Gates Home Space: For The Record

Scary Trip to the ER

Fri, 04 Jul 2008 19:04:58 GMT

I just wanted to update you on Stevie. Last Monday night, she went really high in the middle of the night, but we thought it was food or growth hormones, which both can cause her to go high in the middle of the night. Well, when she woke up at 6:45am, she said she felt like she was going to throw up, so I knew that was a bad sign. I grabbed the urine ketone test strips and when I dipped one in her urine, the color immediately went to the darkest color (indicating high ketones). So, I went and got the blood ketone strips, which are more accurate and can give you an actual number. The chart says things like "below 0.6 is negative", "0.7-1.5 is small (for ketones)", etc. The last category says "if 3.0 or higher, go immediately to the ER" (it actually has it bolded like that). Stevie was 3.7!

We went right to the hospital and had her admitted. We brought all of her supplies to be able to change her infusion site at the hospital. (We suspected her site wasn't working.) When Charles removed the old site, sure enough, it was bent and hadn't been in her skin, so she wasn't receiving any insulin at all. One thing that really bothered me is that my biggest fear about putting Stevie on the pump was the fear of DKA (diabetic ketoacidosis), which is when ketones build up to a life-threatening level, causing coma and even death. I had asked the diabetes educator, before putting her on the pump, "what if her site comes out at night when we're all sleeping and we don't even know it?" (DKA with pump users can become life-threatening in as little as 3 hrs.) She told me "oh, don't worry, before she got to that level, she'd be up urinating more, drinking more, she'd be vomiting..." Well, Stevie didn't get up any more than usual to urinate, and didn't get up to drink at all. She only vomited after she got up at 6:45am, and by then we were already at the "go directly to the ER" stage.

Luckily for us, even though we were instructed to go to the ER, she wasn't in the super serious stage yet. The Dr. tested her for bicarbonates, which indicates what level of ketoacidosis they are in, and she wasn't yet in actual ketoacidosis...she just had very high ketones. But poor Stevie was put through the ringer. After feeling horrible and vomiting, we get to the ER, and she has dark circles under her eyes (I think maybe from dehydration?).

They decided to do blood tests and give her IV fluids. Well, they had an EMT trainee do it! If I had known how badly things would end up, I would have insisted on a real nurse. The girl poked around one arm for literally 5 minutes...in and out of her skin. Poor Stevie was in such pain, but she's too sweet to say anything. I could see it on her face. Then the girl announces that she has to use the other arm. Stevie looked horrified. The girl poked around that arm for another good 5 minutes, before finally getting one in. Then she didn't cap the thing off fast enough, so blood was spurting all over the place. Stevie swears she will never have another IV again. The sad thing is, now she is petrified of IVs and there's a pretty good chance she'll have to have more as life goes along. I tried to tell her that if a real nurse does it, it isn't that bad, but she is traumatized.

Anyhow, the good news is, as I said, although she was very ill, and did need to go to the ER for the IV fluids, she is doing well now. The IV saline and extra doses of insulin helped to flush out the ketones, and the new site worked, so the ketones didn't come back. It was pretty bad when it was all happening, but we are very thankful that she is all better now!

--Lynnanne

CGMS Frustration

Mon, 17 Mar 2008 03:14:06 GMT

Lynnanne and I have been very disappointed in the accuracy of the CGMS sensor. We have had to calibrate the sensor several times a day because it becomes inaccurate compared to her actual blood glucose levels.

During this 14 day trial that Stevie is on with the sensor, we had hoped to gain so insight into how her insulin affects her, and hopefully determine a better course of treatment for her. Her A1C has been steadily increasing (8.4 at her last appointment), which has made us concerned for her long-term health.

We had a really strange thing happen last night at dinner. Stevie ate some homemade tacos and we bolused her right after she finished her meal. We usually prebolus for food because it normally takes so long for the insulin to take affect, but last night we got busy and didn't bolus until after she ate.

As anyone would expect, the carbs from the food should have started to affect her before the insulin (she had some cinnamon peaches also...high glycemic). Normally Stevie will go high before the insulin starts to work, but last night she actually went low and we had to keep giving her carbs to keep her up. We didn't change her I/C at all either. That's the weird thing. We didn't do anything at of the ordinary. Same I/C, normal food, normal activity. Then she goes low...what the heck!

Every day is a challenge for us with Stevie because her blood glucose is so erratic. I just don't see us getting this under control any time soon and it is very frustrating.

Thanks for listening.

Minimed CGMS

Sat, 15 Mar 2008 06:08:30 GMT

I haven't posted in awhile so I thought I'd post tonight about the CGMS that Stevie is using right now.

On Tuesday of this week, Stevie had a three month checkup at Kaiser, and they finally put her on the MiniMed Continuous Glucose Monitor that they've been promising since last November. The purpose of her using the CGMS right now is to determine if the Novolog insulin actually has a 4 1/2 hour duration in her, and to determine if it takes longer than the normal 15 minutes for the insulin to start working.

Stevie will be on the CGMS for 14 days. The first seven days she will use her normal Novolog; the next seven days she will use an insulin called Apidra. We have heard from some users of Apidra that it is faster acting than Novolog (in some people) and that it's effective duration is usually around three hours.

Our goal is to switch Stevie to the Apidra if it proves to show that it will start affecting her sooner, and not affect her for the long 4 1/2 hours. This long effective time in Stevie of the Novolog causes problems in treating her (and it is slow in affecting her at post-meal bolus so she goes high right after a meal).

If you are considering using a CGMS, email me and I will give you more details of our experiences with it.

Crazy Numbers

Tue, 15 Jan 2008 23:19:42 GMT

Well, I haven't blogged for a little while because, frankly, I'm sick of computers since I have to work on one all day, everyday.

I thought I'd post a bit about recent happenings with Stevie's BG at night. We did a site change the other day before dinner and forgot to do the standard two hour BG check to make sure the site was working. At bedtime we checked Stevie's BG and it was 584 (ouch!). We quickly deduced that it must be the site and did a quick site change (no numbing cream...way to go Stevie!) After a few corrections through the night, we finally were able to get her BG down to about 150.

The next night, we forgot to give Stevie her bolus after dinner and at bedtime she was in the high 400's. We felt so bad because of what she had been through the night before. Again, after a few corrections (and many BG checks) during the night, we were able to get her back in range.

And so goes living with Diabetes...

Merry Christmas!

Mon, 24 Dec 2007 21:27:40 GMT

It's Christmas Eve and the kids are all excited to see what "Santa" has brought them this year. We are getting ready to go to the Christmas Eve service at our church (Impact Community Church) at 5 PM and aren't really doing much of anything else today.

This year, only Stevie is home on Christmas Eve as the other kids don't get home until 11 AM Christmas morning. This makes Christmas Eve a little boring for her because there is no one to play with, so we let her open a few small presents to help with her anticipation of Christmas morning. On Christmas morning, we start with a fire in the fireplace and opening of presents that "Santa" brought in the stockings hung above the fireplace. The kids love to see these empty the night before, and stuffed on Christmas morning. They don't believe in Santa anymore (Stevie might still, not sure about that), but they still like to have what they consider the traditional Christmas morning; how they remember it when they were little.

After stockings, it's off to the living room to open their gifts. Yes we spoil them, but we also try to instill in them the true meaning of Christmas and let them know how blessed we all are because many people at Christmas time don't even have enough food to eat, let alone presents to open.

I hope you all have a very Merry Christmas and remember the true meaning of Christmas; how our Lord and Savior Jesus Christ was born into this world for the purpose of saving you and me by sacrificing himself on the cross.

May God bless you all!

Folsom Lake

Sun, 16 Dec 2007 05:31:35 GMT

Today I took Sam (and Brandon) out for some more driver training, and we ended up in Folsom. After she was tired of driving around, I decided we would drive over to Folsom Lake. Normally the lake is full and beautiful, but today it was nothing like that. We haven't had much rain this year, or snow in the mountains, so the lake is almost completely empty.

Since we were in the Jeep, I thought it would be fun to do a little 4x4'in. We drove around the lake bed, about a half mile down into the lake (where water should be). On our little adventure, we came across a car and a truck stuck in the sandy mud. The guy in the truck had been trying to pull the car out of the sand when he himself became stuck.

I drove down to them to offer my help but was unable to get either of them out because the tow strap kept breaking. I guess I should have been better prepared with a chain, since I don't have a winch on my Jeep.

Anyway, it was fun for me and the kids to get out and get a little crazy.

10th Anniversary

Thu, 06 Dec 2007 03:48:47 GMT

Today Lynnanne and I celebrated our 10th wedding anniversary. As in any marriage, we've had our ups and downs, good times and bad times. But there is no one else I would rather spend my life with than her. Lynnanne is such a caring person who gives everything of herself to me and the kids and expects nothing in return. She is my best friend.

We went to dinner with the kids to Texas Roadhouse. The kids love loading up on steak and ribs there. We had a pleasant time and the kids actually got along!

Kings vs Houston

Mon, 03 Dec 2007 19:01:49 GMT

On Saturday night, Sam and I went to the Kings game against Houston. It was nice to spend some one-on-one time with her because she is usually gone at Brandon's house, or Brandon is over and she spends all her time with him. Not that I don't want her to spend time with Brandon, Brandon is great, but it's nice once in a while to be able to spend some time with her.

Usually when we go to the Kings game, we stop and have dinner together. This time Sam wanted subway and I wanted arena pizza, so we stopped at subway for her sandwich and then I got my pizza at the game. Of course at half-time, we had to have ice cream! It's what we do.

We sit in box seats at the game (thanks to my work), which has waiter service. Sam ordered a water and found that it was five dollars (with tip). I paid, of course, but she was shocked at the price. I'm glad that she had that experience; I want her to get better at money management and to realize just how far and fast money can go.

This picture was taken with my phone. At half-time you can send in a picture to the kings web site for a chance to have it displayed on the big screen at the arena. We got ours displayed and it was the first one selected -- cool.

JDRF Awards Ceremony

Thu, 29 Nov 2007 16:21:25 GMT

Last night we went to an awards ceremony put on by JDRF. This was to present information about the success of the recent JDRF Walk to Cure Diabetes in Sacramento. Teams and individual walkers received awards based on how much in donations they raised for the JDRF event.

Stevie received two awards. The first was for raising, as a team, over $5,000 (see "Walk to Cure Diabetes Fundraiser"), and the second (Golden Sneaker Award pictured left) was for an individual effort to raise over $1,000.

I thought it was great that JDRF recognized the achievements of Stevie and all the other participants; that really says a lot about the JDRF organization. Stevie was really excited to receive the awards and wanted me to hang the plaque in her room as soon as we got home (I was too tired to do it, but I will, I promise!)

In Memory of Megan Rountree

Mon, 26 Nov 2007 23:08:38 GMT

Today I found out that Megan Rountree passed away over the weekend from a freak accident. Megan was skateboarding with her friends on top of a 10-story parking garage and decided to take a break and sit down. Apparently she lost her balance and fell off of the building to her death.

I did not know Megan personally. She worked at Starbucks in Elk Grove and was the first to remember me and my "specific" drink order. She always greeted me with a smile and called me by name. I remember seeing her outside of Starbucks around town, and she would remember me and say hello.

Megan was excited to move to downtown Sacramento and be on her own. From what I know of her, she was always very helpful to others and cared very much for the homeless and less fortunate.

Megan will be missed.

Elusive Patterns

Sun, 25 Nov 2007 18:30:49 GMT

The past few nights have been very strange with Stevie's blood glucose (BG) numbers. We've been running her at 140% of her normal basal insulin overnight, and then just recently backed off to 120% because her cold was not as bad. For the last three nights we've tried going back down to normal basal because her cold is completely gone.

The weird thing is that she is not following any kind of pattern at night now (not that she ever really did). Some nights she goes low and we can't get her numbers up and other nights, like last night, her numbers go high and we can't get them to come down. Last night at 11 PM I gave her a correction because she was around 240. This correction was based on a 1/300 sensitivity (1 unit will drop her 300 BG points). I meant to give her a 0.3u correction, but instead accidentally gave her 0.4u. I realized my mistake only after it was too late; I must have been tired.

So, knowing that this could potentially drop her more than I was comfortable with, I could not sleep (Brandon was online so I played xBox with him for a while). Normally without food a correction will have done it's job by three hours. I decided I would test Stevie at 12:30 AM and 1:30 AM. By 12:30 she was dropping as expected, but by 1:30 she was on her way back up again.

This is the unpredictable nature of Diabetes! You just don't know what is going on inside the body that one day will make it react one way, and the next day it will react completely different. It is extremely frustrating and this is exactly why we test Stevie frequently throughout the night.

Continuous Glucose Monitoring

Wed, 21 Nov 2007 00:48:28 GMT

Today Stevie had an endocrinologist appointment for a 3 month checkup. Because she has recently experiencing many high BG numbers, we were worried that her A1C was going to be much higher than the low 7's at previous appointments.

Stevie's 30 day average BG was 185 and her A1C was 7.8 (not as high as we thought it was going to be, but higher than we wanted, of course).

Stevie has a long insulin curve of 4 to 4 1/2 hours, meaning it starts out slower than normal, and ends stronger than normal. This makes it hard to keep her BG at a reasonable level soon after she eats, even if we pre-bolus the insulin. We've tried using the dual-wave bolus, but without much success (we're still working on this).

We found out today that her endo wants to put her on a Continuous Glucose Monitor (CGM). This is a device that will connect to Stevie's tummy (see picture) and wirelessly transmit her BG information to her insulin pump (MiniMed 722).

We are very excited about this. It will only be temporary that she will be using the CGM, but it should give us much better information about her insulin curve.

The main purpose of going on the CGM is to determine if we need to switch from Novolog to Apidra (insulin). We are trying to determine if the Novolog is not working as effectively for Stevie as it should be, since it seems to affect her more at the tail end of the curve rather than at the beginning, as it should. So, we will do two six day trials on the CGM; one using Novolog and the other using Apidra. Now Apidra hasn't been officially approved for pediatric use (as of today), but we have found that other doctors are using this for their pediatric patients, so we requested that Stevie be allowed to try it (we've also tried Humalog without success).

If you are using a CGM we would love to hear from you to let us know how it is going, or went. We will be starting this in December. Please email us your CGM story/info to gateshome@hotmail.com . (Or you can leave your comments here.)

Couples, Don't Forget Each Other

Sat, 17 Nov 2007 20:24:00 GMT

With the constant attention required to care for our daughter, Lynnanne and I get so consumed with her care that we forget to care for each other, and give one another the attention each needs.

This attention is required to maintain a loving and close relationship. Without it, we can start to feel alone while we battle the daily needs of Diabetes. We battle it together, but without the intimacy of a loving couple. It becomes work rather than loving care.

Ever since Stevie was diagnosed, Lynnanne and I have not spent any quality time together as a couple. We do not have the confidence in others to care for Stevie, so we take it upon ourselves to do everything for her, and thus creating a condition where we will never be apart from her.

This of course creates a condition in our marriage where we never have "alone" time. I'm not talking about sex either; I'm talking about the "alone" time that couples need to sit down and talk to each other about their day, laugh with each other about their day, and to just keep "knowing" each other, even though they may have been together forever.

We recently entered into a couples Bible study. The host family is awesome and provides childcare at their house where we have the study. We can go study God's Word, fellowship with other couples, and feel comfortable that Stevie is just in the other room if she needs us.

This time together has been extremely important to our marriage and being a couple.

We have learned to speak each other's "love language" and to focus more on the needs of one another every day. The result has been a more fulfilling relationship, better coordinated care for our daughter, and definitely better "alone" time.

If you are a couple struggling with this same issue, I want to recommend a book for you to read. The book is "The Five Love Languages", by Dr. Gary Chapman.

Thank You Veterans!

Tue, 13 Nov 2007 01:01:35 GMT

I had the day off of work today and didn't really have anything planned except for working around the house and being lazy. It's on days like these that it is easy to forget the sacrifices our veterans and military personnel have made for us so that we can sit around, being lazy, and enjoy the freedom that they have paid for in blood, sweat and tears.

My daughter sees this as an extra day to spend with her daddy, who is usually at work. It is my duty to explain to her why I have this day off, and what Veterans Day is all about.

I want to thank all veterans, including my sister Jackie, who have served our country with honor, and to thank all those who never came home; your sacrifices will never be forgotten.

Halloween/Birthday Party

Sun, 04 Nov 2007 18:38:00 GMT

Last night (11-03-07) we went to a party at my boss's daughter's house. The party was put on to celebrate the 60th birthday of my boss, Chuck, and his wife Linda. The party was a surprise party for them. They were told that it was just a Halloween party.

Tyler and Sam didn't go with us (they skipped out and went to friends houses); it was just me, Lynnanne, Noelle and Stevie.

It was fun for me to see my coworkers dressed up in costume and we had a good time. Stevie won first place in the costume contest, winning a $50 gift certificate to the Cheesecake Factory (restaurant). I loved my hair (wish it was real)!

Halloween 2007

Thu, 01 Nov 2007 17:18:59 GMT

All the kids were home this year for Halloween. This is the first time in four years that Sam, Tyler and Noelle have been home on Halloween, because it usually falls on a Monday or Tuesday, when they're at their dad's house.

Now they are older, of course, so they want to go off and do their own thing (going around with Mom and me is not cool I guess). Sam and Brandon spent the evening together, Tyler went around the neighborhood with Grant, and Noelle and Stevie stayed with us to trick-or-treat.

We left the house around 7 PM when it was dark enough to set the Halloween mood. Our neighborhood was completely dead; hardly anyone was handing out candy, and only a few kids were out. We decided to go over to "The Woods" (a more up-scale part of the neighborhood) to see if it was better over there. It sure was; tons of kids were out and almost every house was decorated and handing out candy. That was great and the kids really started having a good time. We even ran into Tyler and Grant.

From a Diabetes stand-point, Halloween can be a real nightmare! We really want Stevie to be able to take part in the Halloween fun, but need to make sure her blood glucose level doesn't shoot through the roof because of the candy. Luckily, walking around helps lower blood glucose levels, so we were able to let Stevie eat some candy as she trick-or-treated. Not too much though, or her blood glucose would start to go crazy.

We got back to the house at around 9 PM and the girls dumped out their candy to see what they got. Noelle broke one of the ortho things (I don't know what it's called) in her mouth (ARG!!) so she'll have to get that fixed soon. Stevie's blood glucose was low enough for her to eat a couple of pieces of candy.

All in all, the night went well. Stevie did start to go low later in the evening so we had to give her more food to keep her up in a safe range for the night, but after checking her at midnight and at 3 AM, all was fine.

Diabetes: A 24x7 Disease

Mon, 29 Oct 2007 01:32:31 GMT

On August 21, 2006 Stevie's life changed forever; she was diagnosed with Diabetes.

Before Stevie was diagnosed, I never really thought about Diabetes, or how it affects the life of the person who has it and their immediate family members. Stevie is the only child at her school with Diabetes, so you never heard anything about it among other parents at school.

When Stevie was diagnosed, I thought the doctor had made a mistake because. How could she have Diabetes? There's nothing wrong with her! Total denial. One of the social workers called me to discuss the diagnosis and help me come to terms with the thought of having a diabetic child. When I did, I broke down in tears.

Honeymoon Phase

Stevie is in what is called the "Honeymoon Phase" of the disease. This means that her body is still trying to produce insulin to help process the glucose in her blood. That sounds like a good thing, but what it really means is that we have to be extra careful when giving Stevie insulin, because her body might also be producing insulin at the same time. The consequence of too much insulin is her blood glucose (BG) level dropping to dangerously low levels (hypoglycemia). This could cause Stevie to go into a diabetic coma, which is fatal unless treated immediately. This phase of her Diabetes is no honeymoon and could last up to two years, so the doctors say.

Finger Pricks

Stevie needs to have her blood glucose (BG) checked before every meal, when she is not feeling well, and several times throughout the night. On a normal day, Stevie has her finger pricked eight (8) times. Even more when she is sick.

Insulin Injections

During the first year of battling this disease, Stevie had her insulin delivered by injection. Insulin needs to be given to cover the food (carbohydrates) Stevie eats, whenever she eats. Insulin also needs to be given when her blood glucose (BG) becomes too high. Her BG might go too high due to factors such as too little insulin for food, stress, anxiety, injury, or illness such as the common cold. On a normal day, Stevie would receive from five (5) to seven (7) insulin injections.

Insulin Pump

On August 6, 2007 Stevie started using an insulin pump to deliver the insulin that she previously received from injections. The pump is a device with a reservoir of insulin that is programmed to deliver a continuous amount of insulin throughout the day. This delivery is called a "basal".

Basal Insulin - The basal insulin is used to cover all of Stevie's normal activities during the day. The amount of insulin delivered each hour must be set based on a hit-or-miss estimate, but once determined, should be consistent from day to day. We have found that her basal rates differ between school days and weekends. We have also found that we must temporarily change her basal rate when she is sick, or when she has mysterious highs at night (which we think might be caused by growth spurts, or by the way the planets are aligned, or something!)

The basal insulin only works to help keep Stevie stable during the course of the day. When she eats, she needs more insulin to cover the carbohydrates in the food. The delivery of this insulin is called a "bolus".

Bolus Insulin - The bolus insulin is used to cover the carbohydrates in the food that Stevie eats. To determine how much insulin she needs compared to the carbohydrates she eats, we need to estimate a ratio of insulin to carbohydrates that will work in Stevie without making her BG go too high or too low. The time of day also affects how the insulin works in her body. For example, Stevie is more resistant to insulin in the morning, and therefore requires more insulin per carbohydrate than in the afternoon. To come up with these ratios, we have to make educated guesses based on how the insulin affected her on previous days. Every day is different; a ratio that worked well one day, may not work at all the next day.

Sometimes the amount of insulin Stevie receives is not enough to cover to food she eats, causing her BG to skyrocket. Other times her BG skyrockets due to illness. When this happens, Stevie requires a "correction".

Correction Insulin - The correction insulin is given to correct a high blood glucose level. Not necessarily hyperglycemia, but a BG level that is far out of the target BG range. How much of a correction to give is based on how sensitive Stevie is to insulin at the time of day she is receiving the insulin. This is called a "sensitivity factor". For example, in the morning Stevie might need one (1) unit of insulin to bring her down 100 BG points; however, in the evening that same one unit of insulin might bring her down 300 BG points. It is extremely important to know Stevie's sensitivity to insulin before giving her a correction. Too much of a correction could cause her BG to go dangerously low. No one can tell you what the sensitivity factor is; you just have to experiment until you get it right. This experimentation is extremely stressful because being wrong could have serious consequences.

The insulin from the pump is delivered through a tube that runs from the reservoir of the pump to an infusion site on Stevie's body (usually on her arm or belly). The infusion site has a plastic needle, called a canula, that is injected into Stevie using a device called a QuickSet. The infusion site needs to be changed every three days.

Site Change Day - Every three (3) days the pump infusion site is changed. This is changed because the site where the insulin is being delivered may become more resistant to properly absorbing the insulin. The site also becomes dirty from normal play activity. On "site change day", Stevie is temporarily disconnected from the pump, gets a bath, and then reconnected to the pump with a fresh infusion set at a new site. We rotate sites (left arm, right arm, belly) so that each site can have a chance to recover from the last infusion set. During the time that Stevie is disconnected from the pump she is not receiving her basal insulin. This sometimes causes what we call a "pump high", where her BG levels go up to hyperglycemic levels, even hours after the pump has been reconnected. The time from pump disconnect, bath and pump reconnect is usually less than an hour. This small amount of time can cause her BG numbers to elevate.

A Good School Day

At the present time, Stevie is not comfortable trying to calculate the amount of carbohydrates she is eating. Because of this, Lynnanne spends much of the day going to and from the school to monitor Stevie, giving her the insulin she needs for the food she eats at school. So you can have an idea of what type of care is involved, below is a chronological list of a "good" school day:

6:30 AM - Stevie wakes up
7:00 AM - Stevie tests blood glucose level. Bolus insulin is given for breakfast. Lynnanne calculates carbohydrates and determines the proper insulin to carbohydrate ratio. Depending on how well Stevie's BG did over night, Lynnanne might have to calculate a correction if Stevie's BG is high.
7:45 AM - Off to school.
10:05 AM - Stevie tests blood glucose level because she is going to eat at "snack time". Lynnanne calculates carbohydrates and determines the proper insulin to carbohydrate ratio. Stevie is about to go to recess, so Lynnanne must take into account the amount of activity Stevie might have at recess. Once Lynnanne has determined all the factors, she gives Stevie a bolus for the food.
11:45 AM - Stevie is about to eat lunch and then go to recess. Lynnanne calculates carbohydrates in the food Stevie eats. Again, she must take into account the amount of activity Stevie might have at recess and balance it with the amount of insulin Stevie should receive.
1:45 PM - Stevie is about to have P.E. Stevie must test her blood glucose level to determine 1) is her BG high enough to do activity without food? 2) does she need to eat something before exercising so her BG level won't drop too far fro the exercise? 3) is her BG too high for her to participate in P.E.? To help Stevie make this judgement, Lynnanne goes to the school to see how Stevie is doing.
2:30 PM - Stevie leaves school. The other kids get out of school at different times, so Lynnanne and Stevie go to the various schools to pick them up. During this time, Stevie tests her blood glucose to be sure she is not dropping low; Lynnanne carries a supply of fast-acting carbohydrates to give Stevie just in case.
3:45 PM - Lynnanne and the kids arrive home. The kids take a break from their school work and sometimes have an after school snack. If Stevie eats, she first tests her BG and then receives a bolus for the food.
5:00 PM - Homework.
6:00 PM - Dinner. Stevie tests her blood glucose level and receives a bolus for the food she is about to eat. Depending on her BG level, she might receive the entire insulin amount or only a portion of it (like half). If Stevie receives the entire insulin amount, then she needs to be sure to eat all of the food she is given.
7:00 PM - More homework.
9:00 PM - Stevie tests her blood glucose level to get a base reading before bedtime. We usually do not give any insulin corrections at this time unless her BG level is above 270. Stevie gets ready for bed. If her BG level is below 150, we will give Stevie a small amount of carbohydrates to elevate her BG level. Teeth are brushed, PJs are on and prayers are said.
9:30 PM - Stevie is (or should be) asleep.
10:30 PM - We test Stevie's blood glucose level to determine which direction, up or down, her BG level is going. If the level is going down, we wake her up to give her carbohydrates if her BG level is below 150. If the level is going up, we give her a correction based on how high her BG level is, and how sensitive she is to insulin corrections at night.
12:00 AM - We test Stevie's blood glucose level to make sure she is in a good range. We follow the same protocol as we did at 10:30 PM.
3:00 AM - We test Stevie's blood glucose level again to make sure she is stable. Again, following protocol for food and/or corrections.
6:00 AM - Lynnanne and I get up to prepare for the next day.

Diabetes: A 24x7 Disease

Diabetes has completely changed Stevie's life and the way we all live in our family. It is a disease that requires constant monitoring and attention. You can't go anywhere without being prepared to take care of Stevie's needs. This includes making sure you have the Glucagon shot with you just in case Stevie's blood glucose crashes and you need to save her life.

I've tried to give you a glimpse into what Stevie (and our family) goes through with this disease. Hopefully you will come away with a better understanding of what it takes to care for Stevie each and every day.

Thanks for taking the time to read this. Stevie would love to hear from you. Any comments you have are also welcome!