Welcome to a piece of our sweet journey of life. This blog is about our family life-- my husband, my type 1 diabetic kindergartner, my spunky pre-schooler, my newborn baby girl, and myself! Enjoy!

Monday, October 20, 2014

When his blood sugar's in normal range...

...and he doesn't want to eat his whole plate of food, what do you do?

To the untrained eye, this looks like a situation to do a fist pump and raise your hands in the air like you just don't care. However, to the mom of a type 1 child who ALWAYS gets insulin with EACH meal and who does NOT get insulin before bedtime (due to the risk of falling too low), this posed a dilemma.

When we check Michael's blood sugar before meals, we plug that number into a Correction Factor. We record that number and it indicates the amount of insulin Michael needs to bring the blood sugar into normal range. We feed Michael supper and then we count the number of carbs he has eaten. We plug that number into a carb to insulin ratio to find out how many units of insulin Michael will need to work with the carbs he ate. Then we add the Correction Factor number and the insulin-to-carb ratio together, round down to the nearest half unit, and give Michael his insulin.

Tonight, his blood sugar was 158. When we plugged that into our Correction Factor formula, we knew it would come out to no units of insulin. Michael's dinner ratio is 1/50, meaning one full unit of insulin per 50 grams of carbohydrates eaten. That meant he would have to eat at least 25 grams of carb to warrant getting a half unit of insulin. Normally, this is no big deal. Usually, a sandwich (on reduced calorie bread), a no-sugar added fruit cup, and a veggie totals 25 grams of carb no problem. However, tonight we had made English muffin pizzas. Michael's serving was exactly 25 grams of carb. He gets 30 minutes to eat his meal before he gets insulin (since he's not old enough yet to promise to eat his whole meal-- and when he is, then he'll get insulin before he eats). We have to inject insulin before 45 minutes goes by. This gives Michael a 15-minute buffer to finish eating, and for us to do our math. Tonight, the timer went off at the 30 minute mark. Michael hadn't eaten all his pizza. Since I knew he wasn't going to finish, I got out 6 Ritz crackers with some peanut butter to try to get him up to 25 grams of carbs eaten.  After a few more minutes, he had only eaten 5 of the crackers, and wasn’t going to eat the last one.  The poor little guy was getting full.  So I poured a quarter-cup of chocolate milk—something with enough carbs that can be consumed quickly.  Finally, he had eaten enough to warrant getting a half unit of insulin. 


To any random person, they might be thinking “why would you try to make sure your child got insulin?  Shouldn’t you be happy that they didn’t need any?”  The fact of the matter is that Michael does need insulin because his body makes none.  Insulin is not medicine, and insulin is not a cure.  Insulin is life support.  Without insulin, Michael’s blood sugars would keep rising overtime and could lead to DKA again (which is the dire situation Michael was in when we were admitted to the hospital on our day of diagnosis).  If Michael did not get insulin, then the amount of carbs that he ate would not get converted into energy for the cells.  They would remain in his blood stream.  Since I do not give Michael insulin with his bedtime snack, (due to the risk of him going too low overnight if we did so), not getting insulin with dinner would mean that Michael would wake on Monday morning not having had any insulin since Sunday at lunch.  His blood sugar numbers would most likely be very, very high and unsafe.  Therefore, I felt like he needed to get a half unit of insulin in order to work with the carbs that he had eaten at supper, and to work with the carbs that he would eat at bedtime snack. 


Typically, his blood sugar numbers prior to his bedtime snack have been in the 200 range.  This makes me feel like he will be stable overnight and wake up the next morning with a blood sugar range between 150 and 195.  So, of course, after eating so much processed food at dinner to get his carb number to warrant insulin, his blood sugar was high.  385 high.  I stuck a cotton ball in his diaper to check for ketones before he went to bed.  However, after eating his snack and playing for a while, he hadn’t urinated.  So, we put him in his pajamas and an overnight diaper, stuck in a cotton ball, and tucked him in.  I hemmed and hawed over whether I should get up at 2am to check his blood sugar to make sure he wasn’t rising too high.  I decided to let him sleep and forgo a blood sugar check at 2am, and I would check him at 5am.  


A couple hours later, I went to bed only to be awakened yet another 2 hours after that by crying coming from Michael’s room.  Instantly I hopped out of bed, ran to his room, grabbed him, checked his pants to see if he was soaking wet (he wasn’t), and carried him to the living room and told him it was okay and I was going to check his sugar.  I held him while I checked his blood sugar by the light of the laundry room streaming into the kitchen.  His blood sugar was 339.  It had come down from 385 and that’s what I wanted to see.  I changed his diaper, and tightly rolled up the used diaper and tossed it into the hallway so that I could check the cotton ball for ketones.  I stuck a fresh cotton ball in his new diaper just in case his blood sugar was still high in the morning.  I tucked him back in and he was super about it!  I closed his door and picked up the used diaper on my way to the hall bathroom to check that cotton ball.  I grabbed a ketone strip and unrolled the diaper to get to the cotton ball.  Wouldn’t you know it, the diaper was wet, but the cotton ball was not.  I tried smushing the ketone strip against the areas of the diaper that had been urinated on, but those diapers are so super absorbent that there was no urine left to transfer onto the ketone strip.  I chided myself silently for wasting a ketone strip as I tossed the diaper in the trash can and washed my hands.  I got back into bed and eventually fell back asleep.  In the morning, his pre-breakfast blood sugar was 218.  Go figure.  I am very happy for this nearly normal number, but I am also baffled by diabetes.  Most nights if he is 153 at bedtime snack, his pre-breakfast number will be 141, etc.  I don’t see too much of this pre-bedtime blood sugar of 385, pre-breakfast blood sugar of 218.  A jump that big just doesn’t normally happen with Michael, but then again, what is normal about Type 1 Diabetes?


Until next time,


I’m just learning the curve.


Much love, Reba


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