Off the Dial

Making The Low Go

Day two of Diabetes Blog Week. But before I go any further, I really have to thank Charlotte Parent Magazine for a great article this month on kids with type 1 diabetes. It was nice of them to feature us, but I'm really glad they talked to our doctors. You can read it here.

Today's posts are supposed to explain how we treat low blood sugar. Here's what I tell my kids' friends when they come over to play. In my house, juice boxes are medicine.

Benny was diagnosed at 23 months, and we didn't give our kids juice boxes pretty much as a rule (I have a daughter, three years older than Benny). But the little ones are 15 carbs – perfect for treating most lows, and they act quickly on Benny.  We tried sweet tarts for a while, but he always wanted one when he wasn't low!

Juie box

You can see that I keep ours up high, out of the kids' reach, although they never try to drink them anymore.  After 3 years, they know! That grape one is clawed open, 'cause I did after Benny woke up low at 3am Sunday night. Oh, I mean Monday morning. Lovely.

A Day In The Life… With Diabetes

I just found out about Diabetes Blog Week. More than 100 bloggers with a different subject every day.  How cool is that? Today is "A day in the life.. with diabetes." As you know, for us, it's a day in the life with a 5 year old with diabetes (diagnosed at 23 months). So here goes:

Sleeping. Hear a noise. Up. Check? Yes, just in case. Good number. Back to bed.

Breakfast. He checks his own blood sugar.  Feel proud that he can do it. Feel sad that he's five and he has to. Feel guilty that you ruined feeling proud with feeling sad. What? Oh, breakfast.

Count the carbs, give the bolus.

Off for a family day at the park. Pack extra test strips and lancets. Driving there, realize you forgot extra pump supplies, just in case. Remember you stashed a couple of insets in your purse last week when you had to drive to preschool because his came out.  Feel grateful that preschool takes such good care of him. Worry what will happen this fall when he goes to Kindergarten. Remember other kids in school with type 1 and tell yourself he'll be fine. Deep breath, feel better. Realize extra insets are in your other purse.

Test bg. Eat snack. Bolus.

At the park, see a child with a disability (or with dangerous food allergies, or hear about a child with cancer). Feel thankful that diabetes management has come so far. Feel terrible and guilty about feeling thankful. Feel sorry for the other family. Feel stupid, 'cause you don't want anyone's pity. Settle on: everybody's got something.

Laugh and enjoy the time with your family.

Test bg. Eat. Look up carbs in ice cream treat you've never seen before. Spider-Man has gumball eyes?Bolus. 

Test bg.

Playing hard, number comes up low. Juice box – back in action. Should we suspend the pump for an hour? Remember that worked really well a while back.  Remember it didn't work so well that other time. Wonder if he should have an extra cookie. Will test again in 20 minutes. Eat the other extra cookie yourself.

Test bg, test bg, test bg.

Are the numbers going up this week? He's growing again – look at those pants! Probably have to adjust basal. Call the doctor tomorrow. Feel grateful for our incredible doctors. Hope they think we're good patients. Remember the fit he pitched when they drew blood last year? Remember they need to do that again, next visit. Mental note to ask husband to take him. Erase the note, want to be there to hold him while your heart is breaking.

Home. Eat. Bolus. Bedtime. Test.

Sleep. Dream of a cure.

Misinformation – What A Pain

I'm so happy to hear Bret Michaels is out of the hospital, but troubled by some of the reports. Specifically, that there was something about the Celebrity Apprentice contestant's type 1 diabetes that kept him from getting pain relief.

I'd never heard diabetes can interfere with pain relief and, as a mom of a little boy with type 1, it made me worry.  What happens if Benny – heaven forbid – ever needs that kind of help? Will he have to suffer?

Here's what I read in People Magazine:

"In addition to the side-effect hyponatremia, which can lead to seizures (Michaels's doctor said he has not had any), the rocker has been suffering from back pain and increased spasms – because as a diabetic, he has not been able to take certain medications. (Doctors say they'll) usually give patients steroids to lessen the pain but they can also "make glucose levels go out of control so unfortunately [Bret has] had to suffer."

I know, it's People – not the Journal of the American Medical Association – but millions of people will see it and take it at face value. I read the same thing in some other publications and in blogs, so I emailed my fabulous pediatric endocrinologists for their take.

Dr. Mark Vanderwel wrote back:

"The only thing I can think of which could even remotely limit pain relief is if he already has microvascular complications from poorly controlled T1DM, but even then I don’t know how this would limit pain relief.

If you’re talking about glucocorticoids like prednisone or hydrocortisone, the answer is yes, if absolutely needed.  Glucocorticoids will cause significant insulin resistance, and people with type 1 may find that they need to double or more their insulin doses while on glucocorticoids.

But Dr. V was clear, there is no reason to assume that type 1 diabetes means pain can't ultimately be treated.

His associate, Dr. Mark Parker's response was a little more direct. I can't print his actual wording (this is a family blog) but he called the report erroneous and mistaken. Just with more, um, colorful language.

Did I mention I love my docs?


Type 1 TV (follow up)

I still haven't see a full episode of The Celebrity Apprentice, but I know I'm going to have to start.  Apparently, last week's episode was a love letter to radio.  The task even included making spots for a client that is a major advertiser on WBT. (Hi, Benjamin Franklin Plumbing!)

I'd mentioned here that many of my friends have been pushing me to watch the show ever since Brett Michaels talked about having type 1 diabetes.  It's strange to see him running around on the show when we all know he's been in the hospital. Some very good news on that front this week.  Apparently, he's been released and his doctors expect him to make a full recovery.

I'd still like to know more about how his type 1 diabetes affected this situation. USA Today reports Michaels will "…probably continue to suffer from severe pain for another seven to 10 days as blood pooled under his brain dissolves. Michaels is a Type 1 diabetic, which limits the available options to ease discomfort." 

Why? I've never heard about type 1 interfering with pain management.  I'm going to ask my endocrinologist (you are warned Dr. V).  I'll let you know what I find out. I'm guessing this is another example of the media not understanding what type 1 is all about (I'm looking at you, Dr Oz) but that may be wishful thinking.  Easier to believe they got it wrong than to add another thing to worry about!