I promise to catch up... one of these days... here's a start.

I promise I will start blogging about this journey soon. It's been so crazy lately that I just haven't had time to sit and type. I do want to share a moment from last night. First off, I don't want anyone to be fooled that this transition hasn’t had its challenges.  Like most everyone I tend to show the “all rainbows and butterflies” side of the story on social media. The fact is… ADA is only 17 weeks old and still learning. She’s doing amazing and has such incredible potential and is/(will be) a fantastic service dog. As she continues to “hone in” on her skills and we (humans and ADA) begin to understand each other a little better “alerts” will become clearer to us (humans).

With that said… Last night in typical fashion our house got CRAZY. The kids were wild. ADA was wild. Jeff and I were reaching our limits of sanity. I thought ADA was feeding off the kids. She was “bouncy” and “running” and refused to settle. Jeff even came in and said… “She’s like Tigger… she won’t stop jumping.” I took her out- I tried to walk her- eventually she calmed down… and laid down. At the beginning of the “crazy” I had glanced over at the MySentry… and saw he was 190. I remember thinking… okay… he’s fine.

Now… had I done – what I was supposed to do- I would have realized that ADA was not just “acting out” but actually trying to “alert.” When I finally realized…. almost 35 min later (which happened to be when I glanced over at the MySentry and saw 90 two arrows down) I checked him and he was 55.

I can’t explain it. I don’t fully understand the science behind it… and I know we’re in the process of “perfecting” it. But I can say… ADA is pretty amazing… and we are so thankful to have her in our family and taking care of Saul.

A Dog For Saul Website

Ch-ch-ch-ch-Changes

They're not always bad.

 

(changes)

 

They're difficult.

 

They're necessary.

 

 

They're inevitable.

 

(sometimes)

 

 

I could attempt to explain what led us to enduring a 7.5 hour apt at Cincinnati Children’s Hospital last Friday (one that involved a series of thorough hour long + appointments with a Social Worker, Pediatric Endocrinologist, Nurse/Diabetes Educator and Dietician) oh… and agreeing that the 1.5 hour or so drive both ways… was “totally no big deal” ............... but instead… I’ll just say… my devastation over our Ped Endo at UK leaving coupled with this brought on the change.

 

 

And it was great.

And it was worth it.

 

 

Having been fully informed about the length of our initial apt, Jeff and I decided to drive up on Thursday so we could spend the day with Saul at the Aquarium and hang out in Cincinnati. We thought the alone time with Saul might be nice.. and we were right. We had a wonderful "mini-vacation." Because it’s possibly the only one I’ll get this Summer – I took full advantage of all hotel amenities and was living it up at Embassy Suites.

Cincinnati Children’s is amazing. I will try not to compare our experiences with UK Children’s (mainly because I have friends and contacts at UK) but it’s hard not too… The Pediatric Endocrinology Dept/Clinic at Cin is so much bigger and better staffed (granted… bigger is NOT always better) so quality of care will be determined as we progress through this journey. The striking difference however, is the approach to treatment. There is something to be said about the unique (and it is, believe me, “different” than what we’ve been accustomed too) method that is used.

 

From the beginning of the process I was told the Clinic institutes a 4 team approach. You are followed by a Pediatric Endocrinologist (there are a number of them-  and the Clinic encourages you to find someone who "clicks" and is the "right fit" for you). Many of Dr's specialize in a specific Diabetes/Endocrinology “area” so you have options in terms of who you see. Because this was our “initial visit” they automatically scheduled Saul with someone - and in the end- we were very pleased- so we agreed to follow up with her for our next apt.

 

Other than the wait (which I had mentally and emotionally prepared for) I was most concerned about meeting the Dr. I loved Saul’s former Ped Endo and had very high expectations… I’m happy to say they were exceeded at this first visit. Our Dr. was so thorough- so detailed and so great at communicating and explaining that Jeff and I seriously walked away saying… “Wow. That was awesome.” She also had good bed-side manner – suggested we take a half an hour lunch break between appointments and even walked us to the hospital cafeteria. Needless to say… I felt a huge burden lifted.

 

We – literally WE (the Dr. and I – Jeff was wrangling Saul during most apt’s…lol) sat and reviewed Saul’s data which they uploaded from Carelink. WE sat and discussed his A1C which upon finding out was an 8.4 nearly caused me to melt down. My memory is fuzzy- but I’m pretty sure she had to scrape me off the floor and hold me up for a good minute and a half… I was prepared for a “higher” one… but NOT prepared for an “above 8.”

 

 

The Dr. on the other hand was totally okay with it- and said it was great. She showed me the print off where 8.5 and below is the “target.” She said, “I understand you are shooting for perfection- but you have to realize you are doing a great job and you won’t always get perfect A1C’s.”

 

 

We both agreed that our first and most important “target goal” was to start “smoothing out” those peaks and plummets in blood sugar levels. Saul’s been on quite the roller coaster for the past month or so- and appears to be extremely sensitive to insulin corrections – so WE made a number of adjustments to bolusing and left his basal rates alone for the time being.

 

She also ordered blood work to test for Celiac and a few other “type 1 related” diseases and issues. She also talked about the varying types of diabetes “within Type 1” and wants to try and find out “exactly what we’re dealing with, to know how to go about a treatment plan for managing his care.”

 

 

*Because... side note (not all Type 1 Diabetics are the same) I have to keep telling myself this over and over and over and over when I listen to someone say... "Well so and so's kid... has so much better control... so and so's kid NEVER has lows... so and so's kid never had to deal with any of this stuff."

*Because... (second side note) I take it all so personally- as a reflection of my performance as a Mom and a Type 1 caregiver... I know... I need to get over it. Already.

 

Jeff and I were equally impressed with the other specialists we saw during our visit. I felt like I easily bonded with both the DE and dietician (who I think I cracked up a good 65% of the time). The Clinic encourages you (like with your Dr) to find “someone you click with” in terms of the other team members and I will def. follow up with them next time.

 

In general- most of what was reviewed and discussed – I already knew- but am happy to have walked away with a way more detailed “step by step” instruction guide on “sick day management” and treating ketones.

 

Oh... and we also now treat at 80 as opposed to 70.

 

All 4 specialists encouraged communication and all 4 took pride in the fact the Clinic offers so much support through communication (because of the number of staff and resources).

 

They have a 24 phone line.

They return same day calls.

Nurses rotate taking calls all day.

 

I was told twice by the D.E. “You have a Type 1 two year old. You are a priority. If you need to speak to someone regarding a high or low episode you tell them… I have a two year old. You will be made a priority.”

 

I was also told by the D.E. “If you ever- talk to someone on the phone who comes off as rude you ask to speak to their direct supervisor. You are dealing with a Children’s Hospital. You have a child with an illness. You deserve excellent care.”

 

So. At the moment. For right now. Despite the drive. I’m sold.

 

Oh… and they have a pretty awesome Fire truck in the waiting room which kept Saul entertained for hours… literally. So I think he's sold as well.

I'll leave you with a few documented photos of our adventure!

 

Excited for a trip to the Aquarium!

 

 

Entertained everyone by his constant yelling of "Yee haw Froggy"

Mesmorized

 

 

Always my favorite part of visiting the Aquarium

 

Wanted to "get closer and closer and closer"

LOVED the sharks- his favorite

 

 

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Penguin watching

Coulda played with this thing for hours

Ackward. Eating tuna while at the aquarium?

We begged and pleaded... just come lay down and take a nap... he's saying... "let's go on an adventure!"

Swim time

This kid LOVES swimming and kept yelling "I'm a swim-teamer"

Saul and I had the entire pool to ourselves... and it was fabulous!

Pumped

Annnnddd.... then the next day... lol. He was actually in a great mood all day... just making faces here!

LOVED wearing the backpack... which was pretty adorable

 

 

He kept checking himself out in the reflection saying "I just like Dora"

 

 

He's two- and he knows all the routine... lol.. he seriously is a pro.

 

E2 Will always be easy to remember

This might just be my favorite pic of him from the whole trip

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He was so so so so so so good for HOURS... and HOURS as we met with all the different folks. I planned ahead and got 5 little "dollar store" gifts for him to un wrap through out the day... to try and keep him busy and "good" LOL... which he totally was

Ended the day with blood work at 4:15- He's just like EH and has to "watch" the entire process

Still smiling... still wearing that backpack... enjoying a "treat" for being so good after 7 and a half hours!

This was 2 minutes after I buckled him in - wiped - out-

Kryptonite

You were “Super Robot Guy” again this evening (you have been for days). I guess the transformation occurred while Sis and I were at Gymnastics. You’re the only Super hero I know that stops mid-mission to give kisses. 

Tonight’s been rough. I guess it started once you shed your “Super Robot Guy” attire. If I had super powers I’d protect you from what just happened. I’d fight that stupid Lex- Luther- pancreas of yours and show him whose boss. He’s done nothing but plot your demise since he quit functioning over a year ago.

Everyone is hard to love sometimes… even super heroes. I had to remind myself of this tonight when the incident occurred… that it’s not really you… you’re not really in control… it’s the diabetes… and I’m sorry I couldn’t stop it from happening. I’m sorry your bloodsugars were so high that it made you sick. I’m sorry that during hyperglycemic episodes you are altered from a strong, kind-hearted hero to an angry, wrathful fit-throwing villain.

I know you won’t remember screaming. You will forget yelling at Daddy telling him to “just leave” “just go away.” I won’t make you feel bad for hitting and swatting me… for shouting “NO MOMMY… NO TOUCH…NO TOUCH ME… NO KISS ME… NO TOUCH ME” and shattering my heart into a million pieces because other than giving you insulin it’s my only means of comforting you. “

When you wake up in a few hours- you’ll ask if you can be “Super Robot Guy” and you know of course, I’ll say yes. You’ll run around the house pretending to be “super strong” and “super tough.” We will play the game we play every single day - “Super Robot Guy” saves “Super Mommy”and when we do, I’ll try not to think about what happened… how I couldn’t save you from getting sick tonight… how I can’t always shield you from the highs and lows that seem to hit you from all angles outta nowhere and for no reason.

I’ll tie my cape a little tighter tomorrow… and maybe for a few hours I’ll pretend to fight criminals instead of diabetes. 

A little something I wrote for the ADA in March

Here is a little something-something I wrote for the American Diabetes Association last month.

Click here to access the newsletter.

A Day in the Life of Diabetes

Living with a type 1 diabetic can be challenging. Living with a type 1 toddler and managing their care 24/7 is a test on the limits of your sanity.

We spend our mornings untangling dinosaurs and trucks from insulin pump tubing. We find ourselves constantly cleaning covered CGM sites (I won't tell you in what), and then there's dealing with those seemingly random, unexplainable high BG readings that always leave us guessing—did your sister hide another pack of candy under the couch?

Saul was diagnosed on January 27, 2012. He was 15-months-old. His ability (or lack thereof) to communicate immediately became our first concern. Straight away we started signing "high," "low" and "okay" when doing BG checks which occurred at a rate of 15-20 times a day during the first two months after diagnosis.

1. We were newbies, nervous and maybe a little overcautious.
2. What else could we do? He could never tell us how he felt so we were constantly left wondering—typical tantrum or the result of a high blood sugar? Was that fall just normal gross motor development or the sign of a hypo? I kept telling folks, "If we can just get him talking, it will get easier. It's got to get easier."

A pump, a CGM and a year later we still worry about communication and now face a number of new obstacles – potty-training, sporadic, non-stop picky eating habits and the tantrums. Oh, the tantrums which have only increased in number and display. You know it's the typical two-year-old stuff that all toddlers tackle—just with type 1 tossed in to the mix.

Friends ask me, "But what's it like?"

Much like the nature of the disease, my response is ever changing. Most days however I can see the big picture of life with a chronic illness.

"It's like running a marathon you know will last a lifetime and you're carrying the runner right now. You know that soon you'll have to set them down and let them run on their own even though you'd rather carry them all the way."

Counting every carb in every bite of food that enters his mouth, calculating doses of insulin and giving injections, waking up 3 and 4 times in the middle of the night every night to check blood sugar levels… These things are easy in comparison to attempting to explain how type 1 diabetes effects a toddler and their loved ones. Some days, diabetes controls our family but some days it doesn't.

Being a caregiver to someone with diabetes is difficult, but we are thankful that with modern medicine, technology and education we are capable of caring for, managing and treating an unpredictable/crazy/chronic illness in a typical/unpredictable/crazy two-year-old toddler.

Sure, Saul will look back and wonder why he wore overalls the first two years of his life—only way we can keep him from ripping off the CGM site on his stomach—and I have no doubt he'll ask why in the world I took so many pictures of him with skittle juice and cake gel on his face.
But ultimately I hope he marvels at our family's attempts to normalize this disease in daily routines and functions. I want him to be amazed at our efforts to educate others and be proud of our advocacy for him and others like him living with this chronic illness.

He needs to know and understand that no one in his family will rest until there's a cure. And until that day, we'll continue to use humor to cope.

Life as a person with diabetes will be the only life Saul knows. It will often be used to describe him but his family is not going to let it define him.

Courtney Grimes lives in Winchester KY with her husband Jeff, four-year-old daughter Harper and their two-year-old son with type 1 diabetes, Saul. She is currently on a leave of absence as a School Library Media Specialist to care for Saul. She blogs about living with a type 1 toddler, as well as a variety of other family antics, at www.myddays.blogspot.com She loves connecting with others with type 1 and type 1 caregivers on Instagram, Facebook, Pinterest and Twitter.

A letter to you, pancreas

Sometimes I wonder what you’ve been doing in there. I assume you’ve just been floating around- hanging out- laying low. I continually speculate whether or not you’re dead?

Are you alive?   …     just a little bit?

Are you still working…     just a little bit?

They told me you might… you might occasionally work on and off before completely kicking the bucket -but really, we have no way of knowing for sure.

Every now and then, I think you’re holding on… and I wish you’d just let go.

 

I’d never tell anyone but you… secretly (mainly at night when I lie in bed) I plan and carry out elaborate funeral processions and eulogies (in my head) just for you. I imagine you there… cloaked in black somehow listening and acknowledging what I have to say.

I mourn your loss and the suffering your death has caused - Saul and our family - but mainly I exult in your passing… because finally… with it… we can officially move on.

The battle for control is over. You can now rest in peace knowing that your job will be performed… (not as good as you could have done, had you not gotten sick) but nonetheless, we (and soon Saul)  will carry out your functions … every minute of every day for the rest of his life.

A year later, a year wiser, a year of humility and humbleness under my belt, I can sincerely say “I forgive you.  It wasn’t your fault.”  You held on as long as you could. You got us to 15 months and according to what they tell me you were probably sick and dying during your entire existence so to even make it that far without assistance is pretty amazing and a testament to your perseverance.

You are an underappreciated organ. Your loss does not reflect a daily physical reminder- like a limb or a digit. You, unlike other internal organs, do not get the credit you deserve for keeping a body alive- not like the heart, or brain... yet without you one cannot survive.

You, a tiny, non-functioning pancreas- have shaped my life, my career, my outlook and my family more than any other “thing” (living or non) in this world… and this factor isn’t necessarily bad.  In fact, I often think… that maybe- you will be (what partly) makes Saul a unique, strong, amazing kid who will grow up to be an extraordinary adult who accomplishes, and achieves incredible things.

Yet… your passing doesn’t mean that I still don’t get angry or frustrated, that I don’t ask questions or demand answers, that I don’t wish there was some way we could have brought you back to life… saved you… lengthened the state of your health... prevented your ultimate demise.

 

 

In all variations of your memorial service (and believe me… I’ve thought of lots) – I close in the exact same way… I picture myself (with our family) standing alongside thousands of dollars’ worth of medical equipment and supplies (CGMS, Insulin Pumps, Tubing, Needles) and a very expensive life-saving diabetic alert dog… and I chuckle… because this is what it will take… all this… and more to do the job of an organ we all take for granted… an organ that none of us think much about… until  one day it just up and quits working. 

 

oh yeah... that last post... that was nothing.

Just for fun... I'm gonna post these... and you can laugh (or cry) with me.

These are the "unopened" bills

$2,823.26 (if I added it right) lol.

I gotta laugh to keep from crying

I went through the Rite Aid drive through to pick up 3 RX’s for Saul - and to ask about ordering  test strips for our newly acquired meter. The girl who was checking me out was new (because I’m there every other week… I pretty much know everybody… and even if the tech’s don’t recognize me… they seem to “know Saul”).

All 4 kids were with me- and being pacified by Bubble Guppies, so I had the rare opportunity to actually “watch” everyone in the Pharmacy -scrambling to wait on folks – answering  phones and grabbing medications to hand out.  Any other day I’d be yelling at EH to put her gum back in her mouth or fumbling with buttons to turn up music for Saul… but- because I had my full attention on “people watching” I was able to witness the genuine look of sheer shock and terror as the tech rang up my bill.

Tech: “Oh. Oh. My. Um. It’s 656 dollars for your 3 scripts.”

Me: “Got it.”

Tech: “Huh? I’m so sorry.”

Me: “Oh it’s okay… I got this (hands over insurance credit-card thingy)… I’ve got insurance.”

Tech: “It’s like you didn’t even blink an eye. That really stressed me out.”

Me: “Ah… whataya gonna do? He’s gotta have insulin to live.”

She shook her head in agreement and sent the med’s my way.

I waved to a few folks who recognized me – who were working inside and mouthed “see ya in a few days!”

I chuckled as I pulled off and thought… I wish I’d gotten a picture of that ladies face to show Sebulsky.

 

 

Believe me… medical costs around here are no laughing matter. I feel like we’re up to our eyeballs in medical bills for Saul… and the funny thing is… they just keep on coming… cause we gotta keep on ordering … cause he’s gotta keep on using…  to keep on living.

I beg you... please read.

* Disclaimer- I am not a Dr. or a CDE... just a Type 1 mom with a Type 1 toddler.

When you have Type 1 you must constantly balance/manage/control your blood sugar levels. Your Endocrinologist gives you a "range" in which you must attempt to stay within. You (or someone) must take on this responsibility and perform the duties of a pancreas by controlling the amount of blood sugar in your body at all times. If you get out of range... blood sugars rise too high (hyperglycemia)- (consistently high blood sugars lead to long-term complications- damage to kidneys, eyes, heart, amputations) or if blood sugars drop too low (hypoglycemia) you will die.
 

Before I had a toddler with Type 1... and even in the hospital at diagnosis, I honestly thought... "ah... it's just diabetes." I know that so many of you out there think this as well... I'm ashamed to admit that I taught students (both sweet elementary babies and high school young adults) who were Type 1 and I never really gave much thought to how I would handle a hypoglycemic episode if it happened in class. I didn't think Type 1 was a big deal, because I didn’t know. Because I watched my Granddad live with Type 2 and thought that Type 1 and Type 2 were basically the same. Because I thought diabetes was about "sugar free foods" and "weight loss" about "finger sticks" and "insulin injections” not about having to save someone’s life in an emergency situation.


Saul has now had 3 “serious” hypoglycemic episodes. Because of the severity of the circumstances I feel the need to advocate and educate about hypoglycemia and what you do if you find yourself having to assist in a hypoglycemic episode.  


I can only speak for Saul- and how they have occurred thus far.


All of Saul’s “serious” hypos have taken place during “sleep.” 1- during his nap (you may recall that post- our first ambulance experience) and 2- during the wee hours of the morning (this post).

 
While Saul does wear a Continuous Glucose Monitor (a device with a cannula that stays in his skin and measures the amount of blood sugar in the interstitial fluid) the technology is not 100% accurate. The CGM is linked to his Insulin Pump (a device that is inserted – it has a steel needle which stays in place and provides both “long lasting insulin” (basal) as well as the insulin used to cover the carbohydrates he eats (bolus). The insulin pump must be operated by a human. Both the CGM and pump are just technological tools to help ease the difficulty in keeping a Type 1 “in range.” While I am appreciative and thankful for today’s medical advances and our family’s ability to acquire them…they are not fail proof… and they will not prevent death.

 
Managing Saul’s Type 1 is extremely difficult because of his age. His eating patterns, communication, growth, development, etc, etc, etc, only complicate controlling his blood sugar levels- therefore he is more prone to instability and at a greater risk for experiencing both hyper and hypoglycemia.

 
I will save hyperglycemia for a later post and focus efforts on hypos for this discussion.

 
There are numerous sites with hypoglycemic information and education out there. Here are two as starting points. 


Hypoglycemia Information
 
Hypoglycemia Information


The lowest hypo we have recorded for Saul has been a BG of 35.  Ironically he appeared “hypo-unaware” at the time. He was talking and playing and “acting” like normal Saul.  When he suddenly “fell down” I thought to myself “hmm… strange” and just happened to check him. His CGM read 110 at the time. We attempt to keep Saul between 100-200 (though he often runs higher). We “treat” at 70. So seeing a 110 on the MySentry (a large screen that shows CGM reading at all time) would “typically” be no cause for alarm.

 
During Saul’s severe hypo episodes (the 3 really bad ones) he exhibited the following symptoms.

• Heart palpitations/fast/pounding heart rate
• Sweating
• Acting aggressive (hitting, swatting)
• Convulsing
• Shaking/trembling
• Uncontrolled shouting/screaming  (it’s hard to describe this… but he did it both in terror “Stop” “Stop” and once it kind of went parallel with the aggression… or at least that’s how it seemed at the time)
• Dilated pupils
• Mental confusion/disoriented
• Seizures

 
Saul has never lost consciousness or gone into a coma.

 
We have not used glucagon (yet). Glucagon is a hormone secreted by the pancreas that raises blood glucose levels. Because a Type 1’s pancreas can no longer produce or secrete glucagon an injectable form is used in cases of severe hypoglycemia (when someone is unconscious). Glucagon should be carried at all times by Type 1 individuals. Saul’s glucagon is in a red case and must be mixed before injecting. We have been instructed by our Ped Endo to use glucagon if Saul has another terrible episode.

 
If you are ever with him (or any other Type 1) and you see hypoglycemic signs (again… Saul’s often hypo-unaware at this point so he cannot “tell you” how he feels you must watch for the symptoms and check his BG level)

 
You should follow these steps.

1.      Check BG with glucose meter.

2.      If 70 or below - treat the low with 15 grams of a fast acting carb (juice, skittles, cake gel, glucose gel or even table sugar if that’s all you’ve got).

3.      Wait 15 min and re-check BG level if still below 70, treat with another 15 carbs and re-check in 15 min.  

4.      If he is unable to swallow you can rub cake gel/glucose gel in his mouth

5.      If he’s unconscious you must administer glucagon.

Really- Saul’s hypos have been so bad we should have used glucagon… he choked and aspirated on juice during 2 of his hypos- which adds danger to an already dangerous situation. Also… skittles would be a really bad choice for treating a severe hypo.

 

We have been lucky so far to be able to get Saul out of his hypos fairly quickly. Obviously, preventing them is the ultimate goal- however, we’ve learned first- hand that even under the closest watch hypo’s can occur.

 

 I saw this on FB yesterday:

 "Type 1 diabetes is a continuous balancing act. Imagine trying to manually control your temperature or heart rate all day, every day. It must respond and change throughout the day, but not too high or too low or you die. That's exactly what people with Type 1 are doing with their blood sugar"

 

Type 1 is truly an on-going balancing act. It’s easy to forget that sometimes folks walking the tightrope might need a hand, or a net.