to advance her understanding of type I diabetes. 

We spoke about all emergency possibilities in very, very real terms. I explained that I needed her to understand all that could happen, even though the likelihood of it happening was extremely remote. 

I said thank you for her willingness to except the extra responsibility and went about the seemingly impossible task of preparing a person for an evening with type I without overwhelming or causing them to obsess during the event. The last thing I wanted was for the extra considerations to take away from the experience that she was going to have with her own daughter.

We spoke about supplies, testing times, CGM check ins and how to talk to the security guys in a way that makes bringing food and drinks into the venue easy. We talked about panic situations, CGM arrows and how to use glucose gel. I explained low blood glucose seizures and that I was going to discreetly slip her the glucose gel because the sight of it makes Arden anxious.

I couldn't have been prouder of Arden and her friend's mother when they pulled out of our driveway for the concert. The conversations that we had and the topics that they had to consider, just to go to a concert, were more than a nine year old and her friend's mom should be asked to think about - but they did it. When Arden got into the car with her friends she was smiling just as a little girl on her way to a concert should. Thankfully, her BG's were rather uneventful during the evening, she required two maintenance boluses during the show (Adrenaline I imagine)  and a juice box on the ride home (No more Adrenaline) but other than that, easy sailing. When she walked through the door at almost eleven, her BG was 104 (DexCom had the BG at 74). Success!

Never once that night did I have to speak with the adult who accompanied Arden about anything related to diabetes. Actually, at one point she sent me a text and asked, "Is there anything I need to be doing?".

The bag of supplies I sent was returned to us unopened. Arden didn't need the extra OmniPods, insulin, needles or food. In fact, she would have been just fine had I not sent any extra supplies, all she needed was the juice box that she always carries in her bag.

I want this story to illustrate that everything is possible with type I, but what I don't want is to make you feel like planning ahead isn't necessary. This trip included a number of conversations, pre planning, a well packed bag and a little luck. Actually, to show you how much luck - Arden's OmniPod experienced an error the morning after the concert and I had to go to school and change it around 8:30 am. Can you imagine if the pod would have shut down during the concert? I could, and that's why we had a plan for how to handle that situation, should it arise. We planned for every conceivable possibility and talked about each ahead of time so that if they did occur, no one would be caught off guard or be unprepared for what to do next. 

Arden popped out of bed for school the next day and put on her concert t-shirt still smiling from the evening before -- suddenly, the effort that it took to get to that moment felt like no effort at all. 

Helping Children with Diabetes Gain Independence Part 3

If you read part one or two you can skip this little description and move on to the post...

So a while back the people who make the OmniPod asked me if I would like to contribute to their new blog called Suite D. I said yes, but I had one caveat that I honestly never thought that they would agree to - but they did!

See, Insulet wanted me to write a series of posts about how we use text messaging to manage Arden's type I and I wanted to tell that story here on Arden's Day. My caveat? I get to repost my writing here after it has run on their blog. This is not something that many websites would agree to because they understandably want their content to be fresh and exclusive -- I want to give major kudos to Insulet for agreeing. You may be wondering what I said to get them to allow me to do this... Well, it was simple really. I couldn't write for them and give them my full effort if I felt like my writing was taking something from Arden's Day and taking something from you. I was honored to be asked and I wanted to take the freelance work, but not at the expense of my readers here. So we struck a simple, and I think, very reasonable deal. I get to repost after the piece has been live on their site for at least thirty days. A BIG "way to go!" from me to Insulet for being so cool and blogger friendly! Here's part 3 of my 6 part series on gaining independence through technology.

In my last post, Helping Children with Diabetes Gain Independence Part 2: Texting Diabetes, I promised to tell you about Arden’s A1C. There are a number of things that I attribute to the reduction of Arden’s A1C, including:

• The support of friends, family and teachers

• The OmniPod insulin pump

• Finding the correct insulin dosing for Arden 

• Utilizing Continuous Glucose Monitoring (CGM)

• Taking advantage of overnight monitoring (no food makes it easier)

• The Diabetes Online Community

• Being aggressive with high blood glucose levels

• Making good food choices

• The way that we manage diabetes while Arden is at school

Our children are at school for eight hours a day and that is a substantial chunk of time. In the past, Arden would eat or take insulin and then not see the nurse again for hours, scheduling her next check around the time we expected the insulin action to compete. So if there was a miscalculation of insulin at lunch or some other anomaly, Arden would go hours with an elevated blood glucose level. By removing other people from her diabetes management process at school,we also removed the constraints of relying on those people’s schedules. Arden no longer only considers her diabetes at 10:00 AM, 12:00 PM and 3:00 PM. Now we address diabetes-related issues as they arise and have the ability to make small adjustments. Being able to bump a low blood glucose and reassess in 20 minutes is far more effective than taking in a predetermined amount of carbs, hoping for the best and addressing any high blood glucose values that may arise hours later.

Similarly, if a mealtime bolus doesn’t work the way we expect, Arden’s CGM tells us her blood glucose is on the rise and she instantly texts me. I couldn’t expect the nurse to be comfortable giving more insulin an hour after a meal, but I am. I know Arden and how she reacts to different situations. I have the full knowledge of her diabetes history in my head. I can make adjustments on the fly, just as she will be able to do one day when we transition away from me being involved with her diabetes care every moment.

This access to Arden during the eight hours of each school day allows me to have the same control I do when she is with me, because honestly… it’s like I’m there.

Now, I promised you information on her A1C, so I better get to it!

All of the things I listed above are, in my opinion, critical to Arden’s A1C. I love the fact that she sleeps for a third of every day; diabetes management is so much easier then when there’s no food involved. There are two reasons I was able to let go of my fear of nights: the OmniPod and CGM technology. Using an insulin pump is key, because it allows for the reduction or temporary suspension of background insulin. For me, manipulating temporary basal rates is the essence of controlling borderline lows throughout the day – and especially overnight. The CGM lets me know if my plan hasn’t worked out and that’s already a third of the day covered.

The part of the day that she is with me and awake is the toughest for me. Handling things like big meals at inopportune times, running to sports and homework can be challenging. And I can get tired and unfocused in the late afternoon.

Arden’s A1C was in the nines when she was diagnosed. It languished in the mid-eights for years. I finally began to combine all of my diabetes theories into a cohesive plan in the early part of 2012 and we saw a reduction to 7.8. At the beginning of this school year we managed to get that number to 7.5. I was happy! Then the new school plan went into effect, which allows me to happily tell you two things today that you may not believe…

Arden has NEVER visited the nurse’s office for a diabetes related issue since we started our texting system and her A1C is 6.5.

Update on Thursday, October 10, 2013 at 10:12AM by Scott Benner

This post was written over four months ago. Since then Arden's A1c has been tested again and was 6.7.

Helping Children with Diabetes Gain Independence Part 2

If you read part one last week you can skip this little description and move on to the post...

So a while back the people who make the OmniPod asked me if I would like to contribute to their new blog called Suite D. I said yes, but I had one caveat that I honestly never thought that they would agree to - but they did!

See, Insulet wanted me to write a series of posts about how we use text messaging to manage Arden's type I and I wanted to tell that story here on Arden's Day. My caveat? I get to repost my writing here after it has run on their blog. This is not something that many websites would agree to because they understandably want their content to be fresh and exclusive -- I want to give major kudos to Insulet for agreeing. You may be wondering what I said to get them to allow me to do this... Well, it was simple really. I couldn't write for them and give them my full effort if I felt like my writing was taking something from Arden's Day and taking something from you. I was honored to be asked and I wanted to take the freelance work, but not at the expense of my readers here. So we struck a simple, and I think, very reasonable deal. I get to repost after the piece has been live on their site for at least thirty days. A BIG "way to go!" from me to Insulet for being so cool and blogger friendly! Here's part 2 of my 6 part series on gaining independence through technology, part 1 is here.

I sat down in my daughter’s 504 meeting after she finished second grade with a plan. Each year we make small adjustments – preparations for new aspects of the school day that come with advancing to the next grade level. These meetings are very productive, somewhat brief and usually not very eventful.

The nurse began to talk about how we could give Arden a little more responsibility with her diabetes management in third grade. This was something we did each year during this meeting and sometimes, if warranted, during the school year. We strive to shift Arden’s diabetes care onto her plate bit by bit, as she is able to accept new responsibilities. The idea is to slowly get her acclimated until the day comes when she is completely self-managing her diabetes without even realizing anything has changed.

I like that process very much and it was working extremely well. So well, in fact, that before the nurse could finish her thought I stopped her and said, “I don’t want Arden to come to your office next year. It takes up too much of her day and I think the lost time is damaging her learning process. She is missing vital parts of instruction and I want to change that.” They of course agreed, but were initially confused about how I intended to change the situation.I continued, “Arden is going to manage her diabetes herself from now on and I am going to help her. She will handle everything right from her desk and I will oversee each decision with text messages (and phone calls if and when necessary).” 

Cue the blank stares…

I filled the silence before anyone could protest too much. Our previous governor signed a bill giving students with diabetes the ability to test their blood glucose anywhere in the school. So testing in the classroom wasn’t an issue. And Arden’s 504 plan already allows her to carry a cell phone, so all I needed to do was explain that sending text messages wasn’t going to be a distraction to the other students. They were intrigued.

I began to explain how much better I imagined Arden’s A1C would be if we could make small adjustments throughout the day instead of only addressing her blood glucose every few hours. Then I turned to her teacher and asked how much cumulative time she thought Arden missed each day while she was at the nurse. She replied, “Forty-five minutes maybe.” I didn’t hesitate to show off my impressive math skills and said, “That’s almost four hours a week… fifteen hours a month.”

They couldn’t disagree with my argument. Everyone knew that a student can’t thrive when they miss that much of their school day. There were a lot of faces in the room and I could see on each one of them that I had made my point. I reassured them that my idea would work and that we should try.

Arden and I practiced all summer and came up with our own little diabetes management shorthand. I found a few emoticons that were representative of the arrows on Arden’s continuous glucose monitor and we were off.

Putting Arden’s New Diabetes Management Plan into Action

Today, almost one complete year later, even I can’t believe how well my plan has worked. One week towards the end of the school year Arden’s blood glucose had been low all week. I didn’t know why. I had been using temp basal rates and adjusting boluses, and she just kept running low. I’m talking about blood glucose levels in the 50, 60 and 70 range – situations that required immediate action.

But guess how many times Arden had to go to the nurse’s office that week? Zero. Guess how many times Arden had to go to the nurse’s office all year? Yes, you guessed it… zero! Arden did not need to leave her classroom once to address a diabetes-related issue. We treat lows, bolus for highs and count carbs all with text messages like in the screen shot above.

This simple technology that most everyone possesses is one of the most valuable and productive diabetes technologies that we employ. The independence that it gives Arden and me is unmatched. The peace of mind that being able to text her brings me is soothing. The effect that this process has had on her diabetes management is staggering! Just wait until I tell you about Arden’s A1C in my next post.

Helping Children with Diabetes Gain Independence Part 1

So a while back the people who make the OmniPod asked me if I would like to contribute to their new blog called Suite D. I said yes, but I had one caveat that I honestly never thought that they would agree to - but they did!

See, Insulet wanted me to write a series of posts about how we use text messaging to manage Arden's type I and I wanted to tell that story here on Arden's Day. My caveat? I get to repost my writing here after it has run on their blog. This is not something that many websites would agree to because they understandably want their content to be fresh and exclusive -- I want to give major kudos to Insulet for agreeing. You may be wondering what I said to get them to allow me to do this... Well, it was simple really. I couldn't write for them and give them my full effort if I felt like my writing was taking something from Arden's Day and taking something from you. I was honored to be asked and I wanted to take the freelance work, but not at the expense of my readers here. So we struck a simple, and I think, very reasonable deal. I get to repost after the piece has been live on their site for at least thirty days. A BIG "way to go!" from me to Insulet for being so cool and blogger friendly! Here's part 1 of my 6 part series on gaining independence through technology.

Helping Children with Diabetes Gain Independence Part 1

I recall being handed syringes in the hospital and thinking that they seemed so very lightweight. I guess that I had never held one before that day and didn’t know what to expect. They felt flimsy in my hand and I struggled to understand just how these bits of plastic and metal were going to keep my daughter healthy.

That was my perspective only a few days removed from our two-year-old daughter’s type 1 diabetes diagnosis in August of 2006. Today, I realize that if Arden had been diagnosed fifty years earlier those little needles would have likely looked and felt like something from a science fiction movie.

Gaining Independence through an Insulin Pump

The technologies that help to improve the lives of people with type 1 diabetes are nothing short of amazing – and the ways that we use that technology are ever expanding and evolving. I love the idea of utilizing what we have available today to the fullest, but I always keep an eye on the future and wonder where it will take us.

The first time I saw the table full of insulin pump samples at our endocrinologist’s office, the OmniPod insulin pump jumped right out at me. I was first struck of course by the tubeless nature of the device, but quickly, my mind raced with the possibilities of how the manufacturer could continue to adapt and blend advancements, because of its self-contained design. I told my wife, “I like that one. When they improve it we won’t have to wait to benefit.” That’s what I liked most about the OmniPod – it felt like the future and I couldn’t see a limit to the possibilities of where it may go.

Here we are many, many years later and I find myself about to talk to you about technology and how it has improved my daughter’s life – really my family’s life – and given her more independence. But now I’m going to talk about another piece of technology that we all have in our pockets, something that when used correctly will take you to the future and free you from restraint. Let me explain…

Giving Our Children More Freedom with Diabetes

Our children go. They go to school, to their friend’s house, to a movie – they are constantly going. Parents of children with type 1 diabetes are conditioned to fear the feeling of their child’s natural desire to just go. We want our children to have that leisurely feeling of course – that carefree, run-out-the-back-door feeling that we enjoyed as children. I don’t want to think about what could go wrong on a school bus ride. I hate telling my daughter she can’t visit a friend’s house because their parents don’t have a working understanding of diabetes and I am willing to bet that you feel the same.

Freedom and independence for our children with diabetes – but how?

How Technology Can Provide More Independence

Arden was missing class each time she visited the nurse’s office at her school. Before recess, before gym, before lunch, after exercise and every other time diabetes came to call, Arden missed class time. It was only five minutes here and three minutes there, but by the end of the day those minutes added up. After a week, they were hours and by the end of the year, they were days. Days of learning, days of socialization and days of her life – gone.

If only I could just be there, stand in the corner so I could invisibly wander to her desk and oversee her insulin dosing decisions. I just needed to be able to whisper in her ear that she didn’t need all fifteen carbs to correct that low blood glucose. I only needed to be there for a second, just like when she is home with me. Then it hit me… I can be.

Arden was in her bedroom one Saturday afternoon when I needed to know what her blood glucose (BG) was. Instead of walking upstairs I sent her a text message that said, “Test your BG please.” A few moments later I received a return message: “134.” I was with her, but I wasn’t. We were managing her blood glucose with only a momentary pause to her activity; this was the minimal interruption that I dreamed of. If only she could have her phone with her at school…

I’ll be back soon to tell you how I explained to the school what I was planning for her diabetes management, their surprising reply and all the goodness that’s come since.

The next two parts can be found on Insulet's blog, Suite D here. I've just completed parts 4 and 5, they will be going live on Suite D sometime soon. I hope that you have a great weekend... We are going to watch our kids play softball and baseball this weekend until our butts are numb from the bleachers. Best, Scott