Tuesday, April 27, 2010

CGMless gaming

Adele's last Continuous Glucose Monitoring (CGM) sensor only lasted 3 days. It was inserted into her buttock and she was begging to take it out after 3 days because it was very, very itchy. The skin surrounding the insertion site was very red and inflamed. After trying to convince her to leave it in since it was working well, we gave in and let her take it out. After all, it is her body and she's the one who has to wear this thing 24/7. She doesn't have a choice with the insulin pump infusion site unless we go back to multiple daily injections, but she can go without the CGM. This was last Thursday. We wanted to insert a new one for our busy weekend, but we just couldn't seem to make the time for it. Adele insists on freezing the skin with the emla cream before the insertion (this takes like an hour), then the system needs to be calibrated... Anyway, we were running with our eyes closed, back to making dosage decisions using finger prick results only.

Saturday morning was the first swim of the spring session. Adele now swims from 11 am to noon instead of 10 am to 11 am in the last session. This means less active breakfast insulin on board and her morning snack an hour before getting into the water instead of a light snack right before swimming (yeah, I know that you're not supposed to swim until at least 1 hour after eating, but sometimes she just has to eat something to avoid going low). Swimming is a tricky situation. She's disconnected from her pump since it can't be submerged in water and I'm way up in the grandstands for the entire hour, so I can't ask her how she's feeling. A low is really not something you want to happen when she's swimming in 12 feet of water. I'm watching her like a hawk the whole time even if there's nothing I could do if I noticed that she was having a hard time staying above water except maybe shout at the teacher and/or lifeguard. Her sugar was 5.9 (106) when we got to the pool. 15 grams of carbs with no bolus and she was 7.2 (130) after the session, so we nailed it this time. I was still quite anxious during her class though, continuously trying to convince myself that my decision was correct.

That afternoon was the long-awaited meet and greet with Jason Earle (Jackson from the Hannah Montana show). During the 2 hour wait to see Jason, we tested to find Adele's sugar high at 13.8 (248) 1.5 hours after lunch. This could have been avoided with the CGM. We would have seen the rising sugar and could have corrected before it got this high. We corrected and she came down before supper. She was actually low at 3.6 (65).

The next day, she needed 45 grams of carbs prior to her swimming lesson. Her sugar before was 5.8 (104) and 6.4 (115) after, so again we were lucky to nail it. I figured she needed more insulin for her lunch given that the day before she went high, so I changed her lunch insulin to carb ratio. At 2:15 pm, just before going over to her friends house to play, her sugar was 9.8 (176). A tad high, but since she's going to be at her friend's house, on her own in regards to her Diabetes and without her CGM, I decided to not correct and wait and see in another hour. I called her at 3:30 pm and told her to test. She said that she felt low. She didn't feel it while they were playing on the trampoline (had I known that they were trampolining I would have called sooner!). So, I tried to remain calm and let her test. Her sugar was 2.4 Crap ! The CGM would certainly have caught this. I told her to sit down and drink a juice and take a Dex 4 tablet. This wasn't a problem since her body needed and was craving sugar soooooo badly. After her juice and sugar tablet, she said she still felt low and wanted to eat more. I told her to sit and wait for the sugar to enter her bloodstream and make her feel "normal" again. It's not always easy trying to reason with a 9 year old over the phone when every single cell in her body is litterally starving and in desperate need of fuel. When all was said and done, she had taken in 33 grams of carbs. A bit much, but I knew she was safe from the low. I told her that I would call back in 20 minutes to make sure she was okay. 10minutes later she called. She had tested and told me the result was 4.8 (86). She was good for now, but she would likely be high by supper without a bolus for part of the ingested 33 grams of carbs. I guesstimated 25 grams was enough to treat the low, so I told her to give herself a bolus of 0.3 units for the extra 8 grams. I was lucky in that it was the correct answer, her sugar was 5.0 (90) at 5 pm.

Close calls and constant changes are what playing the Type 1 game is all about... We inserted a new CGM sensor last night. It's been accurate so far and a little less scary to now be running around with our eyes open...

1 comment:

Shamae said...

Well Mike...well done with the guessing! I thought you did a great job!