Tuesday, October 12, 2010

The Post I'm Embarrassed to Publish

Grace has finally come out of her honeymoon period (the time after diagnosis when her pancreas still intermittently works. This time frame can last 6 months to a couple of years.) Now her body relys only on the insulin WE provide it to function.

As I see it, the honeymoon phase has some pros and some cons. The pros include needing less insulin to get through the day (her pancreas still provides the rest), being able to "guestimate" carbs more, since her body tended to pick up the slack where I guessed wrong, and periods of slightly more stable numbers (or so it seemed to me) due to her body's underlying output of insulin to smooth out the edges.

And then there's the one that I'm embarrassed to admit. I had the feeling that since Grace was on such a low daily dose of insulin, somehow that meant that she didn't "have it that bad" or at least, "not as bad as others." Believe me when I tell you, I KNOW how ridiculous that sounds. And my brain always knew how stupid it was to think that. But I think it was my brain's way of slowly accepting her diagnosis.

The cons of honeymooning mostly have to do with wack-a-doo numbers resulting from an unexpected surge of pancreas-produced insulin. Picture me bolusing Grace for dinner, and then her body kicking out insulin as well.

So here we are, a year and a half after diagnosis, fully out of her honeymoon. Grace is 100% at the mercy of the insulin her pump provides. I say that because I now know there's pros and cons to being OUT of her honeymoon. Take today, for example. Grace was high at snack (217). She was bolused to correct her high as well as to cover the food she ate. Then she went to PE, where they've been practicing for the mile run by running and/or walking around the track. Now, get that they've been practicing for the mile run since the beginning of the year, and I've never seen a correlation to low blood sugars after. Today, however, when she felt low after PE and went to the nurse she was 29.


Recheck - 32. The worst part is that she says she felt low, but not THAT low. Three glucose tabs and a healthy rebound output of glucose from her liver brought her up to 229 fifteen minutes later. She's been fine the rest of the day, but I realized that she never went low like this when she was honeymooning. Her body's natural output of insulin would shut off in situations like this preventing her from going too low. Now there's nothing more to shut off. If she's low and going lower, her pump still pumps out insulin it thinks she needs, thus taking her even lower.

To actually type the words, "it never occurred to me to lower her basal for a mile run," is humiliating, to say the least. If I was with her and saw that she was about to run/walk a mile I would've definitely lowered her basal. BUT THIS HAS NEVER HAPPENED AFTER P.E. CLASS! After she ran the mile last year she went right in for a blood sugar check and was fine. That's why I blame coming out of her honeymoon.

In a year and a half, I've never had to lower her basal for PE class. I guess I need to revisit that. Do you lower your child's basal for PE? By how much? How do I go about instructing the school nurse? Should I just cut back on how much she's bolused for snack?

Can you help out an embarrassed D-mama?


  1. Don't be embarrassed Pam -
    Diabetes is tricky, especially when one exits the honeymoon stage.
    Bolusing and temp basal rates require lots of trial and error. When I swim, I don't bolus for my breakfast and I cut back my basal rate by 70 percent. When I walk, I cut my basal rate in 1/2.
    The fact that your aware that things have changed is half the battle!
    Hang in there girl!!
    Kelly K

  2. We would just have Justin eat a snack right before. We do not have PE everyday, so I don't know how I would lower the basal just for that time. Maybe some of the other mamas have some better insight :)

  3. Hi Pam...we have been having some PE issues this year. Joe has PE at 8:40 in the morning. So I had been having the nurse check Joe at 8:35 and he was going to get 15grams of carbs if he is 80-140. Even if he goes into PE at a 330...he has been going low. So what I started doing is decreasing his basal one hour before PE by 30%...and the basal decrease goes for 2 hours. I think I need to up the percentage of the decrease. I did think about cutting down on his breakfast insulin, but I don't like that he is already in the 300s pre-PE...hence the basal decrease attempt. It is such a crap-shoot sweetie. Hang in there.

  4. Hey Pam - Welcome to the 'Out of the Honeymoon' club! I know, I know, you didn't want to join (but I am sure glad you are here with me!) No need to be embarrassed or anything like that sister - we have all been there at some point on this journey.

    Funny thing PE class. My Grace has it right after lunch, so she does her check after lunch. Right now, we lower her basal by 40% for 1 hour after lunch. It seems to bring her in good range so far. Then again, they are inside for PE class now that it's colder outside. Once they hit the Spring, I usually hit the basal by -50% for an hour.

    It always keeps us on our toes, doesn't it?
    Hugs and love to our counterparts :0)

  5. We don't lower basals for PE...but that can change quickly...as can everything with diabetes. Constant changes are part of the mind numbing battle. That is one of the cruelest parts of diabetes...trial and error. Learning from what we preceive to be our mistakes...when really it is diabetes just being the monster it is. We learn from what it throws at us. You learned something about the monster today...and your daughter is safe. sure she didn't feel THAT low...but she felt low...and that is huge!

  6. Love ya, girl :)

    Sugar has PE twice a week. Once before lunch and once after lunch.

    We leave out 10 carbs.

    So I'll give her breakfast on AM PE days and leave 10 carbs off what I enter into the pump -- the school nurse does the same thing for lunch on PM PE days.

    It works really well for us :)

    The only thing that keep popping into my brain is that Sugar was only dropping to the 60's...if we were having those 20's and 30's, I may be inclined to make it a 20 carb cushion.

    Keep up the good work!

  7. So sorry about the 29! That stinks.
    We just carb Emma up before she goes to PE...of course she is hardly running a mile! We have just recently left the honeymoon period too and it is like learning everything all over again. Sheesh.

  8. We've been lucky this year. We haven't had to make any adjustments for PE, but PE is also first thing in the morning this year. In years past, when PE has been after lunch, the nurse would look at his pre-lunch BG, and then reduce his insulin, if needed, taking PE into account.

    BTW, Jack went from a 31 to 286 in 15 minutes today. Then 30 minutes later, he was back down to 90. This is a CRAZY disease!

  9. Just wanted to say I feel you. It changes all the time, doesn't it? We don't have PE at school yet, but for his tae kwon do class (which is 30 minutes of intense physical activity we do a 2 hour 50% basal decrease starting a half hour before the activity. For his old soccer team, we couldn't decrease insulin during practice because his coach was so intense that Liam went high from adrenaline, then dropped later. New soccer team, similar to the tae kwon do routine. On extra active days at school, we just have them give him about 10 extra carbs before he goes out.
    We're intermittently in and out of honeymoon land- which is fun- and I as much of a pain as it can be, I also dread the days where I will be thankful for what his body is doing now. :)