I like my birthday less than I used to. Of course it still happily marks another year of life to celebrate with friends and family, but March 5th also marks the last day my son would ever not have type 1 diabetes. On March 6, 2016, my son has been living with (diagnosed) T1D for 731 days (there’s a leap year in there), roughly 37% of his life.
We haven’t figured out how to mark or celebrate his diaversary, a neologism for the anniversary of a diabetes diagnosis. I think we’ll wait for Henry to take the lead on this. However, I’ve been reflecting on this upcoming date for a few weeks now. Moments like this are mile-markers because they disrupt the routine of counting carbs, insulin delivery, and correcting highs and lows. If I think about the preponderance of diabetes care all at once, it’s overwhelming, so the task-to-task perspective allows me to get up each day, put my boots on, and do it all again. Yet, around these mile-marker moments, I usually peek out the window at the vast appalling and inspiring mountain range that is T1D management.
On March 1st, I recorded all my actions related to T1D care. Here’s one day of T1D care. It’s only one day. Some days are better. Some days are worse. We’ll do it all again tomorrow.
basal= background insulin being delivered by pump
bolus= a larger amount of insluin delivered at meal and snack to cover carbs
BG= blood glucose
CGM= continuous glucose monitor, provides an estimate of Henry’s blood glucose every 5 minutes
Dexcom Share allows us to see blood glucose values on our phones
ezBG= pump function calculates how much insulin to deliver to correct a high BG
IOB= insulin on board, the amount of insulin that has been administered and is still circulating
12:03 a.m.- check BG by blood, 74 with an arrow down to the side, half a juice box
2:00 a.m. – wake up to alarm, check BG on CGM, 147 with an arrow straight across go back to sleep
5:00 a.m.- wake up to alarm, check BG on CGM, 220 with an arrow straight across, so check BG by blood, it’s really 309, give 1.25 units of insulin, go back to sleep
7:00 a.m.- wake up to alarm, check BG on CGM, 137 with an arrow down to the side, so I get ready for work
7:30 a.m.- check BG by blood, 130, while Henry is still asleep, prebolus 1.5 units of insulin for a breakfast of 25 carbs
7:35 a.m.- help Henry get dressed so that the pump and CGM sites stay secure
7:55 a.m.- Henry eats breakfast, a low carb, sugar free muffin and a scrambled egg with cheese
8:35 a.m.- check BG on CGM 107 down to the side, get d-bag ready for school
9:05 a.m.- drop Henry off at preschool, get CGM on Wi-Fi, check BG by blood, 210, give .15 units of insulin to correct high
9:15 a.m.- listen to a diabetes podcast during morning email and class preparation
10:08 a.m.- text from Henry’s preschool teacher/s: Did another ezBG, I look at BG remotely, 320
10:59 a.m.- right before teaching, look at BG remotely, still 320
11:17 a.m.-text from Henry’s preschool teacher/s: We did another ezBG at 10:30 and it gave another .3. He had 1.07 IOB at the time.
11:45 a.m.- Husband calls during class, saying he went to check on Henry, who has large ketones. Pump said to give 6.6, but this would be way beyond the most insulin Henry’s ever had at once, and it made my husband nervous, so he gave Henry 5.6 units of insulin to correct for large ketones and cover his lunch of grilled cheese and tomato soup. 5.6 is the second highest amount of insulin Henry’s ever had on board.
12:01 p.m.-look at BG remotely, 329 with an arrow up at the side
12:15 p.m.- listen to voicemail from drugstore about prescription problem with test strips
12:45 p.m.- while on a way to a meeting, read text from husband: I called the school and told them to go ahead and give the additional unit I was worried about, look at BG remotely, 363 with an arrow up at the side
1:15 p.m.- during meeting, unsuccessfully try not to think of Henry’s ketones and blood sugar
1:53 p.m.- text from Henry’s preschool teacher/s: We gave another unit and are continuing to push water. Will have cheese stick and beef stick for snack, husband texts back and asks that Henry be given 1 additional unit of insulin to help clear ketones.
2:30 p.m.- look at BG remotely, 263 with an arrow straight across
2:33 p.m.- look at BG remotely, 260 with an arrow straight across
2:38 p.m.- look at BG remotely, 260 with an arrow straight across, realize I have to stop obsessing and get some work done
3:08 p.m.- look at BG remotely, 141 with double arrows down, which means Henry’s BG is falling faster than 3mg/dL per minute, text to his teacher/s: Now he’s falling fast! What’s his real BG and how much IOB?
3:16 p.m.- look at BG remotely, 111 with double arrows down, call classroom and talk with student worker who tells me that IOB is 1.16, I tell her to give Henry 2 glucose tabs, text husband this information
3:25 p.m.-look at BG remotely, 95 with double arrows down, I tell myself I am a logical person, that the sugar will do its job and the CGM is lagging, so he’s probably leveling off, not spiraling down
3:29 p.m.- text from Henry’s preschool teacher/s: 97 and .92 IOB, gave two tabs 15 min. ago, CGM says 84 with double arrows down
3:58 p.m.- look at BG remotely, NO DATA
4:16 p.m.- my phone buzzes with a Dexcom alert, I check, says he’s 64 with an arrow straight across
4:31 p.m.- my phone buzzes with a Dexcom alert, I check, says he’s 64 with an arrow straight across, then Henry walks through the door with his papa, who said his BG by blood was 112
4:46 p.m-. my phone buzzes with a Dexcom alert, I don’t check, knowing it’s still catching up form the fast drop
5:40 p.m.- check BG by blood, 95 and prebolus 1.4 units of insulin for a dinner of 40 carbs
6:10 p.m.- during dinner my phone buzzes with a Dexcom alert, CGM says BG is 74 straight across
7:00 p.m.- check BG on CGM, 121, an arrow straight across
7:28 p.m. – help Henry change out of his clothes and into his pajamas to preserve pump and CGM sites
7:32 p.m.- check BG by blood, 111, give .55 units for a high protein bedtime snack of 11 carbs
7:40 p.m.- add some new basal times and programs to avoid nighttime highs, which have been more or less constant for the past few days
7:56 p.m.- check BG on CGM, 160, an arrow straight up
8:56 p.m.- check BG on CGM, 157, an arrow straight across
9:32 p.m.- check BG on CGM, 134, an arrow straight across
9:46 p.m.- silence reminder alarm from pump to check BG 2 hours after insulin delivery
10:10 p.m.- check BG on CGM, 181, an arrow straight across
10:39 p.m.- check BG on CGM, 177, an arrow straight across, decide to check BG by blood, 209, give .7 units of insulin
11:32 p.m.- check BG on CGM, 168, an arrow straight across
11:42 p.m.- check BG on CGM, 158, an arrow straight across, set alarm for 12:40 a.m., 3:00 a.m., and 6:00 a.m.