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Saturday, February 4, 2012

Insulin Drama

Sooo...Sugar is Toto!

I know!  Such a big part for her first school play.  We're very proud!  Drama meets every Wednesday after school.  For the past 2 weeks, her specials rotation has meant that she has PE on Wednesdays as well.  PE falls at the very end of her school day.  Her PE class ends at 2:55, and school gets out at 3.

She eats lunch at 12:30.

The school nurse leaves campus at 3:30.

Drama doesn't end until 4.


She needs to check her BG before then it's been just shy of 2 hours since lunch. Experience has taught us that she's likely to go low, so to compensate we give her a snack and cover it with insulin, minus 10 carbs, while taking the current BG/IOB (active insulin on board) into consideration before administering the final dose.  We've learned through trial and error that 10 uncovered carbs helps prevent lows during PE class, AND highs that strike from feeding carbs without insulin.

On any day, except Wednesday, I'd be there at the end of the day to follow-up after PE.

BUT...on Wednesdays she has drama.

So there lies the dilemma.

She's just had a snack and a carb bolus an hour before the end of the school day, followed by intense physical activity for 45 minutes, and the school nurse is preparing to leave campus.

She needs a sugar check, right?  And probably a snack to cushion her from a potentially drastic drop in blood sugar.  But how much insulin should she get?

Remember, there's still plenty of active insulin circulating from the pre-PE snack an hour beforehand (that may or may not have included a correction), and I'm not there to use the adult level critical thinking skills that keep her alive from one bolus to the next (okay, maybe that's a tad dramatic -- but this is a post about drama, after all!).  The school nurse will be leaving soon, and anything can happen with the peaking-insulin-post-activity-drama-adrenaline combo.

She's on her own to choose a snack, consider the physical activity she just participated in (which could vary based on weather), and administer insulin while compensating for whatever BG pops up on the meter.

It's a tough call for an adult to make, but it becomes more precarious when a child needs to figure it out.

She's 8 years old and gaining increased independence every day.  I'm administering boluses and prompting blood sugar checks less often, while she's stepping up and taking responsibility more often.  Learning to step back has been a struggle for me, but I know it's necessary for her growth and well being.

Fortunately, her Animas pump doesn't make this as much of a dramatic moment as it may seem.  The IOB feature will deduct insulin she doesn't need from the dose while compensating for her current BG. She's responsible for pushing the buttons, but we rely on the pump's algorithms for keeping her safe.

Because, let's face it, Toto is a superstar who needs her own personal security detail!

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  1. Toto is definitely the cutest and most precious superstar I have seen and her security detail is one of the best!

  2. WOW! Drama for sure! I'm shaking my head trying to figure it all out. I know with your mad skilz and her budding mad skilz, it will work out!
    Toto is too stinkin cute!! :)

  3. WoHoooooooooo for DRAMA! Love the Toto costume and you know... am a huge fan of Animas and the IOB feature. Joe too. More and more independence. He even knows when to be sporting a combo. XO

  4. I'm so proud of you both!!!! You are right - things like this are tough to figure out as an adult. I can't even imagine trying to get it right as an 8 year old. Good for her for doing it, good for her pump for helping, and good for you for letting her grow. And I bet she's the best Toto in history!! :)

  5. All of that activity and drama was making my head spin just reading about it LOL! I'm sure you girls will rock it though! and that has got to be the cutest Toto on the planet :o)

  6. Well, I guess I'm showing my age. But Toto was a screamin' classic rock band in the 80's and I thought there'd be a pic of Sugar with an electric guitar...............
    She is adorable in the doggie costume.

  7. Good for you for be able to "let go" a little, and good for her for learning how to take care of herself. Have to say though, it's situations like this where a cell phone comes in handy, (it was you posting about the cell phone conversation on facebook wasn't it?) Anyways, Kortnie is 7 and her sister (the non-d) is 9. When we upgraded our phones, we activated one of our old ones with a new number for the kids to use. Kortnie uses it for stuff like this, she'll take it to birthday parties, dance class, riding her bike, and field trips. I always go on the field trip, but usually have to take my son along as well, so she'll take the cell phone on the bus and I usually follow in my car with my son. Sometimes we take trips to Phoenix with other family members and she likes to ride in Grandma's car or the car with her cousin, she takes the phone and all her stuff and calls me if she needs me. A lot of the time the 2 girls are together, so they share the phone, sometimes when the older non-D girl goes somewhere by herself she takes the phone (not that she needs it, but she wants to have equal ownership of the phone, I told them they were sharing it, but mostly got it for Kortnie). They don't take it to school except on the special days, like track and field day or field trip day.


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While I'm happy to share our experiences with what works, and what doesn't work, for the management of Type 1 Diabetes and Celiac Disease in our house, please do not mistake anything you read here for medical advice. Decisions regarding your/your child's health care should be made only with the assistance of your medical care team. Use any information from this blog at your own risk.