Negative Corrections

I have one thing that I am not pleased with when it comes to the T:slim. I think that it is everybody's complaint.  The T:slim does not do negative corrections or backwards corrections.  If you have no idea what that is I will try to explain it but first I am going to have to explain about carbs and our equation that we use to dose Rose.

We have all heard of carbohydrates before but learning to recognize what foods have carbs and which ones don't are essential for T1D's.  Luckily there are some really cool apps out there that you can search for specific foods.  I can't imagine trying to memorize all of the foods and their carb amount.   We also read a ton of labels.  On all of your food that you buy from the store they list how many carbohydrates there are per serving.  Here is an example of a label and where to find carbs.

http://lowcarbdiets.about.com/od/nutrition/ss/nutritionlabels_5.htm

In this food label there are 15 g of carbohydrates in every 20g serving.  When we were first diagnosed I was just guessing how big a serving size it but you never knew for sure.  So I bought myself a scale and I love it.  I no longer have to count our every carrot or piece of cereal because I just put it on a scale. Here is one that is similar to mine. Two things to consider buying a scale is to make sure you can zero out the amount when adding new food to plate and also comes with ounces and grams.

http://www.sears.com/ozeri-pronto-digital-multifunction-kitchen-and-food-scale/p-00824520000P?prdNo=3&blockNo=3&blockType=G3

Okay so now that you know a little bit more about carbs and how to find them here is Rose's equation that we use to calculate out her insulin dosage. 

First we have to calculate if there is a correction dosage.  

(Blood Glucose- Target Blood Glucose) / Insulin Sensitivity Factor

For Rose her equation looks like this...

(BG-150)/200

Once we have figured out her correction dosage than we need to figure out how much insulin she will need to eat her food. Rose's ration right now is 1 unit of insulin for every 60 carbs.  For example a piece of bread has 15 g of carbohydrates.  Rose would need 0.25 units if she ate that piece of bread. 

Last part of figuring out Rose's insulin dosage is adding up the two above answers to the equations.  This is how we lived for almost four months until we got the pump.  The pump does all of our calculations for us and then it doses her too.  So cool.  

Remember how I said that T-slim doesn't do negative corrections or backwards corrections.  When we are trying to figure out Rose's correction dosage is doesn't account for Rose being lower than her target BG.  For example...  If I tested her blood and she was at 100.  

100-150= -50  

 -50/200= -0.25 

For her food she is having a piece of pizza. One piece of Cheese pizza is 27g.  

27/60= 0.45 units of insulin for pizza

Rose should only need what ever the correction plus the food insulin to eat pizza.  

Which is 0.45 - 0.25= 0.20 units of insulin.  The T-slim would not calculate the negative amount of insulin so the T-slim would say that she still needed 0.45 units for the pizza. 

Sorry that is a ton of numbers but I hope it helps you better understand what we do every time we eat.  For a while I hated eating and I still hate meal times.  Not only do I have to cook and serve dinner but I also have 2-3 minutes of calculating insulin dosages.  The pump has made it a lot easier but we still have to make sure the pump is calculating properly. 

I hope you have a wonderful Thanksgiving.  We have so much to be thankful for and we are so blessed.  

 

Keytones

I have been trying to figure out what is another interesting thing about diabetes.  One of Rose's favorite things to test for is keytones.  I think it is because I get to catch her urine in a cup and then test it. She is always asking me before her "pee is down" if I need to check for keytones.  It is one of my least favorite things to test for. If you would have asked me ten years ago what I would have to do for my kids I would never had said catch their urine and test it for keytones.  Oh the things you do for your kids.

Before Rose was diagnosed with diagnosed with T1D I had no idea what keytones are.  So for those of you who are not familiar with the term keytones here is an explanation.

A typical healthy body uses glucose as fuel for the body. When there is not enough insulin in the body to use the glucose, your body turns to fat to use as energy.  Keytones are acids found in the urine and blood of people whose bodies burns fat for fuel instead of glucose.  When you are first diagnosed with diabetes you keytone level is through the roof because your body has been using fat instead of glucose to function, because you have no insulin.  Remember my analogy about the plate of food being in front of you but having no mouth.  You body will do everything it can to survive so it turns to fat as a fuel.  High levels of keytones in your blood and urine will make you very sick and is known as Diabetic Ketoacidosis (DKA).  DKA is a serious condition that can lead to death or a diabetic coma.

Most diabetics are able to manage their diabetes well enough that there are no traces of keytones in their urine.  If you have two Blood Glucose test that are above 250 or if you are gettting sick, then there will most likely be some traces of keytones in the urine. It is simple to fix though if you catch it early enough.  You increase water intake and also increase the amount of insulin to help get rid of the acid.

Testing for keytones is easy.  You catch the urine then stick a test strip into it.  The test strip changes colors depending on the amount of keytones in the urine. It is a great indicator if we are dosing Rose properly.  Here is a picture of what a test strip looks like and the different levels of keytones that are found in your urine.

http://e.cityweekly.net/cityweekly/2011/06/09/#?article=1291751

An interesting fact about keytones, is that you are either diabetic or losing fat if keytones are in your urine.  I guess it would be a good way to see if you are actually burning fat when you are working out. Or if you are curious if your child is diabetic you can always test for keytones.

On a none diabetic note we went fishing yesterday with my Dad and Rose's cousins.  It was so much fun and I loved letting Rose feel like a normal kid.  She got to eat her first Happy Meal ever and eat snacks whenever her cousins did because of her pump.  We love our t-slim.

Snapshot Sunday

These are old pictures of Prince James but he melts my heart.  Sometimes I wonder if I don't give him enough attention because I stress and worry about Rose all day long. So today this blog post is all about him.

 I hope he knows that I love him and I am so grateful to be his mom.  We have always had a special connection since the day he was born.  James is always trying to get everybody to laugh at him and he is a little monkey.  He climbs everything.  His new favorite place to climb is on top the back of the toilet and hang from the towel rack. His one down fall is that he does not sleep.  I thought Rose was a bad sleeper when she was younger but James diffidently is worse.  We love him even though we never sleep.  Just last night he was getting mad with me because I wouldn't nurse him.  So he got up and went into the other room.  Thirty seconds later, he came back in the room with a flashlight.  He thought he was so clever.  One of my favorite parts about being a mom is watching Rose and James play together.  I love that they get along and he loves to do whatever Rose is doing. We love you James and so glad that you are part of our family.

My first time giving a shot...

I need to start out by saying that I have always been terrified of shots.  When I had to go get my blood drawn for both of pregnancies I had to fight not to have a panic attack.  The whole mental image of a piece of metal going into my skin is just sickening.  So when we were in the hospital and they told us that Rose was going to need shots at least four times a day, it was time to over come my fear.

My husband did the majority of the shots the first day in the hospital.  I didn't want to give a shot and I especially did not want to hurt my child.  As you can imagine Rose acted like any normal child does when they go to the doctor to get immunizations.   Rose screamed, begged, and pleaded with us not to give her a shot.  Now try to imagine giving your child a shot four times a day.  For the first two weeks this is what we heard every time it was time to eat. Rose would beg and plead for us not to give her a shot. Luckily my husband was able to step up and actually do the shots.  I was totally okay with just holding Rose and trying to calm her down.  I had no desire to give shots and if I had my way, I would have gone to work and let my husband stay at home to watch my kids just so I didn't have to give shots.

By the second day in the hospital reality started setting in.  I was going to have to give Rose shots in order for her to live.  If I did not she would die. So I finally got up enough courage to give Rose a shot.  I think I stressed about it for a good four hours before I actually gave her the shot.  My husband held Rose down and I stuck the needle into her arm.  Watching the metal being inserted into my child made me sick to my stomach. I tried to hold back the tears so Rose wouldn't sense how scared I was.  I wanted more than anything to be strong for Rose.  She was dealing with so much and she didn't need to worry about what I was going through.  I pushed in the insulin and quickly took the needle out.  Rose was crying and wanting to be comforted.  I gave her a hug and a kiss to try to comfort her. My emotions caught up with me and I had to get out of that room.  I walked into the hallway, past the nurses station and into the stairwell.  I sobbed.  I did not and still do not want to give shots to my child.  I hate it.  I hate having to hurt her every time that she eats.

Rose's newborn photo.
https://www.facebook.com/FabianaBeatrizPhotography?ref=br_tf

As a mother you want to protect your child from everything that is going to hurt them.  If you could you would take away their sicknesses, their pain, and you would die in order to save their life. No matter how much I did not want to give Rose a shot I also was going to do everything in my power to let her live.  So I made the choice. I was going to have to inflect pain on my child so that she could live. Although she begs and pleads with me even to this day not to get a shot, Rose needs them to live.

It has been so hard to get used to giving your child a shot, but now I am able to set aside my emotions and just do it.  Rose is much better with getting shots, she still tries to talk you out of it, but she also understands that she needs insulin to eat.  We have been very open with her and have tried to explain to her what is going on and why the shots are necessary.  I don't know how much she actually understands but I think that helps her know that we are trying to take care of her as best as we can. We have always told Rose, that we do not like giving her shots and we wish we didn't have to, but she needs her insulin to eat.

The best part about the pump, is not having to give Rose shots every time that she eats. She gets a shot every 3 days instead of five times a day.  Rose and I are really starting to love the pump and now that I have been using it for a week with insulin, I am ready to do some trail and error research to figure out how to dose Rose perfectly with every type of food.

The Highs and Lows

Before Rose was diabetic I had no idea how much diabetes is a number game.  I grew up with a diabetic Mom but I was never really involved with all of the steps of managing her diabetes.  So now that my life revolves around Rose's Blood Glucose number, I've realized diabetes is a number game.

For those of you who don't know what Blood Glucose (BG) is, I will try to explain it to you. Every time a person eats, we consume carbohydrates which are the main source of energy for your body. The carbohydrates are converted into sugar or glucose which allows are bodies to function. When the amount of glucose in our blood rises, our pancreases releases a hormone, insulin, to help the cells use the glucose that is the blood. Type 1 diabetics (T1D) do not produce any insulin. For T1D's, it is kind of like having a plate of food in front of you but no mouth to eat it. Insulin is essential to live.

We test Rose's BG anywhere from 5-10 times a day because if she is high she needs insulin to help her use the glucose in her blood and if she is low she needs more glucose in her blood to function.  High levels of glucose in a person's body for long periods of time start to damage eyes, kidneys, nerve, and blood vessels.  Very Low blood glucose causes comas, seizures, and death.

So here is where the numbers come into play.  Rose is supposed to have a BG anywhere between 80-150.  That is her target range.  Anything greater than 150 we try to lower using insulin and anything lower than 150 we treat with food. 150 is our special number right now.  Very low BG starts at anything lower than 40.  If you can get the person with low BG to eat than you can prevent them from getting any lower.  If they become unconscious or start having a seizure you are to use a glucagon pen.  Glucagon is also a hormone that is produced in the pancrease that rises your BG.  Insulin and Glucagon are the complete opposites. We have two glucagon pens that we have with us at all times in case of emergencies.  They look like this.

http://en.wikipedia.org/wiki/File:Glucagon_emergency_rescue_kit.JPG

I think I know what to do if Rose passes out on me, because she is too low, but it scares me.  This is why we check her every four hours all night long and check her through out the day to help make sure she isn't too low.  Today when she was at 49 I couldn't believe it.  It made my heart race and I was scared.  I was grateful to have some food on hand and to prepared for such a number.  

Diabetes is a number game.  My whole life revolves around Rose's BG number. Sometimes I want to climb into my bed and hide from the stress of making sure Rose stays with in her range.  But the reality is that I can't ignore it. My child needs me to take care of her in order for her to live. 

Our Diagnosis

It was Tuesday, August 6th, 2013 when we found out that Rose was diabetic. Our diagnosis story really begins on Saturday, August 3rd.  We went to the local water park to play with cousins and enjoy the warm weather.  I didn't think much of it at the time but looking back I should have recognized some of the symptoms Rose kept telling me. All day at the water park Rose told me she was thirsty and had to go to the bathroom. I just figured that it had something to do with being in the sun and swimming for a long period of time.  It was a pretty normal day.  That night we had family pictures.  Rose was pretty good, except for a couple tantrums. But she had always thrown tantrums so I figured it was normal plus she was exhausted from swimming earlier that day. I first became suspicious of something being wrong with Rose on Saturday night, she wet the bed 4 times.  Rose had been potty trained since she was twenty months and yes she wet the bed every once in a while but 4 times in one night! She had never done that before.  We went to church on Sunday morning and took Princess to nursery.  During her two hour stay in nursery they had to come get us twice because she said she had to go to the bathroom but couldn't go and she kept telling us that she was thirsty ALL of the time .  We would give her something to drink and it would never satisfy her.  Sunday night, we had dinner with my family.  I remember discussing with my family what could be wrong and if I should be concerned with Rose's behavior.  I remember specifically telling my family that I was worried that she might be diabetic.  (I know now it was my Heavenly Father trying to prepare me for this trial.)  We went home, Emma wet the bed 2 times that night. We had a full day planned with hanging out with my sister who had flown in from out of town.  Rose did the same thing she had done the two previous days, complained of always being thirsty and having a hard time peeing.  Monday night, Rose didn't wet the bed but on Tuesday morning she said it hurt to pee.  I called the doctor and set up an appointment with our pediatrician at 10:00 AM.

I took the Prince and Princess to the pediatrician.  When we arrived they asked if I could catch some of Rose's urine.  Rose was so great and went to the bathroom right away.  As we waited for the nurse to come back and tell us if Rose tested positive for a Urinary Tract infection, I once again felt like Rose might have something more serious than just an infection.  The on call doctor came in and said that the urine test came back negative for an infection but there was sugar in the urine.  She then asked if she could test Rose's Blood Glucose. My Mother is a Type 2 diabetic so I knew the process.  I don't know how I did it, now looking back, but some how I was able to hold Princess Rose still enough to test her blood.  She was at 535. (If you don't know, the average blood glucose is usually between 80 to 120.)  I remember the look on the doctor's face as she told me that Rose was a type 1 diabetic and that we needed to go to the Downtown Hospital as soon as possible.  She asked what she could do to help me and I told her I just needed to call my husband and my mom.  The doctor stepped out of the exam room and I called my husband and my mom.  I remember my kids being so quiet and letting me make the phone calls that I needed to make.  (Which is so not like them.)  I know that there were angels round about me helping me with my kids and helping me deal with this devastating news.

We rushed down to the hospital and I met my husband in the parking garage.  We checked into the Children's Hospital and we began the long process of getting an IV into Rose.  Luckily my parents had arrived to take Prince James for a walk, so we could put all of our attention on Rose.  Even now almost four months later, I struggle talking about this part.  It was horrible.  I can't even begin to tell you how hard it was to try and get Rose to let us put an IV in her arm.  We tried three times with no luck and then finally after wrapping her up like a burrito, in a blanket, we were finally able to hold her still enough.  It took us two hours to do it.  Every person in the room was exhausted of trying to hold Rose down.  She is one very strong girl and man does she have a temper.  Rose had no idea why we were trying to hurt her and she kept begging us not to hurt her.  Words can never express how horrible I felt.  I wanted to rescue her from the pain but I couldn't.  I was so torn.  I tried really hard to hold it together when I was in the room with her but I remember loosing it several times.  I would excuse myself and cry in the hallway.  I didn't know how I was going to care for my baby and then the reality hit me, Rose was never going to be able to go a day with out being poked.  One of my biggest fears has always been needles and here I was forcing my child to overcome her fear of needles.  It was heart breaking for me.

One of the first emotions that I felt, was guilt.  I felt responsible for her being diagnosed with diabetes.  I felt responsible because I had made her body. Maybe if I had done something different during my pregnancy  I would have been able to prevent her diabetes.  It was so hard not to blame myself for her disease, but the reality is I couldn't have done anything to change her diagnosis.  This is her trail that she will always have to bear and it is all part of Heavenly Father's plan for us.  I had to trust that and let go of the guilt I felt.

When we finally got the IV in Rose, we settled into the hospital.  We would be there for the next several days learning how take care of Rose.  The hospital stay was exhausting.  The people at the hospital were great and we had so many family and friends come visit Rose.  It was wonderful to be surrounded by such wonderful people.  But it was also very overwhelming.  All of the new information, constantly checking Rose's BG, giving her insulin shots, counting carbs, and trying to keep it all together so Rose would not get scared. It was a whirlwind of a week and we were so glad to make it home.

Snap Shot Saturday

Today we spent the whole day as a family and it was great. We went shopping this morning and stopped by Rose's great grandma's house to help her with her phone. Rose is named after her and I love when we get to hang out with her. She means so much to my husband and we are so grateful for her. Then Princess Rose went on a date with her Dad. It was nothing big but they headed out to go get Daddy's old truck ready to sell. I got to spend some one on one time with Prince James. It was such a relief to take a break from constantly worrying about diabetic things and just enjoy James's personality. He is so quiet compared to Rose. When she isn't around you hardly know he is there. I love them both so much. 

We are really starting to love the pump. We keep asking Rose what she thinks and she tells us all the time that she loves it too. It really doors make life a lot easier on all of us. I am so grateful that we decided to get the pump.