Education

One way to show diabetes who's boss is to act like everything is normal. At least that's my tactic. In the spirit of carrying on with life, I sent B and C#1 to look at the college they were scheduled to see that day, while M and I hung out at the hospital. M, B, and I had already had a few lessons with the doctors and nurses there, and there were more to come. Some of them would have to wait until "the boys" returned from their adventure in suburban Boston, but there were still things on our If-you-want-to-go-home-you-need-to-do-this checklist that I could take care of on my own.

Here are some of the things we learned.

Blood Glucose would have to be tested several times a day. The Blood Glucose (bg) levels are measured in milligrams per deciliter or mg/dl. The bg levels are tested by taking a little pricky thing (a lancet), and poking a hole in the side of a finger tip. Then you put a little wick thing (test strip) to the drop of blood that comes out of the hole in your finger. The wick is attached to a meter (as seen on TV), the number you see on the screen of the meter is in mg/dl. A normal person has bg levels somewhere around 90.

Ketones are bad, unless you are following the Atkins' diet. Please bear in mind that Dr. Atkins died of a heart attack. Ketones show up in your urine and indicate that your body is basically eating itself. Your liver and kidneys are especially subject to damage if there are a lot of ketones in your system. To find out if you have ketones, you pee on a stick that looks like one of those sticks you dip in a swimming pool to check to see if the ph is right. Different colors mean different amounts of ketones. Lighter is usually better.

See? It really does look like the pool ph thingy.

Insulin is what your pancreas makes to break down sugars so that your body can use them. If your pancreas fails, then no insulin is made and your body basically pees out all of this unusable effluent. This explains the constant hunger (not getting any nutrients or sugars into the body because they can't be processed), the excessive peeing (purging unusable sugars) and lethargy (no energy is converted to keep you going). M would have to inject herself with human insulin (don't worry folks, people are not "milked" for insulin. It's biosynthetic.) several times per day.

Carbs (grams of carbohydrate) would have to be counted. I would later learn that as we got better at this, other stuff would have to be taken into account as well, but for now we just counted carbs. The amount of carbs M eats at any given time would partially determine how much insulin she would need to inject. Bg is also accounted for in determining how much insulin M would need.

Guilt is something that a lot of parents and siblings feel. Guilt that they did not figure it out sooner. Guilt that they ignored their child's complaints. Guilt that they were not paying attention to the child. Guilt about doing something wrong during the pregnancy, not breastfeeding long enough, or saying "needles, needles, needles all the time," just before the child was diagnosed.

Feet. We now had to be spazzy about M's feet. Apparently, feet are very sensitive and prone to infection when you have diabetes. M would have to wear footwear all the time from now on. Even while in a pool.

Skin is very dry when you have diabetes. M would have to get over her hatred of moisturizers and have to use them more often. Especially on her feet.

Two programs were recommended to type 1 newbies. The more rigid plan and the flexible plan. The rigid plan had a better name than that, but I can't remember it or find it in our paperwork. The more rigid plan is made up with the patient and the dietician, and requires that the child eat a proscribed number of carbs at certain hours of the day. The child takes fewer shots than with the flexible plan, but needs to take the shots at the same time every day. The flexible plan allows the child to eat the number of carbs s/he wants, but s/he must take a shot every time a food or caloric beverage is consumed. Considering M's fear of needles, we decided that rigid plan would be best for us. Plus, we were clueless. The plan would tell us what to do and when to do it.

M and I met with the dietician, (another hottie). She was very nice, like everyone at Children's, and she asked M questions about her diet.

As a mother, it is very hard not to bristle when someone asks your child about her food choices. Intellectually, I understood that it was important for M to be truthful, but part of me was hopeful that she wouldn't reveal that she ate 3 to 4 donuts every Sunday during fellowship after church.

Church didn't come up, but typical foods that M ate for breakfast, lunch, dinner, and snacks, did. M pointed out that during the past three weeks, she had been VERY hungry, and wondered if the dietician wanted to know what her eating habits were like prior to that time. The dietician told her that both pieces of information would be helpful, and before you knew it, she had put together a plan for M. The plan allowed M 25-30 carbs at breakfast, 15-20 at snack, 40-45 at lunch, 15-20 for an afternoon snack, 65-70 at dinner, and 10-15 for an after dinner snack. M got to apply her new plan in time for lunch, and chose her menu of 40-45 carbs.

Coming up with a meal plan. CHECK.

Time to fill prescriptions. I was given a list by the social worker concerned about my guilt levels and whether or not we could pay for M's medical care. She sat with me as I went over the list and asked what each item was for. This list was huge. A large stack of prescriptions were handed to me, and I took the elevator down to the pharmacy. The nice young man behind the counter told me it would be about two hours. After lunch with M, and a visit to the well-equipped recreation room on her wing, I was armed with $485.00 (AFTER insurance) of diabetes gear.

The social worker showed up. "How did it go? Did your insurance cover everything?" I looked at the receipts. "Ummm, no. They didn't cover the ketone strips."

She looked closely. "Wow, no they didn't. Give me a minute, let me see if we can get you some samples."

While she was gone, I looked at the box of ketone strips. They fit into the bg monitor. There were 20 strips in the box, and they cost $183.

Well, that seemed just a little unreasonable.

The social worker returned with a box in her hand, "Here you go," she said. See if you can get your money back from the pharmacy." She waited with me while I called.

The nice young man at the pharmacy was still nice, but advised me that most things are not permitted to be returned to a pharmacy. He took back the ketone strips, and explained that most insurance did not cover these fancy non-urine ones because people on the Atkins' diet were using them to monitor their ketones. (Damn, you Atkins!) He also let me know that when we needed the urine ones, the pharmacy or the doctor might have to call the insurance company to assure them that they are for a patient with diabetes, "even though you are buying all of this other stuff that is clearly for a diabetic." I thanked the young man, and took back my $183.

Prescriptions filled. CHECK.

The next few items on the list involved needles, needles, needles all the time. I would wait for B to come back for that. Stabbing my daughter was not something to which I was looking forward.

M and I played cards, chatted with the nice nurse about topics ranging from diabetes to  "Family Guy", and waited for Daddy to arrive.