Pump Visit Number Five: Mysteries solved

Have I mentioned that driving in and around Boston is a bit problematic?

That is, the traffic is unpredictable, with swings in perception and mood that cannot be foreseen. As a result, M and I routinely leave 2 hours ahead of our scheduled appointment. Sometimes the journey takes one hour and a quarter from my place of work. More typically it takes about an hour and a half.

Today it took two hours and twenty minutes.

We were ten minutes late.

We had been repeatedly warned that being late for an appointment can result in having to reschedule it, so I was panicked. I don't have time for this again in the near future.

Fortunately, the dire warnings must allow for some traffic-related flexibility. Everyone in the office was telling me not to worry about it.

I was probably still in my traffic-induced anxiety when we were ushered in to see Dr.

Firstly, I want to say that Dr. looks great now that her braces are off.

She also looks really fat in the middle, as if carrying a basketball under her shirt. Apparently this will be child number three for her.

Before M goes in to see the doctor, she typically hands over her bg meter to the nurse, who then gathers information from it via some really cool computer thing. This time, the nurse collected M's insulin pump from her, and apparently gathered a multitude of information from it, printed out the information, and handed it over to Dr.  Dr. looked at the printout of M's readings from her insulin pump.

The good news was that M's A1C was 6.3, the lowest it had ever been. Again, great news, except that it might be due to the many, many episodes of low bg that occurred over the last two weeks.

I expressed my frustration at the insane variation of numbers and lack of control I felt. I began to tear up as I explained how tired I was, how concerned I was that her numbers were dangerously all over the place, and how I am not finding the pump to be any better than the basal-bolus system with Lantus and Humalog.

I told her that I need logic, and while I am trying to make sense of how these numbers can go from one extreme to another, I am growing frustrated, because I can't make heads or tails of it.

Dr. listened and nodded as she looked over M's printout. She was silent, biting her lip as she tried to make sense of the numbers she was seeing.

Then she dropped the bomb.

"M. I think that it is clear that your numbers are higher when you eat a large number of carbs. For example, here, on Sunday (Easter Sunday), you ate 527 carbs in one day." (!!!)

M tried to say that she couldn't have, but Dr. politely stopped her protests. "I see here that you covered for every carb you ate, and that's great. I am really glad you are doing that, but it might be a good idea for you to visit with Karen, our dietician."

She looked at the printout again, and cited other days with high carb amounts (over 200 in a day). She looked at me meaningfully as she explained that M really should try to keep her carb count below 170 per day.

While Dr. was looking at me, I was looking at M with the same meaningful gaze. M and I had had this conversation before. Many times. She typically glared, got angry, got defensive, covered her tracks, and sneaked food. Thank God she always covered for her food with insulin, but I knew she wasn't always telling me the truth when she told me what she ate.

Now we have proof.

M can't hide from the numbers. Because of the pump, which tracks everything for which she boluses, what her bg is, and how much insulin she takes, we can now have a real, honest conversation about managing her diet, and therefore her diabetes.

But she won't like it.

When we first started on this diabetic adventure, M and I were a team. We were going to show diabetes who was boss! And we did. We counted carbs with precision, logged exercise and insulin doses into a cute little book, and learned how to fill her up with low-carb snacks.

But it got old for M. After all, it's not an adventure. It's a hassle having a life-threatening illness. Two years is a long time to keep up one's adventuresome spirit about managing something that you are stuck with for life. There is only so much sugar-free jello one can eat.

Because I am a mom, however, it will never get old for me. I will continue to remind, suggest, and advise (nag, from M's point of view), because I understand the consequences if I don't.

This is where worlds collide.

So yes, we will make our appointment with Karen. It might be good for M to hear the same information from another source besides her annoying mother. And Dr., you might want to start addressing this information to the perfectly capable 13-year-old.

It is she who is ultimately responsible for what goes in her mouth.

Choose your poison.

Bumps along the road

This pump is not doing what it promised.

Just look at all of those happy, carefree people on the brochure, literally jumping for joy. "Just look how simple living with diabetes will be! Look at all of the freedom you will have! Welcome to your new life!"

Bullshit.

It has been two weeks since M started on insulin with the pump. The first third of this time period was fraught with dangerous lows. M's bg level was generally in the 40s and 50s. Sometimes it dropped to the 30s, which left me in the bizarre position of force-feeding her carbs at all kinds of hours throughout the day and night.

We adjusted her basal rate. We lowered it so that she was receiving fewer units of Humalog per hour. 1.35 to 1.25 to 1.15, to 1.1 at night, and 1.15 during the day.

Then it happened. Two days where nearly every test came back with a bg in range. 108, 99, 112, 128, 89.

Yes! We found the magic numbers.

After the two days though, her bg began to spike 348, 398, 378.... What the hell?

We looked at her new infusion site. She had just changed it to the front of her thigh, where some folks had told her she might be more comfortable. Everything was connected. She gave herself bolus after bolus with no visible result. Her blood sugar wasn't going up, at least. We checked, but there was no leak in the tubing.

I thought that maybe the cannula was kinked, delivering some of the insulin, but not all. We decided to switch her infusion site. M took an injection of Humalog using her insulin pen. In an hour her bg was 118.

Phew!

M chose to put the new infusion set on the back of her arm so that her belly could get a rest.

Later that day, she ripped it out while doing some yard work.

Ugh.

Insurance only covers one new infusion set for every three days. Now we will have gone through three in one day.

Super.

M put a new infusion set in the back of her arm. Things are better, but we are still readjusting her basal rates back up. Right now, we have her at 1.35 during the day, and 1.15 at night. Her bg is still in the 200s for the most part.

I am sure that not sleeping through the night isn't helping, but this pump is making me mad.

Evidently, I had some unrealistic expectation that perhaps M's insulin doses would start making sense to me. That maybe we would have better control of her bg.

Right now the control has seemed worse.

I am also sure that it's not the pump's fault. I am sure that I am doing something wrong. Or maybe I am not patient enough.

All I know is that we haven't even paid for the damned thing, and I am ready to send it back.

I am waiting for M to look like those happy people on the cover of the package that we were given, instead of bewildered about her bg levels.

It can't happen fast enough.

Bewildered parent and/or diabetic child.

Midnight to three

This whole checking M's bg throughout the night is not fun. I chose to have kids young so that I wouldn't have to suffer the inconvenience of having my sleep disturbed at this age. We older folks need our sleep, man!

In fact, I am one of those cruel friends who mocks those who are cranking out babies in their forties. "Ha ha! I've got one out of the house already! You're going to be sixty before that happens, and I'll be kid-free, sleeping in on Saturdays, and going out without having to worry about where the kids are! Nanny, nanny, boo-boo!"

My kind-hearted friends never say, "Well, ha ha! Your kid has diabetes, and parenting is a lot more complicated for you than it is for us!"

Then again, maybe they don't say that because they sense it's not true. Parenting is complicated no matter what.

Regardless, my sleep is being disturbed.

But it is essential.

On the day M started "live" on the pump, she was given a basal rate of 1.35 units per hour of Humalog to start. After checking her bg throughout the night, and having it consistently below target range (55 mg/dl and 68), our DNE decided to lower her rate to 1.25 units.

We decided to keep it that rate through the weekend, but I suspect we will lower it again, at least at night. Her bg is in the 50s nearly 100% of the time. Which means that I am feeding her small amounts of fast-acting carbs in the middle of the night. Which is a little weird, but is better than her passing out.

She has never lost consciousness due to her diabetes - a record I intend to keep.

The first night was hard. I couldn't sleep after the midnight check. We didn't prepare well. The meter was downstairs, so after waking M, at 12:00 am, I had to go retrieve it.

Her bg was low, so I had to go back downstairs to the fridge to find some quick carbs. I settled on grapes, since M's mouth still hurt from recent adjustment of her braces. I had to wash them and bring them upstairs.

M didn't really wake up through the whole process. She kept telling me that she didn't need to eat, because she was fine. I sat and watched her eat the grapes, recorded the information on a form, and went back to bed, where I did not sleep.

The alarm then went off at 3:00 am, and I stumbled back upstairs, where the meter was still sitting. Bg was still low this time, so another handful of grapes from the kitchen, and we were all set.

I flopped back into bed, where I fell asleep pretty quickly, only to have the alarm go off at 5:30 am so I could go to work.

Let's be forgiving of the tired teacher by saying that my students "suffered a little" due to my lack of sleep.

Fortunately, each night since has gotten better. We have been laying things out before going to bed. And because it is becoming a routine, I am sleeping solidly between checks.

So, evidently, I am pretty adaptable. Maybe I could have had my kids later in life. But then I couldn't mock my friends.

And after all, what are friends for?

Pump Visit Number Four: LIVE

We are home now, after a long drive to and from Children's Hospital.

When we scheduled M's insulin pump appointment, we were informed that it was a very special appointment that could only be made on Wednesdays at 8:00 am. This means leaving the house at 6:00 am, but M thinks that it is worth it.

We receive a phone call two days before the appointment that assumes we are slightly less than "all there". We are told to bring a list of items that a diabetic would typically find elementary. While I understand that the nurses at the hospital often have to deal with inept people, I find the list mildly insulting.

Bring:
1) insulin (mentioned twice)
2) the pump (!)
3) an infusion set
4) a reservoir
5) the bg meter
6) a bottle of chardonnay (I am just kidding about that one)

The night before the appointment, we gather all of the needed supplies into a JDRF backpack, and go to bed a little early.

The drive to Children's was trafficky and long, due to a lot of rain, but we arrived safely and on time.

The visit itself was a piece of cake. The DNE reviewed everything that the pump rep had told us last week. May played with more screens, and created her settings for trial and error with the pump.

One interesting fact. She had taken her Lantus the night before. Being that it is a long-lasting insulin, it was still in her system. So how do we make sure that she doesn't get a double dose of insulin? After all, the pump is supposed to feed M a basal rate of 1.35 units per hour. Wouldn't that make her dangerously low?

We learn to set the pump for a temporary basal rate of 0 units per hour for the next 12 hours. Then we start her on her new basal rate tonight.

Sleepless nights are coming again. M has to check her bg at midnight and 3:00 am. Which means I have to get up and check M's bg at midnight and 3:00 am. She will also need to check it before eating, and two hours after eating for the next week or two. Lots of finger sticking, but all for a good cause.

M felt good leaving the office. We began the long, rainy drive back home. Then M got hungry. We stopped at the healthiest place nearby: a Hess station. I got gas for the car, and raided their ice cream selection. I needed something relatively soft. Not only does M have diabetes, but she also has braces.  Which were adjusted yesterday. So her mouth hurt.

Ice cream sandwich: 43 carbs. No. Ben and Jerry's single serve: 29 carbs. Much better.

M smiles as she receives her tiny little gift, with a tiny little spoon in the lid.

Then it hits me. She only has to enter the number 29 into her pump, and BOOM, it's all calculated and dosed. Her first pump-injected insulin is coursing through her system.

This might make life a little easier after all.

Are we live? YEAH!

The Deal

You know,  once we've become parents, we've signed up for "The Deal".

The deal that says we will do everything in our power to protect our offspring and bring them forth to a healthy, productive adulthood.

I signed up for this deal. I signed up willingly. Eagerly, even. I enjoy being a parent, and hope that my guidance will provide my children with what they need. I try really hard to do justice to the deal. I nursed them, I held them, I scolded them, I advised them.

Things seemed to be going along swimmingly. My kids arrived, composed of good raw material, and I didn't mess them up.

At least not too much.

Then this whole big monkey wrench called diabetes came into the mix.

Now just one second. I don't remember signing up for THIS deal! In THIS deal, I have to watch what my daughter eats like a hawk. She gets pretty snippy about it, too.

In THIS deal, I have to make sure that my teenager isn't falsifying records so that I won't worry about her, because "she can handle it."

In THIS deal, I have to become one of THOSE parents, who needs to make party hosts, coaches, and teachers aware of a condition that makes my gorgeous, intelligent, funny daughter less than perfect. I have to work hard not to wax dramatic by pointing out that it is life-threatening. Even though it IS life threatening.

In THIS deal, I have to let her go deal with it herself, or else she will NEVER be able to do it on her own. If I don't let her make mistakes now, how will she handle life in college? The dating world? The bakery?

In THIS deal, I have to wonder which mistakes she makes are acceptable, and which ones might kill her, and then somehow make her understand the difference, when maybe I am not entirely sure myself.

I am not fond of THIS deal. No siree, Bob.

I am not sure who in the universe thought I would be equipped for THIS deal. I would like to give that committee a piece of my mind.

Because you know what? Even if I deserve THIS deal. My daughter, most certainly does not.

Pump Visit Number Three: Noisy Tamagotchi

I am not sure how much this episode can be considered a pump visit, but since it involves further education regarding the insulin pump, I decided that it counts.

We have a pump educator come to us to start M on saline.

The pump educator works for the pump company, and tells us that we will want to go to see the DNE in about a week to see how we are doing, and hopefully to get M on the pump "live". In the meantime, where do we live so that she can come to our home to train us and get M started?

We live nowhere near anything.

I ask the nice representative where she is coming from. It is nearly one and a half hours from my home, but a mere 45 minutes from where I work. I ask her if she would like to meet us around 3:00 pm at M's school. I assume that this will be okay with the administrator.

The representative agrees, and the appointment is set for a couple of days away.

We all arrive at the school and set up at a round table in the administrative area of the building. M has brought her infusion set, her reservoir, her bg meter, test strips, and, of course, the pump itself, all stocked up with fresh batteries.

We go through diabetes 101 again, and then the pump rep shows M all of the cool safety features, many of which I had read about.

I think that the pump sounds like a really expensive Tamagotchi. If you don't do something to it on a regular basis, it starts beeping at you. Don't touch it for twelve hours, and an alarm sounds, because it thinks you are in a coma and you need someone to help you.

After all of that, M uses the reservoir to draw out the saline from the vial that the rep gives her. Then she makes sure that the little screw that pushes the insulin out of the reservoir is rewound to the start position. M attaches the infusion set to the reservoir, and the rep realizes that she is our of alcohol swabs.

"They were recalled this week, and I forgot to put new ones in my bag."

Recalled alcohol swabs? Really? I guess the medical profession can't be too careful in our litigious society!

M pokes the infusion set into her body, and she's good to go.

Throughout the training, various people stop to sit and watch, or stand and ask questions. These people include teachers, the principal, and students. Everyone wants to know how M's new toy works, and how it will make her life easier.

M and I found this behavior perfectly normal. Supportive, even. The pump rep had to be put at ease. "Don't worry," I tell her, "This is like our family here." I realized that she may have been concerned about HIPAA, but in reality, these people need to know what all this stuff is on M's body, and what to expect.

So, with a quick quiz at the end of out one and a half hour visit, M is using the pump to calculate carbs, do phantom boluses, and pretend to cover bg highs. All using the miracle of saline.

In another week, she will be using the pump without a net.

At least the batteries for the pump are easier to find than the batteries for this little fella!

The Pump arrives

The pump has arrived!

Since such an expensive piece of equipment requires a signature upon delivery, we opted to have it delivered to M's school. One can never predict when one will be home, but the owners of M's school not only own it, but also occupy the upstairs. Someone is nearly always there.

I received the phone call from Wanda, the school's director, letting me know that the pump has arrived, and that I can pick it up at my convenience.

My husband Bill and I take a drive to the school to pick up the pump. I bribe him to come along by telling him that we can look at motorcycles - an annual spring ritual that sometimes ends up with us actually buying a motorcycle. Being a good husband and father, Bill has sold his last motorcycle when M was diagnosed, so that we could pay her medical bills. The previous one he sold so that we could pay Big Brother's tuition. It's probably about time to get another one.

Bill agrees, and we take the half hour drive to the school to pick up the pump. We nervously leave it in the car while we browse the motorcycle selection. We look at stupid bikes, ugly bikes, and nice bikes. Then we leave so that M can view her new pump.

When she climbs into the car and sees the box, she makes little happy squirrel noises. She wants to rip the box open right then, but we ask her to wait until we get home.

We tear open the box immediately.

Inside is the pump ( a Medtronic Revel), a lot of manuals, a HIPAA policy, four boxes of infusion sets, four boxes of reservoirs, four AAA batteries, a One Touch Ultra Link glucose monitor, and a USB stick.

I had been told by the area rep for the pump company that M would be okay if she wanted to start pressing buttons on the pump. She wouldn't hurt it.

She pulled it out and pressed buttons, while I showed my parents what the infusion sets looked like. They had been reading up, and understood how they worked. I didn't have to explain that the infusion set is not surgically implanted.

Then I pulled out the reservoirs. All of this equipment looked pretty confusing. I figured I would have to read all of the literature that came in the box before I understand it all.

The first booklet of literature was called "The Basics of Insulin Pump Therapy". I read through it. There was no news in there. Check bg a bunch. You will still have to take injections once in a while. Bg is affected by diet and exercise. Basal is the constant insulin, bolus is the insulin you take to cover food that enters your body or to cover a spike in bg. Lows are caused by insulin. This was diabetes 101.

I figured I would learn more in the next booklet, "A Step-By-Step Guide to the Minimed Paradigm REAL-Time Insulin Pump." On page four, I found a diagram of the pump and all its parts and functions.

This helped a lot.

Now I understood what all this other stuff did.

Evidently, we were going to go back to purchasing vials of Humalog, instead of the cartridges that we had been buying for M's super cool insulin pen. The reservoir has a little plunger on it that sucks the insulin out of the vial for easy storage in the pump. According to the information in the booklet, the reservoir should hold about two or three days worth of insulin.

The screens and buttons on the pump can be locked or protected.

There is an airport card that can be given at airport security so that you don't have to remove your pump when you go through screening.

The bg meter will communicate with the pump, which will help it to calculate which dose you should give yourself, but will not administer the insulin until you tell it to.

Cold insulin tends to form air bubbles in the reservoir and the tubing, so it is better to fill your reservoir with insulin that is at room temperature.

There are "alarms" on the pump for empty reservoir, weak battery, failed battery test, and no delivery.

There are "alerts" for low battery and low reservoir.

M has been playing with the buttons. She has put the correct time and date on her meter. She has been wearing it, even though it is not attached to her body yet. She can't wait to show it off.

Now we wait for the trainer to call us to schedule M's "saline start", her week long practice with the pump using saline ( "It's like salt water" she told her grandparents.)

I can hardly wait to learn more about diabetes management with the pump: something I never thought I would have to know, nor did I intend to know anything about.

Flexible Spending

I think I have written before about the glories of the Flexible Spending Account.

I love having one. The Flexible Spending Account, or FSA, is not the same as a Health Savings Account, or HSA.

The FSA was first introduced in the 1970s, but being that I was under 12 at that time, I was not aware of it or its benefits. It seems to have increased in popularity lately, because health care costs have been increasing. Or maybe now that I know what it is, I hear a lot more about it. I remember hearing about FSAs for the first time during the Clinton administration on Good Morning America, but at the time my husband was a student, and I worked in a private school, neither of which offered any kind of benefit package.

Basically, an FSA is a benefit that employers can offer employees, along with 401(k)s, disability, and life insurance. You agree to have a preset amount removed from your paycheck, before taxes. This money is then set aside for pre-approved purposes, like health spending or dependent care. You could use this money for any health care items that are not covered by your insurance. Your deductibles, your prescriptions, chiropractor visits, and medical equipment could all be purchased with the money in your account. Since the account is pre-tax dollars, you will not pay taxes on the medical expenses paid out from your account.

What I like best, however, is that for those of us living somewhat close to the bone, when an unexpected expense comes up, you know that you can pay for it, because the money is already set aside.

There are two disadvantages, however.

One is that you must pay your expense out of your own pocket first, then be reimbursed by the company who manages your account. This can be tough when you are, for example, buying durable medical equipment like an insulin pump. Maybe you can't come up with the $1600 up front. In these situations, many people put the equipment on their credit card, then pay off the expense when their reimbursement check arrives. I have heard that some plans offer debit cards with a preset amount on them, but I have yet to meet anyone with one of those. I would LOVE one. It sure would be more convenient.

The second, which infuriates a lot of people, is that you must use all of the money that is set aside in your account by the end of the year. Actually, there is a two month grace period, as long as the EXPENSES occur during the year during which the funds are set aside. If you do no use all of your money, it goes away. In other words, it is forfeited back to your insurance company. Which makes sense, since we know how broke all of our insurance companies are, poor babies. I remember hearing on that Good Morning America episode about how it is important to set aside only the money you know that you will use. In other words, low-ball it.

My first real encounter with the FSA was quite by accident. My husband was working at a company that did offer the plan, but I didn't pay attention to it. Then one year, my husband's paycheck seemed suddenly much larger. When I looked at the previous year's pay stubs, I saw that we were having about $150 per pay period taken out for something I couldn't identify. When I called HR, they explained that we had signed up for the FSA, and that these deductions were going into our account.

Well, no we hadn't. The HR department at his employer made the Keystone Cops look like the Navy Seals. I am sure some incompetent boob put our money aside and left the next person in the alphabet alone, wondering why he had no FSA.

I know when not to pick a fight, however. Instead of railing against incompetence, I asked the nice lady on the phone if there was any way to get our money from last year back. The woman sighed loudly in anticipation of actual work. Then she explained, through what sounded like gritted teeth, that we couldn't, unless we could a) find receipts for $3600 worth of medical expenses that we paid AND b) that those expenses had occurred during the previous year. If, and ONLY if, we could do that, could we c) submit the expenses, using the proper forms, before March 1st.

$3600 is a great motivator. And besides, Older Brother had recently gotten braces. I needed only to ask the orthodontist to print out a receipt to get my money back. Which I did. So HA! In your face HR people!

After that, we began actively using FSAs whenever they were offered. Back then eyeglasses were covered (they are not now, thanks to the new health care legislation), so we set aside about $1000 per year.

The year M was diagnosed, we had set aside $3500 for braces. We were a little bummed when the orthodontist told us that she wouldn't be ready for braces for another 18 months. We thought we wouldn't be able to use up all of our money and would lose it.

But she was diagnosed. And we used it, and thousands of dollars beyond. Her second year of diagnosis, we set aside $4000. We used it easily. Now we are setting aside the limit that is allowed starting in 2013, $2500.

So paying for M's pump will be a little easier than it would be otherwise. Which means that she can have a pump sooner. And she can control her bg even better. And she can be healthier.

Which is why, even though it is not perfect, I love my FSA.

That's the name of the game!

Answer to: How much does an insulin pump cost?

The pump costs $6,500
After insurance, it costs us $1,586

There is no discount for paying the full price up front.
There are payment plans that charge you $5 per month to be on them.
The lowest monthly payment is about $55 for 35 months.

I pay the final payment on college tuition for the older child next month.

I will pay the pump people the full amount them.

Thank God for our FSA.

Sick

Tap, tap, tap "I puked."

It was three in the morning, but M was outside my bedroom door, and I had to spring into action. The first thing I ask is, "What day is this, Sunday?" She tells me it's Tuesday. Now I know I have to call in for a substitute.

I remembered that nearly two years ago, when M was diagnosed with Type 1, we were told that vomiting is very serious business that could lead to hospitalization. This was the first time in those two years that we have had to face this problem.

I remembered nothing. Oddly enough, when M and I went down to Children's Hospital for her infusion set appointment, I went out of my way to grab a pamphlet on sick day management. But where was it? Where was all the information I was given two years ago?

Braaaack

Okay, now that's twice. I am glad this child knows how to get all the way to the toilet.

She wasn't feeling better after vomiting, which is not a good sign. I mean, I usually feel fantastic after throwing up. It must be that rush of adrenaline...

BRaaaack.

Three times in less than half an hour. This is going to be a long night.

Okay, so a loss of glucose from vomiting can mean a drop in blood glucose (bg). We had better monitor this. We pull out the monitor, and with a comforting beeDEEP, we are advised that M's bg is 161. I think that's good, because it leaves us a safety net of about 80 mg/dl.

She vomits again. We test again. 172.

Again. test again, 162.

M continues to vomit every 15 to 20 minutes. It is 4:00. At this point I have pulled an extra mattress into her room, written up sub plans for my Spanish class, brought M a glass of water, and brought up enough test strips to supply a battalion for a week.

I doze between vomits. So does M. After a while I realize that a) I must call the substitute coordinator, and b) testing M's bg every 15 minutes might be excessive. I decide we will test every other time she vomits. I have a sheet of scrap paper with a long list of times that M has vomited. Next to it is the bg level.

The sub coordinator at my school is an excellent human being. He knows that I am never sick. He knows that if I will be out, I will leave plans. He know that I feel guilty if I screw something up. He understands me, because he, too, suffers from Catholic Guilt. When I call him, he gives me no indication that this is a bad time (which, I soon discover, it really was). He just says, "Okay, thanks for calling."

Having handled the school situation as best I can, I devote some time between vomiting episodes to trying to find that information about sick day management. Being that my brain is addled and I am exhausted, this is no easy task.

Two years ago, my mother had put together a binder with M when she was first diagnosed. It helped both of them to organize the information that M had, and made them both feel better empowered and informed. I locate the binder, but there is no sick day management sheet.

I look in the car, hoping I had wedged the guidelines I had taken from our last appointment in between the front seats  on my way back from Children's.

Nope.

I go back to the binder. BRaaaaack.

M's bg is 126. I bring up a Coke and ask her to take two sips. M's target is 110. 126 feels a little too close for comfort. I want wiggle room, baby!

Okay, binder. Now, let's look through each individual sheet.

I look. The only information I get is from the test strip company, that says "When to contact your doctor". Vomiting is at the top of the list.

Fine. I vow to call the doctor once office hours begin.

At 9:00 am I call the DNE, who is not in today, would I like to speak to the endocrinologist? As I wait on hold, my anxiety increases. I felt like I was fine before now, but the haste with which the operator referred me to someone else makes me nervous.

I speak to M's doctor, who tells me to watch her Ketones. Damn! I forgot about those things! M hasn't has a high enough bg to warrant checking them in a while. If the Ketones are higher than 2, Dr advises us to go to the hospital.

Now where are those Ketone test strips? M says that she doesn't know, and I sure as hell don't. I find the urine strips, but not the nice blood strips for her monitor. Hopefully she will be hydrated enough to pee. I have been forcing her to drink two sips of water every time she vomits.

I run up to her room with the urine strip. She is asleep. Sound asleep. For the first time in 7 hours, she looks comfortable. I choose to leave her alone.

After two hours she awakens. I explain about the Ketones. She says she can pee. She does, but then she gets upset. The Ketone strip indicates a 5 or a trace amount. She says, "Should I pack for the hospital?"

I tell her to hold on, I will telephone the DNE on call for the day and ask. I think "trace" doesn't sound that bad....

Before I get downstairs, the phone rings. It is Dr. She asks about M. I tell her about the trace. She tells me, "Trace is fine. Stay home. Why don't you phone the DNE on call, and fill her in, just so we have a baseline in case something else develops."

M doesn't feel like vomiting any more. The final score: her bg ranged from 126 to 202. I feel like congratulating myself. When I talk to the DNE, she does. "Good job!" she says.

She then advises me to allow M to stay a little high in her bg range over the next day or two. Also, reduce her Lantus by about 20% for tonight. After all, she has no stores on which to draw. Keep pushing liquids. Maybe see if she will eat some broth or something.

Phew! We made it through our first test.

Now for the big question: Will sick day management be easier on the pump?

Boo on being sick. Double Boo on being sick with diabetes.