Wednesday, July 28, 2010

Back from the travel front

Yes, I'm alive. At least, I think so. We went to a family reunion and baptism (my darling niece!). It was fun, and a great chance to reconnect with extended family. It was also exhausting - mainly because we were in a multistory house that H loved to run up and down. Hence, I was running up and down - not constantly by her side, that would be impossible, but arriving in time to, say, keep her from falling off a bunk bed or walking out an open door to a balcony. Despite everyone's best efforts, kids get themselves into compromising positions astonishingly fast (kids do, as well as say, the darndest things).

My BG went high at first (little did I know, my hormones were also ahead of cycle and contributed to this). Then, with all the running, they went low. In fact, I had my first-ever double-dip low: Down to 40, then up to 90 with glucose in about 20 minutes, then back down to 38 within another 20 minutes, despite additional food and no extra insulin. I got my glucagon kit out of my purse (where it normally resides), set it on the table, and told hubby what was going on. Fortunately, with a little more glucose, things normalized. I think the combination of a slight time change (meaning a 1-hour delay in meals), the extra exercise of chasing H, and my hormones gave me a triple whammy (I refuse to call it a perfect storm!). I only realized the hormone piece of it after the fact, one week later (ladies, you know what I mean, right?).

The other "fun" was going through airport security. As always, I had a letter from my doctor explaining that I need to wear the pump at all times and carry supplies (insulin, syringes, sugar, etc.). I liked that the doctor also wrote that I can't go through the x-ray machine because it can erase the pump's data. I've known about this for a while - it's really rare, but it can happen. It doesn't "kill" the pump, per se. But pump users know how bad it would be to lose all your data: Some settings you could easily reprogram, but others are ones that you constantly change, it would be nearly impossible to keep a separate record of these to be able to reset them if they're lost. What's more, you would almost certainly miss your flight because of the time it would take to reprogram. And no, Virginia, it's not a good idea to wait to reset the pump; you can go for about an hour at a time without the pump, but that's it.

Besides, my pump always sets of the alarm anyway. After the first three or four times, I decided it wasn't worth it because of the risk of lost data, and I'd have to get a pat-down anyway. But I have actually never gone through airport security without some security person saying "Oh, you can go through the machine, it won't set it off/won't harm the pump." They obviously need educating on this matter. ADA, where are you on this? It's time for me to write to them.

So, here was my experience this time (on the way home): I tell the initial security person I will need a pat-down and ask where to go. He narrows his eyes and says, "You can go through the machine." I pull the doctor's letter from my bag and say, "No, I can't. Here's a letter from my doctor about it." He waves the letter off (no one has ever actually read one of these letters, but they are useful for making people take me seriously), then tells me to speak with the personnel at the actual machine. I put my purse, carry-on (with all my supplies), shoes, H's food bag, diaper bag, and stroller on the belt. Hubby holds H's hand during this, while she's saying, "Mommy! I want to stay with Mommy!" I explain that I have to go through separately but that Daddy will be with her and I will be back with her soon. She, looking doubtful, goes with Daddy, after he puts all his items on the belt.

Meanwhile, I ignore the man waiting behind us who mutters several times, "What's taking him so long?" (meaning my husband; he doesn't see hubby is with me and H). He says to the narrow-eyed security guard, "When I was in the army, we got on and off those planes in no time. Why can't this guy do that?" I bite back my comment - "Since when have two-year-olds been in the army?" - and carry on. (Note to airport security: Don't send people with young kids through the military personnel line. You're asking for trouble. It was a shorter line, though, so thanks for the thought.) I step up to the x-ray machine, tell that person I have to get a pat-down. A small conference between guards, then I am let through a side gate and taken over to the pat-down area.

I won't describe the pat-down routine in detail; it's slightly different every time. You've probably seen it, or experienced it. I just endure it, explaining calmly that I have the pump, it's attached to my body by a catheter and has to stay that way, and offer to show it - but I don't just pull it out of my pocket, until they ask me to. During the pat-down, I try to keep an eye on H and on my belongings. The latter tend to get opened and rifled through - er, checked, simply because I'm getting a pat-down, or perhaps because the security personnel get suspicious when it isn't picked up immediately. In this instance, the woman puts my carry-on back through the x-ray because she saw H's (empty) sippy cup in it.

At the end, I struggle to make sure I have everything I came through with, because other people were annoyed that my stuff was holding up the line and tried to shove it aside, and the security folks also shoved it along (that is, the stuff they hadn't opened). So some of my stuff is with the security folks, some is on the belt, H is clamoring to be picked up, and the security folks are telling me to hurry along.

But all in all, this was a relatively incident-free trip (don't even ask!). We had some fun, we're back safe, and we're mostly back into our routine. My BG is much better. I wish I could say the potty-training is going well, too, but travel always throws that sort of thing off. I'm sort of grateful to be back at it, though.

Wednesday, July 14, 2010

A mother's perspective on lows

I had an epiphany at 4:30 this morning. Okay, so when I write this, it will sound like a Deep Thoughts blip. But really, it seemed deep to me, as I woke up in the fog of low blood sugar.

Wow, I thought (epiphanies generally beginning that way), my mom used to make sure I ate enough, so I wouldn't run low (not that it always worked, but she tried). The worst thing, in her mind, was running low - not going high. To me, it was sometimes annoying, because I was probably more terrified of running high - all those scare stories about complications actually got to me. The scare stories about people never waking up, having gone too low in their sleep, also were scary, but I knew that just eating a lot wasn't the way to avoid lows (because swinging from high, to low, etc., was - is - the likely result of overeating). I thought my mom wasn't "getting it."

But, as I lay in bed this morning, too tired yet to get up but thinking, "I need to get up, I can't let myself go back to sleep, I might never wake up again," I realized - wow! - my mom was just being a mom when she was constantly feeding me. She literally feared for my life. To her (I realize now), the worst thing in the world would be not being able to wake me up one morning. Just like, when H was an infant, I crept into her room constantly, leaned down, and listened for her breathing. I really did. And now, when she accidentally steps from the end of the driveway, just into the street, my heart leaps. I just couldn't stand it if anything ever happened to her. I hover. She hates it.

So now, of course, I understand why my mother did what she did. It's not always rational, this motherly fear. It can make us do silly things - like putting helmets on our babies as they begin to walk (no, we didn't, but I could see why people came up with the idea). Or overfeeding our diabetic kids, because we just couldn't bear it if they didn't wake up. (I consider myself to be diabetic - just not "a diabetic." No offense meant to those who consider themselves to be people with diabetes.) Never mind the long term - that the kid needs to learn not to walk into the street (well, keeping her safe until she learns where the driveway ends and the street starts doesn't seem so unreasonable). Never mind that constant high blood sugars will do damage down the road.

Actually, the other reason my mom probably did what she did was the way she was taught to care for me. At the time, high-carb diets were in, including for diabetics. It was supposed to be complex carbs - whole-wheat bread, etc. But it was probably more than is good for us. Cereal with milk and fruit, plus toast with jam, and eggs, plus oj - that was a typical recommended breakfast. (Did they think I worked on a farm?) I hardly ever ate that way, but my grandfather, who had type 2, did (it didn't work very well for him; or maybe it was the bacon he ate along with it). As a teen, I did have cereal, milk, and oj, though. Then a morning snack of crackers and cheese or an apple (apples were my mother's cure-all, I always had to carry one), lunch of a sandwich, fruit, and maybe chips (low-fat chips weren't around at the time). Afternoon snack: tons of crackers and cheese or pb (my cholesterol wasn't great). Or maybe half a box of cereal. Lots of white rice with dinner, and maybe angel food cake for dessert. Yikes! I did figure out that I couldn't eat that many carbs, even of the complex variety - and the sad thing is, I figured it out before anyone else told me, all medical specialists included.

These days, I might have a little granola with my plain Greek yogurt for breakfast (plus a little milk in my must-have coffee). Definitely no oj - I'm far too insulin-resistant in the morning, even using the pump. I might have some blueberries, or even a little banana, especially if H is having some. I do actually eat a morning snack (a hold-over from pregnancy - but also, I get up a lot earlier than I used to!): either a granola bar, or the yogurt if I had to scarf the granola bar for breakfast instead. I take a big bolus with that snack.

Lunch is usually left-overs from dinner (pretty small portions), or a salad with low-fat chips. Maybe some fruit, if I'm in range. Afternoon snack (if I eat one), either another granola bar (I eat too many of these!), yogurt, nuts and raisins, or peanut butter and crackers (but not nearly as many as when I was a teenager!). Dinner is pretty low-fat. We've cut back on red meat because H just doesn't like it much - this is good for us all! I still eat ice cream at night, but it's often the low-fat variety, and I've figured out the dual-wave bolus for the real thing. I think I can eat more (and more carbs) than I otherwise would if I didn't have H to run after. But my diet is still a lot less carb-centric than when I was a teen. And that's okay, because I'm a lot less worried about running low (the pump has very much to do with that). Ah, let me correct myself: I'm a lot less worried THAT I will run low all the time, especially overnight (last night was an anomaly). I'm still worried - let's say vigilant - about catching the lows, and the effects of the lows. I can't even imagine how I'd handle that if it were H with the diabetes. I'd probably hover. Bite my nails. Pack an apple maybe.

Saturday, July 10, 2010

Summertime, and the living is wacky

Ah, summertime. The blast of hot, humid air always takes me back to my childhood days of swimming and biking, of hiding out in the air conditioned library, sleeping on the screened-in porch listening to the crickets and the scarier night sounds, with the cool breezes, looking at the stars. Long days or short evenings on the gold course (yes, I played a lot of golf as a kid - no time for that now!).

I get a blip of this memory now, and then, zzzziiip! The needle scratches the record, and I return to my current reality: Long days of work in the office, followed by chasing H around the house, trying to get her to the potty, and make dinner, and clean up the breakfast dishes, and get H to bed, and prep lunches for the next day, and do a little laundry so H has underwear. Maybe change my pump (infusion set) out, if it's not too late (if I can stay up at least an hour, to make sure it's working right). I stay up later than I should, trying to capture some of that summer atmosphere, and the daydreaming that went with it.

For some reason, summer always makes me think about what I'd like to do with my life -- you know, when I grow up. Am I where I'd like to be? Where do I want to be in, say, 5 years? But most of all, how do I make the most of the summer, right now? I haven't had much chance to do this kind of thinking yet, though - we're always so busy around the Fourth with family and friends, and this year was particularly crazy. We hosted several meals for a crowd, and some house guests, watched one parade and a bonfire (of which H was scared), and participated in another parade (in which H was terrified of our own float). All while still working on the potty training (a.k.a. many, many outfit changes and laundry). Also while trying to stay cool without air conditioning (although our summer cottage is a little cooler than the rest of the world). Fortunately, we broke down a couple of years ago and put AC in every room in the house (not central air - can't afford to retrofit our 100-year house with that - but a unit in every room). I feel no guilt whatsoever - I help the environment out in other ways.

I appreciated the reminders from a posting on, via Diabetic Connect, about the special risks we folks with diabetes face in the heat. I certainly notice that, although I sweat, I don't do that well in the heat - I think my sweating is a little delayed, because of a slightly wonky autonomic nervous system (like most of our bodies' systems, this one can get thrown off after years of diabetes). I'm in air conditioning more than I used to be (in my childhood), but when I am in the heat, I take extra precautions to stay hydrated, to not spend too much time in the direct sun, wear sun screen when I do, and check my BG extra often. In fact, switching between AC and no AC all the time makes it even harder. I need a lit less insulin in high heat - I think it's because the insulin works faster in the heat (insulin being an enzyme, and all enzymes work faster in warmer temps). Also, I bet I eat a little less in the heat. So I crank down the pump significantly. Then, when I go back into AC, I have to amp up the insulin right away (or, uh, as soon as I get that first high reading).

Also, all the weird summer foods make for a lot more guess work in carb counting. I realize now that part of my problem with my pregnancy (lo these three years ago) was that I was eating out a lot more (as we do during the summer), so I got a lot more salt - no doubt that contributed to my maternal hypertension, as much as the heat and the diabetes itself did. So, between the extra salt (and calories), and the greater uncertainty about what I'm eating, summer is indeed fraught. I take every chance I can get to balance that out with exercise. And oddly, perhaps, yoga is figuring high on the exercise list. I need the stress busting maybe even more now, when I'm trying to balance work, H and her potty training, and the extra summer activities.