Getting In Synch With Your School Nurse

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We recently moved houses and schools. At our last school we had 3 other children with Type 1 diabetes and so we thought that we were in “good” hands because the nurses that supported the school and the teachers both had a fairly solid understanding of Type 1 and how to manage a child with it.

When we moved to our new school we were somewhat worried to find out that our son would be the only student with Type 1. However our fear subsided when we met the nurse. She too had Type 1 diabetes! She immediately showed our son her pump and he showed her his and they were quickly on the same page.

For the first few weeks at the new school we felt everything was fine. Our son is quite mature for his age and tends to take care of himself well but we soon found him returning home quite high each day. After some questioning we finally realized that the nurse was correcting his “low” BG ratings with juice. This of course is fine, however, for her “low” meant anything in the 80′s and so our son would be taking in juice and rocketing up to the high 100′s.

We really should not have assumed that just because she had Type 1 that she would manage it the same way we would. In fact, it’s probably safer to assume that everyone with Type 1 manages themselves in different ways primarily because the disease experience is different for everyone.

We’ve decided to manage our son a bit lower with the hopes of averaging around the 90-110 range with an A1C of around 7.0. We do this because we’ve found that our son, when he experiences lows, still does a really good job of identifying it and treating it quickly. He also seems to be able to go pretty low without any real negative effects (like in the 40′s). Of course we don’t want him this low, ever, but having him in the 70s appears to be just fine.

Others however may find themselves completely out of it even in the 60′s and so they tend to manage themselves higher.

After realizing what was happening we simply had a conversation with our nurse and explained what we were trying to do. We also had our son’s doctor reiterate it with a short note explaining not to undertake any ‘corrections’ unless he was under 70.

Once again, open and honest communications has helped to ensure our son’s days are smooth and healthy.

World Diabetes Day – Nov 14th

This item was filled under [ Learning, News ]

Today, November 14th, is World Diabetes Day.

Though Diabetes is nothing to celebrate, it is something to understand. Not only in the US, but in numerous places throughout the globe diabetes has now become an epidemic and the effects of the disease is one of the most critical drains on healthcare around the world.

Take some time to better understand diabetes. If you know someone with the disease, take the opportunity to ask them about it. To be honest, most with diabetes are willing to help clarify what the disease means for them.

Here are some resources for you to start your education:

The International Diabetes Foundation’s List of Diabetes Day Activities

The Juvenile Diabetes Research Foundation’s Research Page

The American Diabetes Association’s Diabetes Basics Page

As we all become better educated, it will be clear to everyone how important it is to find a cure. Help any way you can.

Documentary on Type 1 Diabetes

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We wanted to let everyone know of an upcoming documentary about a potential cure for Type 1 diabetes. The film still needs financing so please head over to Kickstarter to contribute.

The film, Patient 13, will follow Scott King who has researched and developed a potential cure for the disease.

Here’s a synopsis from the film makers:

Patient 13 follows Scott King – scientist, entrepreneur and Type 1 diabetic – at the climax of his 30-year quest to cure diabetes. Working with a team of world-renowned scientists, Scott is battling the odds to bring one of the most dramatic medical discoveries in history to human trial – even if it means experimenting on himself. Will the scientists be Nobel Prize winners or failed visionaries? If Scott succeeds, not only will he cure Type 1 diabetes, he will cure himself.

Here is a short video about the project.

Tips to Prevent Omnipod Errors

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We’ve been using these 3 simple tips with our Omnipod and though we still experience the occasional bad pod, these tips have significantly reduced pod errors.

    1. Rotate Your Sites: Since you have to change your pod every three days, it is important to rotate through a number of different pod sites.  We have 4 sites that we prefer – each side of belly and each side of upper buttocks.  In addition we rotate having the cannula facing out or in, so in effect we have 8 different placements.  This ensures that our son doesn’t create any hard tissue where we place the pod.  Such hard tissue can affect the ability of the pod to release insulin.
    2. Pinch When Inserting The Cannula: We always pinch the skin around the cannula when it is about to insert into the skin.  This helps to ensure the cannula is inserted into the skin layer and not down into muscle.  Not only does inserting into muscle really hurt, but it also will cause a blockage of insulin and likely bend the cannula, thus causing an error.
    3. Insulin At Room Temperature: We store our insulin in our refrigerator.  Not entirely sure this is needed or not, but we’ve just gotten into that habit.  However, we store our pods in a cupboard at room temperature.  Because the two items are at different temperatures, when we add the insulin to the pod we’ve sometimes experienced immediate errors.  Nothing like destroying a pod before you even get to use it.  Now what we do is either leave the insulin out for 30 minutes before injecting it into the pod or simply hold it in our hands for a few moments to bring the temperature down.  This seems to have eliminated these early errors.

Are there other tips that we should be following?  We still certainly get the occasional error but we haven’t yet figured out why.

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Changing an Omnipod: 4 Easy Steps

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The Omnipod, by Insulet Corp is really one of the easiest pump management options out there for those with Type 1 diabetes. We’ve been using it for almost a year now and have really enjoyed the new freedom our son has with the system. We’ve now become pretty adept at changing the “pod” every three days and so I thought it be good to share the steps we take to change it.

Overall, it takes us between 2-4 minutes to change a pod, depending on how organized we are.

You’ll need 4 items on hand to make the change:

  • Your Omnipod Personal Diabetes Manager (PDM)
  • A new Omnipod packet (comes with a new pod and a new syringe)
  • Your insulin (we use Novolog)
  • An alcohol wipe

Here are the steps we take:

  • Deactivate and remove the old pod:  By turning on your PDM and going to Home>Actions>Change Pod you’ll be able to deactivate your existing pod.  Make sure the PDM is close to the body and wait for the 2 little beeps that tell you your pod is deactivated.  Once deactivated, remove the pod from your body.  We find starting at the back of the pod is easiest so that the cannula comes out smoothly.
  • Fill the new pod:  You’ll now want to fill the new pod with your insulin.  Just take the alcohol wipe and clean the top of your insulin.  Then, on your PDM, given your old pod is deactivated, it will ask you if you want to activate a new one – select yes.  Use the syringe that came with your new pod pack and fill it with the correct amount.  The minimum is 100 milligrams.

With the insulin in the syringe, make sure your PDM is on (sometimes it auto shuts off) and insert the syringe into the fill spot on the pod and pump the insulin in slowly.  With the PDM right next to the new pod, once the insulin is in, you’ll again hear 2 small beeps, letting you know you’ve succeeded.  At this time, hit Next on the PDM and it will ‘prime’ the new pod – essentially making the necessary connection between the PDM and the new pod.

Here’s a tip:  We store our insulin in our refrigerator and keep the new pods at room temperature.  Sometimes this difference causes errors with the pod.  When we load the insulin into the new syringe, we simply wrap our hands around the syringe for a minute to warm it up a little before placing it into the pod.

  • Place new pod: Once your PDM says that it is done priming, you’re ready to place the pod onto your body.  We tend to rotate through 4 different spots:  each side of the tummy and each side of the upper buttocks.  Choose your location and clean it with you alcohol wipe.  Make sure it dries and then remove the cover to the new pod’s cannula area and the sticky tape and position the pod.  Make sure you smooth out the edges and press them down so you have a nice seal between the pod and your body.
  • Activate new pod: This is the only part where you may feel a little pinch.  This is when the cannula gets inserted into your body.   Your PDM will guide you and ask you if you’re ready.  Say yes.  It is recommended that you pinch the skin around the area of the cannula so that you give it an easy entrance.  You’ll hear a couple of clicks from the PDM and then WHAM, the cannula will be inserted.  At first this was a bit shocking for our son and it hurt a little.  He’s now well used to it.  The PDM will finally ask that everything is inserted ok.  To be honest our eyes are good enough to see if the cannula is properly in there, but as long as we don’t see anything strange (blood, bent cannula, etc.) we press OK.

You’re now good to go.  Feel free to head out and go swimming if you want.  The Omnipod will allow you to do that.

Enjoy.

Diabetes Camp

This item was filled under [ Activities, Learning, Living, Services ]

We have become absolute fans of diabetes camp! What a fantastic adventure and an amazing perspective into the world of Type 1 diabetes.

With our son being eight years old and having been diagnosed with Type 1 diabetes just last summer, we were obviously extremely hesitant as we thought about summer camps for him this year. Not only has he never spent any significant time away from home, but with the added stress of worrying about his health, we were resigned to the fact that he would likely not be able to experience the joys of summer camp until later in life.

But then we were told of camps that specialize in adventures for kids with Type 1 diabetes. I did a little research, finding two camps within a relatively short distance from our home, and reached out. The camp we eventually chose was Camp Conrad Chinnock, located in the San Bernadino Mountains in Southern California.

The camp was excellent and completely inspiring. Being our first time, we chose to go to their ‘transition camp’ which allowed both parents and the child to stay for the weekend before setting the child free for the next week. During the weekend not only did our son immediately gain a sense of independence (“see ya!”) but we enjoyed a series of discussions with the camp staff, counselors, doctors and the other parents learning not only about how the camp is run but also what it is like to live with diabetes (note: almost all the staff and counselors have Type 1 themselves).

Of course the experience was valuable to us as parents, being able to ask young adults about their own lives with this disease and being able to learn about other parents’ experiences, but it was tremendous for our son on two levels.

First he got the great camp experience – staying in a cabin with friends, rock climbing, swimming, archery, hiking, all the great outdoors stuff. That alone was worth the money. By the end of the week he was completely exhausted.

But more importantly (and this may not have dawned on him given his age) but he got to meet a lot of other kids going through the same exact issues he goes through. He no longer was the odd kid out. There was no awkward moments where he had to excuse himself to go to the nurses office to get a shot – his whole cabin did this together. He didn’t need to feel shy about feeling ‘low’ – all his friends at one time or another did and all the counselors had testers and glucose tablets on them at all times to help out.

He also got to learn how other kids manage their diabetes. About half the kids his age were on the pump and the others were taking shots. He got to learn about the pump and see how to operate one. And they all learned about carb counting and bolus and insulin calculations.

We are so happy we found this place and so relieved to know that kids with Type 1 diabetes can not only experience a camp just like every other kid, but that they can grow up to be responsible and inspirational people – all the counselors were perfect models of this.

Our son was so enamored by the experience that he asked to go back, so we’re going to send him again in a couple weeks.

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Artificial Pancreas: The Quest Continues

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Artificial_Pancreas

Though we are all hopeful for an eventual cure for Type 1 diabetes, the continued wins researchers are seeing in their quest to create an artificial pancreas is heartening.

Most of the focus in the news recently is on recent improvements in combining insulin pump technology with continuous blood glucose monitoring.  Intuitively it would seem simple.  Have a single device that measures blood glucose on a continuous basis and based on readings release insulin into the body.

Ah, but nothing is as easy as it seems.  Numerous challenges exist, but a key one is the lag between food consumption, what a glucose monitor measures, and the ability to get insulin into the system.  What needs to happen is to be able to predict glucose levels based on types of foods being eaten and immediately release the insulin to welcome the food. (Our body’s ability to do this is simply remarkable)

There are folks working on this problem luckily.  A recent article in US News and World Report describes the effort of a team of mathmaticians, let by Boris Kovatchev, that are developing algorithms based on specific individual’s insulin requirements.  So far they’ve had some luck.

Another group attempting to tackle this are out of the University of California Santa Barbara.  They recently released results of a study of a software program that they have developed to do just this kind of anticipation and ensure that not too much insulin is released.

Soon enough (in the next year or two? maybe?) all-in-one devices will be on the market to help manage this disease.

Best Foods For Hypoglycemia

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oranges used for hypoglycemia

Oranges are great for hypoglycemia

We’ve tried lots of different foods when our son suffers from low blood glucose levels (hypoglycemia).  Depending on how low he is and what activities he’s about to undertake we’ve gotten comfortable with a good variety of different choices.

The obvious goal when treating hypoglycemia is to get some food into the body that will quickly turn into glucose and raise those levels.  If you’re really low (typically below a reading of 60) you want to act quickly and so you’ll go for something with a faster-acting sugar.

If you’re just a little low and you know you’re going to be exercising soon (and so likely to go lower) you may choose to eat a more complex carbohydrate that will digest and turn into glucose over a longer period.  Managing diabetes and sports is complex and this will help sustain you through your exercise.

Old school diabetes treatment was to pop some kind of candy into your mouth and chew.  Obviously, our son loves this.  Post Halloween we caught our son out running on our treadmill (which he’s not allowed to do).  When asked “why?”, his response was that he wanted to get low so he could enjoy one of his candybars.  Pretty saavy for an eight year-old, but we obviously gave him a bit of a scolding and explained to him why that was a bad idea.

We do try to monitor his intake of sugars (including high fructose foods) and so tend to stay away from using the traditional candy and fruit juices to combat lows.  Here are a few of our favorite foods to use:

  • Natural Orange Juice – 4-8 oz.  Great for when he is really low and we need to raise his levels quickly.
  • Apple – Also good for a relatively quick rise.
  • Tangerine – Natural sugars work great.
  • Dried Apricots – Good natural sugars.
  • Dex 4 Glucose Tablets – 2-3 tablets.  These act quickly and perfect though for a kid they’re not as ‘fun’.
  • Whole Wheat Toast – 1/2 slice.  Better for a bit of a longer digestive cycle.  We’ll use this when he’s not too low and is still active in the day.
  • Milk – 8 oz.  This is good when he’s not too low but also hungry.  Helps to fill the stomach and is a bit slower acting.

We’re always trying new foods though as we’re eager to have our son enjoy the variety of what the world has to offer.

Tell us about the foods you use…

Managing Sleepovers with Diabetes

This item was filled under [ Home Life ]

Here’s a great, brief article that came from the American Diabetes Association’s Parents eNewsletter.

Tips for Sleepovers

The following section was taken from posts on the Place for Parents Message Board on diabetes.org. These tips should not replace advice and/or recommendations from a health care provider but reflect issues that parents deal with day-to-day.

“I know my 7–year old daughter who has diabetes will start to be invited to sleepovers soon. Do you let your kids go on sleepovers? How do you deal with it??”

Parent to Parent -

  • We have a policy. If our daughter is going through a wacky BG numbers time period the sleepover has to be at our house. No exceptions. We tell her yes, we know it’s unfair, but it is what it is and we have to do what’s best for her.
  • If my daughter’s numbers are OK at night, she can sleepover at someone else’s house, but she has to call me at 11:00pm with her BG number.
  • We start with only allowing her to spend the night at close friend’s homes. Between her being able to do the BG tests on her own and a parent who is willing to learn what to do in various situations( make a cheat sheet), we feel one’s safe.
  • We actually do what we call 1/2 sleepovers for our eight year-old daughter and friend. We do the dinner, get on the jammies, make the snack, watch the movie and then her parents pick her up when it’s bedtime. Maybe that can be a compromise for your daughter, if it works out that she’s just not able to spend the night, for whatever reason
  • You can plan to have most of the sleepovers at your house. Set it up so your house is the coolest!


Expert to Parent:

When your child is ready for sleepovers, the thought of a night away from home may make you nervous. But with a little planning and preparation your child can have fun and be safe at sleepovers.

Be sure that the parent of your child’s friend knows your child has type 1 diabetes and is comfortable with a sleepover.

You can help the parent be prepared to care for your child overnight by:

  • Providing your contact information so the parent can reach you with questions.
  • Making parents aware of your child’s diabetes regimen including food requirements. (A short written summary may be helpful.)
  • Making the parent and your child’s friend aware of your child’s signs and symptoms of low blood glucose as well as how to respond to lows.
  • Agreeing on an emergency care plan both you and the parent are comfortable with.

Along with their toothbrush and pajamas, be sure your child packs their diabetes supplies. Don’t forget to remind your child to always wear their medical ID bracelet or necklace!

Include:

  • Insulin
  • Syringes or Pens (and pen needles)
  • Blood glucose (BG) testing supplies
  • Pump/CGM supplies
  • Glucose tablets or other fast acting sugar to treat low BG
  • Snacks

Harold Starkman, MD is Director of the BD Diabetes Center for Children and Adolescents at the Goryeb Children’s Hospital in Morristown, NJ.

Diabetes Mellitus – What is it?

This item was filled under [ Discovery ]
Mellitus comes from the Latin for 'honey'.

Mellitus comes from the Latin for 'honey'.

Diabetes Mellitus is a term often used to describe Type 1 diabetes or even diabetes in general. As we became exposed to the condition, the different names and types of diabetes was an initial source of confusion. Let us give you a little history lesson on the origin of the word and hopefully it will help to clear things up.

The term Diabetes is Greek and means ‘that which passes through’. It was originally used in the 2nd century to describe a patient of a Greek physician who was exhibiting the symptoms of excessive urination.

Later, in the 17th century, the term Mellitus was attached to the disease. This term has its origin in Latin meaning ‘honey’ or ‘sweet’ and was used to distinguish between those with sweet-tasting urine (diabetes mellitus) from those with urine with no taste (diabetes insipidus).

Today, the two predominant forms of diabetes – Type 1 and Type 2 – are both considered forms of diabetes mellitus. As such, the term diabetes mellitus has become somewhat synonymous with the general term diabetes.

Confused? Don’t be. If you simply ignore the ‘mellitus’ at the end of the term you’ll basically be back to simply ‘diabetes’. Because the vast majority of people suffering from diabetes have a form of diabetes mellitus, you’ll be ok with this generalization.

Once you’re back to simply reading things as ‘diabetes’, then all you have to do is understand the differences between Type 1 and Type 2 diabetes.

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