100 grams: diabetic in Europe

It must be harder to be diabetic in Europe. If anyone knows if this is true or not, I would like to hear from them.

 You see, here in the US our food and nutrition labels, with which I am alarmingly familiar, identify what a serving size is. Then the information on the label is based on the serving size.

People here complain  about the "everyday American" not being able to understand our system of labeling, and have been messing around with what constitutes a "real" serving size. There have been, in the past, ways for companies to insist that their product is low in calories. They would say: "Less than 100 calories per serving!" on the package. Careful reading of the label, however, might reveal that a small candy bar was to be considered 3 servings.

Such misleading labels don't matter much to a diabetic, however, as carefully reading the label is part and parcel of the relationship with your malfunctioning pancreas.

One bag of King-sized M&Ms for example, has two servings per package(who are we kidding? this is America!), meaning that a serving is about 47 M&Ms (you can thank me for my dedication to research on this one)  Each serving has 32 carbs, which means that if M eats a whole bag of King Sized M&Ms, then she had better bolus for 64 carbs, (more than a typical meal at our house).

Even though this requires a lot of math, it's pretty straightforward.

Eat this serving, calculate for this many carbs.

In Europe, I visited supermarkets and duty-free shops in Spain, Paris and Amsterdam (just the airports for the last two).

The nutrition labels there are probably "simplified" from one perspective. They use the same unit of measurement for every "serving": 100 grams.

In other words, if you buy crackers, the label will tell you how many carbs are in 100 grams of crackers. If you buy peanuts, it will tell you how many carbs are in 100 grams of peanuts.

This is probably great if you are trying to compare how many carbs are in different items (thus learning what actually is low in carbs), but what about for calculating your insulin doses?

Do people in Europe weigh out their food and calculate how many carbs are in it, and then bolus?

Let's say I want to eat a pork chop, some mashed potatoes, and some asparagus (not very European, is it?)

100 grams of pork chop = 0 carbs. Easy.
100 grams of mashed potatoes is 21 carbs
100 grams of asparagus is 4 carbs.

Now here is the problem. After you weigh your food, you eat one pork chop at 150 grams, 138 grams of potatoes, and 68 grams of asparagus. So you have to do this:

grams of food
divided by 100 grams
times the number of carbs per 100 grams

So for this meal:

(150/100 x 0) +(138/100 x 21) + (68/100 x 4) = your carb amount.

So reducing this problem becomes:

0 + 28.98 + 2.72 = 31.7 carbs

Maybe, like with calculating for carbs at all, doing this becomes easier with practice. Maybe you get to know what 100 grams of Marmite looks like compared to 100 grams of chorizo,  and you just sort of calculate it all in your head. Or maybe you only eat in 100 gram increments.

I don't know. But I am pretty sure that I won't be complaining about our nutrition labels in the US any time soon.

Phew! 100 grams for easy calculation!

A simple childhood, and other things left behind

M was diagnosed on April 15, 2009. Our first real trip together as a D-family was that summer. Older brother was looking at colleges in California, and we committed to visiting friends, renting a car, and checking out the Four Corners area.

I thoroughly researched the JDRF website, looking for helpful tips about traveling with diabetes: airline requirements, changing time zones, transporting insulin, etc. Upon our arrival in San Diego, we found our warm and loving friends, who let us rest a bit, and then squired us around what they call "Old Town".

M was a bit groggy from a day of traveling, and seemed to be faltering as we climbed the stairs to a Mexican restaurant that our friends frequented. M whined that she wasn't hungry, but I figured that since her energy was low, sitting down in a pleasant atmosphere might not be the worst thing she could do.

Once seated, I asked her to check her bg.

It was 47 mg/dl.

In a panic, M began chowing down on the complementary nachos. I remember that day as being the first that M looked really scared since she had been diagnosed.

A 47 wouldn't scare us a much now, since we have seen her bg range from 22 to 525 over the past two+ years. But it didn't bode well for our travel experiences.

Sometimes we are right on, and everything goes great.

But more often, some minor disaster occurs that necessitates the summoning of my inner MacGyver.

Case in point: last year's trip to Manomet.

M had packed her belongings carefully, and checked the contents of her fashionable diabetes fanny pack twice.

We loaded the car, and about a half hour into the drive, I asked M if she remembered her "diabetes stuff". She assured me that she had. Since this is a near-daily interaction, I was neither concerned nor suspicious that she had not remembered everything.

Two hours later, at the beach, M wanted to eat some lunch. She looked for her fanny pack, so that she could check her blood sugar and make all of the necessary calculations, but couldn't find it in her room. We decided that it must be in the car. She searched. I searched. No fanny pack.

Being a mom, I searched every inch of luggage, beach equipment, and rolled-up towel that we had. M decided that she must have left the fanny pack right where she keeps it at home: next to her seat at the dining room table.

This was a major bummer. First of all, she was on the Luxura pen at the time. The pen was at home. As was her bg meter, Sweet Tarts, glucagon kit, and test strips.

The good news was that she had packed some extra supplies in her suitcase and the cooler.

We took inventory: test strips, extra Humalog cartridges for the pen, a vial of Lantus, 10 syringes, a half box of pen needles.

Hmmm, how could we make this work? We had no way to test M's bg, and no way to administer the fast-acting Humalog for meals.

M did have an appointment at Children's Hospital in a few days. Was there something we could do until then?

I called the diabetes hotline at the hospital.

Me: "Uh, Duuuhhh. I am an idiot mother who didn't verify the presence of my daughter's diabetes stuff when we left for vacation. Any suggestions?"

The hotline nurse was super helpful, and didn't even hint that I was a completely disorganized bag of moronhood.

I gave her my inventory list, and explained our financial limitations.

The plan became this:

1) Buy a new meter (cost: about $19).
2) Use the syringes to CAREFULLY remove the Humalog from the Luxura pen cartridges.
3) Inject insulin as needed.
4) At our appointment, request a new sample of a Luxura pen.
5) Resume life as if nothing had happened.

Considering that the alternative was driving home and back (a total of 5 hours), or missing our vacation, the proposed solution brought tears of relief to my eyes.

When we went to our appointment that week, our DNE scolded us mildly, and reminded us that using a pen cartridge in such a manner was less than ideal (apparently the cartridges are very fragile), but was in good cheer when she saw that we kept M's bg in check.

This year's Manomet trip was also fun. Especially since, being an emerging adult, M was very self-conscious about making any mistakes.

In addition to guessing what her blood glucose reading might be, we had the additional challenge, unbeknownst to me, of not having enough insulin or test strips.

M revealed her secret when she could no longer keep it: the day her insulin would run out (also the day that I learned that she was not testing her bg levels).

The solution was two-pronged.

I made some calls to the local pharmacy, who transferred M's Humalog prescription to Manomet.

We used the old meter that M had packed with her corresponding test strips as a back-up. This meter did not automatically communicate with her pump. She tested her bg on that meter and plugged in the numbers necessary on her pump.

It wasn't until she reminded me about last year, that I understood her trepidation about sharing her mistake.

She said to me, "Mom, maybe YOU should pack my diabetes stuff for me."

But she's not getting off that easy.

I said, "No, but the next time you go away, I will double check that you packed what you think you packed. As a young adult, you need to pack it yourself."

M nodded in agreement, and the rest of the car ride went smoothly.

She is going away on a Catholic retreat this weekend. She has already made her D-list.

She has checked it twice. And so have I.

 

And a whole bunch of diabetes stuff....

Snowed

Have you ever avoided looking at your bank statement?

Most of us at one time or another (not you, Mom!) have been aware that our bank statement would only provide us with the bad news that we already knew - that we didn't have enough money in the account, and there were still bills that had to be paid, gas to be bought, and food to be picked up from the grocery store.

Rather than face reality, some of us might go ahead and buy the groceries and fill the gas tank. Then we would figure out what was left (if anything) to pay the bills.

If you are one who has had this experience, then by the end of this post you will feel a lot of sympathy for M.

When I returned from my trip to Spain, I of course asked M how her blood glucose had been while I was away. She said, "pretty good."

Not completely trusting her memory, I asked her to Carelink. The printout did indeed show some pretty good bg, especially starting a few days before my return. I was pleased and relieved that she had done so well without me.

As I was, evidently, not satisfied with leaving the country for two weeks,  I did my laundry and packed up. M and I headed to Manomet, MA for a week of fun and sun at the beach with Auntie, cousins, Nana and Papa.

There is typically a lot of tempting food with high carb counts when we go to the beach with the family. But I have always felt that M had to learn how to cope with situations where the food selection was less than ideal, rather than force her diabetes-style diet on everyone else while they are on vacation.

Despite the breakfast sandwiches, the potato chips, the candy, and the ice cream,  M reported that her bg numbers were generally in the high 100s (173, 157, 144 etc.) "Not bad," I thought. "I guess that walking-along-the-beach thing is really keeping her numbers in check."

But as a few days went by, M didn't have any bgs over 200.

I began to grow suspicious.

"When exactly was she checking her bg?"  I wondered. I wasn't seeing her do it. Was she doing it in her room so that it wouldn't bother her cousins at the dinner table? Or was she not checking it at all?

To test her reaction, I asked M to check her bg in front of me.

She checked it. Then she told me the results, but didn't show me.

I asked to see her meter so that I could see the results from the previous days. I tried to sound casual.

This is where it hit the fan.

When we asked her bg meter to "show all results", it showed only 5 readings from the past 7 days.

One of them was the one she did right in front of me.

That's right, folks. M had only checked her bg 5 times in the last 7 days! The pump manufacturer recommends a minimum of 5 tests per day.

Needless to say, this is not healthy diabetic behavior!

M tried to convince me that she had been checking her bg several times every day, that there must be something wrong with the meter.

HA!
I was a teenaged girl myself, once. Covering one's butt is high on the list of priorities when one makes a bad choice.

What I didn't know, was how, exactly, M got the Carelink readings that showed up on her printout?

I learned the answer when, later during our vacation, circumstances required that M enter her bg manually into the pump itself.

Aha! M had been estimating (aka guessing) what her bg was, then entering it into the meter so that it would administer the appropriate bolus. The printout comes directly from the pump, not the meter.

So on any given day, M might think to herself, "Hmmm. I would like a snack. I will have a cheese stick and some grapes. That's about ten carbs. And I feel fine, so I'll enter 143 for bg levels and take whatever insulin the pump decides I need."

For all of you out there in blog land, in case you didn't know, this is a BAD IDEA.


If you guess too high on your bg levels, you are in danger of going into a bg low, for which side effects include, shakiness, dizziness, weakness, and, oh......death.

If you guess too low on your bg, you will not get enough insulin into your system to keep you healthy. Long-term side effects include kidney problems, loss of vision, poor circulation, and, of course, death.

It was time to have a talk.

M and I had a heart to heart. It included my understanding how it feels not to be in control of your life; to be tired of knowing that you must always be thinking about your health, and not wanting to talk to your parents about it.

When we returned home, I let Bill know that we had been snowed. We had pulled back from our responsibility, and allowed M to monitor things herself. In pulling back, we allowed M's choices to go unchecked for a couple of weeks. Now it was time to bring down the hammer. Sympathy and empathy aside, M's health is too important for us to let it go.

Accepting our decision, and our sense of urgency, M has had a (probably temporary) turn around. Her attitude its better, and she is checking her bg 6 times per day. It is too high, but now that we know truly what we are up against, we can put together a plan of action.

Together.

Not anymore, M. But it was a nice try.

Killjoy

So the first thing I want to say before I tell this story is that diabetes is the killjoy here. Not Auntie Jeanne.

As a Spanish teacher, it is wise for me to periodically visit a Spanish-speaking country so that I can keep my knowledge fresh and up to date. This year, I went.

Which meant that, since Daddy has to work all day, M was to be left to her own devices for 11 days.

Auntie Jeanne saw the opportunity to spend some quality time with her goddaughter and seized it. The two of them chose to go zip-lining and generally hang out for a couple of days.

Now Auntie Jeanne is a medical professional, and has been asking me good questions about M's diabetes from the start. She files this information away for future use.

But then it comes back to haunt her.

Things that Auntie Jeanne remembers include:

1) M does not do as well managing her diabetes on the road as she does at home
2) M needs frequent snacks when doing physical activity
and for carb absorption:
3) Foods with fat and sugar in them are better than foods with just sugar in them

After a long day of swimming and running around, M informs Auntie Jeanne that she is hungry and would like a snack [2) M needs frequent snacks when doing physical activity]. She states that she would like some ice cream [3) Foods with fat and sugar in them are better than foods with just sugar in them]. Auntie Jeanne agrees and decides to take her to the local ice creamery for what she anticipates will be a small dish of ice cream.

When they arrive at the the ice creamery, M peruses the menu and decides that perhaps she would like a hot fudge sundae. "Uh-oh", Auntie Jeanne thinks, "3) Foods with fat and sugar in them are better than foods with just sugar in them."

But as M continues down the menu, she decides that she will have a milkshake. "Hmm," thinks Auntie Jeanne. "That's more ice cream than I'd like to see her have, but 3) Foods with fat and sugar in them are better than foods with just sugar in them."

As they continue to wait in line, M declares that she would like to have a malted milkshake.

Now up until this point, all of Auntie Jeanne's misgivings have gone unspoken. She is the fun Auntie. The one who lets M do stuff she doesn't always get to do at home. Sometimes "stuff she doesn't do at home" includes extravagant food choices, such as having shrimp for breakfast, lunch, and dinner.

But the word MALTED catches Auntie Jeanne's attention. She thinks, "What is malt, exactly? And why does M want it?"

So she breaks her silence and asks, "So what is malt?"

M says, "It's a thickener. It makes the shake taste really yummy."

Jeanne's brain processes this information. It seems to her that malt is some kind of grain, which means added carbs, which means that the rule of small numbers is likely to be broken, which means that M's bg could become pretty high, because 1) M does not do as well managing her diabetes on the road as she does at home.

Auntie Jeanne thinks about this to herself, and makes no comment to M. After all, M is supposed to be having fun. On the other hand, Auntie Jeanne is responsible for M's general health while M is in her care. On the other hand again, M is a surly teenager, and at times grows frustrated when others tell her how to manage her diabetes.

Auntie Jeanne hems and haws about whether to let M know about her concerns.

M interrupts Auntie Jeanne's thoughts. "Do you think I should get the malted milkshake, or just a regular milkshake?"

Auntie Jeanne, relieved, says, "Well, since you brought it up.... I think you should have the regular milkshake, because I think it will be lower in carbs."

M looks at Auntie Jeanne and sighs. "Yeaaahhh. I know." She sighs again.

Auntie Jeanne, feeling badly, says, "Sorry, but somebody has to be the killjoy ."

M says, "Yeah, I have a lot of those in my life."

No, M.

A lot of people have those in their lives. But you have a super-extra-annoying one, that most kids don't. While some girls your age forgo the malted milkshake to avoid packing on extra pounds, you have to do it to keep yourself from getting sick.

Good for you for recognizing the smart thing to do.

Good for you for asking Auntie Jeanne to verify what you already knew.

And good for you for making the better choice.

And nobody is sorrier that you had to make that choice than I am.

Except maybe Auntie Jeanne.

Diabetes: the ultimate killjoy.

A malted milkshake, hold the malt.

Flying solo

M made her first no-joke solo travel attempt this week. She had to fly from Indiana to our New England state all by her little lonesome.

Once her flight took off, I received a call from her grandmother.

"She's on her way!" she said, cheerily.

"How was security?" I asked. After all, not only was this M's first solo flight, it was also her first flight with a pump. I remember being behind someone with a dialysis machine at airport security right after 9/11. Needless to say the experience was less than pleasant for all involved.

"It seemed fine. We could have escorted her to the gate, but she said that she could do it herself, so we watched her go through security, and it seemed to go just fine."

Well, this sounded like good news. When M received her pump, she also received a medical device card that says, "I am wearing a required medical device prescribed by my physician" and includes general information about what to do if she acts peculiar.

Just what constitutes "not peculiar" for a teenaged girl, I would like to know.

After a few hours, I went our local airport to retrieve M. Aside from looking about a foot taller (a common side effect of gaining valuable life experience), she looked great.

I asked her about airport security.

She said it was fine.

She didn't have to remove the pump. She did have to go through the metal detector. Then she had to have her hands swabbed with a cotton ball. The cotton ball was then tested, presumably for explosives, and she was sent on her merry way.

She thought that whole thing with the cotton ball was weird, and nobody explained it to her until I gave her my theory at home.

But it sounds like the TSA gets the whole insulin pump thing, which made M's life easier and less stressful.

So, yea! My baby's home!

Who has an embarrassing mommy who loves her? You do! That's right, yes you do!