Sunday, November 27, 2011

Eating disorder

There has been some discussion on the interwebs about diabetes and eating disorders.

Now here's something I hadn't thought about, or worried about enough, evidently.

I first came across the topic after Joanne had posted her fabulous video, "What not to say to the parent of a Type 1 diabetic". In the video, she mentions Halle Berry. Saying that if Halle Berry can cure herself, why can't the protagonist's daughter?

The response? "Halle Berry is Catwoman. My daughter is not Catwoman."

This prompted me to research the topic of Halle Berry and diabetes, because I had never heard anything about it before.

Wow! Was I out of the loop!

It seems that Halle Berry had been diagnosed with Type 1 diabetes, and declared on a national talk show that she had "cured" herself, and now has what she likes to call "Type 2" diabetes, because she can control it with diet and exercise.

Well, I've got news for you: Halle Berry didn't cure herself, (There is no cure for diabetes. You can only manage it.) nor did she convert herself into a different type of diabetic (The difference is not in the use of insulin, nor in the age of the patient during diagnosis). As a diabetic, she should know the difference between the two.


I mentioned that when M was diagnosed, she had lost 20 pounds in three weeks. My daughter was starving to death because her body could not process that food entering her body. In fact, she was not only starving to death, but her body was being poisoned by the food she ate.

If not for insulin, my daughter could have looked like this early recipient of insulin:

courtesy of http://www.diabetesindia.com/diabetes/diabetes_insulin5.htm(same child, before and after experimental insulin treatment in the early 1900's)








and eventually would have died after a few months, maybe a year if she didn't eat much.

Which leads me to this idea about eating disorders.

During my "Halle Berry research phase," I read a blog that suggested that Ms. Berry might be deliberately keeping her bg high, at risk to her own health, in order to stay slender. Knowing what I know about diabetes and weight loss, I could see why someone might jump to that conclusion, but I said "pshaw" to the idea, thinking that a celebrity with a gajillion dollars and some determination might find just the right diet and exercise combination to keep her bg levels in range.

Not "cure" herself. But control her diabetes.

Fast forward to mid-November of this year, when I received a catalog from the ADA.

This time of year they sell things like Christmas cards and ornaments at a high price, a portion of which goes to diabetes research. The catalog is full of items to purchase as well as inspirational or frightening articles about diabetes.

I was surprised to see an article in the catalog  about diabetes and eating disorders. It told the stories of some young women who were risking their long-term health in order to stay slim. They fully acknowledged that they did it. They knew that they shouldn't. But apparently they didn't think that what they were doing qualified as an eating disorder.

So, if this is a bonafide problem in the Diabetic Community, maybe the suspicion about Ms. Berry had some merit.

On the other hand, maybe she was misdiagnosed.

So great.

As the mother of a teenager - a daughter- with diabetes, who clearly doesn't have enough for which to be watching out, I now have to stay alert for signs of an eating disorder in my kid.

The signs and symptoms are the same as for other eating disorders.

As a high school teacher, I am familiar with them all.

I want to end by saying that I am hopeful that my pragmatic daughter will be wise enough not to get caught up in the pursuit of perfection through extreme body management.

But I will indeed keep my eyes open.

Thought I'd end with a healthy-looking image.





HIGH school

Not all of my diabetes excitement comes from having my own offspring afflicted with diabetes.

Teaching high school, I have other young ones for whom I am responsible, and at times, they have diabetes. When working with these students, I feel grateful for my knowledge and experience with the disease, although I wouldn't have minded acquiring the knowledge in some other way.

One of these students is in the school's Spanish Honor Society. He has had Type 1 diabetes since he was three years old. I have had several conversations with his parents about the experience of having such a young child with Type 1, and boy, do I not envy them.

Last week we were holding a meeting of the club, for which I am an advisor. During the meeting, the young man checked his bg levels, which were just over 300. After checking his bg, he left the room huriedly.

The students in the room knew how this could go. One of them asked me, "Did he go to throw up?"

I didn't know, but I knew that he needed to get his bg down soon.

Often when he is nauseous, this student needs some water, so I left the room to get a couple of cups of water for him for when he returned.

When he did return, he said, "Sweet. Water." and downed the two cups.

I asked him if he had bolused.

He said he had over an hour ago, and since his bg hadn't dropped since then, he had better go home.

Alarm bells went off in my head: I knew this kid had recently acquired his driver's license, a must for teens in rural areas like the one in which I teach.

"How will you get home?" I asked.

"Drive," he said.

"Oh no, you don't," I said. "Let me call the nurse to see if she is still here. If we can't get your bg down, I will drive you home."

The student explained that he thought that when he inserted his infusion set, it might not have installed properly, so he might need to change it.

"Do you have a spare one?" I asked.

"Not on me," he said.

The nurse wasn't at the school (after all, it was about an hour after school was over), but the student went to the main office to have someone unlock the door to his diabetic supplies, so that he could access his spare infusion sets. Then he returned to the classroom.

He was a little wound up. He sat on one of the desks and removed his infusion set. I peppered him with questions about how long it typically takes for his body to respond to the insulin, and whether he had a syringe, just in case. While he answered my questions, he unwrapped the infusion set and lifted his shirt, pinching the skin on his belly.

At this point the club president said, "Oh my God, are you going to do that NOW?"

I think he and I both gave her the same look, because she made some apologetic noises and discreetly turned her head to talk with a friend.

While he put in the infusion set, we set the timer on the computer for him to check his bg again in 15 minutes. Then I made him promise to check it one last time before he left.

Needless to say, our meeting about planning a day trip to NYC was thrown way off topic. By this time it was nearly one and a half hours after school ended. The meeting was adjourned, and the kids went home.

I left the school with a number of things on my mind. My diabetic student, evidently, was not one of them. About halfway home, I realized that I never did have him check with me before he got in the car to drive away. Just like M, he probably never gave it another thought, thinking he was perfectly all right, and that he could handle it, even if his bg was too high.

After my half-hour commute, I made the phone call.

He answered the phone, obviously having made it home safely.

I told him who it was and that I just wanted to make sure he was okay. He immediately apologized for worrying me; it had slipped his mind.

He's a really nice kid.

But I am glad that I only have one of these at home.


No such luck. Maybe next time, kid.


Friday, November 25, 2011

Reboot

Things have been going well, diabetically speaking. M has finished her field hockey season and was designated MVP of her team. Now she is living a more sedentary life. Her grades are going up, as are her blood sugars.

Higher blood glucose readings are to be expected. After all, exercise keeps bg down. Remove the daily 2 mile runs and 1 hour practices, and the bg will go up. So, although it is a bit of a bummer, it is not an unexpected one.

About two weeks after her last game, we noticed M's bgs creeping upward. We adjusted her basal rate by 0.25 units per hour over all.

Her pump had been delivering a steady stream of 3.0 units of insulin per hour at night, and 3.25 units per hour during the day. The basal rate, in theory, is the part that will keep her bg within range when she is not eating. Anything she gives herself when she eats is considered a bolus.

So now she was up to 3.25 at night, and 3.5 during the day, but we did have to make another adjustment about a week later. It seemed we had found the magic numbers. She was healthy, and her numbers seemed to be doing well.

On the Wednesday before Thanksgiving, we drove to pick up big brother at the airport. Since I was not driving, I though I would ask to see M's meter so that I could see how she had been doing the last few days.

She pulled the meter out.

She paused.

She started flipping through her numbers.

This is when I knew that something was up.

"You know, M, " I said casually, "I can read the meter all by myself. Just hand it up."

Long pause. Frantic pushing of buttons.

"M, hand it up," I repeated.

"There's something I have to tell you, " M said.

"Here it comes," I thought.

"Some of my numbers are missing, because I have been forgetting my meter when I go to school. So if you see any missing numbers, it's because I used my other meter at school."

When I collected the meter, I flipped through the numbers for the day. Except that there was only ONE number for the day. In fact, it was the only number for TWO days. She had only checked her bg on that meter six times since October 30th.

Here we go again.

"M," I said, "You told me that your bg was 131 this morning. That number is not here. Did you run to school and use the meter there to check it?"

No answer.

Rather than give her "buck up" speech, I said this.

"All right. starting today you will be checking your bg six times per day, and I will need to see it."

And that was all.

I was worried. I was furious. But yelling was not going to cut it. And neither was telling her that she was putting her life in danger.

So yesterday and today: six times, and I see them all.

Which is great because I can monitor her.

Which is not great, because how is she going to be responsible enough to do it herself? Ever?

I don't know.

But we will need to figure it out.

Not shocked this time!

Wednesday, November 16, 2011

Just annoying

I feel, sometimes, like I must be a bad mother.

A good mother would never feel like her kid was just another thing she had to worry about before going to bed, would she?

We had a great dog for a long time. But sometimes, I would want to go right to bed after our family finished watching a movie. I wouldn't want to wash my face, or brush my teeth, or let out the dog.

But I knew that if I didn't let the dog out, I would have to clean a little puddle off of the floor, or that she would wake me two hours before I wanted to get up so that she could access the great outdoors to meet her needs.

So I would begrudgingly let the dog out before collapsing into bed. I would still skip the teeth and the face, just to mollify myself.

I will not say that I felt guilty about feeling resentful that the dog had to use the bathroom. I didn't. My dog loved me unconditionally, and she never sensed that I was feeling whiny about this particular chore.

Unfortunately, I occasionally have similar scenarios with my diabetic daughter. And I wonder if she picks up on my internal whine-o-meter.

Case in point: Around dinner time yesterday, M checked her bg.

It was 207 mg/dl: not outrageously high, but not in the range we are generally looking for.

After finishing dinner, doing our homework, and watching some television, we all went to bed.

I crawled under the covers with my beloved and warm husband. I snuggled my face into the pillow and began the quiet process of unwinding the day in my head.

That's when it hit me: I should have had M check her bg again before going to bed.

I lay there, without moving from my very comfortable position, wondering if I really had to get up. After all, I reasoned, a bg of 207 was unlikely to get outrageously high. There would be no immediate, serious consequences. Probably.

On the other hand, what if it did climb a lot higher? Then my daughter would feel crummy, she might not sleep, her day at school would be shot, and, worst of all, her long-term health would have another ding in it.

I lay there debating.

Whining internally.

I tried to pretend that I hadn't remembered that she needed to check her bg one more time.

It didn't work.

Sighing, I tossed the covers aside, and fumbled my way to the dining room. I grabbed M's purse, and brought it upstairs to her so that she could check her bg.

She seemed unsurprised to see me.

With absolutely no fanfare, she pricked her finger with the lancet, and squeezed a droplet of blood onto the test strip. 5... 4...3... 2... 1.

It was 274, so M ordered her pump to deliver the appropriate dose of insulin.

End of story.

Instead of being pleased that we prevented a potential night-time high, I had only one thought.

"Finally. 

Now I can get some sleep."

Bad mother.

Bad, bad, mother.

But it really is annoying!

Saturday, November 12, 2011

Fair

Life isn't always fair.

But sometimes you get to attend a fair.

How you feel about attending a fair can depend on both the circumstances, and those you meet.

Due to the hours I have spent typing away at this keyboard,  I was asked by a childhood friend if I would like to come work at her church's "Joyful Giving Fair".

"What," you might ask, "is a Joyful Giving Fair?" It turns out that it is like many Holiday Fairs around New England, except with a twist.

Many of the churches in New England have a Christmas Fair to raise money for the church and its good deeds: their food pantry, their fuel assistance, etc. This church holds a fair where each table is covered by volunteers from a charity organization, and every dollar you spend at the table goes directly to that organization.

As we are trying to help raise money for diabetes awareness and research, M and I thought that we could dedicate some time to this kind of work, so we said that we'd do it.

As one of the organizers, my friend seemed disproportionately enthusiastic about our participation. We didn't feel like we were doing her that big a favor! We were glad to help out my friend and JDRF at the same time.

But how would we do it? It somehow seemed inappropriate to sell baked goods to raise money for an organization that lets people know to count their carbs for better disease management. Furthermore, we are not especially crafty. What could we do?

Having absolutely no inspiration about how to raise money for diabetes, I contacted our local "special events coordinator" at JDRF.

Dear _____,

My daughter, M has type 1, and we sponsored a walking team this year. Because I talk about Type 1 so often, an acquaintance invited me and M to participate in her church's "Joyful Giving" fair.

I told them that M and I would participate, but I have no clue what we should do. Are there items that we could sell on behalf of JDRF? Flyers we can hand out? Ideas that you can share with me?

I would like to raise money and awareness of the organization, but I am not sure if there is a protocol that I must follow with JDRF.

Please advise. The fair is in a month.

Thank you,

Me


Unfortunately, the response was a little less than I had hoped for. It boiled down to: "We have bracelets that you can buy from us and then sell. Or we can send those paper sneakers that we sell for a dollar at the supermarkets. Otherwise, good luck!"

I suppose this might be one of the reasons that JDRF is so highly ranked as a charity. There is no overhead for things like mugs, or t-shirts, or anything else that might be sold at a Joyful Giving fair.

So M and I tried to wing it. We had the paper sneakers sent, and converted them to tree ornaments by punching holes in them and tying ribbons to them.

My mother also propagated some plants for us to sell - a big hit at our own church fair.

We set up, and everyone was kind to us. After 5 hours of talking to people, smiling, and explaining what an insulin pump is, we cleared $41. It would have been $21, except that my mother stopped by and gave us a $20 bill to show her support. (Thanks, Mom!)

All was not lost, however.

The highlight of our day arrived around noon in the form of an elderly woman who visited our table. Before I could dive into our spiel about JDRF and its good works, she told us that she had been diagnosed with type 1 66 years ago.

She was ten years old at the time.

She told us that she participated in basketball and cheerleading when she was M's age. She told M that she looked healthy and to keep up the good work. The she shared an oft-repeated slogan: "It's all in the attitude!"

At 76, I have to say, this lady looked pretty good. She said that she still uses Lantus and Humalog with the disposable syringes, and that they work just fine, thank-you-very-much.

She was a delight. And a testament to the effect a positive attitude can have on those with a chronic illness.

When she left our table, M said: "That just made my day. Just saying."

We grinned a lot that afternoon. And why not?

JDRF will have $41 more in its coffers. And we had our inspirational coffers refilled, free of charge.

Very cool.
Cashing in for JDRF.

Tuesday, November 8, 2011

Pizza

Fact: If you want teens to participate in any kind of extra effort, be it volunteering, doing an extra credit project, or whatever, it is easiest to get them to participate with the promise of food.

Fact: Teens are hungry, hungry people with seemingly bottomless stomachs.

Fact: Feeding more than one teen can get expensive.

Fact: Satisfying the tastes of several different teens can be a challenge.

Fact: Anticipating the serving size one must allot per teen can be tricky.

Solution: Order pizza!

It is cheap, comes divided into manageable portions, and has a flavor to match just about every taste!

But.

But, it is super high in carbs.

M has never been concerned with pizza in the same manner that she has been with cake, but it still takes a lot of skill and luck for her to keep her bg in range for several hours after consuming even one small piece (defined here as a one-inch wide slice of a 12 inch pizza).

The tricky part is that it doesn't seem to behave in a consistent manner. Cutting back the "dose" of pizza doesn't lessen the wacky impact it has. Adding more insulin seems to make no difference either.

So what is a mom to do? Neither M nor I find the option of making a stink about the lack of food choices to be a viable option.  Especially when the food is really only provided as a courtesy, not as a part of a culinary experience.

Additionally, people think we are crazy when M brings her own food, because pizza is so awesome.

Right now, even though she only has pizza maybe once every two weeks at events for church, school, or at the home of a friend, I still have this nagging feeling that we are playing a little Russian roulette with M's long term health.

So yes, folks. I will be sending food with M from time to time. After all, she doesn't even like the pizza provided at church. She eats it because she is hungry and there are no other options available.

And before you parents of non-diabetic children judge me by what an amazing killjoy I am, count your blessings that pizza is not on your list of worries.

I will offer up a prayer that it never will be.

Oh pizza, why must you be so cheap and easy?