Thursday, November 7, 2013

Transitioning



**This article was originally published in August of 2009 just 6 months after our second daughter 
was diagnosed with Type 1 Diabetes.
My goodness, how times have changed for us!!***



On the 1st of June, over 2 months ago, my husband and I attended a 3-hour class at the Children's Medical Center Endocrinology Clinic entitled "Take Charge". The purpose of this class was to learn how to ratio Ashlyn's carb to insulin intake. We were there to basically learn how to "take MORE charge" of Ashlyn's eating/insulin regimen. We'd been hearing that once we learned this concept she would have so much more freedom; things would be so much easier. Well, I'm here to tell you that I'm STILL waiting to see how this gives her more freedom. Honestly, I can't tell you why this adjustment and new regimen has been so difficult to transition to. It's not that terribly confusing. It's definitely a LOT more math. Since her diagnosis in February we've just carefully followed the plan that our endocrinologist and diabetes educator's gave us. Her meal plans looked like this:


Breakfast 50-55 carbs
Mid-morning snack (no less than 2 hours after breakfast) 15 carbs

Lunch 50-55 carbs
Mid-afternoon snack (2 hours after lunch) 15 carbs

Dinner 50-55 carbs
Bedtime snack 15 carbs plus a protein

With every meal we were told how much insulin to give her. We checked her blood sugar before every meal, charted her numbers, and then emailed these numbers every week to the diabetes educator who would then email back any recommended changes to her insulin amounts based on how high or low her blood sugar levels had been that week. Sometimes we adjusted just one meal's insulin amount, sometimes we would adjust more than one. It has become very easy for us now to have that "lifeline" of sorts where we are just told what to change.

Now they want us to learn how to make the changes on our own. I guess I feel like my parents are trying to break free of us a little. Like we're making these baby steps toward Diabetic Adulthood. And I'm not comfortable with this AT ALL!! Her meal plans now look like this:

Breakfast 1:14 (Humalog)
Snack two hours later

Lunch 1:11 (Humalog)
Snack two hours later

Dinner 1:16 (Humalog)

Bedtime - 6 units of Lantus with 15 carbs


It's very confusing at times. For instance, the other night we had "Friday Night Movie Night" here at home and I had purchased drumsticks ice cream for everybody to have. So I know automatically that we're going to have to use our ratios for this snack because it has 33 carbs in it. But I couldn't find in any of the information ANYTHING about using our ratios for bedtime snack. The difference is that at bedtime we use a different insulin (Lantus) than at mealtime, and I know it works differently than the mealtime insulin (Humalog). So I figured I would just add another dose of the Humalog to cover the extra carbs in the drumstick, but then I didn't know where to start counting the carbs that needed the coverage. Normally, we don't give humalog at the bedtime snack which is 15 carbs. Ashlyn's dinner ration is 1(unit of insulin):16 (carbs). So I was questioning if I needed to add insulin to cover the entire 33 carbs in the drumstick or just what was over the normal snack amount of 15 carbs? Do you see my confusion??
So I called and talked to one of the diabetic educators this morning to get clarification on that as well as to just vent some of my hesitations about this whole ratios thing. Supposedly Ashlyn will have more freedom, but I'm not seein' it yet!!! She will still have to look at all her food before a meal, decide what she will want to eat, and then get her insulin before she eats. Once she's got that insulin in her, she's then committed to eating ALL the food she chose. But what 9 year old do YOU know that will actually eat EVERYTHING at every meal every time?? So she before she eats, she thinks, "Yeah, I'm starving, I'll eat 3 pieces of pizza." But after the first piece or so, she's full and doesn't want any more. Too bad......you've had the insulin and if you don't eat all the carbs, you're blood sugar will plummet and you'll feel terrible. Now I ask you, WHERE is the freedom in THAT????
I've also been concerned that now we're moving into this new zone of freedom that we will inadvertently give her more calories or insulin per day than she is supposed to have for her age/weight. I certainly don't want to make food become an issue or a focal point in our family because I know of the eating disorders that can come from that. But I do want to be aware, and teach her how to eat healthy and appropriate amounts instead of just gorging on junk food to get in all the carbs she needs.
I guess all of this is just a reminder to me that living with diabetes is a daily journey. We're always to be learning and growing in our skills and management of this, but we cannot make it better. It will always be elusive and changing and frustrating, all we can do is learn to manage it as best we can. So many aspects of it are mysterious to both us and the doctors, and I have to constantly remind myself that that is what living with an incurable disease is all about. I can't change the daily up's and down's and mysterious problems that pop up out of nowhere, and her regimens and routines will always be changing as she grows. Some days I just wish that everything would just stay the same. I used to have it in my mind that with every insulin change we were getting closer to the point where there wouldn't BE any changes, that somehow it was like a medicine we were giving her that would make her better over time. But we're just simply MANAGING life with this disease. I have to keep reminding myself of that......it will always be changing. To keep her alive, we will always have to be on top of it. But that's a small sacrifice to have her here with us lighting up our days with her smile, her laugh, her exuberance, her corny jokes. We love her so much and thank the Lord for how precious she is to us and for what He has in store for her life because of this disease!!