Make the Call

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Make the Call

This is the first thing I saw as I opened my eyes on June 18, 1996, the 5th Birthday of my daughter Cayla. A toilet.

As I open my eyes and look around I realize I am sitting on the floor of the bathroom. I am freezing cold. I am covered in something sticky. It is in my hair, on my face. It is all over me. My lips are numb. My left thigh aches.  I note I have on the same clothes I wore to bed.  An oversized t-shirt with the decals that celebrated the Toronto Blue Jays World Series wins in 1992 and 1993.  The t-shirt is so soaked in cold sweat it could’ve been wrung out. I am shaking profusely.

I then look over to my left and see my then husband. He is sitting on the edge of the tub. I mumble to him “I’m low.”. I see that he is holding my glucose meter.  As he shows me the face of it, evident he has just tested my sugar I notice his hand is shaking. He says “No, you’re high.” and shows me the number on the meter. I feebly argue I am definitely low despite the number on the blood glucose meter. I then say my leg is sore and ask if he gave me a needle.

He then explains to me the events that occurred that lead to this point.   As he is sound asleep in bed he feels my arm fall across his chest in bed. As he grabs my arm to remove it from his chest, he realizes that it is very cold and clammy. So cold and clammy he wonders if I am alive. After placing my arm back at my side, he nudges me and ask if I am okay. According to him the only sound out of my mouth is a moan. He continues to tell me that he then picks me up out of the bed and carries me to the kitchen where he attempts to feed me honey, as he tries to tuck the honey into the corner of my cheek to allow it slowly drain into the back of my throat, down into my stomach where it will begin to raise my sugar, I fight.

According to those who have cared for me during a severe low, I am not a nice person.  Despite my small stature I am a fighter & don’t like to cooperate.  I have been known to be holding my son Kurtis when he was a baby, refusing to give him up, insisting I need to protect him.  When I injected my insulin using vial and syringe I made a habit of leaving a new syringe and vials of insulin on the kitchen table so I didn’t forget to take my insulin.  After being carried from the bedroom, unresponsive and seated at the kitchen table, while my caregiver gets the honey out of the cupboard, I have been known to unconsciously draw up my insulin from the vials into a syringe & insist I MUST give me my insulin.  With adrenalin kicking my mind into fight mode, I have been known to hold the syringe full of insulin tightly in the air, making it challenging for the person trying to save me from my low to get close enough to treat it.  I have been known to place both feet on either side of the outside of car door to prevent my caregiver from getting me in the car to take me to the hospital.  Yes, I am one of THOSE in a severe low.

He continues to attempt to place the honey in my mouth.   According to the story I hear the # on the BG meter reads high, well above target.  As a result he re-adjusts his plan and determines that when he found me in bed I was not low but high. He injects 10 units of Humulin® R (regular) insulin in my left thigh. I don’t remember any of it.  It is 5am when he found me cold and clammy in bed, it is 10am when I wake up to see the toilet.

After I come to my senses in front of the toilet, he helps me clean up and leads me to the couch. I feel so guilty. Not because I had the low…it was considered inevitable with that type of insulin and I always tried to convince myself it wasn’t my fault. Back then the insulin I took caused me many severe lows.

I feel guilty because it is Cayla’s 5th birthday and birthdays are important. My Mom always made birthdays a very special day and I made a point of carrying that tradition on for my children.

I felt guilty because I am not able to get up and make Cayla’s morning as special as I typically did. I am not able to smile, hug her and wish her a Happy Birthday. I felt guilty because I can’t make her Birthday breakfast.

Instead, she is witness to her Father trying to bring her Mother out of severe low.

I feel guilty because I have to lay on the couch testing my sugars every few minutes to make sure I don’t bottom out from the 10 units of Humulin® R I have active in me.  I feel guilty because I am a bystander as I watch her Dad present her with her new bicycle. I feel guilty that on that day, her special day I feel like a failure as a person, a parent, as a person living with diabetes.

The learning I received from this morning is that she was more worried about me then how the morning of her 5th Birthday unfolded. She smiled as he presents her with her new bike. Then she says to her Dad, ” Daddy, I think you should’ve called for an ambulance.”

“God grant me the serenity to accept the things I cannot change; courage to change the things I can; and wisdom to know the difference….” –Reinhold Niebuhr

An Unexpected Anniversary

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An Unexpected Anniversary

October 30, 2000 I am in the kitchen baking up Halloween treats for the kids Halloween parties at school. I loved these moments. The excitement, the energy, the creativity. Halloween was so much fun.

But…that day transitioned into a life I never thought I would ever entertain on October 31, 2000. That was the day I learned I would become the parent of a child with Type 1 diabetes.

On the morning of October 31st I got the kids ready for school. I packed the plastic containers with Halloween baked goods & saw them on the bus.

That afternoon as the kids unloaded off the bus & I walked them in the door asking how their day went & how their Halloween parties went, Kurtis say’s the words a parent does not want to hear.

“I didn’t eat any treats today because I felt sick to my tummy & drank & peed all day.”

I felt the energy drain out of my body. I didn’t even have to test him. I knew.

I asked Kurtis if Mommy could poke his finger like Mommy does to test her sugar. He flat out refused. I was on my own so did not have the help of another adult to convince him otherwise. Luckily I happen to still have Keto-Diastix in the bathroom. After I dipped & confirmed what I already knew with 4+ sugar & negative ketones, I placed the call to my GP’s office. He reassured me that based on the fact he had no ketones, take him out for Halloween as usual but don’t allow him to eat any treats loaded with sugar & bring him in first thing in the morning. At that point we would begin the transition to insulin with education to be a parent of a child with Type 1 & subsequently living with it.

Initially, the next 2 nights were the hardest. Halloween involved me trying to portray it was a normal night out with the kids trick or treating. With the exception that my 7 year old baby had just learned he had diabetes like his Mom. He would have to take needles & poke his fingers & have low blood sugars that didn’t look nice. As we walked up the road, from house to house, Kurtis would throw himself on the side of the road belly first & wail “I don’t want diabetes” or “I hate diabetes.”. I would leave him briefly then say as I tried not to cry “Okay Buddy, l know it sucks. Let’s go to the next house & trick or treat.” I honestly didn’t know how else to be. I knew he had to grieve even though it was about something he didn’t quite understand in it’s entirety but knew starting tomorrow he would begin to learn the essence of what living with diabetes was about. He only understood the external ‘bad’ things with diabetes….severe lows, needles & finger pokes. He didn’t yet understand the other side….how he’d feel being low, high, going to the Dr’s the next day to have blood drawn or the complexity of counting carbs, the demand it would have on his body & mind 24-7-365 & the ridicule he would receive at school for years to come.

The next day was emotionally distressing for both of us. I was the only parent present. His father refused to come home from out of town to support this critical event or his family.

While Cayla went to school, Kurtis & I made our way to the GP’s office. After a lot of coercion we finally tested Kurtis’ sugar by finger poke to determine his fasting sugar was 13.5 mmol/L. I blamed myself. I felt guilty. What have I done to my child?

The GP called the Paediatrician’s office & the hospital to arrange an appointment at the Adult Diabetes Clinic as there was no Paediatric clinic at that time.

We knew the Paediatrician from 6 years prior when Kurtis had an anaphylactic reaction to Benadryl & severely ill with chicken pox in which he almost died at the age of 1. We chatted briefly & said to me…”Mom, you have Type 1 & you’re a nurse, you know what to do. I’d rather not put him in the hospital so here’s the prescription for the insulin.” He gave me the dose to give him & sent me off to the hospital to learn how to carb count.

Once at the hospital I sat with the dietician as she taught me how to carb count. The entire visit Kurtis had marker in hand. Standing in front of a flip chart he wrote time & time again in big 7 year old letters “I HATE DIABETES” “I HATE DIABETES” “I HATE DIABETES”. It hurt so much to watch but I knew it was good for him to get it out. Me? I was on robot mode. Survival. Take it in. Learn it. Function. Sacrifice emotion for taking good care of my baby. Helping him through this time so that he accepted & transitioned into such a terrible diagnosis.

Once home, I explained to Cayla what had happened during that day. She was 9 & a mature 9. She grasped it fairly easily & knew she had to step back & let me care for Kurtis for a little while. Closing into supper time I explained to Kurtis that just like Mommy he will test his blood & take a needle. That’s where it didn’t go so well. Testing his sugar was a bit of challenge but doable. He tested at 32 mmol/L. I explained to him that he really needed his insulin to bring his sugar down as I didn’t want to have to take him to the hospital & have someone else do it. He didn’t care. He just didn’t want the needle.

After about an hour of trying to convince him, going into another room & having a little cry on my own, I called my Mom. Knowing she had been through worse then me with my diagnosis, I asked for her help. When Mom arrived my head was spinning, Kurtis was crying & Cayla was trying to keep the calm in a whirlwind of frenzy. I was also angry because his father wasn’t present in a time we all needed him.

In my mind I can still see Kurtis sitting on the kitchen chair on an angle from the table explaining to me in tears how he doesn’t want the needle & his rationale as to why he doesn’t need it. His eyes swollen with tears pleaded to me & it broke my heart. Thankfully my Mom had already been through the heartache of my diagnosis at age 5. She had raised a child with Type 1.

In her calm, she finally convinced Kurtis to let me inject in his arm.

After I got the kids settled to bed, I cried & cried. I felt it was my fault. I caused this.

How did I move forward? My Mom asked me a question that changed my attitude which helped me transition to a Mom accepting she has a child with Type 1 diabetes. “Would you have had him if you knew he would get Type 1?”

No regrets. It sucks but attitude & the choice to transition to a new life is essential to living life with Diabetes Beyond Borders. This year is another Diabeteversary. October 31, 2013 Kurtis has lived with Type 1 for 13 years. The transition continues.

Trick or Treat

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Trick or Treat

October 31st is a significant day for me. I have 3 major memories that I associate with this day.

1. Going out for Hallowe’en as a child living with Type 1 diabetes.

2. October 31, 2000 is the day I dipped my 7 year old son Kurtis’ urine to discover he had 4+ sugar and thankfully no ketones but knew he had developed Type 1 diabetes. I dipped his urine as he refused to let me test his sugar with a glucose meter. I had poked his fingers 2 years earlier and knew this day would come.

3. I became a parent of a child with Type 1 diabetes trying to figure out how to let him enjoy going out for Hallowe’en without allowing his blood sugars to go askew.

This Blog is 1 of 3 parts sharing my experiences with October 31st.

Part 1:

When I was a child there were no pumps, rapid acting insulin or carb counting. My Mom did not have the technology at her finger tips to count carbs, push a button &/or inject & eat the treats. For the first few years, my Mom & Dad would take me out for Hallowe’en. They would use the bag of treats for when I had low blood sugars. I don’t recall having them as a random treat.

I don’t recall how old I was but I was under 10 when there came a time my parents figured I would be old enough to keep the bag of Hallowe’en candy in my closet. They told me I could keep it in the closet in my bedroom on condition that I tell them when I felt “funny” so I could dip my urine…yes…dip my urine!! to test to see if I was negative (a possible low). Then I could ‘treat’ with my treats.

I recall trying to have self control but what child under 10 can keep a bag of candy in their closet & not eat it at will? I understand why my parents did what they did, they wanted to try and incorporate some normalcy for me. They felt by doing this it would help me feel included in choice.

What happened? Each day when everyone was busy I would sneak candy. How did I get caught? My Dad was an avid runner. He always chewed gum when he ran. One day he went to go out for a run and realized he was out of gum. He came to me and asked to take some gum from my Hallowe’en bag. I still remember the panic. I felt horrified. The bag was full of wrappers but nothing else.

Little did I know that my Mom had been perplexed for weeks wondering why my urine was dipping positive for high sugar. After trying to avoid my Dad from going into my closet to get my bag of stash that no longer existed I knew the jinx was up.

I stood there with a full body panic as Dad looked into my bag. Dad was pretty cool. I do believe in that moment in time he knew that him & Mom shouldn’t have allowed this to happen. It was explained to me the implications of what happened to my sugars as a result of my choices. Mom was relieved because now she knew why!! Two very important lessons I learned and interestingly will never forget.

What happened with subsequent Hallowe’ens? It was actually pretty cool! Mom, Dad & I with my little sister & brother would go through our stash as most do. When we did, Mom, Dad & I would negotiate the price of my stash. It was a game. With that money I was allowed to go shopping for my own treats. Off to the local convenience store I would with my $1-$2 and go buy whatever sugar free treats that were offered.

I don’t feel like I missed out. Not once.

Stay tuned for Part 2.

Cravings

Want tips & tricks on eating well & losing weight? Here is Eden’s next Blog about her Journey. Eden is a busy woman!! She lives with Type 1, at the end of her years in University, about to graduate in May and working hard to lose weight & exercise so she is looking good for her height for graduation.

Help me support Eden in her goals as she moves closer to her goals!! Cheers, Tracy

“Hey Everyone!
Sorry my blogs have been so spaced out! Last week of classes so my blogs will be every other day lol Lots going on! So I thought I would share some of my favorite snacks that I tend to have during the evening. Sometimes in the evening is when I feel like eating the contents of my fridge ha ha! Before I started caring about my weight, I would typically not think twice about eating chips, cookies, 2 granola bars (sometimes more) and god knows what else! So it is hard to not want to eat at night, and I know if I don’t I will be hungry and probably have low blood sugars. So these are some of the things I now LOVE
1. One thing I always have is a drink of water, and a HUGE chai tea with one Truvia (or 2 splenda) and my almond milk. Almond milk takes a month or so to really get used to in beverages, but there is NO SUGAR and VERY LOW FAT! I LOVE IT!
2. Another thing I love having is almonds. I usually buy Blue Diamond Lime and Chili almonds, these are salted, but I only allow myself 11 at night if I choose this. If I choose this, I usually have 1 cup (usually 6) strawberries or a small apple with cinnamon baked for 1 minute in the microwave.
3. My Cheat Night Snacks: Ok so everyone has these, and if you were to tell me I would never have another chip or cookie again, I would die! So I figured out different ways to have things I love, but that are healthier for me. So tonight (for example) I had Special K cracker chips (they have sour cream and BBQ flavors) 18 cracker/chips are 80 calories, 1.5 grams of fat and 14 carbs! Compared to regular chips which are ten times the amount of fat and calories!
For cookies, I make my own which take 20 minutes MAX! I usually put in a bowl 1 cup of oatmeal, ½ cup of egg whites, 1 or 2 splenda, and I use half a scoop of chocolate protein powder (I think cocoa would be fine) I mix it all up and bake them in the oven for 10 minutes at 400 (depending on your oven, keep an eye on them!) I also like adding some natural peanut butter on top for some extra flavor. If you mix it up, and it seems dry add some more egg whites and some water 
Hopefully you like some of my ideas! I always have a chai tea because of its health benefits and it makes you feel full ”

The Latest & Greatest

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The Latest & Greatest

Up front I will post a disclaimer. I worked for Novo Nordisk in Canada for 4 1/2 years. I loved working for the company. I know the clinical studies they provided inside out and backwards. In researching this article I have done my best to be impartial to the information I offer. The pic is a result of the fact Kurtis & I use Novo Nordisk products. I have no other product to showcase in my portfolio. I am presenting this blog as a health care professional & peep & Mom of a peep living with diabetes, not as a sales person.

Here is the ‘low down’ in a nutshell based on current clinical evidence AND practical information for intermediate & long acting insulin…

NPH (Novolin NPH, Humulin N): first created in 1950 by Novo Nordisk – NPH is an  intermediate acting insulin. The onset is 1-2 hours, peak (meaning the insulin is at its highest potency) is in 4-12 hour & it lasts 18 − 24 hours. Upon injection it can cover about 1/2 a day or night. It is a highly variable insulin, it can add to the challenges of achieving goals of long-term metabolic control. To equalize the distribution of crystals within the solution of NPH , it needs to be rotated an excessive number of time. This in itself does not guarantee accurate distribution.

Glargine (Lantus): It is a long acting insulin. I can not find when it was first created or by who, so I won’t show what I know from that perspective. It’s onset is 1 − 1 1/2 hours. On product monograph it claims to have ‘no peak’. Duration of action is 18 − 24 hours. Once injected it cover about 1 full day, 24 hours. It is an acidic solution so upon injection there may be burning & stinging. There are studies being conducted with regards to concerns of carcinogenicity. Results will not be published for a few more years.

Detemir (Levemir): It is a long acting insulin. Unlike any other insulin which is bound to fat, it binds to albumin. When bound to albumin, it is inactive. It is unclear when it was created. At any given time 98% of Levemir is considered inactive because it is bound to albumin providing more predictability. It’s onset is 1 − 2 hours. It’s peak is 6 − 8 hours. Duration of action is up to 24 hours.depending on dose. It is shown that smaller amounts injected offer smaller duration of action. Many people living with T1 need 2 injections per day.

If you look up the impact of NPH vs. long-term analogue it may seem that is a better choice. As a sales rep & practitioner, I have seen this. Clinically, it doesn’t the peeps that do the studies aren’t ready to say so yet.

So regardless of what insulin you are on, here are some tips & tricks to help make the insulin you are taking work better:

1. Label each insulin bottle upon opening.
2. Discard that insulin, whether it is finished or not, 28 days after first date of taking out of the fridge.
3. Keep insulin at room temperature. If it freezes or gets too warm (>28C) THROW IT OUT!!
4. Know your insulin.
5. Know your body.
6. Know how to inject properly. (any needle tip more than 8mm should be changed under your diabetes team watch!!)
7. Don’t switch brands without consulting with your diabetes team.
8. Do not mix Lantus or Levemir with any other insulin!
9. Levemir & Lantus are CLEAR!! Read the label before injecting!!
10. Keep to the same site to rotate your sites. HUH?!? you say….I tell my patients…Long acting legs, short acting stomach. BUT, rotate. It prevents lipohypertrophy (fat deposits) but guarantees more predictability with insulin release.
11. Higher doses of insulin reduce the blood sugar levels more than lower doses.
12. If you have exercised be conscience of where you have injected or are going to inject. Areas that have been exercised & then injected with insulin offer more unpredictability.
13. Do not apply heat (such as bath, shower, heat pack or massage) to the area injected. Heat speeds the insulin along.
14. Keep hydrated. Insulin is not absorbed as readily when there is not as much fluid available because blood isn’t flowing as easily as it should.

I also urge you to Google the brands. Ask your health care team. Read, read, read. That’s how I started on Humalog!!

Insulin is a complicated topic. It’s variables are abounding. But with common sense, getting to know you or your child well & being informed to the choices available as well as asking for the change that may be needed, this enables you & your loved one to live with Diabetes Beyond Borders.

For most diagno…

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For most diagnoses all that is needed is an ounce of knowledge, an ounce of intelligence, and a pound of thoroughness. – Anonymous

In January, for the second time in two months I arrive in the Emergency Department.  

I have to be in pretty rough shape to go there.  I can count on one hand how often I have gone for myself.  Having worked in the ER, I have seen people’s definition of what an emergency is.   I don’t want to be one of those people.  But, here I am doubled over in pain again.  Just before heading out the door, I stand with my hands shaking, heart pounding, crying…Googling my symptoms one more time, trying to find a diagnosis that I can fix so I don’t have to go.  Then I think to myself…what if I am dying of something and they can treat it?  That would be really stupid!

So off I go.  The Triage Nurse asks what’s happening.  I tell her.  She takes my history.  Takes my blood pressure.  WHOA!!  I guess I am in pain….155/100.  Ok, I feel a little more justified in being there.  They take me right in.  Ok, I’m feeling even more justified.  

The ER Doctor comes into assess me and has already looked up my health history from the past 10 years! That’s a first!!  I describe to him what I have and am presently experiencing.  I tell him my thoughts about it.  I tell him the tests I have had.  He urgently orders a shot of pain medication in my hip.  The nurse comes in and tells me that it will sting a bit as it is going in.  As she injects it, I comment to her that it doesn’t really hurt.  THEN, she pulls the needle out and man, oh, man…talk about a delayed reaction!!  The burn!  But, if it was going to take the pain away, the burn was the least of my discomfort.

The thorough assessment by the Doc gave me some reassurance that this time there would be a diagnosis.  Although I had an Ultrasound and a CT Scan from my earlier ER visit, which showed nothing, the Dr insists I should have another CT Scan.  In my mind, I am thinking MRI! MRI!  But I figure I will humour him.  

Finally the pain med begins to take the edge off.  During the Ultrasound, the Tech is taking the probe across one spot in particular, over and over.  Let me tell you, that was fun…NOT!  A necessary evil.  Finally, she asks if I have a had a different type of Ultrasound.  I have not and feel a sense of relief that she is deciding to do this.  Afterwards, she informs me the ER Dr will talk with us about the results when we go back to Emerg.  She sends us on our way.

Back in the ER, it takes the Dr a bit of time before he comes to speak with us.  I am terrified. Is it, he still doesn’t know or something very serious?

He tells us he has spoken with a Specialist and tells me I have a condition called Adenomyosis.  OK!  I have an answer.  I have a condition.  BUT, what is it, I ask.  He says he doesn’t know, he has never heard of it.  Huh?!?  So is it treatable?  Is it something I have to live with the rest of my life, because pain and diabetes management don’t go well together.  Is it terminal?  He tells us the Specialist wants to see me in a week to discuss treatment options.  In the meantime, he sends me home on Tylenol #3’s and prescription NSAID’s.

I whip out my phone and go to Google.  I guess the Dr doesn’t have Google or a Medical Dictionary at the hospital (insert sarcasm).

After reading about it, a wave of relief washes over me.  I know what the discussion will be with the Specialist now!  It is treatable.  I will need major surgery.  I am excited.  Really, I am!

After researching more, I realize the many issues I am having with my body the past many years, I now know are directly linked to this one condition.  The surgery will fix these things!  

In less then a month I am looking forward to beginning the recovery process.  In the meantime, I have focused on eating well, taking my vitamins and supplements, keeping my blood sugars tight, getting enough sleep and walking.  Ideally, I would like to exercise more intensely to strengthen my muscles but I am not well enough for that.  I remind myself in a few months I will be able to.   I have been reassured by a few friends who have had the surgery that I will wake up one day on week six of the recovery and realize how great I feel, how rough I’ve felt these years.  The countdown is on.

I am looking forward to my new life.

“The secret of …

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“The secret of your future is hidden in your daily routine.” – Mike Murdock

In today’s society we are encouraged to break out, be stimulated, think outside the box.  We are told the less routine we adhere to the more abundant our life will become.  Becoming comfortable is to lose the opportunity to become a better person, to grow and expand our mind and soul.

In many aspects, breaking routine is without doubt a great thing.  Spontaneity can break one out of the doldrums, keep the mind sharp and create excitement.  

With respect to living with diabetes, having routine is essential.  It is proven that testing your blood sugars, taking your medications and insulin injections at the same time each day will increase your chances of success.  

To take it further, creating a routine with regards to healthy eating, meal and snack times is also of great benefit.  By pairing your medication or insulin routine with your meals and snacks, you will notice an increase in well being…once you are settled into your routine, ironing out the wrinkles.  After all, we are very personal in our diabetes.  Although we live with the same diagnosis, we are all unique in how we adapt to certain routines.

One last commitment which needs to be incorporated as part of your daily diabetes routine is physical activity.  The benefits of physical activity are as great as adhering to a routine with your medication, insulin and eating.  

The Centre of Disease Control cites the following as benefits to physical activity: 

By creating and committing to a routine, I hope this will enable you to live life with Diabetes Beyond Borders.