Monday, November 1, 2010

I’ve got something to SAE.

To kick off NaBloPoMo I am joining with other DOC bloggers and speaking out for the cause. Sarah came up with this brilliant idea for SAE Day! And I'm sure it's no surprise to all my readers, that I have something to SAE!

So I am dedicating this post to people who don’t understand Type 1 Diabetes. Especially for those who figuratively roll their eyes at Type 1 Diabetes and for those who have uttered, “How is it that big of a deal?” or have lectured, “At least it’s not cancer!”

Well, for you my dear friends, I am putting you in charge of bolusing my son for lunch today. (Bolusing means giving my son insulin. There is a whole new language that comes with this disease.) Come on…it is ONE time. Fix my son up for lunch. It’s no big deal, right? Give it a whirl!

Here is your scenario: (and I promise this is a VERY typical one.I picked the boy with the easiest ratios too, because I don't want to be mean.)

My son calls you at 12:15pm. He has just eaten his lunch and wants to know how much insulin to give himself.

Some information you will need to know:

His blood sugar number was 130 before he ate lunch at 11:50am.

He ate ½ an apple…most of his pretzels, his yogurt and his entire sandwich. He also ate an Oreo that his friend gave him.

He gets 1 unit of insulin for every 20 grams of carbs he eats.

One unit of insulin brings his blood sugar, (or BG) down 100 points. His blood sugar goal for this time of day is 110.

Ready to calculate?

Correction= .2 units. To bring his sugar down the twenty points needed.

Carb bolus= 10g for the ½ apple, 10g for the mostly eaten 15 carbs of pretzels I packed him, 40g for the sandwich, 15g for the yogurt and 5g for the cookie. That is 80g of carbs. 80g Carbs is 4 units of insulin.

So what would you give him? 4.2 units of insulin?

You would be totally wrong.

You don’t have all the information! Yes, his pre lunch BG was 130. But he had snack 1 hour and 40 minutes before that. He had a banana for snack, which was 30g of carbs. So at 10:15 he got 1.5 units of insulin. Insulin stays in your system for 3 hours, the body absorbing about 1/3 of that insulin every hour. So my boy had approximately 0.7 units still on board.

Better subtract that 0.7 units that is still in his system from the 4.2 units you were planning on giving him.

That means you are now going to give him 3.5 units…

STOP! Don’t do it!

More information needed!

He has PE after lunch today. They are doing relay races. Exercise DROPS his blood sugar like a rock.

Better take away a unit of insulin for good measure! (Why 1 unit? I just know that one unit will do the trick. HOW do I know. I can't file away HOW I know it! My brain will explode! I just know it! Instincts are a big part of taking care of a child with diabetes.)

So now, how much insulin are you going to inject into my little boy?

2.5 units.

Better…but ummm…sorry. There is yet another small bit of information you need to take into account. We have been adjusting this boy’s basal rates. (The underlying insulin that his pump delivers to him in small puffs every few minutes throughout the day.) My son has just ended a growth spurt and has been suddenly, for the last two days, dropping like crazy between 1 oclock and three oclock. Since we wait 5 days to establish a pattern, we need to leave his basals as is…and at this moment, we need to adjust for these potentially scary lows.

Better take off another ½ unit to keep him safe. (Yeah, because I said so!)

Final answer: 2 units of insulin needs to be delivered.

And you were going to give him how much? 4.2???

That is 2.2 units of insulin too much. That amount of insulin would have brought his blood sugar down 220 points. Which with all the running around he was doing…would have put his blood sugar number at a negative number.

Yeah, you can’t be alive with a negative number.

But don’t worry! We get to do this again for his afternoon snack! And again at dinner! And again before bed! And again at 1 in the morning, and again at breakfast tomorrow! LOTS and LOTS of practice!

PLUS! I have two other boys I get to do this for every day!

And the variables are never ending! A meal eaten with high fat changes everything. A meal eaten a couple hours earlier with high fat changes everything! A big test at school changes things! A substitute teacher changes things! A small cold changes EVERYTHING! A growth spurt, changes everything! A fieldtrip changes everything! A night of unexplainable highs, changes everything…for the entire day! The weather sometimes even changes everything! EVERYTHING CHANGES EVERYTHING!

I joke around about my swelly brain, but it is more real than I care to admit. The constant cog turning of blood sugar variables can put me over the edge. I am the only one that knows my son’s basals are probably too high in the afternoon. I am the only one who knows that one son’s blood sugars aren’t affected by pasta, and my other son’s sugars go through the roof with pasta. I am the only one who knows that J has PE on B Block days, and he needs less insulin for breakfast those days.

Sure! I share this information with my husband when I can. But here’s the kicker…the information changes every day! Every day I am storing new information I am learning about my boys’ blood sugar trends.

I couldn’t even write it all down if I tried.

And hey, I just tried.

There is so much information stored up in the attic of my brain, your cogs would seriously be sent into a disastrous tailspin if you tried to absorb even a fraction of it. And I’m not trying to be mean or anything.

I’m only able to tolerate the swelliness because I have been slowly acquiring these mountains of information every day for the past 12 years. I have attended this school 24 hours a day, 365 days a year. I used to be a student, now I run the place. Sorry…you can’t learn it all in one session.

Worst part is…I don’t know everything there is to know about this disease. Cause, I’m not a pancreas. I am a human being. Unfortunately…

So when you think you are ready to judge even one second of my split second decision about my boys’ health…think again.

Because this disease is impossibly complicated. I spend my life trying to hit a moving target.

And that is all I have to SAE.


  1. Bravo Meri!

    MY head is spinning - I can only imagine what people without diabetes are thinking right now after reading that.

    It is like trying to hit a moving target, indeed!

  2. Amen sister!! You tell em.

    BTW I agree with Lorraine. My head is spinning....

  3. Very well said Meri ! More people need to know that this is reality for Type 1 gamers...

  4. Oh my gosh, this post is just brilliant. It's the absolute truth, but a truth that most people just don't begin to fathom. What a great way to educate today!! Bravo!!!!

  5. Very well SAEd! It's crazy isn't it? Thanks for sharing!

  6. You SAE it sistah! BRAVO! I cannot even imagine trying to aim at 3 moving targets! You are amazing and I heart you!

  7. Wow! Its hard enough to do with one. You and your family are amazing! Thanks for putting one meal into words with such a flair!

  8. Dear Lord Meri... I need a nap after reading that! You are truly a rock star and I am jealous of your bolusing skills!

  9. Sweet sassy molassy!! Swelly brain is no jooke! I love how you said you got to this point after learning nonstop for 12 years. Amazing. Big ups to you and the fam.

  10. WHOA! YOU GO GIRL! What a way to put just a smidge of our day into perspective!

  11. THAT IS A FANTASTIC POST, MY FRIEND!!!! So crazy how we manage to sum all of that up into a few seconds of decision making in real life.

    Hi Five!!!!!

  12. Wow Meri, is there ANYTHING you CAN'T DO??? Still my hero!!!! Kim

  13. Meri, I want to formally apologize for thinking years ago that "what's the big deal it's only diabetes" I was completely wrong and feel ashamed for ever thinking it. I know having one kid with diabetes would make me crazy. I can't even remember to brush my kids teeth. How do you do it? You were always the smart one in the family.

  14. Awesome post, Meri!

    I don't know what is crazier ...... what you just walked us all through or that I kinda-sorta followed it ;)

    Thanks for always giving me a unique perspective.

  15. Holy Cow the "That Changes Everything" paragraph cracked me up. It's so true to the point where the kids sometimes look at me and go "But, wait...yesterday we.."

    To which I reply, "I know! BUT..."

    Wonderful post and I still say you need to kick that lady from the soccer field right in the Jenny. Quit trying to educate and facilitate. (hehehe, that was bad)

  16. You are always a great writer Meri, but this is one of my favorites! Such a good perspective for people who are looking in from the outside...

  17. I love you, Meri. We had a friend over for dinner the other day. She is in a wheelchair and gets disability allowance just like I do for taking care of Frank. She asked what the diference was between Type 1 and Type 2. Around half an hour later she offered me some of her allowance! She felt we deserved it more!! She gets it a bit more now and will spread the word, I hope.

  18. You're amazing (hmmm, I think I've said that before...)!
    Taking the time to write that is definitely a labor of love - love for your sons - and even some for the rest of us!

  19. As a mom of 2 kids with Type 1 and the wife of a hubby with Type 1, I so TOTALLY feel your pain!!!! Granted, I don't have to take care of the hubby as much, but in the same respect, he isn't always much help with the 2 kids either.

    Your lunch scenario had me ROFLMAO simply because....well.... that's me every single darn day with my daughter. My son? Only on days he buys his lunch. *SIGH*

    Oh yeah....I too could have something to SAE as well!

  20. Awww Meri, this post will be sent to all who know Ellie and have explained and put into words what I literally get too exausted to finish are my hero and always my air when I can't breath. ((hugs)) & loves.

  21. OMG! This is perfect! You said it so well! We just passed the 8 year mark, so I'm with you!

  22. Thank you for this post! I am making copies to give to people who think I am crazy for not letting the school nurse determine Garrett's insulin doses. Don't get me wrong...she is a wonderful nurse and human being, BUT she would have given the 4.2! Like you said, there is no way for her to know everything going on with my son, and there is no way i could possibly communicate it all to her on a daily basis. Thank you for saying it better than I could!

  23. Brilliant, brilliant post!

    This is so EXACTLY what it is like :) Good grief, it's hard enough just to work out my own doses, but to sort it for 3 growing boys is just amazing amazing work. They are very lucky to have you caring for them.


  24. Meri, I can only hope to be as awesome as you someday! :) Love, love, love this post! Maybe I should refer my friends and family here when it appears to them that I have lost my mind!

  25. HAHA! I LOVE this post! When my dd was dx at 9 months I had someone tell me that she should be easy to manage because her diet should be easy to count...GRRR...yeah, if you can take away teething, learning to walk, growth, stress... I had to share your post on FB and added this comment:

    OH and for my school age FB friends...the next time you are in math class and some kids says something similar to: "I don't know WHY we have to learn this stuff, we'll NEVER use it again in real life." I want you to walk over to them and SLAP them for me (and if it's YOU then come here and I will do it). You never know when life will BITE you and you WILL need all that "useless" stuff you learn in Math. I find myself doing algebraic equations in my head - with variables that you can't really quantify and that change hourly, all hours of the day and night, in varying situations and settings, while 3 other kids ask me questions, on about 3 hours of sleep - every single day! Go hug your math teacher ;)

    I've enjoyed several of your posts so I added you to my blogroll. Keeping SAEing it like it is, Meri!

  26. What a fantastic post, thank you so much for writing that! Whew my head is spinning and it's wonderful. I think everyone should read this. I'm a new reader and I love love love reading your blog. :)

  27. I'm a mom to 2 type 1 diabetics and this is awesome!

  28. This was so awesome to read and for you Meri to share. Our dear friend "J" and his incrediable mom have shared their life with us too ! Awareness and Early Intervention are the key! xo


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