My “Where the eff have I been?” post, Part I – The D-Monster

Where have I been you ask?

Right here. All along. Just… Not HERE.

This summer has been… Challenging.

We spent much of the summer trying to get The D-Monster under control. We’ve still got a ways to go, but I am so proud of her. She is truly being compliant and working hard at maintaining a healthy blood sugar. The D-Monster however, is a bastard and Princess Punk is now experiencing lows on a daily basis. She was 38 during practice last week. TWICE. Like she tested and she was 38 and she had her 15 grams of carbohydrates and waited 15 minutes and tested again and she was STILL 38. At 38, she can barely walk, yet her coach still had to take her off the field because she kept playing. She’s proud about making Varsity and even more excited about starting, but she is continuing to try to impress her coach so he keeps playing her and as a result she plays through the nausea and shakiness that comes with the lows. So now I get to worry about her passing out or having a seizure or something because her sugar gets too low and she’s too hard-headed to stop playing. Fortunately, her coach is on the ball and noticed she wasn’t doing too well (she got pale and uncoordinated) but it took her another 15 minutes to get into the 80’s. She was okay by the time she got home. But then she had another low overnight. 54 this time and she couldn’t even get out of bed. Like, literally, unable to physically get up out of bed.

But… At least now that she is compliant with testing and covering her food, we have a better idea how much insulin she needs and when. Here is a kind of breakdown of what she has to deal with on any given day. I’ll start off simple.

  • Bg-Blood glucose. This is the number that reflects the number of milligrams per deciliter of sugar that is in her blood stream (and not getting into her cells where it’s needed). Our goal is anywhere from 70-120
  • Test– A Bg check. Princess Punk pricks her finger with a lancet and squeezes a tiny drop of blood onto a tiny little strip inserted into her meter. The meter will show a Bg reading within about 3 seconds. It also sends the reading to the pump via RF or something.
  • A1C– Hemoglobin A1C. A blood test that correlates to an approximately 3 month average of blood sugars. Non-diabetics are under 6. American Diabetes Association considers 7.5 fairly good control for a Type 1 Diabetic. Currently the Princess is hovering around 9.3.
  • Low– Bg below 70. Princess Punk has to stop whatever it is she is doing and have 15g of fast acting carbs. Juice or sugar tabs are preferable. Then she has to wait 15 minutes and test again. If she’s still below 70, she has to do it again (15g of carbs and 15 minutes to re-check)
  • High– Bg above 120. add insulin. See correction below.
  • Basal– A constant flow of fast-acting insulin
  • Bolus– An extra “boost” boost of insulin to administer when consuming carbs or when a Bg reads over the target range
  • The Pump– A nifty device that gives The Princess her basal and calculates and delivers boluses as well.
  • Infusion set– a little piece of plastic that is attached to a cannula that goes into Princess Punk’s skin (site). Usually an arm or leg. She doesn’t like using her stomach or butt. The little piece of plastic is attached to a (removable) piece of tubing that is attached to an insulin reservoir in her pump. That way she can remove the pump and tubing (showers, sports and swimming) without having to pull the site out of her flesh and redo it later. She’s supposed to change her site every other day. Not so much.
  • Ratio– the number of grams of carbs for each unit of insulin she takes. Because The D-Monster is an asshole, the amount of insulin she needs throughout the day varies. For example, her ratio first thing in the morning is around 5. Meaning that for every 5 grams of carbs she eats, she takes a unit of insulin. Her ratio at dinnertime is 6. We also have to make adjustments when she has her period and when she is playing soccer (or basketball in another month or so).
  • Correction– Complicated. a correction is what she needs when her blood sugar is too high. If she tests and gets a high, she will bolus 1 unit of insulin for every 12 mg/dl her Bg is over 120. Example… Princess Punk tests her sugar and gets a 220. That is 100 mg/dl of sugar in her blood that shouldn’t be there. So we take the 100 and divide by 12 and get… Crap. Math. Umm… 8.3333333333333. So she will do a bolus on her pump with 8.3 units of insulin in the hopes that her Bg will come down. Thank God for the pump. When she was on shots, we had to carry around a calculator to figure out how much insulin to give her. Not so fun when sitting in a restaurant in a tight booth trying to figure out how much to bolus for a heap of French fries and a strawberry lemonade combined with a Bg of 223, not to mention rounding it to the nearest half-unit. The pump can deliver in increments as small as 1/10 of a unit whereas shots go to a half unit and only if you have the right kind of delivery device (refillable pen vs. disposable pen vs. syringes). Oh and the needles present a problem too. Nothing like carrying a sharps container in your purse. Now she just presses a couple of buttons and she’s all set to eat.
  • Lantus– long-acting insulin. Normally if you have a pump, you just use your basal instead of the Lantus pen (kind of like an Epi-Pen but reusable). Princess Punk has to take off her pump (remove the tubing from the site) for several hours a day during sports. She can’t play or shower or swim with the pump on. Since she’s not getting her basal during that time period, her Bg was going through the roof during practices and games and whenever she went in the pool. To avoid this, we lowered her basal from the pump to a very small amount (basically just enough to keep the tubing from getting clogged) and then she takes a shot of Lantus before bed so her baseline is covered for a full 24 hours, regardless of whether she is wearing the pump or not. She still has to bolus on the pump for highs and for carbs.

Confused yet? Try this…

The other night, Princess Punk went to practice and came home around 5. Her site had gotten ripped out during a scrimmage so she had been unable to re-attach her pump and had to put in a new infusion set. She tested and was high at dinner so she did a correction along with the bolus for her meal. We must have miscalculated the carbs or the ratio because her Bg was 45. She looked a little gray and her hands were shaking. She had some juice, but 15 minutes later she was still low. She had some more juice and was finally in the 90’s. Then she took her Lantus at bedtime. Since we figured we had miscalculated at dinnertime, we dropped her Lantus down a few units so she wouldn’t have another low overnight. Of course, the next day she got her period and spent the whole day high with Bg averaging around 230. We gave her a temporary basal of 130% of normal to counteract the highs.

This is an example of why her A1C is still messed up even though now she’s compliant.

Got it?

Nah, we still don’t either.

 

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