24 Hours, Then Reboot

This post is about how I am dealing with diabetes... one day at a time and not so well.

Ever had something happen to you or your family and find your mind going to others who have it much worse? It's a good way of dealing in the here and now. "My situation is not as bad as..." "At least we don't have to go through..." You say these things thinking you can relax for a moment and maybe breathe.

Breathe. Relax. Smile. HEY! What did you just eat?!

Insulin. It's the ONLY hormone in the body that can turn food into energy. Insulin opens the body's cells and allows them to use food (in the form of sugar). Mattie doesn't have any so he must inject it or slowly starve to death. Unlike the much more common T2 (type 2) diabetes Matt's body will eat itself without his daily injections. He will loose weight and his body will produce Ketones.

Ketones. They are the bi-product of the body eating fat and muscle stores because it can not access the sugar in the blood stream. Ketones are deadly. They are the dread of every mother with a T1 child. If Mattie's bg (blood glucose) goes above 300 for 2 consecutive tests (he tests 5x daily) then we must test for ketones. If they are in the mild range we keep on testing. If they are in the mod-high range we call Vanderbilt and then head to the ER. If, God forbid, our child becomes sick then we must test for ketones every 2 hours.

Sickness. Sickness, in particular vomiting, can turn a healthy T1 into a very sick T1 in a matter of hours. Vanderbilt has given us a very strict sick day regimen. If Mattie throws up we are to call them asap. We then begin a 2-3 hr bg and ketone check. If his bg is below 150 we give him carbs in liquid form, anything he can hold down. If his bg goes above 200 we give insulin in half units for every 100 above 200... clear as mud right? If the ketones go above the moderate range we take him to the ER. We can not give him Phenergan- the lovely no throw up med- because it will make him too tired. If he is drugged he may not "feel" a low in time for it to be treated before he looses consciousness or has a seizure.

Lows. A low is any bg reading below 80. A bad low (like Rob Lowe :) is anything below 70. If the bg is below 70 we treat with "fast acting carbs"- anything sugar in liquid form- soda, juice, low fat milk (fat slow the absorption of sugar) or sugar tablets. The idea is to give 15 carbs then wait 10-15 minutes and retest. If the bg is still below 70 the process starts all over again. If it is above 70 then give "slow acting carbs"- food. If at any point Mattie should loose consciousness we are to test bg, call 911, then give Glucagon if bg is blow 70.

Glucagon- A hormone that will cause the liver to release stored sugar. We have 2 emergency glucagon kits. The kits contain glucagon in powder form and a water filled syringe. It is mixed then given in a large muscle. Once it is given the patient is rolled on their side because a common side effect is vomiting. One of the kits is in the kitchen and one is in Mattie's bag.

Matt's Bag. For now he has a green bag that we came home with him from the hospital. He carries it with him EVERYWHERE. Where he goes the bag goes, no exceptions. It contains: 1 juice box, 2 packages of glucose tablets, food bar, glucagin kit -these are for treating lows; bg monitor kit (monitor, lancet, and test strips); syringes; log book; Novolog.

Novolog/Lantus. Lantus if the slow acting insulin that Mattie injects every night. It provides a steady low dose throughout the day. Novolog is the faster acting insulin that he injects to cover the carbs he eats. Novolog acts fast and is gone a few hrs later.

Carbs. Carbohydrates are what they body uses as sugar. ALL carbs are turned into sugar. Simple, complex, doesn't matter, the body sees them in the same way, as sugar- energy. Complex carbs are broken down more slowly and therefore are a better choice. Because they do not hit the bloodstream as fast, complex carbs don't give big swings up. But they still must be accounted for with insulin. Every carb that goes into his mouth needs to be counted.

Carb Counting. IT STINKS! Well, okay, it doesn't stink if what he's eating came in a package with a label but what about homemade food. We eat at Gran's several times a week what about then. Do I stand next to her and quiz her about the Tbls of floor in her gravy or cups of flour in her biscuits? I tried guessing once and his bg went to 44! Now I'm low balling them. But you may ask what am I even talking about???

Carb Plan #1. For every 25 carbs that he eats we give 1 unit of insulin. If he eats 37 carbs he gets 1.5 units. I HATE 1/2 UNITS!

Carb Plan #2. The first one was not working well. His bg #s between breakfast and lunch were always high so here is the new plan. 1/20 carb ratio at breakfast and a 1/25 ratio the rest of the day. This is where we are right now but this will change.

Change. As Matt grows his insulin needs will change. Right now he needs little compared to the other 2 children in our "class group" at Vandy. The thought is that his pancreas is still producing some small amounts of insulin. When it finally gives out his #s will go up. When he is a teen his needs will increase again.

Our day. It stats with a bg test at 3am to make sure he is not dropping while he sleeps. He tests before each meal and if he doesn't feel well- headache, stomach ache, dizzy, hot, cold, sweaty, shaky, anything "odd". He is allowed 15-20 carbs for snack twice daily with no injection. Any snack more than 20 carbs gets a shot. Every meal that is over 20 carbs gets a shot. He is a growing boy that needs carbs so he gets insulin for every meal.

Rinse and Repeat. No cure, no remission. A lifetime of serious just around the corner. One day at a time. "Day by day and with each passing moment strength I find to meet my trials here. Resting in my Father's wise bestowment I've no cause for worry or for fear"... but I do worry, I do fear.