Wednesday, December 31, 2008

Happy - Merry - New

Resolutions....definitely be more attentive to my blog!

2008 was an AWESOME year. We had many trials but more successes this year. Cadence turned 2 years old, started pump therapy, and our family began to enjoy things outside of the big D.

I spent some time and compiled a video of our year, I hope you enjoy.



b.

Thursday, December 11, 2008

Pump Love


Cadence calls it her "Pack-Pack", just like the one Dora wears at all times. She knows that she can't go anywhere without it, a permanent feature of her clothing is to have the lump on her back, dangling by her side, or wedged into one of those useless pockets they put on toddler's pants. "MINE!" she says whenever we go to change basals, deliver insulin, or just see what's going on. It's pretty funny how much she loves the thing, so do her parents but for much different reasons.

Here's a play-by-play of our decision making last night, we'll get back to the pump-love soon.

Last night was a "D-night", Nic was out for dinner with her sister and it was Daddy-Cadence time! We put in a new infusion site yesterday and it was working BEAUTIFULLY all through the day. Mid single digit blood sugars all morning. Around 3-4 pm though, just over 24 hours after the new site went in, Cadence started to run high. We changed out the insulin cartridge with some fresh stuff, just before. I corrected for a 16.4 and then we chased spokes around the kitchen to try and bring things back to Earth. To no avail, just before dinner, she was 21.4!! A relatively carb-free dinner in the belly and we were off chasing spokey up and down the stairs. At 8pm just after a bath I check again and she's still sitting at 19.4. Bummer.

So here's the variables you face. It's bedtime, she's through the roof on blood sugars. We changed the insulin, soon after she went high. The insulin isn't more than a week old and has been in the fridge. Her infusion site has been working awesome for 1.5 days, normally we change them out on the 3rd, maybe even early into the 4th day with no problems.

Scenario A: I change the insulin,? What if it does nothing to change it out again and she stays hight through the night, develops Ketones, gets sick, dehydrates, and pees through her diaper.

Scenario B: Do I change the infusion site and anticipate that she will invariably go low in the middle of the night? As a habit, we usually don't change a site at night because Cadence is very sensitive with a new infusion site and we have to watch closely for unexpected lows for the first 6-8 hours.

Scenario C: Correct again and see if she comes down through the night? If she doesn't, I'm faced with the scenario as I was with "A" and now it's the middle of the night and we will need to bring down her blood sugar before breakfast, where she invariably spikes.

Scenario D: Change the infusion site and the insulin, and eliminate all possible variables and deal with a night low, and frequent middle of the night blood checks.

What would you do?

I chose a hybrid of D so to speak. I made up new insulin, just in case, and changed the infusion site. That way if with a new site, she doesn't come down I can now suspect the insulin, change that out and we're okay. If the new site does bring her down, I've not wasted a whole bunch of insulin. Solves all issues other than Thursday morning sleep deprivation.

Well, the new site worked beautifully and when I got up to check her at 2 am, sure enough she was trending downward 6.8 with 6 hours of sleep to go. Now we talk about pump love. Without the pump, you have no control over how much work basal insulin is going to do for Cadence, at 6.8 at 2am without an insulin pump ie on insulin shots, I'm probably going to a wake her up and make her drink some juice. With the pump, I manually "temp" her basal, meaning I can control how much she gets over the next number of hours. I reduced her basal level by about 30% for an hour to see if that would bring her sugar up. It wasn't enough, at 4 am she was 4.8. On shots, this is a foresure wake up and juice scenario, but with the pump, we knocked her basal down by 50% for 90 minutes, 2 hours later, she's is back to 6.8. No major low, no toddler sleep interruption (which is the biggest win for everyone).

What the pump allows a diabetic or their parent to do is become a pancreas. We used the pump for Cadence last night in a way that allows her to have normal resting blood sugars and not have any interruption in her rest. It gives us variable control for a variable activity and eating level which is essential when working with a toddler. Now that I hear that British Columbia is directly funding insulin pumps for children....I'm wondering why Alberta is still behind the times. If the parents of a child are willing to learn, the insulin pump can offer a new level of normalcy to your family.

Thanks pack-pack!
b.