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Type 1 diabetes and amusement park rides are not so amusing when put together. Even less so when the person riding them is a child living with Type 1 Diabetes. They are not so fun for the person who is patiently waiting in the wings for the ride to be over either.

As many of you know Type 1 diabetes is nothing if not unpredictable. Stress, excitement, hormones, illness, the weather, and the tides apparently can affect the blood sugar of a person with Type 1 diabetes. This also holds true when amusement park rides are thrown in the mix.

Each time my 7 year old son stepped on line to enjoy a ride my heart started to beat faster. I couldn’t help but wonder if this would be the ride that would cause his sugar to drop too low. I wonder what he will do if he is mid-way through a scary ride and he starts to feel ‘shaky’, his terminology for going low. Would he have the sense of self, while on a scary ride, while trying to hold on,  to go in his pocket to take out the candy that we have in there in case of  low?

Would you?

Yes, we test his sugar as we make our way through the rides, but it is not possible and I believe downright mean to check my son’s sugar before every single ride. I just won’t do that to him. Talk about sucking the fun right out of the air. And quite honestly it wouldn’t tell me much. Yes, his number could be perfectly in range before going on the ride, but if there is a line before the actual ride, and if there is a wait for the ride to start, there is more distance put between the last number I have on his meter and the level where his body actually is.

I watch his face closely as he waits for the ride to start. I try to analyze the look on his face. Smiling and happy are easy ones to interpret, he is feeling good in both body and spirit. It’s the more serene faces that make me nervous. I have to wonder from the sideline if his face is telling me he is a bit scared of the ride he has chosen, or his body is not feeling right. I never know what the face is telling me. I have taken to giving my son the thumbs up signal in hopes that he will reply in a similar manner, thumbs up, to let me know that all is ok, at least diabetes wise. He may be scared of the ride, but that is a rite of passage to growing up. To go low on a ride is not. Going low is not a rite of passage to anything, going low just stinks.

I could live my whole life without ever going to an amusement park again, but I don’t think my son would appreciate that. And so it goes. We will go to amusement parks, although I am not amused, and we will pack our gummy lifesavers, glucose drinks, Starburst, extra test strips, and Glucagon. And despite all this preparation and worry, we will have fun. Diabetes is tough, but rest assured, we are tougher. Six Flags here we come!!

People that have Type 1 diabetes and that use an insulin pump to deliver their insulin have what’s called ‘basal rates’ in their pump. The basal rate for a particular time of day is our best educated guess as to what a working pancreas would be doing. Of course, I can not see inside my son’s body (or anyone’s body for that matter) so I don’t really know how to measure the amount of insulin that is being put into the body by a working pancreas. But rest assured, if you don’t have Type 1 diabetes, your pancreas is indeed doing the work for you.

A working pancreas knows how much insulin your body needs while it is sleeping, when it is waking up, or when it is going to play an active game such as soccer. While this is the same insulin a pancreas secretes into the body when someone eats, this is a little different because it is the background insulin that is going 24 hours a day to keep a person’s blood glucose nice and steady. Whether you eat or not your pancreas secretes insulin. It’s a busy little bugger that pancreas! And on top of all this, a working pancreas doesn’t care what time of day it is. If your teenager without diabetes sleeps until noon the pancreas knows that he is still sleeping so the pancreas still puts out the amount he needs while sleeping. Unfortunately this is not the case when using an insulin pump.

My son has 8 different basal settings programmed (by me) into his pump. The way we determined what setting he needs at what time of day is by testing his glucose throughout the day and evaluating the numbers. An on-the-money basal pattern should keep a person within 30 points. So, on a day when I want to check my son’s basal rate each blood glucose check should be within 30 points of each other. We don’t want to see too big of a drop or rise, we want to see an even line. That means that the pump’s basal settings are correct. The basal setting is for when the person is not eating, it doesn’t have to do with covering food with insulin, that is called bolus, but that’s another post.

Basal settings go by time. My son has one basal setting from 5:00am to 10:30am. Works great on school days when he gets up at 7:00am. Something must happen in his body upon waking that I have subconsciously figured out and he can stay pretty even. On the weekends when he sleeps later, past 7:00am, I have to watch his numbers. For my son, sleeping late means that his sugar will probably go low. So somewhere in his tiny body things are happening when he is sleeping that are different from when he is awake so the basal settings that work all the time with a 7am wake-up just don’t work for an 8:30am wake-up. I do not understand it for the life of me, I just know how it works.

The same does hold true for some food boluses. My son gets way more insulin at breakfast than he does with other meals. So if breakfast is at 7:30am and all is working smoothly, that is no guarantee that the same breakfast at 10:00am would work as well. Different time of day, different body rhythm that I am not privy too.

Being an external pancreas for someone is a difficult job, there are a lot of unanswered questions that leave you making very important life or death decisions based on a combination of research and intuition.

I’ve heard of mother’s intuition, but this is asking alot.

For a person wearing an insulin pump to help manage their Type 1 diabetes there is a lot of behind the scenes action going on all the time, 24 hours a day. At any given moment, someone wearing an insulin pump can be getting insulin from their pump from either a basal rate, a correction bolus or a carb bolus (hence the 3 Bs…basal, bolus, bolus).

At a minimum the person wearing the insulin pump will be getting a continuous flow of  insulin through their pump to keep their blood glucose as steady as possible, this is called the basal rate. Most pumps allow for different basal rates throughout the day to try to mimic the way a working pancreas would put out insulin. Most people find they need different rates for different times of the day. My six year old son, for instance, needs the most basal insulin from 9:00pm to 11:00pm. It may be growth hormones, or sleep that requires this amount of insulin, but whatever the reason, a working pancreas would know what to do, so the person programming the pump (mom in this case)  must do the same.  Throughout an entire day my son has 8 different basal rates all determined by me by checking his blood glucose a minimum of 10 times a day then logging all the numbers and deciding where he needs more or less insulin. I am his working pancreas.

Basal rates are part of a unit. Some smaller people like my son have basal rates such as .150, .325, or .900. That means that over the course of an hour, my son gets .150 units of insulin doled out to him in equal amounts to keep his little body as steady as possible. In a perfect world the basal rate should be set so that the person with Type 1 diabetes does not experience a high or a low blood sugar, just like a person with a working pancreas. Nothing is perfect in the world of Type 1 diabetes, but that is a whole separate post. So lets just leave it as ‘in a perfect world’ the basal rate should keep a person with Type 1 diabetes in a normal blood glucose range of 80-120.

Now to explain the carb bolus, the 2nd B. In an insulin pump there is an insulin to carb ratio. In fact, in my son’s pump there are 6 insulin to carb ratios. Insulin to carb ratio (I:C) is the amount of insulin that is needed to cover a certain amount of carbs being consumed. So for breakfast my son’s I:C is 1:12. So for every 12 carbs he eats (strawberries, toast, cereal, or whatever) I push buttons on the pump to give 1 unit of insulin. So if my son were to eat 48 carbs at breakfast he would get….waiting for you to do the math….if you answered 4 units of insulin than you would be correct. If my son ate 48 carbs at breakfast he would get 4 units of insulin. These are determined the same way. There is a parameter we follow. Two hours after eating the person with Type 1’s blood glucose  should be no more than 50 points higher than when they started the meal. If the person’s sugar is not there, say too high or too than you know to move the I:C ratio to allow for more or less insulin. You achieve the ratios by testing glucose, logging, making changes and testing glucose again at the same time the following day.

Lastly correction bolus, the 3rd B. Insulin Sensitivity Factor (ISF) is the amount of insulin that is needed to lower the blood glucose when it is too high. My son has 3 ISF settings in his pump: 1:100, 1:150, and 1:110. That means, quite simply, that my son receives a certain amount of insulin to get his number in range according the settings that I have placed in the pump. In the morning, my son’s ISF is 1:100. His target blood glucose is 100. If he wakes up with a blood glucose number of 200 he needs to go down 100 points to get to his target of 100. When I put 200 into the pump, the settings that I have created would tell me that he needs 1 unit of insulin to drop him the 100 points. If my son’s blood glucose number was 300 upon waking he would get….waiting for you to do the math…if you answered 2 units of insulin you would be correct.  Trick question. If my son woke up to a number of 225, how much insulin would he get to come back into range?

So back to my original statement that at any given time there is at least one insulin pump setting working on my son’s blood glucose up to a maximum of 3 different settings. Scenario time: If my son were to wake up with a blood glucose of 200, and he ate 48 carbs, he would receive a bolus  for both numbers. 1 unit for blood glucose number and 4 units for his food totaling 5 units. 5 units plus the basal rate for that time of day begins coursing through my son’s blood. Now 2 hours after eating his feels shaky and test his sugar, he tests at 48!!!. Somewhere somehow he got too much insulin, whereas the day before all these settings worked perfectly. So my mind starts to question: Could his I:C need changing? Or maybe it’s the ISF for that time of day that needs changing? Or maybe the basal rate is too high close to the 2 hour point?

Right off the bat there are 3 things that need to be looked at and I only get 1 shot to fix it, the next day at the exact same time. That is not mentioning that exercise, illness, stress, weather and whatever else can affect blood glucose readings, so it may not even be basal, I:C, or ISF that need tweaking. It may just be Type 1 diabetes playing that sick joke on us again.

With all these components affecting 1 blood glucose number it’s wonder when we have any numbers in range. Must be the correct alignment of the moon or something.

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