We're starting 2010 with some reminders that, several years into my son's diagnosis of type 1 diabetes, there will always be something changing.
We drove to my parents' house in Florida for the winter break. It's about a ten hour drive from our house near Charlotte so we broke it up into two days. My kids go bananas at the thought of staying in a hotel. (mom, this room has it's own couch!! there's a bathroom in here!!), so it's a fun way to get a vacation started.
Driving for several hours at a clip, though, means lots of snacks and meals in the car. We have to give Benny insulin every time he eats. His pump makes that pretty easy, but until recently, it's also meant reaching into the back seat to dose him every time. Over the summer, I was driving alone with the kids and Lea stepped up and used Benny's pump for me. Total team effort. He had to agree to let his big sister reach over and take his pump out, she had to enter the numbers and then show me the screen so I could take a quick look and make sure he wasn't going to OD. We were all really excited about how it worked out.
Since Benny just turned 5, this trip we thought he could do some of that himself. By the time we drove home, he was bolusing himself every time. I'm not comfortable with him doing that when it's not a necessity, and he doesn't show any interest in really taking over. I am excited about his learning more about this essential piece of medical equipment he wears 24-7. (Bonus: carbs are entered by 1's and insulin is entered by 5's, so my pre-K kid is getting some math learnin' too.)
Here's the bad from that trip. Benny's grown so much (more than 3 inches in 2009!) that we've been playing catch up with his insulin dosing. There's a basal rate that the pump uses to give him insulin all day long (that's what your pancreas does). Good explanation of basal rate here. As Benny grows, he needs more insulin, so his basal rate goes up.
My mom has a pool, though, and exercise can bring blood sugar levels down. Benny would swim for hours if we let him and we often have to make him come out of the water for blood sugar checks. The lower effects can last for hours – and can be dangerous overnight. We've really ramped up the basal rate overnight, too.
Just before bedtime one evening, Benny's blood sugar was 54. That's dangerously low (should be around 100). I gave him a juice box and a cookie – about 40 carbs – much more than he'd normally need to come back up from a low, but with all the swimming, we figured it was the right call.
An hour later, Benny was 53. I couldn't get him to eat or drink anything else. He seemed exhausted, wouldn't even open his eyes or sit up. That's when we started to get worried. It was clear something was very wrong.
A half hour later we checked again, still low. Then a few minutes later, Benny got sick. Luckily, after that, he felt a lot better and was able to drink a little juice and eat some crackers. Blood sugar slowly came back up and he was much better by morning.
We carry a glucagon shot with us everywhere and would have had to give it to Benny if his BG hadn't started coming back up. I also should have suspended or turned off his insulin pump during that time. We've never done that and I didn't think of it. Always learning.
Of course, now that we're back home and back in our routine, we're having trouble with overnight high blood sugar. Is the kid growing again? Fighting a cold that hasn't shown up yet? We'll figure it out. And then it'll change. Actually, that sounds a lot like raising kids in general! Happy 2010 and good luck to us all!