The CGM: Insertion Change

Every Sunday afternoon, we change out Michael's Continuous Glucose Monitor (or CGM).  This device monitors the glucose level in his tissue cells.  It is not as accurate as the glucose level in his blood, so finger-pricks are still a necessity in order to get a true idea of what his blood sugar is before meals and bedtime.  Also, we have to calibrate the CGM at least once every 12 hours by doing a finger-prick and then entering that number into the CGM hand-held receiver.

Some people don't consider CGMs to be worth it since you still have to do finger-pricks before meals and bedtime.  However, in our minds, we think "Well, if we have to do finger-pricks anyway, we might as well use those opportunities to calibrate the CGM."  The more calibrations, the more accurate the CGM readings. 

The CGM is made up of several parts.  First, we have a hand-held receiver.   This looks like of like an iPod Nano tilted on its side-- though not as slim.  It has a screen where we can see the trend graph showing Michael's tissue-glucose.  This screen shows us a number (ie, 214) to indicate his tissue sugar, and it will also show an arrow (either straight out to the side, gradual up, gradual down, single arrow straight-up, single arrow straight-down, double arrow straight-up, or double arrow straight-down).  We have set alarms on the receiver to alert us to high blood sugars, low blood sugars, and we have set a customized alarm to alert us if his blood sugar is rapidly dropping.  We were able to customize these alarms to go off when his blood sugar reaches a certain level.  For example, Michael's daytime blood sugars are supposed to be between 90-180.  Therefore, we set his low blood sugar alarm to go off at 100 in order for us to do a finger-prick before his sugar drops too low. 

The second part of the CGM is a sensor.  This is the actual part that we insert under Michael's skin into his fatty tissue.  For the pediatric version of this CGM, we must insert the sensor into his upper buttocks or his tummy about two inches to the side of his belly button.  Since Michael is a rough and tumble kind of boy and slides off the couch tummy first, we only insert his CGM into his upper buttocks.  We switch buttock cheeks for each site change.  The sensor is attached to an adhesive pad that hold it in place.  We insert the tiny wire under Michael's skin via a plastic piece that looks like a pen.  We stick the adhesive in place, then we unlock the "inserter pen" and push down on the top of it to stick a needle under Michael's skin and the needle leaves the tiny wire behind.  We then pull up on a collar piece and it retracts the needle from the skin.  We then push the pen part forward and it unhooks from the adhesive base. 

The third part of the CGM is the transmitter.  This is a tiny electronic piece that attaches to the sensor.  We snap it into place once the sensor is under Michael's skin.  Every week, we change out the sensor, and we then remove the transmitter from the sensor.  We use the same transmitter each week.  The sensor pieces are disposable.  The transmitter is not. 

Every five minutes, the tiny wire under Michael's skin sends a signal to the transmitter and the transmitter then sends that signal to our hand-held receiver which displays the data on the trend graph.  I love love love this technology.

Sometimes the CGM is a bit off from Michael's actual blood sugar. This is why it's so important to do a finger-prick before taking corrective action. The monitor should show tissue-glucose levels that are within 20% of Michael's blood sugar levels. One night, the CGM beeped at us to indicate that Michael was low. I checked his blood sugar and he was 161. Therefore, we did not give Michael a spoonful of jelly, because he was not actually low. We calibrated the CGM and it then showed a more accurate number. So, there are instances where the CGM will be off, but that's technology and we expect that to happen. The benefits that the CGM provides, and the peace of mind that it brings, far far far outweighs the little nuances that occur.

When we are ready for a site change, we use an adhesive remover pad to get the adhesive base of the sensor wet.  We then pull it off of Michael's skin and the tiny wire comes with it.  We then detach the transmitter and we wipe the underside with an alcohol swab.

To prep the other buttock cheek for the new site change, we use an alcohol swab or a "Skin-Prep" wipe to cleanse the area where the wire will be inserted.  Then we use a Skin Tac wipe and we rub it in a doughnut shape around where the alcohol was wiped.  Using a Skin-Tac wipe makes the skin extra sticky and allows the adhesive to stick to Michael for the full week.  We cut a hole in the middle of an "IV-Prep" pad and we attach that to Michael's skin, leaving the circle we cut out to be where the alcohol was rubbed-- which will be where the wire is inserted.  The "IV-Prep" pad puts an adhesive barrier between Michael's skin and the adhesive pad of the sensor, since the sensor adhesive can irritate sensitive skin.

We then remove the "inserter pen" from the sterile packaging.  We pull off the white tabs of the adhesive backing and attach the adhesive to Michael's skin on the "IV-Prep pad."  We then insert it using the method described above.

Then, we snap on the transmitter, and Michael gets to pick a prize from the Prize Bag!

Ta-da!  He is always so proud of himself, and words will never be able to describe the emotions I feel during this process.  It's heart-wrenching to cause pain on your own child in order to provide him with the best care.  And it's incredible, the welling of joy in my heart to see how strong this little two-year old boy is.  I love him so. 

Here you can see the sterile packaging that the inserter pen is in, along with a Skin-Tac wipe and a Skin-Prep wipe that I have set on top of the packaging.

Here is the transmitter.  You can see how small it really is. 

This is a side view of the inserter pen.  The piece I am holding onto is the lock that we remove once the adhesive is in place on Michael's skin. 

The Prize Bag!  I fill this with little toys, or cups, or coloring books, etc and Michael gets to pick something each week for being so brave. 

This week, he chose a pail and shovel!

Here is my "sweetie boy" saying Cheese!

This is where the sensor is placed on Michael's upper buttocks-- the right cheek.  Next week, this will be on the left side of his buttocks.

Thank-you for taking the time to read this post about what a CGM insertion change involves.

Thanks for keeping us in your prayers!  We surely appreciate it.  Every single day.


Until Next Time!

Much love, Reba

Milk Allergy

At sweet little Noah's 4 month check-up, he was diagnosed with a milk protein allergy.  I had to completely cut out dairy from my diet since I was breast-feeding him and what I ate affected my milk that he was nourished from.  So, cut out dairy I did.  However, it did not help our sweet boy.  He had constant spit-up episodes and awful eczema on his head.  We made the choice to wean him from breastmilk and onto formula and it worked!  We saw a dramatic difference in his ability to keep his "milk" (ie, formula) down and digested.  Also, along with the help of a prescription eczema cream, the dry-skin on his head cleared up and we could stop using the cream.

He stayed on Gerber Goodstart Gentle formula and Soothe formula until he turned one-year old.  At Noah's 9-month check-up, I had asked the doctor if Noah would be able to drink whole milk when he turned a year old.  I was so ready to stop buying formula!  She said that most babies outgrow the milk protein allergy by the time they are one-year old, and we could definitely try to give milk to Noah.  She said to watch out for signs of spit-up, which would clue us in that he might need to switch back to formula. 

We switched Noah to milk at one-year old, and he didn't have any episodes with spitting-up.  However, he did start to get chronic ear infections (not common in our boys-- Michael didn't have an ear infection until after he turned two).  Noah also developed a chronic cough.  At Noah's one-year check-up, he was diagnosed with a bad ear infection, and I asked about his chronic cough.  I was told that some babies just have coughs.  I wasn't too thrilled with that answer, but we went on our way and treated his ear infection.  Noah got two more ear infections within as many months. 

Last week, Noah coughed so much upon waking up that my mother-in-law (who was there at my house when he woke since Aaron and I were at work), had to pat him on the back to help him catch his breath.  That was the last straw for us.  With a baby who was tugging at his ears again, running a fever, and still had this cough, we knew we had to take him in and get this all resolved.

This time, Noah was diagnosed with a milk allergy.  They said it really was the chronic cough that clued them in this time--  especially when they realized that this cough started around the time that Noah started drinking milk instead of formula.  Noah did have a slight ear infection and a slight upper respiratory infection, probably caused by the milk allergy.  We were advised to switch Noah completely off of dairy products for two weeks.  We went out that very night and bought rice milk and soy milk.  Noah seems to prefer the soy milk-- probably because it has the thickness of whole milk.  Rice milk is kind of the consistency of water-- very thin. 

We are at the end of week one with no dairy products for Noah.  And the results so far? No coughing!  Noah wakes up these days without coughing fits.   He is no longer having coughing fits in the middle of the night either!  We think this is fantastic! 

This doesn't subtract from anything we buy at the store because we still need to purchase milk for Michael to drink (soy milk and rice milk are very carb-heavy per serving).  And we still need to buy cheese for Michael to eat since cheese is a carb-free food that is a good protein source.  So, our grocery list just now will include soy milk or rice milk for Noah (we plan to try almond milk and coconut milk in the future), and lots more eggs.  Since Noah cannot have cow's milk or other dairy products like cheese, we were told to find a substitute for the protein and fat that the milk provided.  The protein is found in eggs!  Scrambled eggs are a perfect meal addition to get some added protein in Noah's growing body. 

We hope in the future that we will be able to introduce some cheese products back into Noah's diet, but we're staying clear for now.

Anything that we can do to get a grin on this precious little boy, we will gladly do!  And he is grinning lots and lots these days! 

Until Next Time,

Much love, Reba

A Link to A Post I Whole-Heartedly Agree With

Happy Friday, Friends!

Below, find a link to a blog I follow.  The link will take you to a post I really agree with.  Sometimes when we tell someone that Michael has diabetes, they reply with a story about how diabetes has affected someone they know.  Sometimes these stories are uplifting stories and sometimes they are not.  Please refrain from sharing your more horrific experiences with diabetes. 

I am capable of crying for my son just because I'm his mom.  I do not need fodder to cry over based on someone else's stories of how horrible diabetes is.  I do research. I do know that we're going to have to fight for a good, healthy future for Michael.  But believe me, I've got my boxing gloves on and I'm ready to fight for that good future.  I don't need to be daily reminded of the horrible wake diabetes can leave.

http://www.d-mom.com/i-already-know-you-dont-have-to-tell-me/



I welcome all stories related to how someone has adapted their lifestyle to include diabetes management, and I welcome all stories depicting how someone has lived a full, successful life despite diabetes.

Until Next Time,

Much love, Reba

Noah: 15 Months

*Written on Thursday April 9, 2015

Wow, Noah!
I can't believe you are 15 months old today! Time speeds by extra quickly these days!

You are as spunky as ever and it is such a joy to watch you grow up right in front of our eyes!

You are not quite walking yet, although you've taken a couple of "half steps"-- bearing a huge grin on your face the whole time!  You always seem excited to learn new things, and I know you will be walking before I know it!  I'm trying to tell myself to enjoy these days an extra amount, while you are not quite walking yet.  Once you walk, then you will run for sure, and I'll have an even harder time keeping up with you!

You love anything to do with your brother.  Although you still like to cling to me, you do choose to venture down the hallway and join your brother in his room as he plays with dirtbike toys, Hot Wheels cars, or train pieces.  I think it's so precious when you two choose to play together-- and I think it's so funny that you two are already so independent of us and don't need to be in the same room as Mommy and Daddy in order to play.  You are quick to pull yourself up to stand at the train table in Michael's room.  If a train track is in place, you will stand at the edge of the table and wait for a train to come by so you can snatch it, wave it in the air and drop it on the floor.  We call you "Babe-zilla!"  If a train track is not currently in place, you will grab random track pieces and clutch them in your hands as your brother pretends that the table is a Motocross Venue for his dirtbike toy.  If Michael gets a wild hare to climb up onto his bed to wrestle the pillows, you are quick to crawl or cruise to his former position at the table and take over the dirtbike toy responsibilities. :)

You love to eat.  Repeat: You. Love. To. Eat.  For this I am so grateful, because it's nearly a fail-safe way to occupy you when we have to pay extra attention to your brother during insulin injections or site changes for his continuous glucose monitor. 

You are still very comfortably in size 12 month clothes.  I do put size 18 month pajamas on you since I hardly have any size 12 month pajamas, and I can't justify buying new clothes in a size that I know you'll eventually outgrow.  Although size 18 month shirts and onesies and pants are much too big on you, the pajamas in this size seem to fit okay, and I for one don't like to wear tight pajamas anyhow, so maybe you are the same way.  I hope. The twice-a-year consignment sale is having their spring sale this weekend and into next week, so I know I will be stocking up on some extra summer clothes for you. 

I will also be buying you some shoes since you have begun to take a few very small steps!  Your little baby feet are just perfectly fat and squishy.  I can no longer put the size 3 baby shoes on you even though I bought them for you last fall at the consignment sale.  You wore them a few mornings to daycare this winter, but you just aren't much for shoes and you weren't even close to walking back then.  Now that you are taking some steps, I'd like for you to have a little support when you stand on your feet especially when you do some of your walking at church on cement floors-- I'm afraid socks might just be too slippery.  At home, you are completely content to be barefoot and it's okay in that setting.  But you'll need some shoes for when we're outside of our comfort zone. 

You wear size 4 diapers.  We like Kirkland signature (Costco) brand during the daytime and we still love Huggies Overnight diapers for at night.  You can say "Tee-tee!" and you don't mind sitting on the little plastic potty in the bathroom after bath.  Maybe we can persuade your big brother to sit on the potty himself if he sees you sitting on it first!

You wear a sleep-sack wearable blanket at night.  Your room gets cold no matter what temperature the house thermostat is set, so we make sure you are safe and warm in your sleep sack.  You like to sleep on your belly with your arms straight at your sides and your hands tucked under your belly.  You are just too precious.

You are teething now, and you just might have an ear infection as well.  You hardly complain at all, but we can tell something is wrong when you just act somber.  Usually you are our happy boy through rain or shine.  However, when you're down for the count, you are extra snuggly and you don't share your smiles as much.

You can say "Dada," "Mama," "Bah-boo" (bottle), "tee-tee,"  "Bah" (bath), "Ba" (ball), and "Muh" (remote-- as in the remote controls from which we've removed the batteries so you can use them as toys). 

You are such a sweetie and we love every bit of you!  You always bring sunshine and happiness to our family and you and your brother just constantly light up our days!  We love you, sweet Noah, and we are so thankful to God for placing you in our family. 

I love you forever, sweet boy!

Love, Mommy

Easter Weekend

This weekend was so nice and it was just what I needed!  Although it was super busy, it was super fun.

On Saturday, we had a nice relaxing morning.  My Nana and Popa came by for a visit on their way through town.  They got to enjoy our new set of patio furniture and watch the boys play with their sand table.  We had a good visit before they headed out on their way to the beach.

After the boys got up from their afternoon naps, and Aaron came home from coaching his soccer game, we took the boys to church for the Easter egg hunt.  We met my coworker and her sister, her mom, and her nearly two-year-old nephew there.  Michael had a blast!  And who, what a turn out!  There were over 100 kids there-- not including their parents and additional family members!  Michael was on  a personal mission to find the Easter eggs that looked like footballs.  He then proceeded to throw them like footballs.  He picked up about 20 eggs, and ended the hunt with about eight eggs in his bucket.  We took the boys home for supper and let them play outside a little longer.

On Sunday we woke up at our usual time (which is early for most of America-- especially on a Sunday) and we headed to Sunrise Service at church.  Noah did pretty well at first, wrapped up in a blanket and sitting on Aaron's lap.  I tried to entertain Michael with his dirtbike toy and Hot Wheels car by letting him play in the dirt.  However, his toddler voice is not entirely conducive to a Sunrise Service, and it was pretty cold, so I ended up taking both boys into the nursery to play. We had a breakfast gathering after the service was over.  Afterwards, we headed home to get a jump start on making Easter lunch.

Aaron headed back to church for the regular service since he plays drums in the worship band.  The boys and I stayed home so that I could feed them lunch and get them in bed for their naps before having family over for lunch.  Aaron and I cooked a ham, warmed up some rolls, baked some potatoes, boiled eggs and made deviled eggs, and baked a carrot cake (with store bought frosting). :)  Aaron's mom brought a beautiful salad.  We had a nice relaxing family lunch complete with lots of time spent outside enjoying the beautiful day.

The evening ended with lots of laughs and giggles from the boys and Aaron playing together.  Michael's CGM sensor failed (second one that weekend), which led to a very stressful experience on Sunday overnight into Monday. Everything worked out in the end, though, which is the goal. :)

Overall, it was a fantastic weekend.  Yes, diabetes made its presence known, but it didn't break us.  We came through the weekend tired, but with our heads held high.  Both boys got to enjoy a piece of carrot cake for a snack and you would have thought they had never seen or tasted any dessert in their lives!  They gobbled up that cake, and Michael became a master negotiator: "I would like to have one teeny tiny little bite of cake please! Just one tiny bite please! It's dee-wishous!" 

"In all these things, we are more than conquerors through Him who loved us."  Romans 8:37


Thank you, Lord, for the blessing of Easter!


Until Next Time,


Much love, Reba