Sunday, September 28, 2014


Answers to the test:
1.A   2.B  3.D  4.B  5.B  6.D  7.D  8.D  9.D  10.A  11.A  12.D  13.B 
14.  in order N,L,L,N, N, L, N, L
15.  in order F, F, T, F
16.D  17.A 
18. in order H, H, H, H
19.C  20.A  21.B  22.A  23.A 
24. in order L,L,L
25.D  26.A  27.D 28.D   29.A  30.C
31. in order T,T,F,T
32.D  33.B  34.C  35.C  36.A  37.A

How did you do? 

My husband missed the fewest when we had to take it.  And the teenager missed one more than me.  We were all exhausted and super stressed when we took it.  We've learned so much more since then. 

Wednesday, September 24, 2014

The Elephant in the Room

 Basically insulin is a key for allowing the glucose (breakdown of food in our digestive system) to be utilized by our cells, all our cells.  Without insulin, glucose builds up in the blood stream causing high blood sugars and ketones and eventually death.  Before the discovery of insulin in the early 1920s by Banting and Best, children were put on a starvation diet to try and prolong their life.  Type 1 diagnosis was fatal.  The main difference between Type 1 and Type 2 (besides the autoimmune response in type 1s) is about the insulin.  Type 1s produce little to none and type 2s are resistant to the insulin their pancreas still produces.  When a child that is Type 1 reaches puberty they can become insulin resistant as well.  Some are put on drugs typically used for Type 2s as well as their insulin regimen.  So those are some basics.  Let's talk food.

When Sugar Bear was diagnosed we were given at the hospital a little booklet that travels in his kit.  We also were blessed with some iphones from my in-laws and between those two things we can figure out how many carbohydrates are in a meal for our little guy.  And then the learning took off.
 We were amazed at what all contained carbohydrates and how much from bananas, peas, carrots, some meats, some cheeses, peanut butter, breads, potatoes, milk, oj, etc...etc...etc...  We invested in a scale to make some of this math easier and more accurate.  Accuracy is so important in keeping Sugar Bear in range.  And even then sometimes it still doesn't work.  So we also have to take into consideration the  glycemic index of food.  Some foods will cause a spike in the blood sugar that will then bottom out like pizza, fast acting sugars (candies, fruits, juices), etc....   Other foods high in proteins and fats can help to stabilize blood sugar but they can also be high in sodium and unhealthy fats.  Peanut butter crackers after a juice for a low can allow the blood sugars not to spike or drop.  In a body with a normal functioning pancreas these processes happen without any thought.  Your body in preparation for a meal will release insulin.  When all the food is broken down and transported to cells it will stop producing insulin to prevent a low.  Your pancreas will also release glucagan to raise blood sugar if your body were to start going low.  The liver stores some of the glucose to release as well.  In a Type 1 this can be very important if one has a severe low.  It's not something one can rely on which is why we carry glucagon and a syringe with us every where.  And the glucose stores in the liver can be depleted. 
 Now let's talk food choices and the emotional toll diabetes takes.  Imagine you've had the worst day ever.  You can't wait to get home, unwind, grab your favorite comfort food, and relax.  What's your comfort food?  Is it "healthy"?  How would you feel if someone told you you shouldn't have that and then directed you to something they feel is better?  What if it was a holiday?  Do you indulge in foods you "shouldn't" at that time? 
Type 1 Diabetes is a never ending, constant source of emotional battering.  From highs and lows, to regular doctors appointments, to worries about long term complications, and social impacts and it all centers around food.  Go to the movies and there is popcorn.  Go on a date and you'll probably go out to dinner.  Friends have a party and there will inevitably be numerous foods (not necessarily "healthy") to choose from. Want to do something healthy like exercise?  Better test and adjust carb and insulin intake. Ever been on a diet or told you shouldn't eat a particular food?  It becomes the elephant in the room.  It's all you can think about.  It's all you want even if you KNOW it's BAD for you.  Can you go one time winning that craving?  How about 100 times?  A thousand?  With Sugar Bear we have taken the very sound advice from another parent of a child with type 1:  Child first, diabetes second.  It doesn't mean that diabetes isn't part of the equation.  It most certainly is.  But when we weigh how to operate or treat him, we err on would we act a different way if he didn't have diabetes?  If the answer is yes, then we have to figure it out. We have to do it. So we SWAG (scientific wild a## guess) that popcorn he had watching a movie with his friends because they wanted popcorn and so did he.   We indulge in ice cream to celebrate moving up a grade.  And he gets chocolates and candies at Easter, Halloween,and Christmas.  He'll get to eat all his carby starchy favorites at Thanksgiving.  And he can most definitely have cake on his birthday.  It becomes about covering with insulin not making him feel different.  Diabetes already makes him feel different enough with testing 6-10 times a day and having to take a shot 4-6 times a day. Feeling awful with highs and lows.  Oh, yea, and doing math just to eat.  This doesn't mean he doesn't have limits.  We all do.  Everything in moderation and sometimes even moderation.  Will we let him sit down and eat the entire Trick or Treat bag in one sitting?  Um, definitely not.  But we wouldn't want him to do that even if he didn't have diabetes.  Will we make him feel guilty for wanting to?  Nope.  But he will get to have it.  We will plan accordingly. 

Monday, September 22, 2014

Testing, testing 1.2.3....

Sudden onset of Type 1 diabetes is like white water rafting holding on to a log for dear life.  Sugar Bear was in the PICU and then moved to the regular part of the hospital after a few days.  Then we had a day of education.  Not really even a day.  Part of the education was injecting saline into each others arms, learning as much info as possible about carbs and how they effect BS.  And we all had to pass a test before we could take him home.  It was a whirlwind of emotions and information and then he was released in our care.  His life literally in our hands.  We've learned so much more since then.  And still not enough.  I thought it might be interesting to post the 36 questions we had.  They were multiple choice.  I'll post the answers later in the week.  Here are the questions:

1.  Without insulin, blood sugar:
     a. goes up
     b. goes down
     c.  disappears
     d.  stays the same
2.  The most accurate way of testing the amount of sugar in the body is by:
    a.  urine testing
    b.  blood testing
    c.  observation for signs of high and low blood sugar
    d.  smelling the breath
3.  In using your blood glucose monitor, it is important to:
    a.  make certain the code number on the test strip vial or packet matches the code number on he monitor
    b.  use only those strips made for your blood glucose machine
    c.  make sure you have an adequate blood drop to perform the test
    d.  all of the above
4.  If your blood glucose reads out 45mg/dl on your blood glucose monitor, the first thing you should do is:
    a.  call the doctor immediately
    b.  drink 4 oz. of fruit juice or sugar containing beverage
    c.  take more insulin
    d.  eat a leafy green salad
5.  If your blood sugar reads out 450mg/dl on your blood glucose monitor, you should:
    a.  call the rescue squad
    b.  check your urine for ketones and get in touch with your doctor
    c.  drink 4 oz. of juice or a sugar containing beverage
    d.  all of the above
6.  Blood sugar should always be tested:
    a.  once a week
    b.  once a day
    c.  after meals and after bedtime snack (at least 4 times per day)
    d.  before meals, at bedtime and whenever your child feels like he or she has a low blood sugar (at least 4-6 times per day)
7. If your blood glucose monitor reads out "HI", it means:
   a.  the meter is not working correctly
   b.  your child is having an insulin reaction
   c.  your meter is giving you a greeting
   d.  your meter can not read the blood sugar because it is greater than 600mg/dl
8.  Blood and urine test strips should be:
   a.  stored at room temperature
   b.  re-capped as soon as strip is removed from bottle
   c.  used before the expiration date
   d.  all of the above
9.   You should check your urine for ketones:
   a.  once a day in the AM for the first few weeks
   b.  when Blood sugar is over 300
   c.  when ill
   d.  all of the above
10.  When testing urine with Ketostix, compare the colors after:
   a.  15 seconds
   b.  2 minutes
   c.  5 minutes
11.  Unopened bottles of insulin should be stored:
   a.  in the refrigerator
   b.  in the freezer
   c.  in the kitchen cabinet
   d.  in the oven
12.  Novolog insulin should be given:
   a.  mixed with Lantus
   b.  no longer than 15 minutes before a meal
   c.  within 30-40 minutes after starting a meal
   d.  b & c
13.   When injecting insulin, you should:
   a.  give it in the same place every day
   b.  give it in a different site every day, using your site rotation chart
   c.  I don't know
14.  Mark Novolog (N) or Lantus (L) beside the following things about insulin.
   ____Starts acting 10-15 minutes after injection
   ____Lasts approximately 24 hours after injection
   ____Is a long acting insulin without a true peak
   ____Lasts about 3-5 hours
   ____Peaks approximately 2 hours after injection
   ____Starts acting about 2 hours after injection
   ____Clear insulin in a short & wide bottle, or cartridge
   ____Clear insulin in a skinny, taller bottle
15.  Mark the following statements as True or False (T or F).
  ____Lantus can be mixed in the same syringe with Novolog
  ____Insulin raises blood sugar
  ____Lantus should be given at the same time every day
  ____Injecting air in the insulin bottle is not important in helping withdraw the appropriate amount of insulin
16.  If ketones are present in the urine of a person with diabetes, they will need to:
    a.  call the physician if the ketones are moderate or large
    b.  be inactive
    c.  to drink water or sugar free fluids
    d.  all of the above
17.  Pick the best answer for the following question.

  A blood sugar of 300 is:
     a.  too high
     b.  too low
     c.  normal
18.  Match the term high blood sugar (H) or low blood sugar (L) with each of the following:
   ____Caused by too much food and not enough insulin
   ____Caused by infections, sunburns, or poison ivy
   ____Symptoms may include feeling ill, vomiting, and deep rapid breathing, increased thirst & urination
   ____May need to give extra Novolog insulin
19.  Which of the items below may cause a low blood sugar?
    a.  illness, i.e. earache, infection, tonsillitis
    b.  skipping insulin
    c.  hard exercise (playing hard)
20.  A low blood sugar is caused by
    a.  too much insulin
    b.  too little insulin
    c.  too little exercise
21.  A blood sugar of 30 is:
    a.  too high
    b.  too low
    c.  normal
22.  A glucagon injection is used when a person with diabetes:
    a.  has low blood sugar and is unable to safely take sugar containing liquid by mouth, is unconscious, or is having a seizure
    b.  has high blood sugar
    c.  has the flu
    d.  all of the above.
23.  If your child has a low blood sugar, you should:
    a.  give 15 gms or 4 oz. (1/2 cup) of orange juice or regular pop
    b.  call the doctor for insulin instructions
    c.  tell him/her to go lie down
    d.  give him/her an extra bread exchange at next meal or snack
24.  Match the term high blood sugar (H) or low blood sugar (L) with each of the following:
  ____Pale, sweaty, shaky, may have headache
  ____Confusion:  if left untreated can progress to seizure
  ____Treat with sugar or glucagon
25.  What raises blood sugar?
    a.  stress
    b.  illness
    c.  exercise
    d.  a and b
    e.  all of the above
26.  When a person with diabetes is ill and vomiting, he should:
    a.  check the BG and ketones, then call the doctor
    b.  give the same amount of insulin
    c.  not take any insulin
    d.  I do not know
27.  Before hard exercise, a person with diabetes should:
   a.  take more insulin
   b.  check blood sugar.  If low, treat with juice & then pre-treat for exercise with carbs.
   c.  take less insulin if exercising after the meal
   d.  b or c
28.  The short term and long term goals in managing diabetes are:
   a.  blood sugars as near normal as possible
   b.  normal growth
   c.  freedom from complications
   d.  all of the above
29.  In Type 1 diabetes (insulin dependent or juvenile diabetes), blood sugar is controlled by:
   a.  carefully controlling insulin, diet, and exercise
   b.  removing the pancreas
   c.  seeing the doctor every two weeks
   d.  losing weight
30.  The best range listed for a child with diabetes who is taking insulin is;
   a.  150-250 mg/dl
   b.  60-100 mg/dl
   c.  80-150 mg/dl
   d.  190-200 mg/dl
31.  Mark the following statements as true or false (T or F):
    ____Food raises blood sugar
            Exercise lowers blood sugar
           Illness and stress usually lower blood sugar
_____Blood sugar should be checked at least 4-6 times per day.
32.  Just before a soccer game, your blood sugar is 58 mg/dl.  What should you do?
    a.  Drink juice to treat the low blood sugar
    b.  Pre-treat for the soccer game by eating extra carbohydrates
    c.  Take Novolog for the carbohydrates eaten for pre-treatment
    d.  a & b only
33.  Before a meal, your blood sugar is 62 mg/dl.  What should you do?
    a.  Call the rescue squad
    b.  Eat the meal & subtract 15 grams from the total carbs eaten to treat the low BG
    c.  Do not give any insulin

Use the following insulin doses to answer the next 4 questions:

Blood Glucose (BG) result                  Daytime Correction Scale            Bedtime Correction Scale
Under 150                                                0 units                                             0 units
150-200                                                    1 unit                                              0 units
201-250                                                    2 units                                             1 unit
251-300                                                    3 units                                             2 units
301-350                                                    4 units                                             3 units
351-400                                                    5 units                                             4 units
over 401                                                   6 units                                             5 units

Lantus insulin= 5 units to be given daily @ 9pm.

Carb to insulin ratios:
- Breakfast = 15 grams :1 unit
- Lunch = 10 grams : 1 unit
- Dinner = 20 grams :1 unit

34.  Before eating breakfast, your child's blood glucose was 100.  He/she ate 60 grams of carbohydrates.  How much Novolog should your child get?
    a.  2 units
    b.  3 units
    c.  4 units
    d.  5 units
35.  Before eating lunch, your child's blood glucose was 340.  You checked for ketones, and they were negative.  He/she ate 78 grams of carbohdrates for lunch, and is planning to watch a movie now.  How much Novolog should your child get?
    a.  10 units
    b.  11 units
    c.  12 units
    d.  13 units
36.  Before eating dinner, your child's blood glucose was 210.  He/she ate 85 grams of carbohydrates.  You are planning to take them to the park after dinner to play.  How much Novolog should your child get?
    a.   5 units
    b.  6 units
    c.  7 units
    d.  8 units
37.  You checked your child's blood glucose at 9pm for bed, it was 279.  How much insulin should they get?
    a.  5 units of Lantus & 2 units of Novolog in separate syringes
    b.  5 units of Lantus & 2 units of Novolog mixed in the same syringe
    c.  5 units of Lantus & 3 units of Novolog in separate syringes
    d.  7 units of Lantus

That was the whole test.  My husband, my teenager, and myself all had to pass before we took Sugar Bear home.  Reading over these again I can chuckle at some of the humor and find this to be so second nature on the most part.  So how do you think you did?

Sunday, September 21, 2014


My sister-in-law and a friend I met at a diabetes conference were both recently dealing with DKA.  Both were caused by lack of insulin.  One was because of not hooking her pump back up while dealing with sickness and the other had a bad batch of insulin.  DKA can happen to anyone.  There is a lot of misinformation out there on so many things related diabetes.  I think I'm going to take this week for some education awareness.  My sister-in-law spent an overnight in ICU and a little time in the hospital.  My friend was able to get some treatment at the hospital and work towards regulating back at home.  One of the EMTs that moved my sister-in-law from the health clinic to the hospital said she was diagnosed with Type 1 at 13 and at 18 thought she knew it all.  She ended up in DKA 9 times that year.  One thing I gleaned from my sister-in-law's experience is that DKA won't necessarily look like it did at Sugar Bear's diagnosis.  It's still scary, but I don't have to be afraid.  This was the first time in 13 years for my sister-in-law experiencing this.  It's awful, and Sugar Bear felt bad for his Aunt.  He got it.  I'm still learning.  I'm so grateful for medical breakthroughs that allow DKA to be corrected.  It used to always be a death sentence.

 Diabetic ketoacidosis (DKA) is a life-threatening problem that affects people with diabetes. It occurs when the body cannot use sugar (glucose) as a fuel source because there is no insulin or not enough insulin. Fat is used for fuel instead.
When fat breaks down, waste products called ketones build up in the body.


As fat is broken down, acids called ketones build up in the blood and urine. In high levels, ketones are poisonous. This condition is known as ketoacidosis.
Diabetic ketoacidosis is often the first sign of type 1 diabetes in people who do not yet have other symptoms. It can also occur in someone who has already been diagnosed with type 1 diabetes. Infection, injury, a serious illness, missing doses of insulin shots, or surgery can lead to diabetic ketoacidosis in people with type 1 diabetes.
People with type 2 diabetes can also develop ketoacidosis, but it is less common. It is usually triggered by uncontrolled blood sugar or a severe illness.


Common symptoms can include:
  • Decreased alertness
  • Deep, rapid breathing
  • Dry skin and mouth
  • Flushed face
  • Frequent urination or thirst that lasts for a day or more
  • Fruity-smelling breath
  • Headache
  • Muscle stiffness or aches
  • Nausea and vomiting
  • Stomach pain

Exams and Tests

Ketone testing may be used in type 1 diabetes to screen for early ketoacidosis. The ketones test is usually done using a urine sample or a blood sample.
Ketone testing is usually done:
  • When the blood sugar is higher than 240 mg/dL
  • During an illness such as pneumonia, heart attack, or stroke
  • When nausea or vomiting occur
  • During pregnancy
Other tests for ketoacidosis include:
This disease may also affect the results of the following tests:


The goal of treatment is to correct the high blood sugar level with insulin. Another goal is to replace fluids lost through urination, loss of appetite, and vomiting if you have these symptoms.
If you have diabetes, it is likely your health care provider told you how to spot the warning signs of DKA. If you think you have DKA, test for ketones using urine strips or your glucose meter. If ketones are present, call your health care provider right away. Do not delay. Follow any instructions you are given.
Most of the time, you will need to go to the hospital. There, you will receive insulin, fluids and other treatment for DKA. Then doctors will find and treat the cause of DKA, such as an infection.

Outlook (Prognosis)

If DKA is not treated, it can lead to severe illness or death.

Possible Complications

When to Contact a Medical Professional

DKA is often a medical emergency. Call your health care provider if you notice symptoms of DKA.
Go to the emergency room or call the local emergency number (such as 911) if you or a family member with diabetes have:
  • Decreased consciousness
  • Fruity breath
  • Nausea
  • Trouble breathing
  • Vomiting


If you have diabetes, learn to recognize the signs and symptoms of DKA. Know when to test for ketones, such as when you are sick.
If you use an insulin pump, check often to see that insulin is flowing through the tubing. Make sure the tube is not blocked, kinked or disconnected from the pump.

Thursday, September 11, 2014


Chronic. Acute. Disabled. Disease. Life threatening. Lifetime. Pain.

I'm starting to get it.  I'm starting to understand.  Chronic pain was always something I felt could just be incorporated into your life with little change.  Acute to mean meant something serious.  But I get it.  Dealing with my herniated back has caused me to contemplate how I view these things.  It's helping me to empathize with my husband and son.  Every moment has to be done with awareness.  You have to plan and think about your movements or you will cause excruciating and debilitating pain.  From the simplest things like taking a walk or just getting up in the morning you have to decide to do it.  For my husband that means just getting out of a chair takes work.  For my Sugar Bear that means living each day.  We have to be here, be awake to keep him alive.  We have to use our sleep deprived brains and make them work.  We calculate carbs and hope we don't make mistakes.  A mistake could cost us something precious.  So we second guess and triple guess everything.  We check and check again.  Did we count too many carbs and give him too much insulin?  Too much insulin could result in a low that could cause seizures, brain damage, coma, and death.  Did we not count enough carbs and not give enough insulin?  This could result in highs that could lead to damaging his body, ketones, and DKA.  I question everything.  "Did I just give the evening insulin?  Did I use the right carb to insulin ratio?  Did we count the carbs properly?  Is he sleeping because he's tired or because of a low or high?"  Check to make sure he's breathing each and every morning.  So thankful to have him wake from slumber.  It's exhausting, challenging, scary, awful and at times beautiful.  The alternative I can't even contemplate.  Every shot saves his life.  Every blood sugar test makes it possible for him to have a happy, healthy, long life.  A life worth living.  But every day is a fight.  It's not manageable or controllable.  Everybody is different in how they react to stress, food, medicine.  Sugar Bear could eat the same thing at the same time every single day and have a different blood sugar each and every time.  Sometimes high, sometimes low, sometimes "perfect".  So we fight.  We live.  We are so grateful for insulin that let's us do this, because without it...well, I just can't go there.

We had our three month endo appointment two weeks ago.  I really thought his Ha1c was going to be higher based on the numbers in our logs.  Amazingly it was a tiny bit lower.  We talked about nutrition, exercise, eye appointments, flu shots, cgms, and ketone meters.  I want Sugar Bear to have a CGM even more than a pump but he's not ready.  And it is his disease.  His life.  We did get the blood ketone meter so now he won't have to pee on a stick.  We're getting ready for cold/flu season.  We have to be prepared.

Same day we had the endo appointment Sugar Bear had an ortho appointment.  It went well.  One of the dental assistants made a point of telling me she was donating to JDRF.  A stranger that Sugar Bear has affected.  We have a walk to raise more funds in October.  I hope my back can handle it.  We plan.
So we keep on walking.  We keep on working.  We take each moment step by step.  There is no alternative.  There is no day off.  There is no break.  We do it consciously.