I have to admit to starting today quite badly. I think this was all my fault, but I think as well that what happened goes to show the unbearable pressure which caring for children with a long term condition can bring to a family. I started the day with head-lice and sensors, not necessarily in that order. I put a sensor in for Joe because he has been having a regular hypo over the last couple of weeks. This has happened since we have begun to concentrate on ridding him of the ‘post-breakfast spike’! Perhaps you have heard of this annoying little friend?
Basically both of my kids, and many others I have acquaintance with, need much larger amounts of insulin with their breakfast, or which ever meal breaks the fast of the night. For example, Tom’s lunch time ratio of insulin to carbohydrate is 1 unit insulin to 38 units carbohydrate; his breakfast ratio is 1:16. Joe’s lunch time ratio is 1 unit to 18 grams of carbohydrate; his breakfast is 1:11. There are good biological reasons for this; the emptiness of the stomach leading the food through much faster and getting it into the system quicker than at other times. But whatever the reasons it is the bane of my life at the moment. Tom’s spike, after much fiddling has finally been dealt with. He has a bigger ratio with his breakfast and then has very little basal insulin for most of the rest of the day. I’ve been trying the same thing with Joe, but have had a hypo happen either mid-morning or just before lunch.
Poor Joe! He is very hacked off with this hypo. He doesn’t want the spike either but a hypo just before lunch, which is actually when Joe goes out to play for thirty minutes as he is on second sitting, is certainly cramping his style. So today he got a sensor to help iron this hypo out. I made a change to his bolus ratio having done some clever maths (going from 1:10 to 1:11 meant 0.6 units less insulin over the morning, which should give Joe a spare 2mmol ish as he is on a sensitivity factor of 1:4) rather than his basal (reducing it would only change his morning insulin by 0.1 as he is on so little already over the hour). So basically I had all the bases covered and had moved through a seemingly faultless series of changes to show exactly which change was the one to stop the hypo. I left Joe to go down for breakfast and got down to the (forgive the pun) nitty gritty of Tom’s wonderful headlice outbreak (little b******s!).
BY the time I came down to breakfast with Tom, Joe was on his last few mouthfuls. When I reminded Tom to do his bolus before putting out his breakfast, Joe said ‘Oh…’ in an ominous way. He hadn’t bolused, even though he was about to finish eating. I was instantly fuming and angry. I really had a go at him about hard I was working to get him good levels and how he was only having to do the simplest part of the whole thing and remember to bolus before he ate!
I mauled the subject about for the rest of his time before going to school. I wasn’t shouting angry but he could tell I was riled at the intrusion on my well-laid plans. How awful is that! Fancy telling him that he had the easy bit of this, just having the life-long, life-threatening disease which constantly rules his life and which I could if I chose walk away from at any time. I feel sick at even thinking such a thing never mind vocalising it. But there is no point being guilt ridden. So I said sorry and told him I was cross at the diabetes and even I say stupid things sometimes – stop press, I know that’s hard to believe!
And the rest of the day, having got Joe down form the spike of 21mmol he had because of having the insulin 5 minutes later than he usually does (how mad is that; you wouldn’t believe it unless you saw it, all you ‘I am back at the right level before lunch’ people; who knows where you went in between?), was taken up with the boys being at sports day. I love watching the kids do sports now. I used to so hate it. They are very sensitive to exercise and will plummet at the slightest extra movement in the day. On mixed insulin or even MDI this was very hard to deal with. However, on the pump it has been a new found breeze. Tom had 20grams of his lunch carbs free, without insulin to cover them, and then after he had walked to the sports field for twenty minutes we put on a temporary 50% basal rate. He is only on 0.05 units at this point anyway up until 6pm, so this meant he was only having 0.025units. How amazing is that?! He slurped a little bit of watered down apple juice between races, but no more than 10g cho worth. Amazingly he was on 10.3 before the races began and went to 8.4 by the end of the afternoon. Hallelujah!
Joe wasn’t going to go to sports day, so I thought I only had Tom to manage. He was actually going to an extra maths lesson for kids who need a bit more of a challenge. However, last night he got a bit wobbly lipped and tearful about missing his last sports day. I didn’t know if the school could accommodate his change of plan so easily, so couldn’t pre-plan very much. However, they were brilliantly flexible and, given that I was going to the sports day anyway, didn’t make any fuss. Joe had a sensor in thankfully, so he just kept checking himself. When I caught up with him at the field he was on 7mmol with one arrow down. He had a fruit smoothie, about 17 grams of carb, without any bolus of insulin and then got on with running having had the same 50% basal as Tom. He was on 4.6mmol when he finished the afternoon. Interesting the difference between the free carb at lunch which would have been low GI, and the free carb fruit smoothie which obviously isn’t very low GI. At this point he had a 20g sports drink without bolusing as I knew he needed something extra from the trend arrows down on his pump. He also had a banana and got himself a bowl of baked beans when we got in, both of which he bolused for. He still went low by 6pm, down to 3.1mmol.
We just had a Chinese take-away as a treat and feel pretty stuffed and happy. Even when you start a day badly you can get something good out of it. Joe and I are still good friends and he is nicely forgetting my morning outburst. That’s the great thing about children; they live so much for the moment. I will, though, have to be sure I didn’t do any damage to him and will have a big chat about my outburst. Its hard to know how pent up I can get about the responsibility of all this. I didn’t train as a nurse, and I never would have thought my time would be so spent as an adult. That can make me feel trapped and overwhelmed sometimes. But I never ever regret my children. Just the disease.