Tag Archives: carb ratio

The Honeymoon Is Over

“The Honeymoon Period.”

Sounds like a good thing, right? Who doesn’t love a honeymoon? Me, that ‘s who. I assure you this is not the “take romantic walks on the beach” kind of honeymoon.

Let me give you a little background. (Remember, I am not a doctor, even though my initials are DR).

So, your body has decided that it is going to now attack the islet cells on your pancreas that produce insulin, thus rendering you diabetic. But your body doesn’t go out in one day and kill all of the cells. It starts attacking them and they systematically die off. When enough of them have been destroyed, the glucose is no longer being carried out of the bloodstream and into the cells to be used for energy, so you gradually start showing symptoms. Everyday, more islet cells are destroyed. Eventually, the insulin that is still working is over-worked and decides to go on strike. It can’t keep up, so it stops working. So one day your islet cells are producing insulin, and seemingly the next day (it doesn’t really happen that quickly), many of the cells are killed and the ones that aren’t killed, are refusing to work.  So boom! Virtually no insulin working in your body and you get really sick, really fast (DKA).

Not every person who is diagnosed with type 1 diabetes goes into DKA. In fact, Medium was one of those who didn’t. I like to think it was because of my keen awareness and attention to detail that I was able to identify his symptoms fairly early on, but who really knows. Nonetheless, the staff in the ER kept commenting on how kids usually are so much sicker than Medium when they come in. It was almost as if it wasn’t really happening because there didn’t really seem to be a real emergency, even though his blood glucose level was 565 mg/dL. (A healthy blood sugar level is between 70 mg/dL and 140 mg/dL). Everyone was very chill, everyone except Medium’s pediatrician whom I am sure was still sitting back at his office with his mouth agape. (He too didn’t think Medium looked sick and was quite shocked at the results in the office). As a former ER worker, I almost felt like I needed to apologize for disappointing them with our drama-free presentation!

But I digress.

Back to the honeymoon.

So, you’ve now been diagnosed with type 1 diabetes. (We aren’t even going to go into how sucky that is in and of itself, you’ve heard enough of those rants from me). And the treatment (not cure) for this diagnosis is insulin. So you start giving yourself synthetic insulin via injections into the subcutaneous tissue of your arm, thigh, belly or buttock and now your body has what it needs to carry the glucose, that comes from the foods you eat, out of your bloodstream and into your cells to be used for energy. Yay. (Please notice the purposeful exclusion of an exclamation point here. While all diabetics and their caregivers are ever-so-grateful for the invention of synthetic insulin, it is not a cure. So, until there is a cure, you get no exclamation point. Sorry.)

But guess what? Remember that insulin that your own body was still producing but had gone on strike? Well, it has accepted the terms of the negotiated settlement and has now agreed to start working again, now that it has the help of the synthetic insulin. So, you have synthetic insulin and your own insulin, and guess what? Now you have too much insulin. And guess what? Too much insulin will kill you. Yeah, this would explain my love-hate relationship with insulin. The very thing that my son needs to stay alive, can also kill him. Super.

This period of time right after diagnosis when your body’s own insulin starts working again, is called the Honeymoon Period.  (Hmmm, seems I could have gotten to this point faster, oh well.) The problem with the honeymoon period is that you don’t know when your body is going to kick out some insulin and how much it is going to kick out, so you are on the blood sugar roller coaster. Never really knowing how much synthetic insulin to give yourself. You do your best to come up with an insulin to carbohydrate ratio, but the hard truth is that, sometimes, you get it wrong.

While there is currently research being done on preserving those islet cells in those newly diagnosed with T1D, the outcome remains the same. Eventually all of those cells are going to be destroyed. So I have been saying all along, “just die already islet cells!” That way we don’t have to guess anymore how much insulin Medium really has working for him.

Well friends, I think the honeymoon is over. His blood sugars have gone up across the board. And I thought I would be relieved when this finally happened, but I am surprisingly saddened by it. I guess it just puts the proverbial nail in the proverbial coffin. The death of his pancreas.

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A Shout Out To Myself

Today’s theme: One Great Thing

“Living with diabetes (or caring for someone who lives with it) sure does take a lot of work, and it’s easy to be hard on ourselves if we aren’t “perfect”. But today it’s time to give ourselves some much deserved credit. Tell us about just one diabetes thing you (or your loved one) does spectacularly! Fasting blood sugar checks, oral meds sorted and ready, something always on hand to treat a low, or anything that you do for diabetes. Nothing is too big or too small to celebrate doing well!”

So you can see from the description that I am supposed to sing my own praises. I like to sing other people’s praises. I find self-deprecating behavior so much easier. I am my own worst critic. So I will start this post by singing others’ praises and we’ll see if I get around to the “tooting my own horn” part.

I was so excited to be a part of Diabetes Blog Week. I have only found a few other D-blogs even though I knew there were others out there. I just haven’t had time to find them. Being a D-mom can be lonely. You feel isolated. You feel like no one really knows what you go through on a daily, no make that hourly, basis. And if you do it well, make it look too easy, others really don’t know what you go through. So I couldn’t wait to find other D-moms to commiserate, and at times, celebrate with.

WOW.

I was overwhelmed today.

Around mid-morning at work I decided to check my personal email. Sometimes Medium’s school nurse emails me with questions or just FYI’s so I like to check it every so often. I couldn’t believe my eyes….several comments from other D-bloggers! I have had more hits today than ever before, I even had someone from Pakistan visit my blog! I’m international! And even though I started this blog for myself and to vent my feelings for myself, I have to admit, it is exciting and rewarding to know that others are reading and may be inspired, entertained, (or infuriated, as the case may be) by my words. And I have over a hundred new blogs to work my way through now! I can’t wait!

And here is the mouth-gaping-open thing I have learned about the DOC (diabetes online community). Even though yesterday none of these people knew me or knew of me or knew anything about me, today we are connected in a way that I can only share with them. It’s like when your child (or yourself) is first diagnosed with type 1 diabetes. One day you know nothing about the disease and, quite literally, the next day you could teach a class on the relationship between blood sugar, carbohydrates and insulin. Diabetes puts you on the fast track, both in education about the disease and anatomy and physiology of the human body. But it turns out it puts you on the fast track to immediate, deep friendships, too. And that part is amazing. Those blogs that I mentioned yesterday that I was in awe of, somehow each one of them found out that I mentioned them and each one of them messaged me with the most sincere words of praise, understanding and encouragement. I so wasn’t expecting it, and I actually started crying, right there at work in my chair with my coworkers looking at me like I was nuts (they do that a lot though 🙂 )

Imagine that feeling when you’ve been stranded, alone, on a desolate island and you realize that you are being rescued. That is how I felt. Those comments from those D-Moms (and others too!) were my life raft. I know it’s just a dinghy in the vast ocean that is diabetes, but I know now that I am drifting back towards civilization and these other moms are going to be my survival fuel. So a huge THANK YOU to them!  (And a special shout out to Laura of Houston We Have A Problem, for telling me how to add the banner!) I know I am going to learn so much from these women (and some men, too!) about things diabetic and not, and I am so re-energized by this. (The first piece of advice from someone will probably be to shorten my posts. I am well aware that they tend to be a little long in the tooth, but if you knew me, you would know that this is who I am. I am cognizant of it and will try my best to have relevant, educational, entertaining, passionate, SHORT posts whenever possible–but don’t hold your breath, I got shit to say! 🙂 )

So I promised to try and pimp myself out a bit, so here goes.

I am a great FAKE nurse.

I have a Bachelor’s degree (not in nursing) and worked a fancy corporate job back in the day, but quickly ditched the pantyhose (yes, we still wore pantyhose in those days) for poopy diapers when Large was born. By the time Medium came around 2 years later, I was desperate to use my brain for something other than nap time nursery rhymes and stimulating toddler talk. So I got a job as a Unit Secretary in an Emergency Room. I. LOVED. IT. I got to be near the action, but no one was going to die if I didn’t fax the correct piece of paper. I worked there for 9 years until a year ago when I went to work in the IT department for the same health system (it was time to start making a little more money for my time). I sat next to the ER doctors and nurses for 12 hours at a time learning from them. That has proven to be great training for being a D-mom.

So I do a pretty good job at all the nursey stuff that comes with having a D-kid (and there is a lot of it!) And while my time in the ER has given me more medical knowledge and experience than the average bear, I, in no way, compare to the true greatness that is a REAL nurse!

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Am I Weird?

I was talking with a coworker of mine today who is a nurse. She mentioned that when she was 18 her 9 year-old sister was diagnosed with T1D and she talked about helping take care of her. Another coworker asked if that is what made her want to be a nurse. She said that it was part of the reason, the other reason was that her own daughter was diagnosed with Leukemia when she was 7 and that taking care of both her sister and her daughter made her realize that nursing was her calling. And then she said something that struck me as odd. She said that taking care of a chronically ill child changes you, it makes you weird.

Now, I agree with the first part of that statement. It has not even been three full months since Medium was diagnosed, but I am definitely a different person. Most notably, I am exhausted. Actually, I am beyond exhausted. I am exhausted on steroids. I am almost non-functioning exhausted. I keep dragging my butt in to work every morning and saying, out loud, as if anyone really cares, “I don’t know how much longer I can keep up this pace”. I sit at my desk and think about whether I think I can make it through the whole day without going to the parking lot on my lunch break and taking a nap in my car. I pump myself full of caffeine and I trudge through the day. It feels like I am walking through quick-sand, like I am in slow motion. Somehow I am making it work, keeping up with my responsibilities at work and, for the most part, I feel I am pulling my weight. I know that I am capable of doing more, being sharper, going above and beyond. But I don’t even feel bad that I’m not because I am giving all I can right now. I am all tapped out. That which doesn’t kill us makes us stronger–if that is true, I am IRON WOMAN. But I still don’t get what she means by the “it makes you weird” part.

I don’t say these things so I can get sympathy. I am not the only tired woman in the world, not by a long shot. And I am keenly aware of how, even though things are pretty rough right now, they could be so much worse. On my daily prayer list are so many other families that are going through far worse. But the fact remains, that right now, life is hard. And I am trying my best to get through with my sanity and dignity in tact (incidentally,bursting into your bosses office and announcing that you have to leave because you forgot to pick up one of your children does not help this plight).

Besides being beyond exhausted, I have changed in other ways, too. I carry needles and glucose tabs everywhere I go, I can divide by 30 in the blink of an eye, I know the carb count of a plethora of foods, I stab my child with needles frequently, I no longer make jokes about being in a diabetic coma, I buy home hemoglobin A1C tests, I have insulin pens in my butter dish in the fridge, I know what basal and bolus mean, I regularly inspect my son’s feet, I stab my non-diabetic children with needles on occasion, I have Skittles and Kool-Aid in my underwear drawer, there are smears of blood all over my son’s sheets and some other random places around my house……

Huh, I think I know what my coworker meant now.

At least I don’t have a zipper on my tongue.

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Uninvited Evil Twin

If you want to try and understand the highs and lows of diabetes, this might help.

Medium’s BG’s on Monday:

7:18 am-116 Good morning perfect number!

10:18 am-120  Hello outstanding after breakfast number, nice to see you!

12:17 pm-102  Time for lunch, who wants a perfect blood sugar number?  Not me, I already am one!

2:48 pm-75  Ok, so we played outside, but still within range. We’re doing great!

4:39 pm-118  Perfect number after a free snack!  (woohoo, we love “free” snacks!)

6:19 pm-73  Yep, more playing outside, it’s the last day of Spring Break, but we are still in range, we are golden.

9:32 pm-103  How about another “free” 10 carb snack, just for good measure to keep us up during the night?  And our 4 units of Lantus, of course.

11:56 pm-271 WHAT???  Two-hundred and seventy-one!!!!  WTH??? It was 10 carbs of honey roasted peanuts for God’s sake!  And we just had Lantus!

2:57 am-217  Really?  Only 54 points in 3 hours?  Why so stubborn?

7:39 am-109  Oh, good morning  perfect blood sugar, where were you last night?  Your evil twin, hyperglycemia stopped by, uninvited.

And this is just a little snapshot of what really goes on.  Every day is a rollercoaster filled with either squashing highs or chasing lows, or, if you are really lucky, BOTH!  Diabetics (or their caregivers) have to think about their every move when deciding insulin delivery.  What am I going to eat?  When am I going to eat it?  How long will it take me to eat it?  What is my BG now?  Will I be exercising later?  Is it bedtime?  Am I stressed or nervous about something?  Do I have a cold?

Aren’t you glad your body just does what it’s supposed to?  I know I am.

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Thirty-One

It has been two months since Medium’s diagnosis of T1D and my husband and I thought we could go out for a quick dinner by ourselves.  Medium’s brother, Large is a very responsible seventh grader and Medium is all over this diabetes stuff.  So we felt okay to leave them all for a quick bite to eat down the street.

Medium’s BG at 6:30 was 113.  He ate a 54 carb dinner and was bolused two units of insulin. (He is on a 1:30 carb ratio.  Meaning for every 30 carbs he eats, he gets one unit of insulin. So in this example he was just a teeny bit overdosed, he should have eaten 60 carbs to make it a perfect 1:30 ratio.)

We left the house at 7:00 after Medium had finished eating and gave them explicit instructions to check his BG again at 7:30 since the drug peaks at 81 minutes and he was just barely overdosed and it was a new insulin pen (new insulin tends to have a bit of a “kick”).  Plus Medium and Small were on their way down to the basement to play a rousing game of indoor basketball when we left so we knew with all of those factors, he could go a little low.  And we told them that if he is low at 7:30 when he checks that he should then have a snack.  Medium is well-versed in snacks.  He is very insulin sensitive and very active and tends to run on the lower side more often than on the higher side.  So he gets “free” (meaning he doesn’t have to dose for them) snacks all the time.  In fact, we rarely ever dose for snacks.  He doses for his three meals a day, and that is usually it.  If we do dose him for a snack, it tends to send his BG’s all out of whack so we try to just give small snacks without dosing when he is lower throughout the day.

So here we are, thinking we are so smart and thinking we have thought it all through and have all angles covered, and we have a plan and everyone knows the plan and so we are leaving for date night.

So much for having a plan.

We hadn’t been gone 5 minutes when Large calls and says, “Medium is thirty-one”.

ME: “I’m sorry, what did you say?  One thirty-one?”

LARGE:  “No, thirty-one.”

ME:  “Shit!”

Medium gets on the phone and asks what he should have.  I tell him he should have 4 glucose tabs and then some peanut butter crackers and we turned the car around and headed back home.  By the time we got there he was on the couch, pale and sweating.  I got him a cold wash cloth and Brian and I sat with him and watched him eat.  We retested him and he was up to 76 ten minutes later.  Thirty minutes after that he was 132 and an hour and a half after that he was 210.  Brian just checked him again, five hours after he was 31 and with nothing else to eat other than the 4 glucose tabs, peanut butter crackers and several pieces of cheese and he is now at 319.  From 31 to 319.

Tonight’s score: Diabetes-1, Rawlings family-0

I hate diabetes.

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