Charlie Kimball

Almost immediately after M was diagnosed with Type 1 diabetes, Bill and I learned that recently confirmed Supreme Court Justice Sonia Sotomayor also had Type 1. We were excited to be able to hold up a prominent role model with Type 1, so that M could see that, even living with Type 1, many possibilities were within her reach.

Sorry Sonia, just not cool enough for an 11-year-old. WE love you, though!

Unfortunately, M was 11 years old at the time, and a supreme court justice with Type 1 did not impress her.

Nick Jonas, on the other hand, did.

At least M notices you, Nick. Even if she prefers your brother.

She watched the Jonas Brothers TV show, and although she preferred Kevin, she admired Nick's handling of the disease. She even bought the Nick Jonas dog tags that helped support diabetic research. And she wore them almost every day.

A few months later she heard about Brett Michaels, some old 1980's rock star, who had Type 1, and she thought it was nice that he won Celebrity Apprentice and donated his winnings to the American Diabetes Association.

Live to rock, rock to live, Baby!

But this year, her father learned about a race car driver who had Type 1. Being a car guy and a mechanical engineer, he found the story of a man driving a car at over 200 miles per hour while managing his bg fascinating.

The man's name is Charlie Kimball.

"Hi, I'm Charlie Kimball!"

Now, if you think that what M goes through every day sounds like a royal pain, you should hear what a normal day at work looks like for this guy.

When she turns 16, M will have to check her bg before starting her car each and every time that she drives. This is so M can treat herself prior to operating the machine if she needs to. If she does lose consciousness, she might hit a tree, or another person/car/cat, and someone could be hurt or killed.

If Charlie has a dangerous low on an ordinary work day, he will likely do millions of dollars in damage to many cars, and most certainly injure or kill someone along the way. Charlie says that no one in the race circuits has ever expressed concerns about his diabetes. I suspect that they really don't understand the disease.

Of course, Charlie is VERY responsible and keeps a doctor on staff in the pits with him.

Instead of a water tank in the car, Charlie has a water tank AND a sugar-water tank, in case his bg slips down a little.

Well, you may be thinking, how does he know what his bg is? It's not as if he can pull over and check his bg with a lancet and some test strips. Well, Charlie has a CGM (continuous glucose monitoring device). This nifty device constantly reads bg, and indicates a trend line showing whether his bg is climbing or descending. Pretty nifty, huh? He straps the monitor to his steering wheel, and calls out his bg readings to his doctor over his headset. She then lets him know what corrective actions to take, if any.

I cannot imagine trying to drive 185 mph, two feet away from 35 other cars while managing any health problem, so my hat goes off to Charlie. Our whole family is - in the New England vernacular - "wicked impressed."

While at diabetes camp, M has heard from skiers and bicyclists who talked to campers about managing their Type 1 while pursuing their athletic dreams. This year, it was Charlie Kimball who came to speak to them.

M loved him. She said that he was interesting, kind, engaging, and that he was smart enough to know to repeat some of the quieter questions from the crowd so that everyone could hear.

As a mother, I appreciate Charlie Kimball. He has faced his diagnosis without fear, and has embraced the diabetic community. He, although diagnosed just four short years ago, has begun giving back to that community.

I wish Charlie the best of luck. Our whole family will be watching him!

504 plan

I have mentioned before that I teach in high school.

I may have also mentioned that my kids attended Montessori schools and my older son attended a Catholic high school.

I have never really had the "public school" experience before. At least not from the parenting end.

Now, as a teacher, I receive 504 plans at the beginning of every semester. These plans tell me which student needs special accommodations, eg: make sure this child doesn't eat peanut products, make sure this child is able to use the bathroom as often as he likes, please allow child to eat in classroom, etc.

Now that M is entering public high school, I realize that she probably needs a 504 plan.

The problem is this: I didn't know I was supposed to write the darn thing!

Now, don't ask me who I thought was supposed to write it. I guess I thought that some medical professional would do it. Our DNE, the school nurse, somebody else that wasn't me. Someone that know what they are doing.

Our DNE gave me a sample 504 plan, prepared by the ADA and the DREDF. The sample was lengthy (8 pages!) , and sounded punitive: "Do this or else!" - not exactly the coalition-building language I was seeking. Being a teacher myself, I found the approach of the sample a little offensive. It assumed that I couldn't be trusted to know that if a kid leaves for health management reasons, he should not be penalized.

So I did what any ambivalent parent might do: I tried to get out of writing it.

I e-mailed the guidance counselor who helped M put together her schedule, and asked if I really needed a 504 plan. After all, I reasoned in the e-mail, we interviewed the nurse before we even decided to enroll M in this school, and decided that she was capable. M is independent with her diabetes management so, aside from the occasional snack in class or walk to the nurse' office, she should be fine. Couldn't I just e-mail the teachers, explain what's going on, and talk with them like civilized human beings?

The short answer was no.

"A 504 plan is a very important legal document that protects all of the individuals involved."

I sighed, understanding that people feel better when there is a form filled out somewhere. I also understand that a 504 plan can simplify things for people new to diabetes.

But I don't wanna! It looks hard. And redundant.

I think I would be far more keen to write and implement a plan if M were a frail 6-year-old with Type 1, rather than the robust 14-year-old that she has become. She is far more independent and less distractable than many children who are younger. Also, since most people are diagnosed with diabetes as children or young adults, it makes sense that more children are diagnosed with Type 1 diabetes by the time they hit high school. As a result, I think that a lot more teachers and staff have been exposed to and understand Type 1 diabetes at the high school level.

I pondered my justifications for being a lazy butthead, and continued reading the e-mail, disappointed.

The guidance counselor indicated that the e-mail I sent him would be forwarded to M's regular guidance counselor, so that he could be in touch with me. The regular guidance counselor and I would write the 504 together.

Well today, I got an e-mail from M's regular guidance counselor. This is what it said:

We have several students in the school who have diabetes and other medical issues. They are managed by the school nurse- in my opinion - extremely well. All teachers are notified and the nurse develops a close relationship with the student with daily check-ins as needed. This is available without a 504 plan.

Of course as a parent you have a right to a 504 plan if you would like. I guess I would suggest that maybe we start off without one and see how things go. We can always develop a 504 plan at any time should any party feel it necessary.

Let me know how you would like to proceed or if you would like to come in and meet me.

And I think, "YES!"

Believing that my laziness has paid off, I triumphantly shoot the regular guidance counselor an e-mail, telling him that I think that the "wait and see" approach is a great idea.


But then I realize that laziness is not going to happen. I have decided that I will print up a diabetic cheat sheet for M's teachers, like I did for her coaches, and give them my contact information in case they have any questions.

I comfort myself with the thought that it will probably take less time to write than the 504. And hopefully the language will not be punitive.

And then we'll wait and see. 

Of course, we still have about 20 other forms to fill out!

Cheat sheet

To: Coaches X and Y

From: Annoying mother

Re: My diabetic kid

There is a lot of information about Type 1 diabetes out there. If you are curious, you may check out these websites:

www.jdrf.org

www.diabetes.org

But here is the stuff you really need to know about My diabetic kid.

1)   M treats her diabetes by using an infusion pump, which can be removed. The pump is a remarkable machine that helps M calculate how much insulin she needs and administers it through a tube into the fatty layer just below the skin.

2)   There are blood sugar (bg) highs and lows. An average person’s bg is between 80 and 100. M checks her bg with another machine, called a blood glucose meter. She will prick her finger to get a drop of blood and apply it to a strip. The meter will tell her what her bg is in about 5 seconds. She will test her bg immediately before and immediately after a game or a practice.

3)   I am not as worried about bg highs.

Bg highs tend to cause long-term complications. When you hear about someone going blind, or having their foot amputated due to diabetes, it is generally caused by unchecked bg highs.

In diabetes world, anything over 200 is high. 350 is considered serious, over 400 is ridiculously high. If M checks her bg levels right before a game, and immediately after, she will not have time to have her bg climb that high. It takes several hours for a bg to climb to what we would consider a dangerous level.

SYMPTOMS OF A HIGH: Extreme irrational crankiness. Have her check her bg and treat as necessary She can do this independently, but a bg high is like serious PMS: You think you are upset for a valid reason. A quick 5 second bg check can put everyone at ease.

4)   Bg lows are more serious, and more likely to happen during a game.

M will try to snack before every game, and enter every game or practice with a slightly higher bg, because her bg tends to go down when she exercises.

Treatment for a low is candy. M will keep a stockpile of Smarties with her equipment, just in case. When her bg is low, a really sugary (in diabetes language – fast acting carb) treat will make her feel better within about 20 minutes. These include Smarties, and fully sugared soda, like Coke, or juice.

A low bg is under 70. Since she is exercising, she will need to eat something before it gets more dangerous ( in the 50s is considered dangerous, although she once hit 22 and revived herself by eating candy and checking her bg every 10 minutes)

M easily recognizes when she is going low. She will give you a signal that she needs to be benched, will check her bg, and give herself the appropriate treatment. She should communicate to you how long she will need to sit. Some days it is ten minutes, other days it could be the rest of the game.

SYMPTOMS OF A LOW: Stumbling, fogginess, shaky, hot. The shakiness really stands out. M is always bright red when she exercises. Do not worry about it. It does not signify anything on the diabetic scale.

5)   We have never had a hospitalization or diabetic emergency since she has been diagnosed. We have never had to use the glucagon. Glucagon is basically pure sugar in a shot. It will be in a bright red case in her equipment bag. It only gets used if she is not alert enough to drink a soda or eat candy. This has not happened to her as of this day.

HOW TO USE GLUCAGON: 1) Open the case, remove the syringe and the vial with the brown stuff in it 2) Inject all of the liquid in the syringe into the vial 3) Using a spinning motion, mix the liquid and the brown stuff together 4) Draw all of the liquid back into the syringe 5)Inject .75 (three quarters) of the syringe into her shoulder or the front of her leg. We want to hit muscle if possible 6) call 911

I will make every attempt to be at as many games as possible, to take the pressure off of you.  But as I said, M hasn’t let us down yet. Most of the time, she is just a normal kid, and aside from seeing her check her bg, you might forget she has diabetes. Chaperones, teachers, and coaches tell me that they forget all of the time, which is usually a good sign that things are under control. I just want you to be prepared in the unlikely event that something comes up.

Thank you for having a great attitude, and giving M a chance to play on your team. She is SUPER excited!

If you have any questions, please call XXX-XXXX or e-mail mye-mail@email.email

Ursula

Thanks for letting my kid feel normal.

First impressions

Sometimes I feel like I am not good at this whole "first impression" thing. Especially when it comes to explaining diabetes to those responsible for my child.

You see, one must strike a balance: reassure people that your child's head will not spin around, projectile vomit pea soup, or simply pop off - "she's perfectly normal!"; while simultaneously telling them that diabetes is a very serious and life-threatening disease.

I have tried several approaches, but none of them really seems to work very well.

The latest attempt I had to make was with M's field hockey coaches. During the first team meeting, M explained that she had Type 1 diabetes. The coach said, "Okay, well, maybe your mom can come talk to us about it tomorrow at practice."

When "tomorrow at practice" arrived, I dutifully waited until the other parents had left or were focused on their own daughters, and began chatting with the coaches.

I started with my usual, cool, laid back introduction to the conversation: " I am not sure how familiar you are with diabetes." I say this, because some coaches have extensive experience with diabetic athletes, and I do not want to talk to them like they are D-life newbies.

The answer from M's coaches today is that they know very little.

Now here is the decision I need to make: Do I need to emphasize that M is capable and in control, or do I have to first let them know how important it is that we keep her safe?

I start with the concrete. I point to her pump. I say, "M is a Type 1 diabetic, which means she needs this in order to live."

I realize my mistake immediately, as I see the coaches' eyes widen. I imagine their pupils dilating in fear. I hesitate, thinking that I may have chosen the wrong route here, but it is too late. I can't say, "Never mind. What I meant to say was, 'you don't normally have to worry about her'."

The die is cast. I must plow ahead.

I try to change tactics. "I want you to know that M has never had a diabetic emergency. She has never passed out or been in the hospital since her diagnosis."

This is better. The coaches nod. One of them says, "She has control."

I think, "Okay, good choice of words. Apparently all of those television commercials  for Type 2 diabetes paraphernalia have a use. They educate the public and give them appropriate key phrases to use." I smile and tell them, yes, she has control, and she is very responsible (at least on the field!) with her diabetes.

I tell the coaches that bg can go high or low, but the one I am most concerned with is the low, because a) it is more immediately dangerous and b) she tends to go low while playing sports.

Sure highs aren't great, either, but it takes a long time for M to "go high", and if she checks her bg before and after a game, there is no way it will go high enough to be dangerous.

I explain the symptoms for a low: spaciness, shakiness, faltering, feeling hot from the inside. I explain that M can identify when she begins to go low, and she will let them know that she needs a rest to check her bg and possibly have a snack, which is what will bring her bg back up.

The coaches are beautifully alert (perhaps because I gave them the death scare right at the beginning, for which I am still feeling badly), and nod. They suggest a hand signal that M can give them from the field to let them know she needs a break ("hang loose"). They encourage her to communicate with them and they let her know that she will not be penalized for taking breaks due to her diabetes. They nod and smile encouragingly. Things are going swimmingly.

Until I have to tell them about the Glucagon.

I hate the Glucagon talk!

Telling people, "Oh, and by the way, if she passes out, you will need to mix an injection and give it to her. Then call 911." is not fun. This is the part that stops the squeamish from having M over for sleepover parties.

The good news is that I can say, "M has never passed out, and we have never used the Glucagon. In fact, when we renew the prescriptions, we practice mixing with the old ones and then throw them away.

"If she checks her bg before and after practice and games, she should never have any problems, so you will very likely never have to use it. Really. Hehe."

But still, the coaches seem to me to get a little panicky (M disagrees with me here. She says that they seemed fine). They start discussing who would be authorized to administer the injection. Would only the trainer be able? Or could they?

This is new territory for me. M has never been to public school. She has only played sports in private clubs. Wherever she went, people just said, "Okay, but if you're here, you'll do it, right?" I didn't realize that we might have to follow some sort of special protocol here.

The coaches tell me they will look into it (to their credit, they learned by the following day that they are permitted to administer the Glucagon), and I spend the last few minutes of the conversation going back to reassuring them.

I feel very sympathetic about their uncertainty. And I understand their eagerness to understand things clearly.

I know it's stressful to watch someone else's kid when they have a potentially life-threatening condition. I remember taking a four hour hike with an asthmatic who left his inhaler at the bottom of the mountain. Not good.

So this is what I say: "Most of the time, you won't even know that M has diabetes. She will do all of the work, and she will act like a normal kid. The chances of her having any major problems are slim, but I just want you to know that if something does happen, you will need to be prepared."

They were truly terrific in their response. They seemed eager to learn more about the disease, and even asked M if she could share the "danger signs" with her teammates. M readily agreed, and we walked to the car: M content, and I worrying about making the wrong impression.

I worried that they were too worried.

On the other hand, I guess I should be relieved that they didn't worry too little. They definitely took it seriously.

But am I robbing M of having a "normal" relationship with her coaches? Am I stressing the coaches out too much?

I don't know, but I hope not.

Maybe there is a chance that I'll get it right next time.

You're right! I am sure that everything will be fine. Diabetes won't stop us! :)

Then again, maybe not.

Diabetes camp

" I'm having tons of fun. What are you guys up to? I feel so happy that I have a new friend and a new way of looking at things (I'll tell you about it when I get back) LOVE YOU! - M

So read one of the two communications I received from M while she was at diabetes camp. The other one was similarly brief.


This one, however, gave me hope. M was at camp after a rough period of feeling frustrated with the disease and the way it interfered with her life. She was not doing what she needed to do. She was not checking her bg, nor eating properly. Diabetes camp couldn't have come at a better time.

She was clearly having fun, because she didn't bother to write (despite the several self-addressed stamped envelopes I had given her).

But the words I clung to the most strongly were, "I have... a new way of looking at things".

"Hooray!", I thought. Diabetes camp is just what she needed. Her attitude about the disease is improving! She will feel better about herself and her ability to manage the disease! This is wonderful!

I pictured her having deep, heartfelt conversations with fellow diabetics while doing crafts, fishing, swimming, and generally goofing off.

I spent days holding these images in my mind.

After M had been home for a couple of days, she came outside to sit on the porch with me and her father.

I asked, "So, what is your whole new way of looking at things?"

"What?"

"In your post card, you said that you had a new way of looking at things."

"I did?"

"Yes, you did."

"Oh, yeah. I don't remember."

Sigh.

Teenagers.

Treatment and trials

When M was first diagnosed with Type 1, Bill and I made a decision almost immediately about research, and our daughter's potential role as a guinea pig for finding a cure for diabetes. We would do anything we could to help support the research regarding the causes of diabetes,  but we did not want to engage in any experimental treatments for it. We decided that if she wanted to engage in experimental treatments as an adult, we would support her, but she wouldn't be doing it on our watch.

We dutifully enrolled in a program called TrialNet, which tracks immediate family members, and some secondary members, for a few years, and helps the researcher identify markers that might make one more prone to Type 1. We had our blood tested, let them gather their information, but, as they tested siblings up to 18 years of age, and parents of up to 42 years, we quickly aged out of the program.

But I did receive a nice tote bag.

As far as other information gathering programs, it wasn't until this year that we enrolled in T1D Exchange, which collects data from families as well. Did you know that psoriasis is possibly connected with Type 1? Now you know.

Now, being a D family, we are always on high alert for any information about Type 1 in the mainstream media. You know the media everyone else reads. Not the JDRF website, nor Children with Diabetes message boards, nor JAMA, nor the Joslin Newsletter.

Recently, Bill, M, and I discovered such an article in the Los Angeles Times about a new treatment for diabetes. The summary is as such: A doctor from Massachusetts General Hospital has been working on identifying a vaccine to prevent diabetes. While working with the vaccine, and while testing it on humans, she discovers that the vaccine can actually regenerate the precious beta cells that make the pancreas work; even in people who have had diabetes for a long time.

And Bill and I think: "Wow! Wouldn't it be cool if this pans out?"

And M says, "I want to get in that study!"

Imagine the sound often used in party scenes at the movies. The teen heroine is trying to share something with her boyfriend, but it's too noisy for him to hear, so she ends up yelling, "I think I'm pregnant!" really loudly. With the screech of a record being scratched by a needle as it suddenly stops, it becomes silent, and the whole party looks at the distraught couple.

That record-scratching screech is what I hear in my head.

The thing is, we, as M's family, want to see a cure in her lifetime.

For M, tomorrow wouldn't be soon enough.

I sometimes forget that this is how she feels. I feel my heart sink. I feel a stone in my stomach. Bill and I look at each other, and a silent agreement passes between us.

"We'll talk to your DNE about getting into the study. We want to make sure it's safe."

In the meantime, I check it out. The vaccine sounds safe. It has been used for the prevention of other diseases, and the only side effects reported are a soreness at the injection site. Am I sure I want her to be involved in this study? No, but I want to talk to someone else about it.

When we bring up the study to the DNE, she tries to sound impartial, but she involuntarily makes a face.

She says, "You just want to be very careful when deciding to enter this study. The doctor running this study is very controversial. People are very suspicious. It sounds like a dream come true: it cures diabetes and there are no side effects. But you want to make sure that you research the study thoroughly before deciding you want to be a part of it. You don't want to risk your health unnecessarily."

She then tells us about a "closed loop" study that is coming up in the fall. M agrees that she would like to be a part of this study, and asks the DNE to make note of the fact that she would like to participate.

While this sounds great, I can't help feeling disappointed.

Our DNE is pretty conservative. We have asked her about eliminating insulin injections through diet, and she shut us down, saying she had never heard of such a thing. Unless she hides under a rock, I know that it's not true. If I have heard of it, she, a professional in the field, has certainly heard of it.

I figured that she didn't want to dedicate our precious office time to something that she thought would not be a viable option for M.

I suppose that she also feels similarly about the diabetes vaccine.

So I am back where I started.

I will do some research. I will read some more. I will check into the study. And I will keep praying.

Hmmm. Looks like the jury is still out.

You too?

There are times in life when one must talk to someone that he barely knows, or perhaps has met for the first time. Maybe he is in a long line at the supermarket, or watching his toddler play at a park, or eating lunch during a seminar required by his employer.

During those times, one makes small talk.

One chats about the little niceties: where he is from, how he got into the business, how old his kids are.

And sometimes one discovers that the person with whom one is speaking shares something in common.

"Hey, my family is from Connersville too!"

Or "No kidding, I also studied in Seville in 1988!"

Or, "Oh my goodness, my in-laws live in the house where you grew up!"

Or, "You must have gone to high school with my cousin!"

In these situations, where small talk is paramount, diabetes rarely comes up.

But sometimes it comes up ... later.

I am pretty involved in my church, and due to my involvement with said church, I know a great number of wonderful, kind, generous people. People who would give you their right arm if you asked for it.

This week, one of those people walked up to me after mass. It had just been announced that a new person (not me, this time) would be chairing the Christmas fair this year. I figured that this woman, with whom I had volunteered many times, wanted to ask me about my decision, or make the observation that my life should be "a lot more relaxing now".

The assumption stemmed from the fact that several people had already approached me about it BEFORE mass.

But this woman caught me off-guard by asking me a totally unrelated question: "Does M have diabetes?"

When I responded yes, she told me that she had Type 1 diabetes herself.

Now this puts us in the weird position of having the "Wow! Me too!" conversation often overheard in airport lounges. Weird, because we are "happy" to know another person with diabetes. Weird, because, in reality, we don't want anyone in the world to have diabetes.

But there is a sense of relief in knowing that one is not alone, isn't there?

I have known this woman for about 10 years, and never once did diabetes come up. But recently, the woman's daughter had gone to "Jesus camp" with M, and noticed her insulin pump, thus prompting my friend's query.

With giddy chatter, we shared our experiences.

We discussed the diagnosis whens and hows: M's ( age 11, sick for 3 weeks) and hers (age 8, sick for 2 weeks).  The evolution of D technology ("Wow, it's been really amazing"). Pump or injection (Pump). Support systems ("Not really, I don't know anyone else with diabetes"). Family history of Type 1 (none for both).

I asked her about her two pregnancies ("That was really hard").

I thanked her for telling me, and told her I was glad to know that she had Type 1. After all, she looked pretty normal to me, which gives me hope for M. It's nice to know that she has a shot at being a 40-something mom with two teenaged daughters, too.

I left church feeling blessed, which I guess is the purpose of church, really.

But I have a plan for the next time I go to church. I plan to pray that soon there will never be a need for someone to feel happy that someone else has diabetes, just so they will know they are not alone.

Heck, I'll pray for it now.

Amen.

For everyone.

Injections better than the pump?

Nobody wants to say that giving oneself six or more shots per day is preferable to the simplicity and elegance of using an insulin pump. So I expect to hear some screaming from the DOLC.

I have been thinking a lot about this issue since we found out that M had been getting "creative" with her diabetes management.

To be sure: with the pump one still must check one's bg six or more times per day, which still requires the sticking of fingers with little sharp things called lancets. One must also change the infusion set, a set with tubing attached to insulin, with a little straw, or cannula, sticking into the skin. That means that every three days or so, one must use a needle to get the infusion set into one's skin so that the pump can deliver the appropriate insulin.

So life with the pump is not entirely needle-free.

But it is way more convenient, especially if you want to take a snack.

Which is why I feel that I can argue that injections might be better for some patients. 

One of the reasons I noticed that M's bg numbers were manufactured is that we were at the beach, and she was eating constantly, like most teenagers. On top of that, the foods she was eating were not optimal PWD fodder.

Because of safety precautions put in place by pump manufacturers, however, M was not able to bolus every time she ate. In an effort to prevent life-threatening lows, she cannot bolus within a half and hour of her last bolus. While this means that her life will be safer, it also means that if M is pigging out, and especially if she is not able to bolus for the extra food, her bg will necessarily be higher than normal.

When her reported bgs were in range, or just outside of it, I knew something was up.

Now, when M was using the insulin pen, we didn't have this problem. If she wanted to pig out, she would plan her snack, and give herself an injection. If she wanted to eat more right away, she would have to give herself another injection. Since injections are unpleasant, as well as a hassle, she often chose not to pig out - a clearly healthier decision.

Maybe some kids are not suited to use the pump. It says a lot that after three months on the pump, M's bg went from 6.4 to 9. 

As M enters high school and becomes increasingly self-conscious about appearances, she will likely want to do whatever her friends are doing: eating pizza, eating popcorn and candy at the movies, and generally assuming that she will live forever, like most teens.

What she will not want to do, I am guessing, is say that "I need to count carbs, so no thanks, I'll pass on the baklava, Bosco, Blizzard."

The pump is making it easier for M to blend in and make less of a big deal about her diabetes. But I am on the fence about whether that's a good thing or not. If she flies under the radar too well, she may not keep herself as healthy as she should.

I hope that she will defy the teen odds, and put her health ahead of her need to conform.

Being a high school teacher, however, I have my doubts.

Unfortunately, I will just have to wait and see. Only time will tell.

"That's okay, I can bolus for that."

A1C 9

After discovering that M was guessing what her blood glucose levels might be, it was hard to act surprised when the DNE came in with the report that M's A1C was 9 this visit. (Attention non-D people: this is very bad!)

This was the highest it had ever been - even when she was first diagnosed.

The DNE came into the room, trying not to betray her concern when she said that M's numbers looked good, but that her A1C was a 9. M and I nodded. I said, "I can't say that I am surprised."

The DNE's eyebrows shot up, and she asked why it wasn't surprising.

To her credit, M launched into an explanation about her methods for tracking her progress over the last few weeks.

The DNE listened silently, and when M was finished explaining what she had done, she asked her when she stopped using this method.

M replied, "When my mom caught me."

As her eyebrows disappeared further into her hair, the DNE asked me how I caught M lying about her bg levels. I explained my methods, and the DNE congratulated me on my powers of observation, adding that not all parents would notice after a week or so (Big pat on the back for the "control freak" mother).

Then she asked M why she did it.

M said that she's just sick of being diabetic. She's tired of the hassle.

Hearing this always makes me want to cry.  I am disappointed that I can't make this particular hassle go away. After all, this isn't something all girls for through and must learn from: like your first bad boyfriend, or doing your three week project entirely on the night before it is due. It's not something I can guide her through in the same way I can typical life lessons with logical consequences.

I told the DNE that I had offered the option of counseling to M, but that she had adamantly refused.

It might have had something to do with the fact that I had just caught her in this self-destructive lie. She might not have been wide open to suggestions at that time.

FLASHBACK~FLASHBACK~FLASHBACK

Me: "If you don't feel comfortable talking to me or Daddy about it, maybe you'd like for us to arrange for you to talk to someone else who might be able to help you."

M: "I don't need a psychiatrist! There is nothing wrong with me!"

Me: "I know there's nothing wrong with you. Everything you are feeling is normal. But if you need to talk to someone so that you can feel better, then I am willing to come up with some way that it can happen."

M: No response, minus a silent glare.

Back in the office, the DNE made the same offer, but it went much better for her. M simply nodded and said that she would keep the option in mind.

One consequence of the whole debacle that I hadn't considered was that we would now have to visit the DNE every month until further notice. This bummed me out. Those visits are not only about $500 a pop, but they also require that I take a minimum of a half day off from work, which I do not enjoy doing.

It makes sense, however. We, as a family, have fallen off the wagon, so to speak. We need time to recover and heal before we can get the all clear.

The DNE was somewhat tactful, saying that she just wanted to make sure that M was "following along the right path" for a while.

So, with stepped up vigilance, we will continue forward. Hopefully we'll find some fantastic support for M along the way....

Diabetes camp can't come soon enough!

Don't fall off!