Diabetes in the home

Maggie was diagnosed six years ago.  Dec was diagnosed about three and a half years ago.  For Maggie it was the summer before second grade; for Dec it was during spring break of his kindergarten year.  Our lives are different from lives that do not have to manage Type 1 Diabetes.  In dealing with a growing child, however, most things are the same.  We struggle with chores and responsibilities, just like any home, but Maggie and Dec have some added responsibilities.

Eating.  Home from school, the pantry or fridge is the first stop.  Grab some crackers, some juice, ice cream if there is any, and chocolate chips.  The snap peas and peaches are merely taking up counter space.  Let me push those aside to make room for my cinnamon toast with an extra teaspoon or three of sugar.  Need to move the canned green beans aside to get to the three packs of Ramen noodle soup.  Did you know you can eat these raw?  You can, but I still like to cook them.  I always drain all the broth, though.  Why waste your time on that stuff?  The noodles is what I need.

They need to eat, they are growing, right?  Yes and no.  They need to eat, yes, but they need to balance the carbs intake with insulin, which means an injection.  It’s all ratios.  To make it more straight forward, let’s say that for every 15 grams of carbs, you need 1 unit of insulin.  Then if you want a snack, you’ll need a shot, unless you choose peanut-butter and celery, or turkey and cheese.  Want a sandwich (40 grams) with some juice (30 grams) and two or three cookies (35 grams), then you’ll need about 7 units of insulin.  Get the syringe, alcohol swab, and vial, then you can pull the shot.

But there is more.  Before administering the shot, you need a baseline to work from.  You need to know what your blood sugar is presently.  You’ll need to check your blood sugar, which involves a pin prick on a finger, a squeeze of the finger to get a drop of blood out, and touching the test strip to the blood.  Then something magical happens as the meter counts down and tells you your blood sugar level.  Most people with healthy pancreas have a blood glucose (BG) of around 100.  Mine is pretty consistently around 110.  Funny how the box and advertisements always have the meter saying “104”.  {Sidenote: the drive to Port Angeles to visit Fiona at camp, and to pick her up on her way home, is exit #104 from I-5 to 101-N.  Very easy for me to remember this}

Some might be alarmed at a 422 reading, but we’ve mellowed in our years of dealing with it. Yeah, it’s high, but it’s not “HI”.

However, our meters normally show something like this:

The “HI” reading means that the blood sugar is over 600.

With up to eight meter readings a day (or sometimes one a day if you are a teenager), it is interesting how infrequently some numbers show up.  In all the years of testing, I only remember one reading of 104.  Declan once got exactly on 600, which we didn’t think was possible.  It is also uncommon to get exactly on 100.  I only remember one each from Maggie and Declan.

Now you have another ratio to deal with.  For every 50 units about 150, you’ll need to add another unit of insulin.  So rewind to getting home from school for your afternoon snack.  You go 365 as a reading (not uncommon in the afternoon), and you have your snack.  So how much insulin do you need to pull?  I think the math is very doable, and the kids start to do it instinctively, but the chore of getting the insulin and pulling the shot and giving the shot and disposing of the needle seems like too much.  At least it feels that way to me.  It’s like having to wash your hands before a meal.  Or brushing your teeth before bed.  Can’t we just get on with the business at hand.  This is especially the case for kids, who happen to have an infinite discount rate.

So how many units?  Eleven or so, right?  Well, maybe.  Now you have to take into consideration how active they have been, how active they will be, and where on the time frame is the NPH insulin, a time release insulin.  This is where the science of insulin-carb balance turns into an instinctual feel for how things might end up, a bit of art here.

Balance all this with the fact that fewer injections is a better option that more injections.  So maybe put an additional unit or two in just in case the snack picked out falls short of the need for fuel.  And then once all this is done, you give the shot.  What a relief.  But wait, some of the insulin leaked out of the site.  Now what?  Take a breath, retest in two hours, and see where they land.

One thought on “Diabetes in the home

  1. Pingback: Bike crash | One more thing

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