Month: August 2009

As a mom of a child with Type 1 diabetes I am always astounded when people ask about my son’s numbers or his A1C. As I am always gobsmacked, I wanted to think about this a little more to figure out why. After some thought, I realize I am shocked because both numbers and his latest A1C are very personal and unless you are on my son’s health/personal care team, they are of no use to you.

For instance, if someone is  going to watch my son for me for a few hours, then asking about the day’s numbers makes plenty of sense. If his numbers have been in range all day then they have a good chance of staying that way. If we had been treating both highs and lows that day, then the babysitter knows to be on the look out for some more interesting numbers.

But when random people on the street (or at a bar) ask me “How are his numbers?” I am rendered speechless. First I am not sure if they want to know in general how his numbers have been for the last two years, or the last two hours. Because if it’s over the whole two years, there’s not enough beer in the bar for that conversation.

I am also speechless because I really don’t have an answer. I have looked at so many thousands of numbers over the last two years that when I do a blood glucose check that particular number goes in one ear and out the other so to speak. Numbers are just that. A number. I check my son’s sugar, I take a nanosecond to decide whether he needs insulin, sugar or nothing, and I move on. Sometimes when I go to write the number in our log not 10 feet and 10 seconds away from the meter where I just tested, I have to walk back to the meter to retrieve the number. It really goes in one ear and out the other.

But the absolute main reason that I am at a loss for words when people ask me about my son’s numbers or his A1C is because it is such a personal question. My son’s numbers are just that…HIS. I don’t go around asking people their blood pressure, their cholesterol levels, their weight, their age, or how their hemorrhoids are.  I don’t because all of those things are personal.

Now if someone sits down next to me and starts talking about their blood pressure I will let them talk. I won’t cover my ears and shout, “Be quiet,” but you can be sure the next time I see them in Shop Rite I won’t ask point blank, “Hey how’s the blood pressure thing going?” Or, “Did you ever get that bottom number down to 120?” It’s personal. Not for me to ask. If they want to bring it up, sure I’ll ask how things are going. But you won’t ever find me pinning someone to the frozen food aisle while I grill them about their blood pressure or cholesterol level.

It’s not that I don’t care about other people’s health and well-being, I do. I just don’t think asking about their triglyceride number is going to do me or them any good.

And knowing my son’s numbers and A1C are not going to do you any good either.

Parents (or at least this parent) of a child with Type 1 Diabetes fear school for many reasons. Sure homework, tests, and attendance give all parents the jitters. Add in the concern about high sugars, low sugars, and mistreatment of your child’s health and it’s a wonder how any parent of a child with T1 makes it past the first week.

We are new to full day school. In our school district there is 1/2 day Kindergarten, so as we embark on 1st grade, we are also getting ready for our first full day of school. That means there are bus rides to and from school that I need to worry about my son’s blood sugar levels. That also means lunch, snack, recess and gym are more specific times that I need to worry about my son’s blood sugar levels.

More importantly I need to be concerned if my son is being treated as if he were at home. No I don’t mean treating him like he is the king of the household, what I mean by this is I have to wonder if there is any way his diabetes management can come close to his diabetes management when he is with me, his mom.

While I understand that this is public school and there are literally hundreds (over 800) of other children in the school, there are some things that need to be done to keep my son safe at school that go above and beyond how the other children are kept safe.

Since some awful school shooting tragedies in recent history many public schools have instituted ‘lockdown’ procedures that would protect the students if there were to be a shooter in the building or on campus. During these ‘lockdown’ drills I also have to be concerned that someone that is locked down with my son also knows how to work his blood glucose meter, identify and treat a low blood sugar, identify and treat a high blood glucose, administer glucagon in case of severe low blood glucose.

May not seem like a big deal, as lockdown drills are not often, but what if it’s the real thing? Yes, protect the children from the shooter, but please don’t forget my son in the meantime. I know as his mom, I would protect him from the shooter and manage his diabetes. It’s what I do.

That may be too extreme for some people. Let’s bring it down a little closer to home. Every child has to use the bathroom in school. In our home we have an open door policy. I have two little children at home, all doors have an open door policy. But really because of diabetes, I will always have to have this policy. I cannot let my son shower, even when he is 16, with the door locked because if his sugar goes dangerously low while showering I will have to get in there somehow. Sure I can break the door down, but just seems easier to keep the door unlocked.

Schools don’t have an open door policy for their bathrooms, and believe me as a former teacher I am grateful for that. But what about the one time my son goes into the stall and his teacher forgets that she excused him to go to the bathroom? What if that is the one time that he goes dangerously low while in the bathroom stall?

It’s the ‘what ifs’ that worry me about the upcoming school year. There is no way any staff member can run through these ‘what ifs’ unless they live it like me. They will snicker behind my back (probably like you are) when I bring these ‘what ifs’ to their attention.

But I am a mom of a child with T1, bringing up the ‘what ifs’ and trying to catch them before they become a teachable moment is my job.

Much of parenting is about making judgement calls. You assess the situation and make the best decision you can at that time. It is the same with Type 1 diabetes. With Type 1 diabetes you assess, treat and hope it was the right decision.

While much of dealing with Type 1 diabetes is pretty cut and dry like giving insulin for carbs eaten, there are times when you have to make a decision based on the situation at hand and things are not so easy.

When my son has a low number while he is awake I know to treat with sugar and retest in 15 minutes. The problem arises when he is low and sound asleep. I can treat the low number and make him eat while he is sleeping, and then retest in 15 minutes.Then if the number is still too low, I can make him eat again while he is sleeping and then retest again in 15 minutes.

OR I can treat the number with more carbs then I usually do because if I got him eating while he is sleeping it may be easier to get it all in at once, and then retest in 15 minutes and possibly correct the number down a bit later.

OR I can treat the number with a normal amount of carbs used to treat a low, and put a temporary basal on him pump for an hour or so. What this means is I would stop the amount of insulin that is normally being put out from his pump at this particular time a day to give the sugar a chance to raise the low number. Of course, then test again in 15 minutes to see if I have turned the low around.

It seems like it shouldn’t be too difficult, as I have only laid out three different scenarios for treating a low while my son is sleeping. And choosing which plan of action is not the part that causes the most stress. The part that causes the most stress is after you have chosen a way to go, and the results are not at all what you expected.

After 15 carbs a person’s sugar is supposed to go up. Sometimes it doesn’t and sometimes it even goes lower. So when that happens to you one time it makes you question the next time. The one time when you check your child and his number is 65, treat with carbs, and then test 15 minutes later to see a 57 on the meter definitely changes your opinion about that plan of action. It is way harder to get a child to eat more carbs after you had already fed them not 15 minutes before all while they slept.

Diabetes is so unpredictable, that unpredictability is the only measurable factor. What works one day is not sure to work the next. It definitely makes judgement calls more difficult because there is no distinct pattern of when you’ve made the right call.

Experience helps you make the right decision, but even experience can not really tell whether you are making the right decision or not, that answer lies only in the next meter reading.