A family living well with type 1 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.

Sickies in a Blanket.

Mommy and Jenna,

Both sick with a flu,

Snuggled together ‘neath a blanket

Or two.

Fevers and coughs and aches

We both share,

But Jenna has ketones;

They’re trace–but still there.

 We’re sipping fluids-

We’re resting and snoozing.

The cartoons on the TV

Are not of my choosing.

For this mommy to worry

Is really not new,

But to fret in this febrile state…

…ah…AH…ACHOOOO!!

I can handle a lot,

Countless times I have shown,

But a little back-up today

Would beat D-parenting alone.

That’s all I got. *sniffle*

A few months back I “met” Steve Richert on Twitter. He commented on a link I posted–completely non-D related–and we got chatting. He introduced himself and told me about what he was planning to embark upon come the new year. I was instantly intrigued and impressed.

Steve is an avid rock climber who has started an initiative called Project 365. He plans to climb for 365 straight days in some of the most extreme environments our continent has to offer. With the help of his wife, Stefanie, he will document the journey.

Oh! And he also happens to have type 1 diabetes.

People like Steve fascinate and inspire me and I knew I had to keep in touch with him and watch his progress while he attempted to achieve his goal. As much as I want to believe in a cure for Jenna, the reality is that she may very well have to live with this disease for the rest of her life. I certainly don’t want her to sacrifice a single dream or ambition using diabetes as an excuse. Fortunately, there is no shortage of inspiring people in the diabetes online community and Steve is a shining example of just such inspiration. He is living proof that a person can do anything, be anything and live a rich and fulfilling life with type 1 diabetes. His determination and courage give me hope.

In mid January Steve and Stef began their 365 day mission. In between climbs Steve found time to answer a few questions I had for him and I am thrilled to share his words with you here:

* * * * *

Sherry: How long have you had diabetes? Would you mind sharing your diagnosis story?

Steve: 13 years as of January 16 2012. I was away from home, living in alaska at age 16. I came down with what felt like the flu and it just kept getting worse instead of better. Blurry vision, thirst, headaches, loss of coordination and I was constantly fatigued. After about a month of this I wound up having seizures and being hospitalized with encephalitis–which resulted in a concurrent diagnosis of type 1 diabetes. There were two days that I completely don’t remember and I just woke up in the ICU. I had been under an incredible amount of stress and it was all pretty disorienting–but once I got out of the hospital, it felt so good to not feel like complete shit, that I welcomed the application of insulin and the whole learning process that went with it.

Sherry: What prompted you to decide to embark upon this incredibly ambitious mission of 365 straight days of climbing in some of the most extreme terrain North America has to offer while managing your type 1 diabetes and what do you aspire to accomplish?

Steve: I want to empower people with type 1 diabetes and other chronic illnesses to think big. To not let a medical condition constrain their dreams–also I want to demonstrate the benefit of being active and eating a fresh, high quality, plant based diet and connecting with nature. Doing more with less (drugs/meds, “stuff”) is both possible and beneficial.

Sherry: You and your wife have taken some risks to make this adventure possible. You have sold almost all of your possessions and are using your savings to help finance this mission. Can you explain what emotions you experienced while you went through the process of preparing for this year long journey? Was there ever a “HOLY SH–! Are we crazy?!” moment? Any epiphanies?

Steve: Risk is an inherent part of life. Living in a conventional setting with an unfulfilled dream in our heart was deemed to be a bigger risk–so we decided to at least try. I think failure and struggle are vital components of human development that we as a society have managed to avoid to our great detriment. I am ok with failing or having to pick up the pieces if the money runs out. You definitely have to go all in and commit fully or else what’s the point? No one lives forever–so do what you can, while you are able!

Preparation has basically been DAYS spent on the computer, wishing I could just go out and climb. Trying to make other people care about this project. The most emotionally taxing part of this has been leaving our home and realizing that if this fails we literally have no home to go back to. Leaving our cat has been SO painful because in our absence he hasn’t adjusted to his new home and has run away several times for a week at a clip with no contact with anyone. It may sound weird but he is my little friend, not just a pet. I have never been a very social person and he (we call him Mr. Kitty or Mr. Bear) has always been there for me when people let me down and it rips my heart out knowing tht he is scared and feeling abandoned. I try not to dwell on that part.

Holy Shit moments? Every single day. Especially at night when your mind just goes to those dark places.

Epiphanies…yes…the little things, the small steps–those are where we succeed or fail ultimately in the big picture of things.

Sherry: You are on injections (pens?). Have you ever been on or considered using an insulin pump?

Steve: I am on pens–never been on a pump. I am not against the idea of a pump but I am used to taking shots and I don’t mind it. I am a fan of simplicity and the fact that it is a lot more affordable. I was offered a sponsorship deal from a pump company that would have cost me 400 bucks a month…needless to say, insulin pens started looking a lot better! I am sure that there are advantages to both–I am just more clued in to the advantages of my system because that’s what I know.

Sherry: As a substitute pancreas myself, I have a keen interest on the specifics of how you plan to manage all that diabetes will, no doubt, throw at you while you are dangling from a cliff in the wilderness. What challenges does having type 1 diabetes present while you are climbing and how do you plan to address them?

Steve: Type 1’s biggest challenge is the variability of insulin sensitivity that goes with varying levels of activity. Also, not being able to carbo-load before a big day of climbing can make it a bit tougher to recover AFTER that big day. Otherwise, you just have to be consistent and check a lot. I find that the quality of the foods I eat makes a HUGE difference in the consistency of my sugar. Low GI foods like Clif Bar Builders Bars and raw almonds keep me from spiking or tanking and give me energy when I really need to pour it on. Basically though I have found that everything is based on cause and effect. If you want to be all ready to roll in the morning, you have to take care of your meal the night before. Consistency is key.

I have redefined my relationship with food as part of being a type 1 diabetic–which is something I see others struggle with or refuse to do. That is their choice, but I can tell you without a doubt that I could not do what I do if I was unwilling to view food as fuel rather than entertainment or comfort. That is part of what I want to communicate to others throughout this project. YOU have the power–no, it’s not easy, but it’s POSSIBLE and you will be better off for taking control of yourself!

Sherry: Although I have never rock climbed before, I would think that it takes a well-planned, methodical, controlled approach–much like managing diabetes does. And yet the unexpected can, and indeed does happen with diabetes. Can the same be said of rock climbing? Do you feel the mental and emotional coping skills you have learned from climbing reflect or enhance your approach to managing your diabetes and vice versa?

Steve: Yes. Climbing is not about some RedBull commercial with a generic heavy metal riff playing in the background. Climbing is about self control, discipline and simplicity. That is the same approach that I have chosen in managing my diabetes and the two are inextricably linked, in my mind. Also, both have risks as a very real part of the equation–which is great motivation not to be lax.

Sherry: What suppplies do you pack with you while you are climbing and how do you tote them?

Steve: I usually take a pack of glucose tabs but I have never opened them. I think I have eaten 2 of them in 13 years. I avoid shooting fast acting insulin when I am climbing–I let my activity lower my blood sugar, which keeps the hypos reasonable and treatable with normal snacks. I carry a couple Clif Builder Bars and my meter–depending on the length of the climb, I may leave the meter down at the base of the climb. If it is one long route that will be an all day affair, then I will bring a small backpack that has enough food to last for several days, as well as my meter. When I was guiding, I would always have plenty of Clif bars to give to my clients because I always pack significantly more than I would eat in a given day.

Sherry: The physical demands of this project will, no doubt, be a challenge to manage and your diet will, undoubtedly, require as much careful consideration as your insulin dosing. Can you explain a little about what you will be eating throughout the year?

Steve: As much whole foods as possible. This means food whose identity can be discerned through simply looking at it, not reading a list of ingredients. Fresh, Raw (when possible). Predominately vegetable matter.

Breakfast: usually raw almonds and some form of oatmeal. Possibly part of a Builder Bar too or a little cheese. Eggs with mushrooms are an option too since eggs in their shell will keep for a good amount of time if you are careful with them. Onions, spinach, work great as add-ins.

Lunch: raw nuts, seeds, a salad (yes greens keep without refrigeration if you are creative!) carrots, crackers, Builder Bar, tuna fish with mustard or sardines, trail mix.

Dinner: salad, veggie stir fry (cabbage, broccoli, sprouts, peanuts, hot sauce, black beans) lentils, whole wheat pasta, raw almonds, sweet potatoes, garlic…and so on.

Fruits are always good too–apples and pears keep magnificently, strawberries…etc.

A few miscellaneous items I have recently explored are kale chips, almond butter and nori–and OH MY GOODNESS I am officially addicted. Sadly I am not going to be able to afford that stuff on a consisten basis, but it is super healthy and GOOD when I earn a treat!

Sherry: The publicity you are receiving by doing this gives you a great opportunity to send a message to other people with diabetes or other chronic diseases. What is the message you want to send?

Steve: YOU have the power to be healthy. Diabetes is a challenge but it does not have to stop you from being healthy. It is our responsibility to avoid adopting a victim mentality.

In the words of Captain Sub-text, “ A little suffering is good for you. If you embrace it instead of bitching, you will be better off for it!”

* * * * *

Thank you, Steve, for sharing your story with me. You ROCK! (pardon the pun. ;))

For more information about Project 365 please visit the website here. You can also check out (and “like”) Steve’s Facebook page where there are many more mind blowing pictures to view!

Verio Cool.

I have had the pleasure of trying out a new meter from OneTouch® — The Verio™IQ. And what a sweet little meter it is.

Upon first glance, it looks a lot like an iPod! Very sleek. Very user friendly, as any meter should be. The display is big, bold and beautiful. Jenna was impressed, as was I. Jenna enjoyed tagging whether her reading was before or after eating. This is the feature that helps the meter determine if there are any trends worth noting; another cool aspect of this sassy little meter! The only puzzler was what to do if the reading is neither. Perhaps a third option to opt out of tagging a reading would be beneficial.

Update: Evidently, there is a way to opt out of tagging a reading. You simply press the go back arrow to return to the results screen or hold down the arrow to go to the main menu. Helps to read the instructions thoroughly. :)

The next feature we liked was how little blood is required to conduct the test and the fact that you can slurp up your tiny sample from either the right or the left of the strip! This proved helpful in preventing test strip waste which is something that makes me crazy. At nearly a buck a pop, the last thing we want is an error indicating an insufficient blood sample. Sometimes this happens when Jenna is doing her own checks. Perhaps she is rushing, being the busy little bee that she is. But Jenna had no problem obtaining an adequate sample with the Verio IQ™.

This meter touts SmartScan™ Technology. It scans each sample 500 times to ensure precise results. I have no idea how it does this in just 3 short seconds but WOW! This is HUGE. We rely on meter accuracy to ensure Jenna is getting the right amount of insulin, and we all know how important proper insulin dosing is.

Besides its accuracy, the feature that really got me revved was the light. This baby has a built in light to help see in the dark during nighttime testing. I didn’t have to hold a flashlight between my teeth! And I could hang up my miner’s hat too ;)

One final note, this meter doesn’t use batteries. It charges via a plug, just like a mobile phone or MP3 player! Very cool.

Over all, I like this meter, Jenna likes this meter and I think its future is as bright as its colour, LCD display.

Disclosure: The OneTouch® Verio™IQ meter was supplied to me at no charge for evaluation purposes by LifeScan Canada Ltd. I was not paid for my opinion. The opinions expressed here are my own (and to some extent, Jenna’s). I was not required by LifeScan Canada Ltd. to mention this product on my blog but it is because I am an active diabetes blogger that I was contacted and given the opportunity to try this product gratis.

Crafty D-Crafting.

So I’ve been busy helping my girls create homemade Valentines to hand out in class next week. I blame Pinterest for this sudden blast of creative ambition. If you haven’t yet familiarized yourself with Pinterest, be forewarned, it is habit forming. As if any of us need yet another online time-suck! But the cool thing about it is you can get some really neat ideas for crafts and art projects (and a plethora of other topics).

One such project that just dazzled and amazed me was this one:

You take a picture of your child holding out his or her hand as if clutching a lolly-pop, then use some sort of photo editing software to add text and embellishments, print it off, cut slits above and below the fist and feed a lolly through! Is that not the coolest thing?!

So after I had my Valentine fun with this idea, I got to thinking — how could I make use of this idea in a D-awareness sort of way? It didn’t take long for me to come up with this:

 

I think these would be cool to make bunches of and hand out at school events during Diabetes Awareness Month in November or any time there is an opportunity to raise a little awareness. What a great way to educate people about how people with diabetes can have treats too and are not relegated to a sugar-free existence. In fact, this myth is a dangerous one that really needs to be dispelled. We know too well how important and, indeed, life-saving sugar can be to a person with type 1 diabetes.

This project is more simple than it appears. Go ahead and give it a try, whether it’s to create Valentines or awareness!

 

Hot Zone

It’s been lurking around the school since the start of the new year, picking kids off one by one. It started in Jenna’s classroom when one of her classmates let fly with a sudden barf-blitz that left one girl’s backpack covered, rendering it trash, and forced the rest of the class to the complete opposite side of the classroom to avoid the infectious, noxious nastiness.

I was bracing myself for Jenna’s first bout of a full-on case of gastroenteritis in all it’s abhorred glory after that day. I can honestly say I felt fear. The idea of my wee, insulin-dependent kindergartener throwing up for two or three days straight, unable to retain even the smallest amounts of solid, carbohydrate-providing food is enough to send me into a near panic state. This is mostly because I realize that a virus like that could easily land Jenna in hospital.

But days passed since the unfortunate “classroom yak-attack”, then weeks. Other kids came down with symptoms in the school here and there, but I started to feel comforted by the likelihood that Jenna had escaped the dreaded bug.

And then it happened again.

This time it was my older daughter’s classroom which is right across the hall from Jenna’s kinder class. I felt the all too familiar cold chill of fear when another Mom told me “Did you hear? So-and-so threw up in class today.”

“Oh NO! REALLY?!!” I’m certain my response seemed an over-reaction to this mom who appeared slightly taken aback by my concern, no doubt oblivious to the implications a stomach flu could have in my household.

I felt thrust back into the hot zone once more. I frequently detected the faint smell of emesis for days after, every time I entered the school. Perhaps it was my imagination … I don’t know. I wanted to keep my girls home until the danger had passed. But I didn’t. I wanted to follow the custodian around to ensure he was doing a good job of cleaning and disinfecting every bathroom stall, tap and door knob. But I didn’t do that either. Instead, I did what all parents do; I sent my kids to school per usual with extra reminders to wash their hands. What else can a parent do?

Then Jazmine vomited this past Friday afternoon after school. Game on.

I spent this weekend wrangling my daughter’s waist long hair out of the line of fire while she proceeded to involuntarily evacuate her stomach of all solid food taken, over and over and over again. For 36 straight hours she was unable to hold any sustenance down. Luckily, she was able to retain enough fluids to stay adequately hydrated.

But the real challenge was keeping the pathogen confined and away from Jenna. Luckily, we had no “misses”; Jaz hit the toilet or the bucket every time. But even still, it’s a messy ordeal that is not easily contained.

So, on Saturday Jenna spent the day with her daddy having lunch out at a restaurant then a movie and a trip to the book store, while Jazmine enjoyed a Gravol-induced nap and I cleaned house like a sleep deprived woman on a mission. Each bathroom was scrubbed and disinfected with a bleach solution, each counter top sanitized, each floor surface mopped. I even had time to run the vacuum and do some hot water loads of sheets and towels with a splash of bleach for good measure.

Jaz was finally able to retain food again mid-morning on Sunday. She is back to her usual, sweet self. Have we once more dodged a bullet and staved off what is no doubt, at some point, the inevitable? I don’t know. I’m almost afraid of getting too cocky at this point. Don’t want to tempt the fates. Jenna could still succumb to this vile bug, in spite of all our efforts.

But in the meantime, I’ve armed myself by boning up on my diabetes sick day management skills. I printed off the procedures for sick day management* and mini-glucagon dosing* from the BC Children’s Hospital website*. Even though I’ve read through these procedures several times in the past, a little refresher course never hurts. And now I feel better prepared to take on the dreaded barf bug while juggling diabetes if it is, in fact, in the cards for us to do so. Knowledge is power. And as lacking as our healthcare system can be at times, it is comforting to know it’s there for us should we need it.

Stay healthy, and if you can’t — stay knowledgeable. It just might save you a trip to acute care.

*Please note that these are Canadian procedures where we measure blood sugar in mmol/L, instead of the American measure of mg/dL. Also, this should in no way be considered medical advice. If you or your child is ill or experiencing flu symptoms you should consult your healthcare provider or diabetes medical team for assistance.

This morning as I scrolled through my Facebook feed I read a post by a fellow D-Mom, Meri Shuhmacher, who blogs over at  Our Diabetic Life. Her post explained how she has noticed that her son has only been doing blood sugar checks on two fingers — his pinky and the finger next to it —  instead of using all his fingers (Jenna insists on this as well, only it’s her two pointer fingers that get picked on mostly).

In this post Meri goes on to tell how she asked him why he is doing this. He explains that he is “creating a shield”. (This made my D-Momma heart ache a little, I confess.) Her post was accompanied by a picture of a close-up of her son’s hand with calloused little digits that looked all too familiar. It brought me back to that first year after Jenna’s diagnosis and a post I wrote on September 15, 2008, just three months after Jenna’s diagnosis, discussing this unavoidable finger fate of all people with type 1 diabetes. It also brought back the heartache that I endured around the clock during that first year. We’ve come so far…

Here is a reposting of that blog post I wrote, because sometimes it’s good to look back and see how far one has come.

*     *     *     *

A Diabetic Rite of Passage

It was inevitable. We were warned about this by our diabetes nurse in hospital when Jenna was just diagnosed. I wasn’t the least bit phased by it at the time, but now that it has happened, my heart hurts for my little girl.

The tips of Jenna’s two index fingers have developed little callouses from the constant pokes with the lancet to test her blood sugar. My two and a half year old, beautiful little girl now sports the trademark of a seasoned diabetic.

I know it isn’t that big a deal, and I am without a doubt thankful for my blessings. It could be so much worse. But still I feel that familiar feeling of sadness that I felt so acutely upon her initial diagnosis every time I push that spring loaded trigger button and squeeze out her precious blood, drop by ever-loving drop.

When Jenna was first diagnosed, I remember friends and family saying that if she had to get diabetes, better now while she is so young. I remember at the time feeling both grateful for this small mercy and profoundly saddened by it at the same time. On the one hand, yes it is true that Jenna will be spared having to change habits that had been years in the making and will never mourn the loss of her far less complicated,pre-diagnosis days. But on the other hand, how tragic that she will never know what it’s like to occasionally eat with reckless abandon, or to run out the door to play with only the clothes on her back and not have to worry about packing glucose tabs or her glucometer with her, not to mention her ever-present insulin pump strapped to her little waist.

The thought that really gave me pause was the one that popped into my head within the first 24 hours of her diagnosis; My daughter can’t survive without the help of modern medicine. Jenna is sentenced to a lifetime of being a heavy consumer of pharmaceuticals for her very survival. She will never know any different.

Jenna is becoming more curious about her diabetes. She is asking questions and making statements, looking for confirmation and reinforcement, saying things like, “I have diabetes, right? I need my pump, don’t I?” I know she is attempting to understand and deal with it all. I also know that this is just the tip of the ice burg. Over the years there will be many more of Jenna’s questions to answer and emotions to feel and they aren’t all going to be as positive and accepting as they seem to be now.

I guess in the grand scheme of things a couple of little callouses isn’t the end of the world. But to me they represent all the pain, and trials Jenna has had to overcome and everything she has yet to endure throughout her life with diabetes. And because of that my heart breaks a little everytime I look upon those precious little two year old fingers.

…but the testament they are to her strenth and courage is what makes me fill to bursting with pride.

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