Tears of Insulin

images courtesy of Lilly Diabetes

Recently, I attended the 2013 Lilly Diabetes Blogger Summit in Indianapolis, Indiana. One part of the visit allowed us to witness insulin being manufactured and I'm here to tell you that the experience brought me to tears.

Maybe it was the overwhelming feeling that Arden couldn't live without the concoction or perhaps it was when I realized how many dedicated people it takes to make the insulin that Arden needs so desperately. I'm still not completely sure why the sight of insulin production was so moving to me. All I can tell you is that as those little glass vials were zooming past me and as I watched the mechanical arm fill them, I cried. There I was in a viewing room with my fellow D-Bloggers, all of us clad in hairnets, masks and gowns, when tears suddenly began to roll down my cheeks.

Arden doesn't even use Lilly's insulin and still the thought of this place existing was too powerful for me to ignore. So many people that I love, and so many of you that I call friends depend on places like this. I never really thought about it before, never considered the scope and effort that went into the production of insulin. It was amazing and overwhelming to behold. "Arden wouldn't be here today without out companies like Lilly", I thought as I watched the vials fly by... Then I looked around the room and saw so many friends and fellow D-bloggers who all could make similar statements about loved ones and themselves.

I found the hours that we spent on the production floor to be altering, they filled me with gratitude and humility. Diabetes did it again, just when I thought that my perspective on life was as clear as it could possibly get, diabetes brought things into even tighter focus.

This visit was as close to spiritual for me as anything that I've ever experienced. I went to the place that makes the very substance that my daughter needs to stay alive. What an amazing day, what an honor!

Lilly Diabetes invited and paid for me to attend the 2013 summit. Airfare, lodging, food and transportation was all covered by Lilly. I did buy a jammin' lemon pound cake slice for myself at the airport. They never asked me to write about my experience or in any way tried to sway my opinions.

Pictures from 2013 Lilly Diabetes Blogger Summit

I have so much coming up for you over the next two weeks, let's see.

I'll be telling you about my trip to Indiana to visit Lilly Diabetes where we:

Saw how insulin was manufactured

Met Kris Freeman

Recorded a group DSMA PodCast

Learned about the man who drives Lilly's direction

and more...

___

My book, 'Life Is Short, Laundry Is Eternal' won a gold Mom's Choice Award - more about that later.

___

While Iron Man was kicking super villain butt, I kicked the ass of a crazy combination of nachos, popcorn and candy. I'll be writing about the unorthodox way that I beat that BG back to where it came from.

___

For today, let's get started with some pictures from the Lilly Diabetes 2013 Blogger summit

Lilly Diabetes invited and paid for me to attend the 2013 summit. Airfare, lodging, food and transportation was all covered by Lilly. I did buy a jammin' lemon pound cake slice for myself at the airport. They never asked me to write about my experience or in any way tried to sway my opinions. 

Pre-Bolus

Original art by Mike Lawson - Check out Mike's YouTube page by clicking on the image

This story begins in 2006 just moments after I asked Arden's nurse practitioner if she was "nuts".

NP: <blank stare>

Me: <incredulous gaze>

Only moments before our staring contest began Arden's NP became the first person to suggest that I give Arden her mealtime insulin before she started to eat. I can't be sure if she referred to the practice as pre-bolusing, probably not as we were MDI, but she definitely wanted me to inject before Arden ate.

"Are you nuts?"

I responded emphatically that I could never give Arden insulin before she ate. Arden was two years old and there was no way to be certain of how much food that she would finish. The NP repeated her very reasonable request but I could not wrap my head around this new idea. Pre-Bolusing, bah, Arden would be safer if I left her alone at the mall with money pinned to her shirt.

I was 100% correct on that day. There was absolutely no way to be sure of Arden's appetite. However the inability to guess how much she would eat wasn't the only reason I didn't want to inject before meals. Arden weighed maybe nineteen pounds at the time and Novolog had a way of peaking intensely in her body. She had already experienced a seizure from an insulin miscalculation that I made. That mistakes lesson was still very fresh in my mind and with that bad memory still looming over me, I just couldn't bring myself to administer insulin that wasn't already covered by food or a high BG.

Of course everything that the NP said made total sense. I wanted to give Arden's insulin a head start, I dreamt of a moment when her food would begin to expel it's carbohydrates just as the insulin was pulling her BG lower. I could picture that perfect image in my mind, a tug-of-war with food on one side and insulin on the other. Both combatants pulling furiously without once moving the rope that is Arden's blood glucose value - the dream of a steady mealtime BG. I wanted very much for that to be our reality and so I promised myself that I would make the adjustment when the time was right.

Fear and poor timing stopped me from taking the NP's advice all those years ago. Eventually the day came when I found my footing with the idea and gave up on being scared... that's the day Arden's A1c began to decrease.

We haven't looked back.

The beginning of our trip down the road to pre-bolus freedom was littered with pot holes. The first bump took some time to traverse, we first had to wait until Arden was old enough to give thoughtful consideration to her hunger. After that hurdle was cleared we took the first step, bolusing ten minutes before a meal. Those next ten minutes were the most tense of my day, I would test and worry so much after the bolus that I barely had time to finish cooking. Initial results were less than stunning so I moved the pre-bolus to fifteen minutes before a meal. The extra five minutes increased the impact of the insulin and lessened Arden's post meal spikes, but I still wasn't seeing a huge return on our efforts. I wanted to take the process to another level but I couldn't, in good conscience, give Arden insulin farther from the beginning of her meal. If only I could see the insulin work, I needed a crystal ball...

... or a DexCom CGM

Arden's CGM turned pre-bolusing into the most valuable weapon in our arsenal. It's one thing to have a good idea of how long it takes insulin to begin working in the body. But when you are able to not only witness the movement of the BG, but also the speed with which your glucose level is rising or falling... it's the difference between rumor and fact... between guessing and knowing with reasonable certainty. The day that my eyes were opened to the benefits of wearing a CGM, that was the day that everything changed.

Arden was 149 before dinner last week. I bolused for the elevated BG and pre-bolused for 50 carbs, it was a significant amount of insulin for her. Before DexCom I would have panicked and served the food in less then ten minutes. Now I take my time finishing dinner while Arden and Cole do their homework and leisurely prepare their plates as I wait for the CGM to tell me when to serve.

I put dinner on the table when the arrow on Arden's DexCom G4 turned south, waiting until her BG was below 110. The amount of time between Arden's bolus and her BG decline can vary most days depending on a number of factors. Glucose monitoring grants the flexibility to wait, providing a level playing field for the insulin and those scrappy carbs to wage their battle on.

At least now it's a fair fight.

Don't forget what the bottom of the site says... Always consult your doctor before making changes to your health care. I am not a doctor.

More about the art: The art work displayed at the top of this post is an original piece from Mr. Mike Lawson. Mike is a tireless advocate for people with diabetes, a friend and extremely talented artist. You can find him working at TUdiabetes, on Twitter and through his fantastic YouTube channel.

Insulin to Carb Ratio

It doesn't matter if you infuse insulin with a pump or inject, you probably know how many units of insulin covers one carb. We use multiple Insulin to Carb Ratios (IC Ratio), in the morning Arden's IC is 1 to 16. One unit of insulin, for every sixteen carbs consumed. Her lunch, dinner and evening ratios are all slightly different. 

Two weeks ago Arden began experiencing unusual BG spikes after lunch, I'm happy that this happened, not because I want to see her BG high but because the anomaly caused me to draw a mental line between these new lunch spikes and a similar spike that I see too frequently after dinner. Post dinner spikes have been an ongoing issue for us this year. I was certain that they were happening due to bad carb counting but this new situation jarred something loose in my head and allowed me to see the problem from a different perspective.

I had become lulled into a false sense of calm by consistently good BGs from other times of day. Those triumphs clouded my ability to see simple issues that caused BG spikes, spikes that shouldn't have been difficult to diagnose. I made a mistake, focusing too much on the food in the equation and ignoring the insulin.

Diabetes: "Knock, Knock..."

Me: ("I'm just going to ignore that and see if he leaves")

I wonder now if I didn't subconsciously just need a break, maybe I didn't have enough energy to tackle another diabetes riddle. Whatever the reason, I figured it all out the other day... the answer ended up being so simple that I'm now annoying myself by retelling the story. 

Arden's insulin to carb ratios needed to be changed, one quick adjustment is all it took. I'm still fine tuning the dinner number and the breakfast ratio needs a little help from a temp basal but her BGs haven't been going above about 160 (CGM) after lunch or dinner since I made the adjustments. Everything has been so quiet around here for the last few days. No crazy highs, no panic inducing lows... it's almost too quiet, but I'll happily take that calm for as long as it lasts.

I'll be writing more this week about other simple adjustments that make a huge difference. Don't be afraid to make small changes, you can always put them back if they don't do what you expected. Please remember to record the old numbers before you make any changes in your pump.

Don't forget what the bottom of the site says... Always consult your doctor before making changes to your health care. I am not a doctor.

Life For A Child

The diabetes online community provides support for those who are a part of it. We cheer each other up and on, lend advice, create friendships and so much more. We are people helping people live better with diabetes. I speak about the power of the DOC all of the time, it's staggering to witness it's reach and impact. It's helped me more times than I can count and I bet it's helped you too. 

A few thoughtful folks in the DOC got together recently and began to wonder who else our community could help. How far can our love reach, can it extend beyond my twitter feed, past our FaceBook pages? Can the power of the DOC touch a child in a country that is an ocean away? I think it can. I'd bet on us any day of the week. So please take a moment, read on and find out where and how your love will be used to save a child with diabetes. 

What is the International Diabetes Federation's Life of a Child Program (from the IDF website)

Donations to the IDF Life for a Child Programme are carefully directed to key areas of diabetes care and management so that established paediatric diabetes centres and associations can provide the best possible care, given local circumstances, to all children and youth with diabetes in developing countries.  

Just $1 a day provides a child with:

• regular insulin
• quality blood glucose monitoring equipment (meter, strips, lancets)
• essential clinical care
• up-to-date diabetes education materials
• specialised diabetes training for medical staff 

“The scope of what needs to be done is vast.  Diabetes management is complex. While the first step is getting access to insulin, it needs to be followed up with education on managing diabetes, extending sustained care and also improving the quality of care. This takes both time and ongoing resources, so donations such as yours are crucial to the success and longevity of the Life for a Child Programme. Thank you for your contribution.”

Dr Graham Ogle, LFAC General Manager.

Please consider making a one dollar donation to the IDF's Life For A Child program right now by clicking on this link and join the DOC in their Valentine's Day effort to Spare a Rose and Save a Child. Give the one you love eleven roses this year and then send the money you save to a child that desperately needs insulin. 

Please share this page with the DOC and beyond. Then write about Life For A Child on your blog, FaceBook wall or twitter feed. Click here for more information on how you can help. Let's take this DOC thing out for a spin and really find out what it can do!