Friday, May 18, 2012
D Blog Week: Trying to hit a moving target.
I am dedicating this post to people who don’t understand Type 1 Diabetes. Especially for those who figuratively roll their eyes at Type 1 Diabetes and for those who have uttered, “How is it THAT big of a deal?” or have lectured, “At least it’s not cancer!”
To those who have learned everything about diabetes from Dr. Oz...this one's for you.
For you my dear friends, I am putting you in charge of bolusing my son for lunch today. (Bolusing means giving my son insulin. There is a whole new language that comes with this disease.) Come on…it is ONE time. Fix my son up for lunch. It’s no big deal, right? Give it a whirl!
Here is your scenario: (and I promise this is a VERY typical one.I picked the boy with the easiest ratios too, because I don't want to be mean.)
My son calls you at 12:15pm. He has just eaten his lunch and wants to know how much insulin to give himself.
Some information you will need to know:
His blood sugar number was 130 before he ate lunch at 11:50am.
He ate ½ an apple…most of his pretzels, his yogurt and his entire sandwich. He also ate an Oreo that his friend gave him.
He gets 1 unit of insulin for every 20 grams of carbs he eats.
One unit of insulin brings his blood sugar, (or BG) down 100 points. His blood sugar goal for this time of day is 110.
Ready to calculate?
Correction= .2 units. To bring his sugar down the twenty points needed.
Carb bolus= 10g for the ½ apple, 10g for the mostly eaten 15 carbs of pretzels I packed him, 40g for the sandwich, 15g for the yogurt and 5g for the cookie. That is 80g of carbs. 80g Carbs is 4 units of insulin.
So what would you give him? 4.2 units of insulin?
You would be totally wrong.
You don’t have all the information! Yes, his pre lunch BG was 130. But he had snack 1 hour and 40 minutes before that. He had a banana for snack, which was 30g of carbs. So at 10:15 he got 1.5 units of insulin. Insulin stays in your system for 3 hours, the body absorbing about 1/3 of that insulin every hour. So my boy had approximately 0.7 units still on board.
Better subtract that 0.7 units that is still in his system from the 4.2 units you were planning on giving him.
That means you are now going to give him 3.5 units…
STOP! Don’t do it!
More information needed!
He has PE after lunch today. They are doing relay races. Exercise DROPS his blood sugar like a rock.
Better take away a unit of insulin for good measure! (Why 1 unit? I just know that one unit will do the trick. HOW do I know? I can't file away HOW I know it! My brain will explode! I just know it! Instincts are a big part of taking care of a child with diabetes.)
So now, how much insulin are you going to inject into my little boy?
Better…but ummm…sorry. There is yet another small bit of information you need to take into account. We have been adjusting this boy’s basal rates. (The underlying insulin that his pump delivers to him in small puffs every few minutes throughout the day.) My son has just ended a growth spurt and has been suddenly, for the last two days, dropping like crazy between 1 oclock and three oclock. Since we wait 5 days to establish a pattern, we need to leave his basals as is…and at this moment, we need to adjust for these potentially scary lows.
Better take off another ½ unit to keep him safe. (Yeah, because I said so!)
Final answer: 2 units of insulin needs to be delivered.
And you were going to give him how much? 4.2???
That is 2.2 units of insulin too much. That amount of insulin would have brought his blood sugar down 220 points. Which with all the running around he was doing…would have put his blood sugar number at a negative number.
Yeah, you can’t be alive with a negative number.
But don’t worry! We get to do this again for his afternoon snack! And again at dinner! And again before bed! And again at 1 in the morning, and again at breakfast tomorrow! LOTS and LOTS of practice!
PLUS! I have two other boys I get to do this for every day!
And the variables are never ending! A meal eaten with high fat changes everything. A meal eaten a couple hours earlier with high fat changes everything! A big test at school changes things! A substitute teacher changes things! A small cold changes EVERYTHING! A growth spurt changes everything! A fieldtrip changes everything! A night of unexplainable highs changes everything…for the entire day! The weather sometimes even changes everything! EVERYTHING CHANGES EVERYTHING!
I joke around about my swelly brain, but it is more real than I care to admit. The constant cog turning of blood sugar variables can put me over the edge. I am the only one that knows my son’s basals are probably too high in the afternoon. I am the only one who knows that one son’s blood sugars aren’t affected by pasta, and my other son’s sugars go through the roof with pasta. I am the only one who knows that J has PE on B Block days, and he needs less insulin for breakfast those days.
Sure! I share this information with my husband when I can. But here’s the kicker…the information changes every day! Every day I am storing new information I am learning about my boys’ blood sugar trends.
I couldn’t even write it all down if I tried.
And hey, I just tried.
There is so much information stored up in the attic of my brain, your cogs would seriously be sent into a disastrous tailspin if you tried to absorb even a fraction of it. And I’m not trying to be mean or anything.
I’m only able to tolerate the swelliness because I have been slowly acquiring these mountains of information every day for the past 12 years. I have attended this school 24 hours a day, 365 days a year. I used to be a student, now I run the place. Sorry…you can’t learn it all in one session.
Worst part is…I don’t know everything there is to know about this disease. Cause, I’m not a pancreas. I am a human being. Unfortunately…
So when you think you are ready to judge even one second of my split second decision about my boys’ health…think again.
Because this disease is impossibly complicated. I spend my life trying to hit a moving target.
And that is all I have to say.
(This concludes day 5 of D Blog Week. The topic was, "What is the one thing you would tell someone who doesn't have diabetes about living with diabetes." Obviously, my one thing is diabetes is complicated. This is actually a repost from a couple years ago. M is turning 17 today and we are getting ready for a big, well deserved party for him tonight. )