Checking in on Diabetes

Dinosaur Girl and I had an appointment on Friday with Dr. Simon @ Simon Diabetes Center in Fresno.  Have I mentioned that we love Dr. Simon?  She is also a Type 1 Diabetic, wears a pump, and is the camp physician for Bearskin Meadow Camp (which we also LOVE). 

After diagnosis, Dinosaur Girl was initially cared for through Children's Hospital Central California in Madera, CA.  It was a busy, large, impersonal practice and through a friend we learned of Dr. Simon.  So, at the age of 2, we began taking Dinosaur Girl to Dr. Simon.  By age 2 1/2, Dinosaur Girl was on an insulin pump (Medtronic).  7 months later, I was diagnosed and was on a pump within 2 months.  

Simply stated, Dr. Simon gets stuff done.  She is very current in her practice and has many years experience.  She tries stuff on herself FIRST.  

If any of you are familiar with diabetes, you may have heard of a test called a Hemoglobin A1C.  This is a blood test that looks at blood sugar control over a period of about 3 months....it is NOT simply an average.....actually, about 50% of the A1C value can be attributed to glucose control in the past month.  The A1C value is read as a percentage.

The goal per the American Diabetes Association is 7% or less, the American Association of Clinical Endocrinologists recommend a value less than 6.5%.  Most non-diabetics have an A1C of less than 6%.

Well.....it is interesting to me that we have been having discussions about our family's priorities and re-examining them.  I knew Dino girl had been running high, but she has also had her share of lows (which all Type 1's have - random, unpredictable lows).  The older girls have been so busy, the little ones just tend to get pulled along and we haven't had proper focus on their diet (though they have been getting plenty of exercise at parks), eating times, or Dinosaur girl's glucose management.  Her management mostly falls to me, as does the bills, the shopping, the house, the job, etc (that is a whole nother post!).

Long story short, her A1C was 9.7%.  HORRIBLE.  WORSE THAN WHEN SHE WAS DIAGNOSED.  Hanging my head in shame, I texted the value to Pigeon Man (who was at his softball team's pizza party).  He responded "I know I need to do better for her."

Well, WE need to do better for her.....and that means slowing the family down enough to safely care for her diabetes.  More to come on this, as I don't want the other kids to feel like their lives are impacted or limited due to Dino's diabetes, however, how can I not?  

Striving to find some balance..........

Meanwhile, we made pump setting changes and wil upload her pump (yes, all electronic, no daily log books - very cool) weekly and call dr simon to go over the reports and make further changes.  

BTW...my A1C= 7.3%.....and i'm now wearing a continuous glucose sensor.

Help Jets QB Mark Sanchez raise $100,000 for Diabetes!

 As you know, our 4 year old daughter - Natasha - was diagnosed with Type 1 Diabetes when she was 22 months old.  This has had such an impact on our family, positive and negative.  We are very thankful that if it must be, that it is Diabetes and not cancer or some other debilitating disease.  We are very hopeful that a cure will come in her lifetime, but more research is needed.  Please join us in supporting Mark Sanchez by voting for him HERE.  Vote often, as much as you can.  Voting ends on Friday, Feb. 5.  Please forward to your friends! and thank you so very much!

Diabetes: It's nothing to ignore

Well, at work, on a daily basis, i am exposed to diabetics with health issues (hence their trip to the hospital). I am finding myself frustrated not only with the lack of knowledge/concern/self-management that i see from patients but also from the medical community. A lot of physicians in the community are treating Diabetes in their patients, but not really MANAGING it.

I have seen a 45 year old who is COMPLETELY BLIND due to his 20 years as a Type 2 diabetic.

I have seen a 14 year old, super skinny, diagnosed as a type 2 diabetic without any idea how to manage her diet, no knowledge of her blood sugar values, in fact - doesn't even check her blood sugar every day! I asked her mom if they had done antibody testing - she had no idea.

I have seen a 20-something man, diagnosed as a Type 2, who had not checked his blood sugar in over a month. Had no concern over it what-so-ever! when i checked it, it was 370. He was not at all surprised....

UGGGG!

Type 1 diabetes and seizures

(image credit to www.kidshealth.org)
We have been made well aware from our diabetic day 1 that seizures related to hypoglycemia were a very real possibility for our little girl. We were duly informed that they most often occur at night, hence the importance of checking her blood sugar at 3 a.m. 2 nights ago, I woke up at 3 a.m. to check her. Matt was up with the little one, she was fussy and not sleeping well. When I checked her, the meter said 38. She has been lower than 38 on other occasions. This time, however, one look at her eyes and I knew something major was about to occur. I ran to get the glucagon and by the time i came back (luckily she was in our bed) she was convulsing and shrieking (pretty terrifying). I drug her into my lap and held her on her side, somehow managed to draw up 30 units of glucagon and inject it. She continued convulsing and i yelled for matt. He - bless him! - came in, was cool as a cucumber, drew up another 30 units and gave it to her. Within about 30 sec she started to quiet and then the convulsing resolved. Matt gave her her blankie, and she wanted to go to him. At that point her blood sugar was up to 100. I called Dr. Mary to let her know. Then we laid her down and continued checking her. The highest she went was 283. I went to sleep finally at 5 a.m. as she was still over 200. At 6:30 I woke up for work, checked her and she was 41!!! More glucagon, but no seizure - thank the Lord!

From this experience, I have learned the following and recommend to any diabetic:

1. Keep your glucagon prescription filled
2. Know where the glucagon is
3. If you use mini-dose glucagon, and have a vial in the fridge - make sure you date it!
4. Keep an Insulin syringe with your glucagon
5. Know basic first aid for a seizure
6. Keep your meter by your bed!
7. Pray your child never has a seizure, it was really scary!

A visit to Dr. Mary

Went to see Dr. Mary today. This was my follow up visit since starting Symlin on May 13th. I'm happy to report that my A1C is down from 7.2% to 6.8%!! Still want to get it lower but this is significant progress. I will now increase my dose of Symlin to 120 mcg with each meal. I haven't lost any weight yet which is a bummer as I feel i eat more like a normal person now (thanks to the Symlin). She explained that as your blood sugar is coming under control - after being high or out of control - that many people gain weight. Reason being is that when you are high, your losing carbs in your urine (rather than putting them on your hips!). So, long story short, I need to further modify my diet - i'm thinking 2 carbs per meal? we'll see.....

Pump changes

Quick call with Dr. Mary tonight. For Natasha we are changing her 9 pm target to a blood sugar of 150 (those nighttime lows scare me, she doesn' t wake up!) and decreasing her carb ratio at 0700 (correction insulin) -we'll see how those changes do....

For me, we increased my basal to 1.2 units/hour and increased my Symlin to 90 mcg. She believes i'm almost on target, but i would like to see my numbers lower.

In case i've never elaborated, we see Dr. Mary Simon in Fresno, CA. She is a Diabetologist, MD, and type 1 diabetic herself. We love her!! She is also the medical director for the diabetes camp we attend every summer at Bearskin Meadow (see my sidebar for the icon). Bearskin Meadow camp saves lives and saves marriages! It's a wonderful experience!

I know the text is too small to see....here are Natasha's numbers for the last week. The red are lows.....look at all the lows! i felt like we were having quite a few, though i've been so sleep-deprived from checking her at night. Will call Dr. Mary tonight (she prefers we download one day, review it ourselves, then call her the next night to review together). Will post later.....

My numbers were improved, though nothing exciting. Average is 140's - better but still have a ways to go....

I have my pump!

My very own insulin pump arrived on Friday. Medtronic gave me some financial assistance so out of the $7000 cost, we will pay $660 divided into monthly payments of $25. Not too bad. When Natasha got her pump, i had different insurance and they paid 100%.

My setting are: basal of 1 unit per hour, carb ratio of 1 unit/10 grams carbs, sensitivity of 33.j
What does all that mean?

• Basal: Rate of insulin that is continuously infused (24 hrs a day). So I get 1 unit per hour for a total of 24 units/day.
• Carb Ratio: how much insulin to take based on the amount of carbs i've eaten. In this case, for every 10 grams of carbs the pump will give me 1 unit.
• Sensitivity: how much 1 unit of insulin will drop my blood sugar.

I call Dr. Mary tonight after I upload my pump and Natasha's pump. I'm sure we'll make some modifications to both hers and mine, so i'll post tomorrow or tonight what we are changing. All in all though, I've noticed better control just since Friday and It is soooo much more convenient. For all the pump resisters out there - this is the life! no joke! sooo much easier and so much flexibility.

An Insulin pump - if you don't have one, get one! (only if you have diabetes, LOL)

Our trip to the Doctor

Well...we went to see Dr. Mary yesterday. Here is a recap:

Natasha -> A1C is 8%, down from 8.2%. I would like to see it lower but she already has so many lows..especially at night. So, we'll work on getting the highs more under control. Dr. Mary was quick to say that many physicians would be very happy with an A1C of 8 in a 3 year old. We made a couple of pump adjustments, that's it. She goes back in 3 months and we'll continue to download her pump weekly and discuss over the phone.

Me-> A1C is 7.2%, down from 7.5%. Still uncontrolled. We had a lot of discussion about my stress eating, bottomless appetite. We made the decision to start me on Symlin. I have been doing some research on this drug and it's use in Diabetes. I will post more when I finish. Basically, Symlin is an injection I will take with meals "when the food is on my plate" that has 3 major effects:
1. Slows gastric emptying (how quickly food leaves the stomach). If food is absorbed slower, it gives my insulin dose time to get on top of the blood sugar spike.

2. Augments my insulin dose. So I take 1/3 to 1/2 my normal insulin dose at meals.

3. Creates a feeling of satiety (feeling full) so I will eat less, feel full sooner, etc.

Dr. Mary states she lost 25 pounds when she started using Symlin. That is a huge incentive.

Like every medication, Symlin also has it's side effects. These include profound hypoglycemia that is difficult to treat (due to the slowed gastric emptying) and pretty severe nausea/vomiting until acclimated to the dose.

I'm a small dose of 30 mcg but anticipate moving to 60 mcg early in the week when i call with my numbers.

Please keep in mind that this is just a quick overview. I've read enough to know there are more intracacies to this drug. More later..........

Off to the Doctor we go!

Natasha and I have an appointment with our Diabetes doctor tomorrow. We see Dr. Mary Simon in Fresno, CA. Dr. Mary as everyone affectionately calls her, is straight up wonderful. She is also a Type 1 Diabetic, wears an insulin pump. She was diagnosed at age 27. Her husband is an RN and also works in her office. She is so devoted to her patients. She forwards the office phone lines to her personal cell after hours and we are free to call at anytime. She takes insulin calls from 6-9pm every night. Each Monday we upload Natasha's pump to the Medtronic site, then call Dr. Mary. She emails us the report, we study it, decide what we think we should do then call her the following evening to discuss. Natasha has been pumping for a year now and we still adjust her pump settings at least weekly. Once in the office, she has a playroom set up for the kids with legos, books, a huge dollhouse, play food, stuffed animals, etc. They test her A1C there in the office.

Now about me.....i am a lousy diabetic. When I was pregnant I was a good diabetic. I just wrote down my numbers for the last 2 weeks. It ain't so pretty - though it isn't terrible either. My dear hubby is looking at them right now. Bless his heart, he's so positive.

I'm hopeful I can get a pump as it would make life sooo much easier. I'm thinking we are gonna discuss getting a sensor for Natasha.

Wish us luck! i'll post our A1C results and some education about all these terms tomorrow.

Uggg...I have Diabetes.....Ugggg

Many days I try to forget that I am a diabetic. I just simply don't like it. I don't like that my daughter has it. I don't like that she probably got it from me. Forgive the negativity, but it is my current reality.

I don't like that every 2 days I have to put a new needle in her tummy or her booty (a site change for her pump). We use EMLA cream (numbs the skin) and it helps, but sometimes it doesn't. Usually Matt and I put her site in together (he holds, I stick) but last night he was busy draining our pool (THAT is another story) so I decided to attempt it on my own. She looked at me with her big blue eyes and said "No, mama. You hurt me." What could I say? It's true, it does hurt her. I hate that she associates me with the hurt. BUT it has to be done. She makes very little insulin on her own, if any. She cannot go more than 2 hrs without insulin or her blood sugar spikes (then the puking, crying, etc begins).

So....I had to make a decision - I decided to go lay in bed with her, chit chat for a minute, and put her pump site in after she fell asleep. Luckily, her blood sugar was only in the high 200's afterwards, so I didn't wait too long. I think I made a good decision.

Here is a picture of her pump and pump site: