We visited Yale last week for Betsey's 1st check up in 2010! It was one of the better visits - for both of us. Her A1c is 6.7 which is really great, again, and I'm happy about it. It is up from last time, but under that magical number of "7" that they like to keep it. It's a lot of work to keep that number down, I tell ya. It's lots of nagging, lots of adjusting and constant management. It's doable. It's a lot, but doable.
We met with a doctor who, incidentally, is a type 1 diabetic herself and Betsey admitted to me after, she liked that a lot. Betsey, she-of-little-words-in-public-but-the-loudest-at-home didn't say much during the visit (shocker) but she listened, watched and felt a connection. I could tell she was comfortable because she didn't hesitate as she normally would when asked to show her site areas which requires her to drop her drawers. But because Dr. Jen stood and motioned to areas on her own self where she wears sensors and sites, Bets kind of relaxed her shoulders. A silent sigh of relief sort of.
Again, I always leave clinic with a new Tid Bit of information. When I leave with more than 1 Tid Bit, it makes me a happy mom-of-a-diabetic-daughter. No pat-pat, but I do a pretty good job of regulating Betsey. I am on it. Too on it sometimes, I know. And I feel like I know what I'm doing. I like that. I think there are certain things you do in life and you have to have the confidence in order to do them well. I read oodles when Betsey was diagnosed, listened often, googled lots, asked many many questions, probably to the point of being annoying. On the ride to the hospital when she was diagnosed, I called my sister in law's (Lactaid) father who is an endocrynologist and with pad and pen in hand, took notes as her gave me the diabetes 101 so I knew what to ask in the ER, what to look for, what to do....
I wanted to be armed with what I needed to know. And I have so much more to learn.
Obviously. I love being put in my place. Honest. It's humbling.
Betsey was having a low kind of day that day-- dropping low constantly, despite eating the normal foods, no excessive exercise the day before, nothing of note to indicate possible low blood sugars. In the course of the morning, she had dropped low 5x, and was never over 110. Several blood sugar checks in the office in front of the DR.
Dr. Jen mentioned the benefits of temporary rate settings on the pump and asked if we utilized that feature on the pump; which we do. Often. Its' one of the features we find to be key in managing blood sugar levels during the day. And she suggested a temp rate b/c sometimes those lows just keep on comin' and you need a temp rate.
Whenever I've been in clinic with Betsey, and I have to suggest her to test, do something with the pump, anything that is diabetes related, I feel eyes watching me. Not judging, but watching. Kind of like a mentor witnessing a student delivering information that has been passed on to them.
When I think a temporary rate is needed, I do a very quick "equation" in my head-- I consider any meals she has eaten that day, any activities coming in the next hours, foods that will or will not be eaten, blood sugar patterns during that same time on previous days... and from all those gathered bits of info, I make a decision about what the temp rate should be. I told Bets the temp rate to put on (the % of her basal to cut) and then the duration to enter. Almost in the same breath, Dr. Jen, a diabetic herself with the same pump and knows about a low blood sugar day, offers her suggestion to me with a great explanation as to why, and what she knows and has seen and dealt with, not only with herself but all the diabetics in the practice etc etc etc. The look I gave her must have caused her a moment of "oops, did I overstep?" I smiled so big. I felt so good at that moment. I love constructive criticism and learning. And I wouldn't even call her explanation constructive criticism, but rather just an educated, experienced explanation and re-direction. I was so excited. Tid Bit #1. A new understanding of temporary rates.
We did some basal adjustments which I try and manage on my own going over info on Betsey's pump from her sensor as well as the numbers we log daily. But an experienced professional sees the things I don't see or know to look at and makes adjustments with some crazy mathematical equation based on total daily dose of insulin and the insulin given for correction vs for food, etc. It's fascinating. It's like one big science experiment. Tid Bit #2.
When "any more questions?" was asked I brought up the swimming issue. 2 of Betsey's siblings have started swim lessons and Betsey would also like to participate, but I have this dilemma with the swim thing and Betsey. The water, the swimming... whatever it is, it makes her sugar plummet. Just last week we went to the pool after lunch to swim as a family and she had forgotten to bolus for her lunch. Checking her sugar before the swim, she was 350+! Normally we'd correct that, but since she would be swimming, I knew better and to leave it. I had Betsey climb out and test an hour later-125ish. BIG drop. Knowing we'd be leaving shortly there after, I let her hop back in, but within 20 minutes, she climbed out on her own saying she thought she was low. She was 37!!!!! I hadn't brought snack in with us and the juice wasn't going to cut it so I ran out to the car to get some food, and she needed it!!
Upon discussing this with the DR, she confirmed it's a given and that it happens with her also. She gave us some great tips for swimming as a diabetic.......what numbers need to be treated, how often to check blood sugars, foods to eat and treat with, and the amounts of fast acting carbs, proteins, etc to eat with any given number range.
Ahhhhhh. Swimming stresses me out with Betsey. It's always an issue. Now I have a better idea of how to help stabilize sugars for a good uninterrupted family swim, and maybe even lessons! Tid Bit #3.
We bumped into Amy T. who is in charge of the clinical studies and informed us that the study Betsey will participate in just got FDA approval and she's 4th on the list. They're hoping to double up kids in the hospital for the stay in which case she may go in earlier than expected. She is still willing to participate and I am excited about the idea of it. Tid Bit #4.
Happy Tid Bits are always a good thing!
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