A family living well with type 1 diabetes.

Archive for the ‘Worries and Fears’ Category

The Last Resort.

Jenna seemed fine at bedtime.

The usual routine was playing out — bath, hair wash, a little family TV time before teeth are brushed, hands washed and stories are read. Then the final step before goodnight kisses are exchanged — the blood sugar check: 4.2 with a truck load of insulin still on board from supper.

A couple of carb tabs and another story later, a second check revealed a 2.8. This was NOT what I was expecting. Jenna has seldom had a stubborn low requiring multiple treatments. It has happened, but it’s rare, thankfully. So I gave her three more carb tabs, suspended her pump and stayed with her for snuggles and soft words of reassurance. But there was no hiding my concern from Jenna who is as smart as a whip with intuitive abilities to boot. She knew there was reason for concern. She tried to be silly to downplay the situation. I wasn’t in the mood to be silly back even though I knew she was just trying to cope the best way she knows how. She wanted me to join in this silliness like I often do. Anything to give her the sign that she was okay–that she would be okay.

I checked again and as I awaited the result I closed one eye while keeping the other firmly fixed on the meter (something I do when I’m afraid of what the number might be) and repeated out loud in a quiet chant, “Please be a good number. Please be a good number. Please be a good number…” BEEP. 2.4.

This is when mild concern rounds the corner on two wheels to desperate panic. That’s the wrong way, damn it! WRONG WAY!! If the carb tabs are not working, what the hell else is there?!

Glucagon. My final weapon against this most terrifying of D-demons. But before I proceeded, I posted on facebook for some much needed reassurance from my D-peeps. (I love you guys.)

Melissa, a person with diabetes and a mom, was the first person to give me a virtual pat on the back and encourage me: “You can do this, Sherry. Do whatever you have to.”

It was precisely what I needed to hear, even though the moment I read it I had to leave the room so Jenna wouldn’t see me bust into a full blown cry.

I went straight into my bedroom closet to where I keep the glucagon along with all of the diabetes supplies. I retrieved the kit from the travel case that accompanies us on all overnight trips away from home while flashbacks of the last time I had to employ this lifesaving intervention pelted my conscious mind like hail stones falling from a slate black cloud.

Blinking away the tears so that I could see what my hands had to do, I pulled out the contents of the kit on my bed and began reconstituting the white powder in the glass vile with the pre-filled intramuscular needle that comes with the kit. I remember thinking that at least I wouldn’t have to use that needle to inject Jenna since mini-glucagon dosing is done with a subcutaneous insulin syringe instead. That would be little consolation to Jenna, however.

I drew up the six units of glucagon (one unit per year of age) and with the needle hidden behind my back I entered Jenna’s bedroom once more. Jenna was upset now and kept telling her Daddy that she was tired and just wanted to go to sleep. She knew I had something in my hand and she knew what it was.

“No mommy! No mommy! Please NOOO!!”

I did what had to be done and left the room again to stomp the shit out of my bathroom floor while letting the tears come.

It wasn’t the fact that I had to give Jenna a needle. I don’t have a problem with that. It was giving her something I had never given her before that really upset me. Glucagon is a last resort. It is harsh. It gets the job done but it can really kick the shit out of the person receiving it. Vomiting post glucagon is not uncommon. How would she react to it? What will the rest of this night bring?

Jenna was craving toast. Before I gave her the glucagon she kept saying she smelled toast and how good it smelled to her. So as a way to wrap up this upsetting end to an otherwise great day, I invited her and her sister back downstairs for a late night, post bedtime toast snack.

Later as I was settling Jenna back in bed with a post glucagon blood sugar of 9.9, I told her she was okay and it was safe for her to go to sleep now. Jenna became emotional. She hugged me and told me how thankful she is to have a nurse for a mom who “…know[s] how to make it all better.” I told her how lucky I am to have her for a daughter and how amazing I think she is.

“I think you’re amazing too, Momma.”

We hugged more and then Jenna told me with her chin quivering and her eyes flooded with tears that when she grows up she wants to marry a man with type 1 diabetes so that they can take care of each other. This glimpse into Jenna’s thoughts made me realize just how much she gets the seriousness of her diabetes and how alone she feels at times facing the challenges diabetes presents.

I think this is one of the most heartbreaking aspects of being the mother of a child with diabetes: to watch her gradually lose her innocence and awaken to the reality of life with a disease that never sleeps and can turn on you without warning. She is thinking about her future with diabetes. And not just tomorrow, but 20 years down the road! A six year old little girl who still loves to play dress up, play with dolls, skip, ride bikes, blow bubbles and play in the mud should not have to worry about such things. And yet, a part of me is relieved that she is aware and gets it, as much as it hurts my heart.

I’ll be up several more times tonight — Jenna’s blood sugar is lunar bound and I just heard her awaken and take a big long drink from her water bottle. Last check was 16 mmol/l. This roller coaster ride is far from over.

*Nothing here should be construed as medical advice. Please consult your healthcare team of professionals if you have any concerns about your or your child’s diabetes.*

I try.

I sit quietly with my cell phone to my ear, listening while Jenna takes instruction from her support worker on what numbers to program into her pump to give herself her morning snack bolus at school.

“Okay. You are going to eat 36 carbs, so make that number a 36. Three – six.”

“Okay. Three – six?”

“Yep.”

A few seconds pass while Jenna presses the up button on her pump. When the pump flies past her goal (the numbers tend to get away from you if you just hold the button down which can be frustrating) she presses the down button to make the number what it needs to be.

“Oops — You went past.”

“I know…”

“THERE! That’s it. Okay, now you press OK. Good. Now you are going to enter your BG. What was your BG, Jenna?”

“14.6.”

“Right. Good job. Okay. So you make that 4.4 a 14.6.”

“Okay. 14.6.”

“That’s right.” More time passes and I listen to the din of children in the background chatting and laughing while they eat their snacks as Jenna toggles up to enter her rather high pre-snack blood sugar reading into her pump. The seconds start to feel like minutes. I know Jenna also hears the other kids — her friends. I know she wants to join them.

“Oops. You went way past, Jenna. Okay. Focus, my friend.”

“Ooops!!”

I hear a sigh of frustration from my little girl. I feel my jaw muscles tighten and I take a sympathetic deep breath for her. I talk to her in my mind. I don’t want to add to the frustration by chiming in. Just stay calm, Jenna. Focus.

Then Jenna’s support worker gives further encouragement,”C’mon, Jenna. Look at your pump. You’re almost there. 14.6.” I imagine Jenna is looking back at her classmates who don’t have to jump through such tedious hoops before they eat their snacks.

Then, in frustration, Jenna blurts out, “Why don’t you just do it?”

Her good-natured support worker retorts, “Ha! Because it’s your job, missy!”

And there it is.

It’s Jenna’s job to give herself her insulin, a life-saving (and potentially lethal if overdosed) drug. She’s five years old and she must do this. She doesn’t know that her support worker isn’t allowed to even touch her pump, let alone give her insulin.

Jenna often doesn’t want to be bothered with bolusing herself for every carbohydrate containing snack or meal she eats. She has worn an insulin pump since she was two years old — far too young to administer her own insulin dose. Oh sure, she would, on occasion press the OK button to initiate the actual bolus after I or her Dad had done the programming. But Jenna has been spared the monotony of bolusing for most of her diabetic life. She has been doing her own snack boluses at school for several weeks now and overall, she has rocked it. And I know that the more she does it, the easier it will be and the faster she will get at it.

Even still, no matter how fast she gets at it, it’s not what most people have to do before taking in nourishment. And it’s always prefaced by the ubiquitous blood sugar check. There are just so many damn HOOPS! Is it any wonder I worry about what the future holds?

I remember in my nursing training, when we were covering diabetes, we were taught that during the teen years it is common for teens to rebel when it comes to the necessary minutia they must constantly carry out to stay healthy. It is so common, in fact, that the training we received in caring for teens with diabetes focused heavily on our verbal interactions with them and the psycho-social implications of this disease on this particular age group. And then, as if to punctuate this theory for me, during my corresponding practicum for this unit, I was assigned to a teen with diabetes who had been admitted with diabetic ketoacidosis and was undergoing further patient teaching as part of his recovery.

It was a long time ago, and I don’t remember much detail, but I do recall getting a sense that this teen was struggling. The struggle was just as much emotional as it was physical. He seemed sad. Perhaps even depressed. I felt so inadequate. I felt like I knew nothing of what this young person was going through. I felt ineffective and in over my head. I was only in my early twenties at the time and this diabetes deal that I was just learning about seemed like such a heavy burden for any person! For a teen? It must feel like the biggest bullshit, shitty hand anyone could ever be dealt. How on earth could I be of any help to this person? I was young, in training, and knew nothing of the ever-present, constant, worrisome, unpredictable, obtrusiveness that is diabetes.

I was a good student and I imagine I did my best with this patient and tried hard to NOT sound like I was reading from a script in my verbal exchanges with him. Honestly, I think I was relieved when my assignment changed. But the sadness that was so tangible stuck with me. I knew this young man was dealing with demons I knew nothing about.

And now here I am, the mother of a child with diabetes. I don’t need to tell you I have my fears. I work hard at keeping them in check. I try to look at my past professional experiences with diabetes not so much as warnings of what lies ahead but as wisdom, if put into proper perspective. I keep reminding myself that just because it is common enough to be taught in nursing theory classes and just because I happened to be assigned to a teenager recovering from diabetic ketoacidosis due to lack of self-care from typical teenage rebellion, doesn’t mean my daughter will do the same thing.

But I know how hard this disease can be. I know how exhausting and maddening it is. I know how much it can mess with your head. I also know how much being a teenager messes with your head. I’ve seen these two forces collide. I’ve seen what can happen. Teenage years + diabetes = the perfect storm for noncompliance (a term I now loath but is all too common in the medical world) and disaster.

I try to not worry so much about the future. I read about other people’s experiences and try to glean from them what is useful without causing myself too much unnecessary, premature aging worry. I try to stay positive. I try to have faith in myself and my amazing, strong, smart little girl. I try.

… but it’s hard sometimes.

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