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Okay so R is now in Japan. Has been there for 5 days, back in four. Having a fab time, taking lots of pictures, and really reveling in the extreme aesthetic differences. Would love to be there with him…! We skype in the odd in-between times, the miraculous hour when it’s not the middle of the night for him or us… This generally falls in the afternoon. In fact one day I shot home from work for half an hour just to see how visiting Kyoto went! So the children have only spoken to him once in all this time. For a family that talks — alot — this has been decidedly odd. And I imagine E especially misses his presence: it’s hard to overstate how much young men need their dads. And in E’s case, he depends on his dad’s objectivity, his clear-thinking, his rock-solid reassurance (the only one E really believes, I know this) around anything to do with diabetes. So it’s probably doubly stressful.

Though everyone’s generally holding up well.

Except for the uh… hour long hypos.

So this exact thing has happened two nights running: a short dual wave (dripping insulin in) for pizza in one instance, fries/chips in the other. (Here I reveal my almost complete lack of cooking skills: we are all struggling with fairly naff food, being used to the dreamboat and exceedingly healthy, home-cooked stuff of R… Ack.) ANYWAY (again), short dual waves. Which usually cause no problem. So an hour after each ends, there’s a plummeting hypo. A very bad one. Taking not one, or two, or three, but FOUR treatments over the hour to sort. E’s fairly swimming in apple juice, and ill from jellied sweets. The adrenalin has kicked in, and he’s panicky, upset, cross…

And who can blame him. Really, really, really a DRAG.

Then, having sorted the long hypo from the night before, yesterday morning I walked into his room and smelled it for the first time: pear drops. Sweets. I sniffed his bin. No, wasn’t that. I sniffed his covers. No, wasn’t that. I realised with a sinking, guilty heart that it was him, his breath. And that this meant he had possibly dangerous ketones. That he would be sky-high, and had been for hours.

Choice words, and crashing guilt. He was high indeed: 17 mmols.

In the event, the high cleared quickly. I signed him off PE (unsafe at 14 mmols plus), and by lunch he was in range. We communicated throughout by text.

Last night the same thing happened. Not just a funny turn then. Something going actually wrong. Four hypo treatments in the space of an hour. I got up in the night (because of the night before) and boy I was glad I did…Once again, he was 17 mmols. I corrected, and by morning he was still too high, but in a more sensible range, 11 mmols.

This is my theory, and R concurs (skype this afternoon!): first, his dinner ‘ratio’ (eg how much insulin needs to be given for each 10g of carbohydrate) needs tweaking. On the pump, ratios are set for different times of day and different meals, depending on insulin sensitivity. For us, traditionally dinner has needed the least amount of insulin (I think this is common?), and it is also the one meal that we change the ratios for quite frequently.

Second, the treatment of the hypos is inefficient. He almost always treats hypos with juice in the first place. Juice is very efficient, enters the bloodstream quickly. He doesn’t like, however, to drink LOADS of juice. So he chose to alternate the juice treatment with fruit pastilles.

The problem was, he was ‘dropping’. This meant that the peak of the insulin was not yet reached when he went hypo (this peak is around 2.5 hours after a dose, or in the case of dual waves, about 1.5 hours after it ends). So it was not a question of ‘recovering’ from a low, it was a question of keeping from going lower… Which didn’t work, both times. Both times he dropped like a stone.

I think I’m pretty clear that fruit pastilles simply aren’t quick enough in for that situation… They don’t work, so you treat again, it sort of works, but you must treat again…My thought is that they kick in well after they need to, stack up, and… result in a scorching high later on.

So. In that situation, no more pastilles. Just juice, just direct sugar. I feel sure that the lows could have been controlled sooner if only we’d stuck with juice instead of alternating with pastilles.

And we’ve changed the dinner ratio. And no dual wave tonight. So we’ll see what happens.

Sigh.

***

It may not surprise you to know that today, instead of marking or doing any number of other domestic and work-related things, I’ve just had a little breather: I met my dear friend Nancy for breakfast, and then later made a spontaneous appointment for the second manicure of my life. My fingernails are now a glorious deep teal blue. E says he’s ‘never really got why girls paint their fingernails’ — and I can sort of relate. I don’t really get it either.

But it is quite unadulterated fun. When I picked M up from school, she saw my nails and said, under her breath so as not to draw attention to them/her/me: how cool are they? how cool are THEY?

Here is a girl who relaxes by lying in a bubble bath, a bowl of chocolate on the side and an audio book playing. She’s as chaotic and non-girly and wacky-arty (seriously more so) than I am. But she gets it, which must be some kind of parenting triumph!

Looks black but is really deep blue/green...My eyes have barely a wrinkle -- but my hands look my age!

All well with the new additions: four healthy seeming, good feeding and content looking sort of white kitties. Cleo continues to languish in her box, kneading the air — which is called bicycling, and is a very good sign that she’s lactating and happy. She’s certainly purring a lot!

Last night and twice this morning she asked to come out of the room. She proceeded to eat loads of Schubert’s food, drink from the bathtub as of yore (remember, she has all her own food and water in her room!), and explore the WHOLE house. She keeps checking out her old possible nests, and at one point found a few more: under the sofa, under the bathroom cupboard… Right.

Absolutely NO WAY, is all I have to say to that. We can’t keep those babies safe in another situation. They will set off across the room again. Schubert will think one is a toy. It’ll be awful.

I’m only just beginning to stop feeling faintly ill from constant anxiety. Stay where you are Cleo, in a nice, furry cat basket, lovely and warm and quiet. You really don’t want to move them to the middle of all the action. You really, really don’t.

I’m also getting over my anxiety about her adventures away from her babies. She leaves them while content and wanders about the house, for 20 minutes sometimes. Although as I type she’s been snoozing with them (who can blame her, after what she’s been through) for six hours. But when she wanders, I fight panic. I’m afraid she’s going to forget about them. I know that’s silly.

I’m silly. She now knows what she’s doing. And they are stronger every hour.

I remember a dream I once had about forgetting newborn kittens in a cupboard in our old house. I looked and looked for them, and never found them. When I woke up, I was devastated. I had this dream years ago, around the time I lost a pregnancy.

Strangely, I think it’s that feeling which has partly come back. Combined with the panic of having an actual newborn baby human: like if you forget about them for a minute, they will come to harm.

Not true, of course. Funny how I have to learn that all over again.

***

In the land of type 1 diabetes, we are still struggling with night numbers in particular. Having lowered the basals, things once again went a little high last night. The thing is: we are dealing with a moving target. Diabetes never stands still, not in adolescents, anyway. What may have worked two days ago has no guarantee of working today. At the moment anyway. We can only keep pitching the balls, and hope to at least stay in the ballpark….

And I forgot to say in yesterday’s entry that roughly two hours into Cleo’s labour E came in and said that just to add to the stress he had just figured out he’d forgotten to bolus (take insulin) for lunch. Which was rice, a seven hour dual wave (dripping in of insulin). Which explained why he was 23mmols and feeling grim.

Sigh. No one’s fault. It’s so easy to do in all the fuss. But it took him three hours to come close to back in range, 11mmols. And then of course by 11pm he was too low.

Sigh again. He handled it well and didn’t complain, even though I know for an hour he thought he was going to throw up.

And during that time, two more kittens were born.

1) no kittens yet, though prowling mama won’t settle and then sleeps for hours. I’m off out this morning to get rubber gloves (eek) and antiseptic. Just in case.

2) E’s nighttime numbers have been CRAZY. First we up the basal, then we lower it, then god knows…. Not meeting with much settled success at the moment. Messed up my alarm last night and didn’t wake til 4am. Tested and he was 2mmols. Mega ugh. CHILDREN DO NOT WAKE WHEN HYPO.  All this when having been 7mmols the night before, and 14mmols the night before that. Sigh.

3) we have not had an unbroken night’s sleep since about 20 July. Feeling quite used to it, but if we can’t get on top of this in some form before school starts, we will be dishcloths. I cannot help but feel that being in our late forties has something to do with this…Not built for it anymore. (Sorry, OH!)

4) AND Schubert disappeared for 12 hours yesterday. Scared us silly. Last thing we need is a runaway cat. Would rather trade in the kittens than that! He is now zonked out, not even rising for breakfast…

Over and out… And around and around…

Things continue to be hither and thither — hence my struggle to post! Apologies. What always then happens of course is an overwhelming urge to say EVERYTHING.

Not possible. So a quick run through: we think Cleo the cat is with kitten! Her brother is able to tolerate her, phew. We had a party for 30 people last week, and the sun managed to shine throughout! Phew. I’ve taught some year 6 (11 yr old) and today year 5 (10 yr old) school children poetry these last few days too. Really excellent fun. Phew! I delivered a paper to the Poetry and Voice conference at University of Chichester over the weekend. On how different sorts of writing have served different purposes since my son’s diagnosis — and on how the beach hut poems came about. Went well I think, and the whole conference was a stimulating one. Phew!

Not so phew: daughter M, six weeks after cracking her cocyxx in a rounders match (seriously painful, missed two days of school), then jammed her ring finger on her, yes, fingering hand…. So has had to re-schedule her violin exam. Oh dear. Very painful, swollen joint. Little delicate hands. Sniff!

Not so phew too: battles with lows. The heat seems to have had the generalised effect of lowering E’s insulin needs, so last week we had several evenings of unfortunately several hours of dragging around in the 3’s and 4’s… Even with the pump on 0%, eg actually off. It was extraordinarily wearing for him, and a I don’t mind admitting that one night it was a little scary: no insulin going in, already treated two hypos, and gee, 15 minutes later he’s still on 2.5mmols... Disconcerting. But we got up I think half a dozen times that night, and by morning he was okay.

Sigh. Then after 3 nights of going high from too low a temp basal (too little insulin) in the day — we think we’ve sort of cracked it. For now! 90% temp basal in the day, plus 90% of the usual carb counting/ratios. Turn off temp in early evening to stabilise for the night. Unless he’s exercised of course…! In which case turn it to 95%.

Assuming he remembers that he’s exercised.

Assuming that we remember what he’s told us. And that we all don’t crash out on the sofa from SHEER EXHAUSTION while watching the World Cup, where England did SO BADLY. Oh dear.

Did I mention that on the way back from Chichester the car sprung a diesel leak and I ran out of fuel while passing a truck? Scary.

And had to wait on the motorway verge 10 miles from home. Never, ever nice, traffic whipping past at 80mph. I took my linen trousers and sparkly flip flops into the nettles and thorns, up the bank, I can tell you!

And did I mention that because one car is in the shop I did all the driving this morning: child to school, OH to work. And oh, deliver a testing kit to the OTHER child across town, because accidentally forgotten….?!

But we’re here. And we’re okay. As long as we keep our juggling hands free.

It continues to be all-go in our household. There are times when I feel like a drill sergeant. Sigh. And I’m sure my family would say the same (!).

However. Good news from last week’s clinic appointment is that E’s HbA1c is once again back down to below 7%. This is approaching the high end of ‘normal’ (I love this word – NOT. It means here the high end of a non-diabetic person’s HbA1c). SO this is all good news, and confirms our suspicions that the vast majority of the blip last time was down to the dodgy sets, the missed boluses, and some plain wacky numbers. Two weeks later and those blips have disappeared more into his ‘blood history’, the measurement is 50% from the last month, and the proof is in the pudding. As it were.

It’s a wonderful clinic. Sensors for the CGM are arriving tomorrow, thanks to their help. The doctors and DSNs are open, kind, congratulatory, and we always come away having learned something — or at least with something to think about. This is incredibly rare nowadays for us: diabetes is such an individual condition, that what works for one may not work for another, and the pattern of x may not be the pattern of y. Not to speak of how things can vary day to day. So a new thought is, unfortunately, not usually one we haven’t already thought of. Nevertheless, in this clinic (our pump one, not local) we come away with food for thought. For instance: one of the doctors picked up what might be a pattern: E tends to have a hypo (below 4mmols), about 8 hours after changing to a new infusion set.

This may be nothing. But it may be something. What we would do about it is place him on a slightly lower rate of 95% of his insulin for that time. Maybe it will work? One of the lows was a severe low — the ol’ favourite, 1.8mmols of ten days ago. Ack. Each time, we count our blessings that he seems to weather these well. I am touching wood like mad for luck, but so far even these lows have not caused him to lose consciousness, fit or even become particularly disoriented. As I say, I realise we have been lucky.

And speaking of temp basals, it’s been ‘low insulin’ city in our neck of the woods the last two weekends. E is keen to earn money, so has been doing a lot of gardening work: sweeping the drive, weeding, hauling cut down branches to the bonfire. Etc. Last weekend he went onto a 50% temp basal to try to account for the exercise, and still had four or five hypos (I know, I know)… This weekend we tried a different approach. On Saturday, a shedload of hypos. One after the other. We reduced him to 0% for at least half the day. By evening he was stable again, though on 95% through the night, again to account for the exercise.

On Sunday however, we whacked on a low temp basal (20%) AND under-carbed his food. For instance: scampi and potatoes plus veg weighed out and added up to about 80g CHO. He bolused for 60g, thus receiving about 75% of his ‘usual’ dose.

Interestingly, this seemed to work (aside from two hypos in the morning, before we cottoned onto this new idea, sigh!), combined with the temp basal. We did the same for the evening meal — risotto, a slightly awkward one, that he normally doses at 25/75% (eg 25% up front, 75% spread out) over 7 hours. Again, no hypo.

What’s been useful to think through is that it makes a kind of sense that if the body is sensitive to insulin generally at a certain time, then it will also be sensitive in all instances: so any insulin going in during a sensitive time is bound to lower the blood sugar more than is desirable — whether it’s a ‘long-acting’ basal insulin, or a ‘short-acting’ bolus one.

This is not something anyone has ever mentioned to us. I’m mentioning it here, and will do so on the forum. But it makes sense, and worked.

Will it work the next time, however?! Ah, who knows….

***

The reason we have been so happy to let E work like a dog (and yes, I have a list for him after school this week!), is that we have about 30 people for dinner on Thursday. Eek. Spare a thought. The GREAT news is that the weather looks very promising: hot and sunny. (And DON’T even mention the possibility of a thunderstorm to break it, as is the tendency is this part of the country! Just keep it to yourself. Touch wood….)

Last year at the same party E had been on the pump for less than a month. We had lentils. And it sent his numbers all over the shop, being low GI. That would be very unlikely to happen this time. Incredible the distance you travel. We have travelled.

Touch wood.

copyright Tim Haynes

But we don’t. After thinking the high numbers of the last post were set probs etc, here we are on the third day since the last change and ALL IS WELL. A relief. Stable ish numbers. A night’s sleep….

And lovely Cleo has passed the worst of being on heat. After two nights locked in the bathroom she’s to all of our great reliefs a bit more settled. Phew! No more earplugs, and a bit happier a cat….

Finally, exams: I phoned the school and they suggested 10% extra time to account for E’s lack of concentration. Which he has done.

It’s good to get in the habit of being obvious and up front about all this: hypo or hyper, he can lose at least 15 mins of a test to treating it. Now, he’s a VERY bright boy. He would do ok no matter what. We know this. The school know this.

But he never complains. He gets on with things. He thrives and excels. So when he says he thinks his performance is affected by his diabetes, the school listens. They want to set up similar formal provisions for him for GCSEs. Just to give him the best of all possible worlds.

They believe in him and trust him. I was quite choked up on the phone, hearing how much they thought of him. In his RS public exam the next day (part of a GCSE) his numbers were fine. But arrangements had been made for him to sit close to the door. All of the invigilators knew the situation. He came home saying he felt so much better now that nothing was unknown. Before he had gone into every exam explaining…. Uncomplaining and necessary, but hard work I’m guessing before an exam.

Anyway. For the first time I feel, tentatively, that the school is beginning to understand….

***

Morning at the hut.

– Posted using BlogPress from my iPhone

Probably possible! But when trying out the 45 degree sets two nights ago, E decided to do as they did in clinic and go through the steps with a soft toy. He chose one one of his older (but well loved then!) ones called ‘Manky the Monkey’.

Poor Manky. He held up well as E went through all the steps carefully, methodically, as he does. And it all looked alright at first, as you can see.

A Monkey and His Pump

Upon investigation though, we could see that the cannula/needle hadn’t actually gone in. Hmm…more complicated than we thought. The fixed prime (eg small amount of insulin to ‘prime’ the system ready for use) didn’t go in. And poor Manky would have gone very high very quickly!

Thinking we knew pretty much what to do and how to correct this problem (a too-soft backside!), E set up another and off we went.

Disaster. After a big build up (the inserter is much larger than the one for the Quicksets, and very fiddly to press and control at first), the needle finally shot out of the contraption — but didn’t go in. Something to do with angle, etc…But whatever the case, we’d had enough. E had had enough. We realised if we got it too wrong it could go very wrong, with the needle at an awful angle…

So we are off to clinic on Wednesday for some help.

Meanwhile, we continue to use quicksets, dragging out each sound one as long as we can. The set change tomorrow will last until Wednesday, when we can hopefully get going on the other ones.

Meanwhile, numbers have gone from being a little high just before the start of school — with high morning numbers in particular, very common — to now being a bit low. Culminating in an hour of 2.5mmols – 3.4mmols last night. Which was pretty miserable, and required the drinking of three cartons of apple juice, which made E feel sick and later upset his stomach, and an 1.5 hours of 0% temp basal. All at 11pm, when he’s dying to sleep.

Oh dear. A low day yesterday all around for some reason, and the last couple of days have been a bit low before bed, though not hypo. So it’s a ratio (eg amount of insulin to grams of carb) change for the evening meal tonight, in the hopes of tackling this. We think last night was so bad because he had three small things to eat at three different times (was in a short play and ate before, there and after!), so the too-high ratio of the evening rate was trebled in effect, if that makes sense.

You live and learn. And live and learn. And live and learn.

Manky is sleeping it all off in the green soft toy bin, anyway!

I have heard from two parents today: one, H, whose son was diagnosed only 10 days ago.

For both, and for me and us, the lasting through is so hard. The holding-up. The way your life is shipwrecked. And you have to wander around, slowly re-collected, gathering up, all the pieces, new and old.

I find myself being in the position of old hand. 18 months in. Like in grief, you watch yourself move further away from that moment of change, that time of unremitting despair and numbing hard work.

I guess all I want to say is that it’s not that I don’t remember before diagnosis – it’s that I can’t, without the same crush of sadness as I felt at the start. So I don’t take myself there often.

So in that sense, um, I guess I’m not much help. Sorry.

But in every other sense: we help each other. Our children will grow up strong and healthy. Burdened – yes- but like us, with a deep understanding of what’s important.

They didn’t need this. Nor did we. Nor did our families.

Damn.

Thank goodness for small mercies. Friendship of a whole new type, to a whole new degree. Even in passing it means something real.

Hang in there, all of us.

– Posted using BlogPress from my iPhone

Location:Tile Kiln Hill,,United Kingdom

So after two nights of VERY stable numbers, we decide that 7.7 mmols at midnight is good going, and we will try for another unbroken night.

Forgetting the significant amount of cheese with dinner: goats, Swiss and cheddar, all hot on toast with salad. Yum.

So this morning: 15.7 mmols! Cripes!

E stays home while we battle him down- have to make sure it’s not a faulty set. By 10 am he’s down to 12 mmols and we set off to school.

I’m due to teach in 30 mins. I’m going to the supermarket to get juice and biscuits for my last class.

The traffic is slow. You ok? E says.

Yes, I say. Just HATE FLIPPING DIABETES! I yell this, no doubt looking crazed.

We swing round the roundabout.

Lol, he says. Dryly.

***

Got to love him.

Cheese has a high fat content and can slow down digestion. So there is no insulin left to deal with the late carb from the toast. He HAD gone hypo very early into the dose. The clue we ignored. Insulin missed the meal completely, and he was high for hours after.

Lol.

Sigh.
– Posted using tBlogPress from my iPhone

1) Never happens. We know this. You know this. We plug on though. After 10 days/2 weeks of strangely low numbers, we finally lowered insulin across the board. As said. And things a little too high. Tweaked. Things still a little too high. Then, yesterday, things just TOO HIGH: 14mmols +. Eek. Went straight onto 120% temp basal, to get more insulin in. By 10.30pm had crashed into a bad feeling hypo (worse of course by virtue of having been a little high for a few days). Another panicky one. Yuck. Removed temp. At 2am was 4.9 mmols. Woke on 4.6 mmols. That’s better. Back to no temp.

Sigh. We’ll see what today brings.

2) Two days ago there was a talk on ‘healthy eating’ at daughter M’s school. During which diabetes was mentioned as a consequence of not eating well.

Oh dear. M then finds herself, not for the first time, defending her brother’s basic health in the face of her peers over the lunch table, who could add to their usual your brother can’t have sweets/ate too many sweets/must be fat, the cry of but teacher said so.

So no one believed her. And she was so cross she was stomping her foot about it when she got home.

So. I went in yesterday and chatted to form teacher. Was, rather incredibly, rung by the school nurse later in the day. Yes she said we will address this. Distinction not made clear and not good for children, not good for M.

Could have knocked me over with a feather, but oh well.

The two year groups who were originally spoken to will be kept back after assembly this morning, and things clarified. Upon arrival at school M was offered the chance to not sit in with them, or to sit in. She chose to sit in.

She is fearful that there will be too much M’s brother, M’s sensitivity etc for her liking and everyone will know it’s about her…

But I tell her, we tell her, that getting some things right are worth it. She feels so strongly about it, so fiercely proud of her brother and so deeply understands that him developing diabetes is just PLAIN BAD LUCK.

She yelled this in the car yesterday: it’s just plain bad luck!

If everyone knows it’s her doing — so what? They will also know that they were wrong. She just needs to be brave. And she’s very capable of that, every bit as brave and strong as the brother she loves so much.

Setting sail

In November 2008 my 12 year old son was diagnosed with type 1 diabetes. The effect of this event on me -- and on our nuclear family -- was like being thrown overboard and watching the ship leave.

'Dealing with type 1' in the family has morphed into another sort of 'dealing' -- a wholesale resituating of parenting, of family dynamics...of life.

At my son's diagnosis I could not to locate a record of what living with a type 1 child in the family is like. I could not see myself or our family anywhere. I longed for a starting point, a resource and a sense of the future. Being a writer, my instinct is to write it. This space, I hope, is a start.

Blood Sugar Ranges (UK)

<4 mmols = low or hypo, life-threatening if untreated
4-8 mmols = within target range
8-13 mmols = high but not usually dangerous
14+ mmols = very high, or hyper, life-threatening if untreated

Bubbles

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Disclaimer

I am not a medical professional. Any view expressed here is my opinion, gleaned from experience, anecdote or available research.