Tuesday, February 21, 2012

A Day in the Life - 5:30 pm

I usually get home from work at about 5:00 and am quickly and enthusiastically greeted by our small mixed-breed dog, Panda. Panda’s insistence on me petting her and scratching her belly usually draws the attention of my kids, who then join in on the scratch-fest. At this point, Leslie will usually give me her summary of the day’s high and low points – how she scored on a test, the unfairness of one her teachers over some incident, her friend’s upcoming sleepover, and, often, whether or not she had a “high” or “low” during the day. In this case, she tells me of her after-lunch low blood sugar.

I won’t go into the details, but preparing our dinner meal includes the same necessity of knowing how many carbohydrates are in everything we eat. Carol meticulously records on a sheet of paper all the ingredients that go into each and every dish that is put on the table and next to Leslie’s seat at the dinner table rests our digital scale for her to weigh some of the items placed on her plate.

Before eating, Leslie is required to check her blood sugar. This is her sixth glucose check of the day.

After eating, we help Leslie count the carbohydrates she consumed and she then takes the required insulin. Once again, the amount of insulin required for each gram of carbohydrate consumed has changed. Recall that there was a ratio of 5:1 at breakfast and 10:1 at lunch. The dinner and evening ratio is 15:1.

In physiological terms, this means that one unit of insulin facilitates the removal and use of 5 carbohydrate grams from her blood in the morning. That same unit will remove 10 grams during the day and up to 15 grams at night. If we didn’t change the ratios during the day, then Leslie’s blood sugars would be all over the map – from dangerously low to unacceptably high.

Tuesday, February 14, 2012

A Day in the Life - 3:00 pm

Before Leslie can board the school bus and come home, she is again required to report to the nurse for a glucose check. The school and her parents fear that a low blood sugar on the 45-minute school bus ride home could be a disaster. Nurses don’t ride the buses and the driver who is dealing with a large group of hormone-raging teenagers is not the best equipped to deal with a diabetic emergency should one arise.

Leslie quickly pulls out her meter, probably forgetting to change the needle that is now dulled by at least the four previous blood sugar tests, and pricks her finger once again. The result: 145. The snack she had after her earlier “low” was just right. This is her fifth glucose check of the day.

She leaves the nurse’s office and heads for the school bus and all her friends, cheerfully bidding the nurse good-bye in her typical buoyant way, “See you tomorrow!”

Sunday, February 12, 2012

A Day in the Life - 1:45 pm

During Biology class, Leslie starts to feel like her blood sugar is getting low. In her words, “I feel low.” Unless you have diabetes, there is no way to understand what this means. Leslie describes it as a cross between being hungry and anxious – and that you need to do something about it quickly. It must be very unpleasant.

As defined in the 504 Plan, Leslie tells her teacher that she needs to see the school nurse and immediately she departs for the nurse’s office. Since she feels low, the plan requires that another student accompany her to see the nurse. Why does one of her classmates have to along? The other student is there to guide her to where she needs to be in case she becomes confused or disoriented from her low blood sugar.

The nurse, a very capable woman named Kelly, greets Leslie at the door and has her take a seat next to her desk. Leslie pulls out her meter, pricks her finger, and awaits the result: 136. This is her fourth glucose check of the day.

She isn’t low; but her blood sugar is dropping rapidly. She finished her lunch about an hour ago, consuming the 79 carbohydrate grams we packed plus a box of chocolate milk she obtained from a friend (12 grams) for a total of 91 grams. Since the insulin was given only about an hour ago, it is still active in her system – recall that insulin remains active for about 2 hours after injected. Her 136 mg/dL would be a great number if it were 2 hours after lunch, but since it has only been an hour, there is still insulin actively removing glucose from her blood. If she doesn’t eat now, then she will be dangerously low within the next 60 minutes.

The nurse gives Leslie a juice box and a package of snack crackers containing a total of 30 carbohydrate grams.

Saturday, February 11, 2012

A Day in the Life - Noon

During Biology class, Leslie starts to feel like her blood sugar is getting low. In her words, “I feel low.” Unless you have diabetes, there is no way to understand what this means. Leslie describes it as a cross between being hungry and anxious – and that you need to do something about it quickly. It must be very unpleasant.

As defined in the 504 Plan (described in Chapter 5), Leslie tells her teacher that she needs to see the school nurse and immediately she departs for the nurse’s office. Since she feels low, the plan requires that another student accompany her to see the nurse. Why does one of her classmates have to along? The other student is there to guide her to where she needs to be in case she becomes confused or disoriented from her low blood sugar.

The nurse, a very capable woman named Kelly Brewer, greets Leslie at the door and has her take a seat next to her desk. Leslie pulls out her meter, pricks her finger, and awaits the result: 136. This is her fourth glucose check of the day.

She isn’t low; but her blood sugar is dropping rapidly. She finished her lunch about an hour ago, consuming the 79 carbohydrate grams we packed plus a box of chocolate milk she obtained from a friend (12 grams) for a total of 91 grams. Since the insulin was given only about an hour ago, it is still active in her system – recall that insulin remains active for about 2 hours after injected. Her 136 mg/dL would be a great number if it were 2 hours after lunch, but since it has only been an hour, there is still insulin actively removing glucose from her blood. If she doesn’t eat now, then she will be dangerously low within the next 60 minutes.

The nurse gives Leslie a juice box and a package of snack crackers containing a total of 30 carbohydrate grams.