A synced life: I think. My Christmas present this year from OH was an iPhone on Vodafone — OH made me teeny-weeny little flip calendar, tied with silver thread (awww!) counting down the days from Christmas. One inch square. So yesterday is the day it’s available, and off I go. Collect. Bring home. Stare at it. Plug it in and watch it go like some kind of information eating monster…all my photos, all my albums, in minutes. Now I can look at pictures of my children taken 4 years ago — on my phone! Ack. Now too, I have to figure out how to ‘push’ my email onto it (erk), work a calendar that syncs the computer and the phone without  you even prompting it (ack), and enter all my contacts (thank goodness for touch typing). THEN my whole life will be streamlined. (Cough.)

An artificial pancreas: this really is BIG news. Received word yesterday of a recent announcement — the first prototypes are expected to be available in the US within four years. Four years. Read the press release. I like this short article. Because it makes clear what the heck living with this is all about. And what a difference even half the job of a pancreas (preventing highs and lows) would make, the impact on every minute of every day…

***

Random case in point: YESTERDAY

Daughter M has a ballet performance (soldier in a version of the Nutcracker) in the evening. I tear home from school with her and friend, have a 45 minute turnaround for dinner. Earlier decided on pizza — hard for E to dose the insulin (pizza, pasta and rice in particular take longer to digest so getting the insulin in at the right speed to ‘catch’ the food and metabolise it is challenging to say the least — see Diabetes Basics for an explanation of the mechanics!), but needs must.

Pizza packaging is confusing: says 25g of carbohydrate per 100g of pizza…but then says that half a pizza is 60g of carb. We weigh up his serving: 200g. But is it more than half the pizza! So per 100g measurement says it’s 50g of carb for him, whereas written amount says it’s more like 70g…These disparities in numbers make the difference between E’s blood sugar going too low, or shooting too high. Since he has to go to the performance, we decide to allow some leeway to avoid a hypo in the middle of it all — we go for 50g. Then the decision about how to measure out the insulin… There is a facility on the pump for spreading out a dose of insulin over time, in order to avoid dumping it all in when the slower-digesting food is not there to receive it (this facility is called a dual wave on the Medtronic pump). Thing is, you have to decide what kind of dual wave to do, and for how long: you have to ask the questions how much insulin should he have NOW (to go in over the next two hours) and how much should he have LATER than that (to go in over anywhere from 1 more to 8 more hours….). Okay, so we know from experience with pizza than Sainsbury’s brand usually works pretty well on a 50/50 (50% now, 50% later) 2 hour dual wave. BUT because I got the pizza from Marks and Spencer (because I was in town getting my iPhone!), we have a different base, and we can see a less cheesy, less oily pizza (fats also slow down food absorption). SO, we make a more or less random choice to make the dual wave a 1 hour 50/50 one, thinking it will go in a bit quicker than usual.

Stay with me!

So, we slam the food in, by now quite late, M changes and I whack her hair into a low bun, slick her face with a curly black moustache and round red cheeks. Meanwhile E has left the crusts of the pizza — aaaah! He’s full. Is this okay? we wonder. Will he hypo later? He’s left some of the carb we have already counted, you see, in case you’re drifting…We decide that we’ve probably under-estimated the carb content anyway because of the packaging mix-up, and leave it.

Meanwhile, M is readying herself for a performance. I feel sick with guilt and stress that this nine year old has gathered her own ballet shoes, a book to read, and her toy rifle to take with her, while I’m trying to contribute to a unanimous decision about dosing and carb content.

She gets there. We take our seats. She does an excellent job, and the whole production is great fun, lots of good dancing, lots of dramatic pretend fighting.

At the interval E is very grumpy. I think he’s high, though he rolls his eyes at me. He tests, and is high. However, the dual wave has not finished having its effect, and from experience we know that if we override the pump and try to correct him now (eg give more insulin), there is a high chance he will hypo later.

So we leave it. He doesn’t feel great, and is sulky-ish. (My point is, here the artificial pancreas would know without him testing, and correct him! He would not still be climbing!)

The performance reaches a resounding climax, and we all go home happy.

At home though, E feels worse. He’s a bit higher. Damn pizza.

M wants to recount the performance…wait, we say, having to interrupt her. We need to look at E’s numbers. Damn diabetes.

She stops talking. We make the decision to correct. It’s 9.15pm. This decision means that we will need to stay up until 11.45 at least — in order to ‘check’ the dosing. As a couple, we have made the decision not to let him go through the night without checking him at a point where his levels may have stabilised, and this always applies to an insulin dose, which takes 2.5 to 3 hrs to complete its cycle. This commitment to seeing every dose and change through has saved numerous potentially dangerous situations: we have ‘caught’ many dangerously low lows by doing this. We have also corrected many out of range and long-term dangerous highs similarly….

We ask M to go ahead, and we all finally get the chance to talk about the night.

So. E’s numbers will come down, M has had a good night (though as ever mediated by diabetes), and OH and I know we will be up much later than we want to be in order for this all to have happened.

***

In the night: at 11.45 pm we do a blood test on him while he sleeps, as usual. He is borderline low. Damn pizza. Damn correction of insulin earlier. We cannot leave him in this state because

1) the insulin still has another hour of activity, so he is likely to go lower

2) he is on new nighttime insulin rates (changed by us yesterday because he’s been rising overnight), and therefore his levels are even more unpredictable than usual. So we wake him enough to drink some apple juice — about 10g of carbohydrate. We calculate that this should be enough to hold him through the night. It’s a guess, of course, because of the new rates.

We decide too that we can’t leave him all night without testing: the new rates, the starting the night low. It’s my turn to get up (we’ve had a bad stretch, been up almost every night since Christmas), and I set the alarm for 2am.

At 1.30 am I hear the finger pricker clicking and shoot out of bed. He has woken up, feeling bad. He is again borderline low. He has some more juice and then falls asleep instantly. 

I go back to bed, and wonder if he’s had enough juice, and whether the rates need changing again. The night before had been convincing, we had thought everything was okay…

(Again, an artificial pancreas, even the basic one in the article, would have caught these slipping lows and prevented them! He would have slept through! We would have got some sleep!)

This morning — again, he is borderline low and feeling unwell. Something clearly needs looking at in his rates, just 48 hours after the last adjustments.

***

Four years in the States probably translates to six years until it’s available here. But for him, that’s partway through University. That’s entering his adult life. That’s great! Give it to us! We’ll fight for it! We’ll campaign for it! Safe and healthy nights in his independent life — bring them on.

 

 

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