Thursday, March 24, 2016

Chasing Highs, Treating Lows -- a LONG Night

Type 1 diabetes definitely keeps ya hopping.

Lately, overnight numbers for the girls have been pretty decent.  In the last several nights Trinity has had a few 'highs' that we were able to correct and get to a reasonable number easily and Selah's numbers and graphs have looked awesome.  Nice, steady, even for the most part.

Until....... last night.

Nothing new, nothing different in terms of foods and insulin/carb ratios and yet..... a HUGE difference in their numbers.

This..... this is diabetes.  This is why living with this disease is so challenging.  You just don't know from day to day what this beast will bring.

As they prepared for bed, we had them both check their BG - blood glucose level.  A normal occurrence.

Trinity was rising toward the 300's.  Sigh.  Why oh why?  We had dosed for all her dinner foods. They were foods she eats on a regular basis and the carbs easily accounted for - nothing new to throw us off.  We typed in the number in her pump and gave the correction it stated.  Since she still had insulin on board from her meal, the correction wasn't as big as it would be 'just' for the high blood sugar number.  Now, all we could do was wait and see if it did the trick.

When this happens you always wonder, is the pump site effective?  Is she actually getting the insulin we are dispensing? Is the insulin working?  Did it get too hot?  Unfortunately, there's no way to know except. to. wait.  Synthetic insulin works slower than the insulin our bodies make. So... it could be 2 hours before that insulin we gave her to correct that high blood sugar would peak and start having a real effect on her high number.

Then Selah.  A different scenario played out with her.  She was 55 at her bedtime check.  WAY TOO LOW!  That was AFTER she had had a juice 30+ minutes prior for an 107 double arrow down reading on her dexcom.  Again, same foods, same insulin/carb ratios and for some reason, her body decided to plummet whereas Trinity's decided to soar.

It can be maddening.

She had just finished eating a decent sized meal a short time earlier and then had a juice box to bring up the low we knew was coming on.  (Which, unfortunately, hadn't worked quite as well as planned.)

Her. Little. Belly. Was. Full!

She didn't want anything else to eat or drink.

As a type 1 diabetic, that wasn't an option. She needed fast acting carbs to bring that low blood sugar up to a reasonable range before she could go to bed.

She didn't want another juice; couldn't fathom eating candy.  We settled on a tablespoon of honey.  Yep, you read that right, "a spoonful of honey helps the medicine go down."  Oh wait, that's a little different.  Anyway, she ate the honey and then we waited................  again.

We snuggled her up on the couch and we set a timer.


She looked ok.  She wasn't drooping.  She wasn't shaking.  She just sat, playing mom's phone, waiting for the honey to make it's way through her slight body to bring up that low blood sugar.

It was slow working, but... it did work.  She was coming up a tiny bit at each check.  Ten to fifteen minutes in - she was around 60.  Moving in the right direction.  Ten more minutes, 66.  Still heading up so we continued to wait.  No more carbs as we didn't want to then be chasing a rebound high from too many fast acting carbs from fighting the low.

Such is the tightrope walk of living with type 1 diabetes.

Finally, after a good 30+ minutes she was in the 90's with an arrow up.  Phew.

Now we could let her go to bed.  Off she went and we continued to watch her Dexcom from our phones.  107 - arrow straight up.  Would she slow down? Would we need to correct now with insulin to keep her from going too high?

Nights like this are hard.  Decisions are tough to make.  Make the wrong one and you fight blood sugars going the wrong way - either way.

Unfortunately, this wasn't the end of our blood sugar woes for the evening.

Techno and I went to bed but Trinity was still in the high 200's.  Yet, it hadn't been 3 hours since her correction.  The insulin could still be slowly working in her little body.  A little sleep then check again.

Her alarm went off a few times as her numbers were NOT coming down.  Finally, around midnight, I got up and gave her yet another correction.  This always makes me scared.  Do I do what the pump says?  Do I give a little less to prevent a low?  What if I give less and she doesn't come down? What if I give the full amount and she plummets to a severe low?  I really dislike these moments.  My heart pounds, my mind swirls, my palms sweat.  What IS the right decision?  I never really know.  Last night?  Last night I decided to err on the side of caution and gave a little less.  She still had some insulin on board from her dinner and correction earlier -- I was surprised to see that.  I think that's what made my decision to go with less.

Back to bed.  Fortunately, she didn't even know I had been there.  She snoozed right through it all.

A short time later, more alarms.  Trinity's phone had stopped connecting to her dexcom and we were no longer getting her blood glucose readings.  That's NOT good after giving a correction. We want to be sure she's not going too low, be sure the insulin is working and actually bringing her BG down.


Up again.  Padding down the hall, I hoped it was just her phone and not a gap with her dexcom. That DOES happen. Technology isn't perfect.  Fortunately, it was her phone.  A quick reset and a short time later -- numbers appeared on my phone once again.  Relief.

Back to bed.  Again, she didn't wake at all. Thankful for that.

A short time later, Techno's low blood sugar alarms chimed.  A shake of his shoulders and he's awake to deal with his own low.

Trinity's numbers didn't come down as much or as quickly as I'd hoped, but they were trending in the right direction or at least staying stable.  Fear often keeps me from giving more corrections even when I probably should.

Finally, around 3 or so, Trinity's numbers were falling below the 200 line.

Sleep - my sleep - finally came at that point.

Techno got up early for work and Trinity had bounced back above the 200 mark so he gave yet another correction.  I didn't even hear his alarm, her alarm, him get out of bed.  Tired.

Now, it's morning.  6:40 am.  I heard the kids moving about.  I realized Techno was up and gone.  I decided it was time for me to get up too.  Even though my body didn't feel rested.  My mind still foggy and groggy.  After 20 minutes of stirring, I finally got myself out of bed.  7am.

I see the jump in Trinity's graph. I figured Techno corrected as now she's ZOOMING downward.

She decided to make her siblings a 'special' breakfast so she hadn't eaten yet this morning.  I asked her what her dexcom read - 66.  To be certain, she did a finger stick and checked with her blood glucose meter.  56.

"Grab a juice."

You guessed it, now. we. wait.


It didn't take long and her blood sugars were coming up. She finished making her little meal for her sisters and herself. They ate.  We gave she and Selah insulin for the fruit salad.

And once again, we'll ..... WAIT.... and see how their numbers go today.

It's not easy being a pancreas.  We use scientific calculations to try to dose correctly,  to try to find the right balance in the carb to insulin ratio.  We rely on figures that tell us exactly how many carbs are in any given morsel of food.  We weigh, measure, and guess just how much they are eating of said food.  We attempt to figure out how much to correct for highs and lows, but.... we aren't the pancreas God created to manage these things.  We can only do what science has discovered -- which is by far inferior to the 'real deal' that God created.

Until a cure is found, however, we'll continue to strive to be the best pancreases we can be for our little girls.  Even when it means sleepless nights, tired mornings, spoonfuls of honey, correction after correction of insulin only to be followed by a juice box because we corrected a little too much.  I'm honored to be a substitute pancreas for our little girls.  I'll continue to strive to be a good surrogate for their non-working pancreases - relying on God's guidance as I do.

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